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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 damage

Assessment “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 National

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Asthma 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 —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

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