Asthma in all forms
by Nurses Notes on January 3, 2010
■ A stimulus → inflammation, which ↑mucus, mucosal edema, and bronchospasm. This traps air in lungs → chronic tissue irritation, scarring, and hyperinflation
■ Peak expiratory flow rate, the maximum flow of air forcefully exhaled in 1min, decreases
■ Occurs secondary to allergens (mold, pollen, dust mites, cockroach allergen) or nonimmunological stimuli (infections, exercise, cold air, odors, smoke, stress, dairy products)
■ Characterized by remissions and exacerbations. May be mild and intermittent to severe, persistent and intractable (status asthmaticus)
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SIGNS AND SYMPTOMS
■ Dyspnea, dry cough, prolonged expirations with wheezing, sternal retractions, flaring nares, barrel chest
■ Prodromal S&S of exacerbation: Rhinorrhea, low-grade Temp, itching on neck/chest/upper back, anorexia, headache, irritability, restlessness,
fatigue, chest tightness, anxiety
■ Progression of exacerbation: Frothy, clear, gelatinous sputum, productive cough, ↑R, SOB, pale or malar flush with red ears, lips dark red
progressing to cyanosis, tripod/orthopneic position, chest hyperresonance on percussion, breath sounds coarse with sonorous crackles
■ Imminent ventilatory failure: SOB with absence of breath sounds
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TREATMENT
Removal of stimulus and medications:
■ Long-term control meds (preventor meds): Corticosteroids (↓inflammation), cromolyn and nedocromil Na (block mediators of type I allergic reactions)
■ Quick-relief meds (rescue meds): ↓Exacerbations; -adrenergics, anticholinergics (↓bronchospasm)
■ Emergency protocol: 3 treatments with short-acting -adrenergic spaced at 20–30min, systemic prednisone, and an anticholinergic; hydration with caution to prevent pulmonary edema, O2 with caution to prevent CO2 narcosis
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NURSING
■ Support child and parent in coping with chronic illness and fear related to SOB
■ Prevent exacerbations: Avoid triggers (dairy, animals); allergy-proof home (eliminate carpets, drapes, down bedding; wet-mop floors). Assess status via peak expiratory flow meter
■ Care during an exacerbation: Provide a calm presence; monitor cardiopulmonary status; place in ↑Fowler’s position; encourage pursed-lip
breathing; give ordered meds
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How to use a peak expiratory flow meter (PEFM):
■ Measures respiratory volume with 1 breath
■ Begin with indicator at bottom of scale, stand straight, place mouthpiece in mouth, blow out as hard and fast as possible
■ Note result on scale
■ Repeat 3xs, record highest value
◆ Green: Under control
◆ Yellow: Exacerbation and may ↑maintenance dose of meds
◆ Red: Severe airway narrowing and give rescue med
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How to use a metered dose inhaler (MDI):
■ Delivers premeasured dose of aerosolized med
■ Shake inhaler, place canister/spacer mouthpiece in mouth with lips sealed (closed method) or 2–4cm from mouth (open method)
■ At end of exhalation, depress canister while inhaling slowly through mouth (3–5sec)
■ At height of inhalation, hold breath 5–10sec and then exhale through nose
■ Wait 1min between puffs, document results, rinse mouth and equipment after
■ Use a spacer particularly with steroids to ↓oral yeast infections
■ Take the bronchodilator first to open airway before a corticosteroid
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How to use a nebulizer:
■ Delivers aerosolized med over several min
■ With mask, place over nose and mouth, take slow deep breaths through mouth
■ With handheld nebulizer, place between teeth with lips sealed around mouthpiece. Take slow deep breaths; hold inhalation for several
seconds, continue until med in chamber is gone
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6 comments
i have been suffering from Asthma ever since i was little kid. i can only manage it by taking medicines and some food supplements. *
by Emile Rydel on April 28, 2010 at 5:46 pm. #
what is a good alternative treatment for asthma? i’m looking for some alternative medicine stuffs ..
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by Dwight Roderiquez on August 31, 2010 at 2:35 pm. #
asthma can really choke me when it attacks, `.`
by Condenser Dryer on October 18, 2010 at 6:04 am. #
;;: I am really thankful to this topic because it really gives useful information ~’;
by Eleanor Simpson on January 25, 2011 at 11:07 am. #