1. Asthma

2. Asthma As a chronic inflammatory disease of the airway that causes airway hyperresponsiveness, mucosal odema, & mucus production. The inflammation lead to recurrent episodes of asthma symptoms: cough, chest tightness, wheezing, & dyspnea. Asthma differs from other obstructive lung disease in that its largely reversabile, either spontaneous or with treatment. Pt may experience symptoms-free period, which last from minutes to hr or day. 2

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4. Asthma can occur at any age and it most common chronic disease of child hood. Allergy is the strongest predisposing factor for asthma. Chronic exposure to airway irritants or allergens also increases the risk for developing asthma. Condition of the pt will change depending upon the environment, activities, management practices & other 4

5. Pathophysiology The underlying pathology of asthma is reversible and diffuses air way inflammation. The inflammation leads to obstruction from the swelling of membranes that line the airways (mucosal odema), reducing the airway diameter (brochospasm), causing further narrowing & increase mucous production, which diminishes airway size and may entirely plug the bronchi. 5

6. The bronchial muscles & mucous gland enlarge: thick, tenacious sputum is produced, and the alveoli hyperinflate. Cell that play a key role in the inflammation to asthma are mast cells,neutrophils, eosinophils, & lymphocytosis. 6

7. Mast cells when activated, released several chemicals called mediators (its include histamine, bradykinin, prostaglandin, & leukotrienes) causing increased blood flow, vasoconstriction, fluid leak from, vasculature, attraction of WBC to the area, & bronchoconstriction. Regulation of these chemicals is the aim of current research for treating asthma. 7

8. S&S Wheezing, (the sound of airflow through narrowed airway). Cough, with or without mucous membrane. Dyspnea. Chest tightness. Expiration requires effort & become prolonged, as the exacerbation progress, diaphoresis, tachycardia, widened pulse pressure may occur. Hypoxemia is secondary to a ventilation perfusion mismatch & readily responds to O2. 8

9. Assessment and diagnostic finding A complete family, environmental, & occupational history. A positive family history & environmental factors, including seasonal changes, air pollution… Asthma is associated with occupational related chemicals & compound as wood, metal, and medication (aspirin, antibiotic…). 9

10. Comorbid conditions that may accompany asthma as eczema,may elevated if allergy is present. ABGS, hypocapnea, respiratory alkalosis 10

11. Prevention Pt should undergo tests to identify the substances that precipitate the symptoms. Pt instructed to avoid the causative agent whenever possible. Knowledge is the key to quality asthma care. 11

12. Complication:  Status asthmatics, respiratory failure, atelactasis  airway obstruction, particularly during acute asthmatic episodes. 12

13. Medical Management Immediate intervention is necessary, because the continuing & progressive dyspnea leads to increased anxiety, aggravating the situation. Pharmacological therapy: long acting control medication. ◦ Corticosteroids are the most potent and effective anti inflammatory medications. They are effective in alleviating symptoms, improving airway function 13

14. Long acting beta 2 adrenergic agonists are used with anti inflammatory medication to control asthma. Theophilin are mild to moderate brochodilators usually used in addition to inhaled corticosteroid. Leukotriene modifiers (inhibitor) or antileukotrienes are new class of medication. Dilate vessels & inhibit act by enterfering with leuktreine synthesis or blocking the receptor where leukotreine exert their action. 14

15. Short acting beta-adrenergic agonists are drug of choice to relieve symptoms. They have rapid onset of action. Anticholinergic may bring added benefit in sever exacerbations, but they are used more frequently in COPD. 15

16. NSG Management The immediate nursing care of pt with asthma depends on severity of the symptoms. Family & pt frightened of dyspnea, the important aspect of the nurse is a calm approach. Nurse must assesses the pt respiratory status by monitoring severity of symptoms, breath sound, pulse oximetry, & VS. Nurse obtains a history of allergic reaction to medication, current use of medications before administered the medication. Fluid may be required. 16

17. Promoting home & community-based care: teaching pt self-care establishment of programs for asthma education,. Multiple inhaler, different type, antiallergy therapy, antireflex medication, and avoidance measures are all integral for long term goal. The pt needs to understand the following: nature of asthma, def. of inflammation, proper inhalation, how to perform peak flow monitor, and when a seek assistance.. 17

18. E.Status Asthmaticus Is serve and persistent asthma that doesn’t respond to conventional therapy. The attacks can last longer than 24 hr. infection, anxiety, nebulizer abuse, dehydration, increased adrenergic blockage, and nonspecific irritants may contribute to these episodes. 18

19. S&S The same as those with sever asthma: labored breathing, prolonged exhalation, engorged neck veins, & wheezing. As the obstruction worsens the wheezing may disappear, & this sign of respiratory failure. 19

20. Assessment and diagnostic finding Pulmonary function study. ABGS if pt cannot perform pulmonary function test.. Respiratory alkalosis is most common finding in pt with asthma 20

21. NSG Management Nurse constantly monitors the pt for the first 12-24 hr. Assess dehydration, increase fluid intake to loosen secretions, & facilitate expectoration. Administer IV 3-4L per day. Pt energy should be conserved, & room should be quite and free of respiratory irritant. 21