Asthma triad- nasal polyps, asthma, and sensitivity to aspirin and Nasals -Emotional stress- psychological factors eke stress can cause panic & anxiety which makes it worse during an asthma attack, HER and breathing speeds up, so keep them calm – GERM- aspiration of gastric content stimulates avgas nerve stimulation 0 back up, cause prognostications, airways narrow, can make it worse Pathologically 2 hallmarks: Airway inflammation leads to Hypersensitiveness (bronchiole’s)- tightens, gets irritated- Limitation of airflow (acute) Long Term Effects- won’t have signs of lung disease when NOT having an attack! – Airway remodeling- if inflammation not treated, resulting in irreversible lung damageAssessment “Attacks” – Primary Symptoms- wheezing, restlessness, chest tightness, coughing (after exposure to trigger), night/early morning, usually no S’: b/w attacks- Prolonged expiration- ratio 1:2, inspiration shorter, expiration longer, can be up to 1:3 or 1 Takes longer for air to move out of bronchioles, wheezing, air trapping leads to hyperventilation – Wheeze not gauge of severity- usually on expiration first, then can become both; Wheezing NOT a reliable indicator of severity of attack! – Position- feels like suffocating, so sitting upright slightly bent forward, use accessory muscles o breathe, very anxious – Additional symptoms- tattletales with diminished breath; Non-productive cough, thick/white/]Eloise sputum, hard to bring up, hypoxia, hyperemia (confusion, restlessness 0 worse s’:) A anxiety, inappropriate behavior, A BP, A rest rate (>30), accessory muscle use – Chest assessment- hyper-resonance (Noisy/wheezing), tattletales, dove pneumonia (air in chest cavity), silent chest= severe obstruction & impending respiratory failure may need ventilators to breathe Classification: p. 13, Table 29-2 Step 1: Mild intermittent Step 2: Mild persistent Step 3: Moderate persistent Step 4: Severe persistent Diagnostic “Silent chest” bad sign- Must be able to differentiate from other diseases: asthma, COOP, pulmonary embolism, GERM, obesity and pulmonary infections, aspiration – H&P- if NOT in distress; detailed, hex of rest infection, prep attacks, pollen/allergies, sleep with animal, sleep pane, GERM, dust mites (in mattress); bring pillow if travel – Pulmonary Fix- usually normal if not having attack or early in disease; Breathe into speedometer, goes into computer, measures air they’re exchanging; Key: reversibility of lung fix; Does it get better after meds?That’s a good sign- Lab- sputum, underlying infection, A sinkholes, A KGB, allergies (serum levels), CB, WEB- Chest gray- normal if not having an active disease; hyperinflation, mucous, pneumonia tattletales dung attack- BAG, pulse ox (REVIEW REST ACIDOSIS/ALKALOIDS FOR TEST! ) Rest alkaloids- breathing faster; Hyperplasia= elevated CA, respiratory/metabolic classes In SEVERE Lease, as teen get worse. Pulse ox monitors meme problems, check often- Allergy skin testing or blood for allergies after acute problem; spectrometry, nitric oxide levels can be elevated; Monitor effects of meds Management: Based on evidenced based practice (EBPP) guidelines of the NationalAsthma Education and Prevention Program of the National Heart, Lung and Blood Institute Education is key to management of disease Corticosteroids Mild intermittent and Mild Persistent Asthma- persistent airway obstruction and frequent asthma attacks- Teach- avoid triggers, exposure to allergies, treat with be adrenaline Zionists before activity (Carolyn or Metronomic- Mast cell stabilizers, interrogatories)- Premeditate В» a-adrenaline Zionists В» Carolyn Metronomic Moderate persistent – Maintenance interrogatories Severe Persistent – corticosteroids – Inhaled 82 Adrenaline Zionists ? Long lasting 82 adrenaline Zionists- NOT first line therapy for acute attacks, ONLY if other cutlers don’t work, don’t use if wheezing worsens, ALWAYS use short- acting for wheezing initially See drug alert in text peg.
61 5 Drug Alert re: long acting 82 adrenaline Zionists Acute asthma episode Determine severity by FEE or PEER, know what change from baseline 02 >90, pulse ox; If low, start 02, monitor with pulse ox Meds 82 adrenaline Zionists- Initial dose should be an MDI (meter dose inhaler) using spacer devices and unbelievers; use every 20 min for вЂ”1 her. Louder wheezing may actually signal them getting BETTER – Corticosteroids- use when initial response to the be-adrenaline agonies is insufficient- may need IV nonphysical Monitor C.V. and Rest system- breath sounds, VS.., pulse ox, Abs -Panic- stay calm/ reassuring