NSG 326 Adult Health IASTHMAAsthmaSlide 4Asthma – TriggersSlide 6Asthma – Triggers (cont.)Asthma-Triggers (cont.)Indoor Air PollutionAsthma –Triggers (cont.)Slide 11Slide 12Slide 13Slide 14Asthma Clinical ManifestationsClinical Manifestations (cont.)Clinical ManifestationsAsthma: HyperinflationSlide 19Complications of AsthmaComplications (cont.)Slide 22DiagnosticsCollaborative CareSlide 25Slide 26Slide 27Drug TherapyPatient Teaching & Drug TherapyPatient Teaching Related to Drug TherapySlide 31Nursing ManagementSlide 33Slide 34Health PromotionPatient Education in AsthmaSlide 37Slide 38Slide 39Chronic Obstructive Pulmonary Disease [COPD]Slide 41COPDSlide 43Chronic BronchitisSlide 45Emphysema DescriptionSlide 47Slide 48COPD & SmokingSlide 50COPD: Risk FactorsCOPD: Clinical ManifestationsSlide 53Slide 54Occupational & Environmental Risk FactorsCOPD & Air PollutionAging & COPDCor PulmonaleComplication of Cor PulmonaleSlide 60Slide 61COPD ExacerbationSlide 63Slide 64Slide 65Slide 66Slide 67Slide 68Cupped-Hand PositionPositions for Postural DrainageSlide 71COPD & NutritionSlide 73Nursing DiagnosesPatient GoalsSlide 76Slide 77Slide 78Slide 79Blue Bloater vs. Pink PufferSlide 81Slide 82Slide 83Slide 84Slide 85Slide 86NSG 326 Adult Health IWeek #10Spring 2011Problems of Oxygenation Part 2ASTHMAAsthmaChronic inflammatory disorder of airwaysCauses airway hyperresponsiveness leading to wheezing, breathlessness, chest tightness, and coughAffects about 20 million AmericansWomen and African Americans have a 30% or greater prevalenceAbout 40% of cases are related to an allergic responseMay be seasonal or year round depending on exposure to allergenAsthma – TriggersInduced or exacerbated after exercisePronounced with exposure to cold airBreathing through a scarf or mask may ↓ likelihood of symptomsAir PollutantsCigarette or wood smokeVehicle exhaustElevated ozone levelsSulfur dioxideAsthma – Triggers (cont.)Most common form of occupational lung diseaseExposure to diverse agentsArrive at work well, but experience a gradual declineMajor precipitating factor of an acute asthma attack↑ inflammation hyperresponsiveness of the tracheobronchial systemAsthma-Triggers (cont.)Allergic rhinitis and nasal polypsLarge polyps are removed Sinus problems are usually related to inflammation of the mucous membranesAsthma triad: nasal polyps, asthma, and sensitivity to aspirin and NSAIDsWheezing develops in about 2 hrsSensitivity to salicylatesFound in many foods, beverages, and flavoringsFood allergies may cause asthma symptomsAvoidance diets Rare in adultsIndoor Air PollutionAsthma –Triggers (cont.)Reflux of acid could be aspirated into lungs causing bronchoconstrictionPsychological factors can worsen the disease processAttacks can trigger panic and anxietyExtent of affect is unknownAsthmaInflammatory mediators cause early-phase responseVascular congestionEdema formationProduction of thick, tenacious mucousBronchial muscle spasmThickening of airway wallsAsthmaAsthmaLate-phase responseOccurs within 4-10 hours after initial attackOnly occurs in 30-50% of patientsCan be more severe than early-phase and last for 24 hours or moreIf airway inflammation is not treated or does not resolve, it may lead to irreversible lung damageAsthma Clinical ManifestationsUnpredictable and variableRecurrent episodes of wheezing, breathlessness, cough, and tight chestMay be abrupt or gradualLasts minutes to hoursExpiration may be prolonged Inspiration-expiration ratio of 1:2 to 1:3 or 1:4Bronchospasm, edema, and mucus in bronchioles narrow the airwaysAir takes longer to move outClinical Manifestations (cont.)Wheezing is unreliable to gauge severity Severe attacks may have no audible wheezingUsually begins upon exhalationCough variant asthmaCough is only symptomBronchospasm is not severe enough to cause airflow obstructionDifficulty with air movement can create a feeling of suffocationPatient may feel increasingly anxiousClinical ManifestationsAn acute attack usually reveals signs of hypoxemiaRestlessness↑ anxietyInappropriate behavior↑ pulse and blood pressurePulsus paradoxus (drop in systolic BP during inspiratory cycle > 10 mm Hg)Asthma: HyperinflationComplications of AsthmaStatus asthmaticusSevere, life-threatening attack unresponsive to usual treatment Patient at risk for respiratory failureCauses of status asthmaticusViral illnessesIngestion of aspirin or other NSAIDsEnvironmental pollutants or allergen exposureEmotional stressAbrupt discontinuation of drug therapyAbuse of aerosol medicationIngestion of β-adrenergic blockersComplications (cont.)Clinical manifestations of status asthmaticus result fromIncreased airway resistance from edemaMucous pluggingBronchospasmRespiratory acidosisAs attack severity ↑, work of breathing ↑, patient tires, and it is harder to overcome the ↑ resistance to breathingUltimately the patient deteriorates to hypercapnia and hypoxemiaComplications (cont.)Complications of status asthmaticusPneumothoraxPneumomediastinumAcute cor pulmonaleSevere respiratory muscle fatigue leading to respiratory arrestDeath is usually result of respiratory arrest or cardiac failureDiagnosticsDetailed history and physical examPulmonary function testsPeak flow monitoringChest x-rayABGsOximetryAllergy testingBlood levels of eosinophilsSputum culture and sensitivityCollaborative CareEducationStart at time of diagnosisIntegrate through careSelf-managementTailored to needs of patientCulturally sensitiveDesired therapeutic outcomesControl or eliminate symptomsAttain normal lung functionRestore normal activitiesReduce or eliminate exacerbations and side effects of medicationsCollaborative CareMild intermittent and mild persistent asthmaAvoid triggers of acute attacksPremedicate before exercisingChoice of drug therapy depends on symptom severityAcute asthma episodeRespiratory distressTreatment depends upon severity and response to therapySeverity measured with flow ratesCan be severe enough to require intubation and mechanical ventilationO2 therapy should be started and monitored with pulse oximetry or ABGs in severe casesCollaborative CareAcute