Nurse Think Exam Notes – Asthma.
Gender Differences/ Ethnic Disparities
Asthma
Risk Factors & Triggers
1. Men: more
... [Show More] common before puberty
2. Women: more common after puberty/into adulthood (higher risk of being hospitalized)
3. Death rate is greater in women
4. Asthma prevalence rates are more than 38% higher among African Americans than whites
5. Puerto Ricans have higher asthma prevalence rates and age adjusted death rates than all other racial and ethnic subgroups.
6. Female African Americans have the highest mortality rates from asthma from all other ethnic/gender groups.
Pathophysiology summarized at the tissue level
Asthma is bronchiolar inflammation with airway constriction and resistance that manifests as episodes of coughing, shortness of breath, and wheezing. Asthma can affect the trachea, bronchi, and bronchioles. Inflammation can exist even though symptoms/signs may not occur.
Subjective assessment
• Pt stating “I can’t breathe”
• Chest pain
• Chest tightness
• Chest pressure
• Cough (can be both objective & subjective)
• Genetics
• Immune Response
• Allergens
• Exercise
• Air pollutants
• Occupational factors
• Respiratory tract infections
• Nose & sinus problems
• Drugs & food additives
• Gastroesophageal reflux disease
• Psychologic factors
• Female hormones can trigger an asthma attack
Objective assessment
1. Inspection— prolonged expiration, tripod position, pursed lips, low pulse ox, blue lips/fingers, tachypnea
2. Palpation— decreased movement
• Define tactile fremitus: vibration intensity felt on the chest wall
3. Percussion— Hyperresonance
4. Auscultation
• What breath sounds might you hear
• Crackles
• What voice sounds might you here
• Wheezing
Complications Star those most severe
• Fatigue
• Inability to exercise (could lead to other health problems such as high BP, weight gain
• Permanent problems with lungs
• Stress
• Anxiety/depression
𝗌 Pneumonia
𝗌 A collapse of part or all of the lung
𝗌 Respiratory failure
𝗌 Status asthmaticus (severe asthma attacks that do not respond to treatment) Lab tests-state the test and what would be found
• Allergy skin testing (if indicated)
• Blood level of eosinophils & IgE (if indicated)
• CBC
• Blood gases
• CMP (evaluates organ function)
Diagnostic tests-state the test and what would be found Lung function tests(also known as PFTs):
- Spirometry: breathing test that measures how much and how fast you can blow air out of your lungs.
• Looks at FVC values; abnormal is less than 80% in
children and less than 70% in adults
- Methacholine: may be performed if symptoms and screening spirometry do not clearly establish diagnosis of asthma.
Chest X-Ray: not an asthma test. May be used to make sure nothing else is causing asthma symptoms.
Allergy skin testing (if indicated); Blood level of eosinophils & IgE
Health prevention and promotion teaching
Avoid contact with triggering substances such as cigarette smoke, pets, foods, cold air, indoor air pollution. If cold air can’t be avoided, bundling up with coat/scarf is a good idea. Aspirins/NSAIDS should be avoided if they are known to precipitate asthma attacks. Encourage pt to maintain a fluid intake of 2-3 L/day, good nutrition, and adequate rest.
Nursing Diagnoses
1. Activity intolerance r/t fatigue
2. Ineffective airway clearance r/t tracheobronchial narrowing
3. Ineffective breathing pattern r/t anxiety Overall goals
1. Preventing long term symptoms that interfere with ADL’s
2. Having the ability to participate in all ADL’s, including work, school, and exercise
3. Preventing repeated asthma attacks
4. Providing the best treatment/medications with the fewest possible side effects
Non-medication interventions- please address psychosocial and spirituality issues here
1. Breathing exercises
2. Avoidance of smoking/exposure to it
3. Exercise
4. Healthy diet
5. Staying hydrated
6. Avoidance of medications that worsen asthma
7. Herbal/Supplemental remedies
8. Rest
9. Yoga
10. Relaxation Education
1. Making sure they understand what asthma is
2. Avoid contact with triggering substances
3. Making sure they know the steps for using their inhaler
4. Educate them on all the medications they are taking
5. Possible hindrances to asthma treatment/control
6. Breathing techniques
7. Correct use of Peak Flow Meter
8. Walking through the action plan with the patient
9. Explaining the importance of good hydration
10. Identifying the triggers they experience and educating on ways to prevent them
Discuss step therapy
• This is as needed therapy that is a short acting bronchodilator. (ex. Albuterol, levalbuterol)
• First line maintenance: inhaled steroid
• Second line maintenance: long acting beta agonist (never to be used alone in asthma!)
• Next steps: increase doses of inhaled therapies, add leukotriene inhibitor (ex. Montelukast), add antihistamines if clinically indicated, consider omalizumab if elevated IgE is present
• Anticholinergics: can help in recalcitrant asthma
• Azithromycin: useful if a patient has frequent exacerbations (as maintenance therapy) but not useful as empiric therapy for acute exacerbations.
Medications used
Drug Class Drug name
example SE Rescue inhaler?/
what step
Beta 2 adrenergic agonists: Short acting Albuterol Nervousness, shaking, headache, nausea, vomiting, cough, irritation in the throat, muscle, bone, or back pain Inhaled; 1st step
Corticosteroids fluticasone Confusion, excitement, restlessness, headache, nausea, vomiting, thinning skin,
acne MDI/DPI; 2nd step
Beta 2 adrenergic agonists: Long acting salmeterol Hoarseness, throat irritation, headache, rapid heartbeat, nervousness, dizziness,
insomnia, lightheadedness MDI; 3rd step
Leukotriene inhibitor zileuton Nausea, upset stomach, diarrhea, trouble sleeping, cold symptoms, headache,
weakness, muscle pain PO; 4th step
Monoclonal Antibodies Anti-IgE Omalizumab Itching, rash, joint pain, nausea, dizziness, tiredness, ear pain, cold symptoms SQ; 5th step
Anticholinergics Ipratropium Headache, stuffy nose, sinus pain, dry mouth, nausea, constipation, hives, itching,
low K+, pain in the eye, rash Nebulizer, MDI; 6th step
Macrolides Azithromycin Diarrhea, nausea, vomiting, stomach upset, vomiting, constipation, dizziness, tiredness,
headache, tinnitus, insomnia, skin rash PO; 7th step
Instructions for Inhaled corticosteroids and order of inhaled medication administration ***you will want to know this!!!
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