Asthma

Question 0

Asthma Pathophysiology

Answer 0

1. Histamine attaches to receptor sites in larger bronchi & causes swelling in smooth muscles
2. Mucous membranes secrete excessive mucus after stimulated by histamine – further narrow bronchial lumen
3. Increased intra-thoracic pressure makes exhalation difficult
4. Mucus fills lung bases, inhibiting alveolar ventilation

Question 1

Asthma

Answer 1

1. A chronic inflammatory disorder of the bronchial mucosa that causes hyper-responsiveness and constriction of the airways
2. Dx in more than 34 million people

Question 2

Early Asthmatic Response

Answer 2

1. Antigen exposure to the bronchial mucosa activates B cells (plasma cells) to produce antigen-specific IgE
2. Cross-linking of IgE w/ antigen on surface of mast cells causes degranulation
   - release inflammatory mediators (histamine, bradykinin, Leukotriene)
3. There mediators cause increased capillary permeability, mucosal edema, bronchial smooth muscle contraction (bronchospasm) and mucus secretion from goblet cells

Question 3

Late Asthmatic Response

Answer 3

1. Begins 4-8 hrs after the early response

2. Synthesis of leukotrienes contributes to prolonged smooth muscle contraction

Question 4

Asthma

-Result of Untreated Asthma

Answer 4

1. Untreated inflammation can lead to long-term damage that is irreversible, known as Airway Remodeling

Question 5

Extrinsic Asthma

Answer 5

1. Atopic

2. Sensitive to specific external allergens

Question 6

Intrinsic Asthma

Answer 6

1. Non-atopic

2. Asthma is a reaction to internal, non-allergenic factors

Question 7

Asthma

-Signs & Symptoms

Answer 7

1. Wheezing
2. Cough
3. Tripod Position or Upright
4. S/S hypoxemia
5. Accessory muscles use
6. Diminished or absent breath sounds
   - Potentially a MEDICAL EMERGENCY

Question 8

Asthma

-Dx Tests

Answer 8

1. Pulmonary Function Tests
   - Vital Capacity decreased
   - Increase in total lung and residual capacity
2. Serum IgE increase
3. Skin tests to ID possible allergens
4. Chest X-Ray & ABG’s

Question 9

Asthma Triggers

Answer 9

1. Allergens
2. Exercise
3. Respiratory Infections
4. Nose and Sinus Problems
5. Drugs and food additives
6. Emotional Stress
7. GERD

Question 10

Asthma

-Treatment

Answer 10

1. ID/Avoid causative agent
2. Drug Therapy (watch for S/S)
   - Albuterol Nebulizers/B-adrenergic Agonist
   - Cromolyn Inhaler
3. Oxygen
4. IV corticosteroids
   - Solumedrol IV

Question 11

Asthma
-Clinical Manifestations
(Beginning of Attack)

Answer 11

1. Individual experiences
   - Chest Constriction
   - Expiratory wheezing
   - Dyspnea
   - Nonproductive cough
   - Prolonged expiration
   - Tachypnea & Tachycardia

Question 12

Asthma & Pulsus peridoxus

-Severe attacks

Answer 12

1. During severe attacks, accessory muscles of respiration and wheezing is heard on expiration and Inspiration
2. Pulsus paradoxus is noted during status asthmaticus or severe attacks

Question 13

Pulsus Paradoxus

Answer 13

1. Decrease in systolic BP during inspiration of more than 10mm Hg

Question 14

Asthma

-Dx

Answer 14

1. Dx of asthma is supported by a hx of allergies and recurrent episodes of wheezing, dyspnea, cough, and exercise intolerance

Question 15

Asthma

-Pt Education

Answer 15

1. ID asthma triggers
2. Teach pt/family proper use of metered-dose inhaler
3. Instruct client regarding use of peak flow meter for self-assessment of asthma status