NURS Clinical Exam 3 Prep - Asthma

What is asthma?

chronic inflammation causes swelling and irritation of the airway lining

What can result from inflamed airways?

hyperresponse; reacts strongly to allergens, irritants, and respiratory infection

What results from airway narrowing?

wheezing, cough, chest tightness, and dyspnea

When does inflammation occur?

persist between episodes; can cause airway remodeling and more persistent obstruction

What are ways that the airway narrows?

bronchoconstriction, mucosal edema, thick mucus

What is bronchoconstriction?

smooth muscle tightens

What is mucosal edema?

the airway lining swells

What results from airway narrowing?

resistance and work of breathing increase

What is airflow limitation of asthma?

typically variable, often reversible

What is airflow limitation of COPD?

persistent

What are the main changes of asthma?

inflammation and bronchodilation

What are main changes of COPD?

small-ariway disease and alveolar demage

What is the pattern of asthma?

varies with time and triggers

What is the pattern of COPD?

often persistent, with exacerbation

What are shared findings between asthma and COPD?

dypnea, wheezing cough

What is asthma etiology and triggers?

allergens; smoke, pollutants, and other irritants; respiratory infections; exercise or cold air

What medication can trigger asthma?

aspirin and NSAIDs

Who is 4x more likely to get asthma?

black americans in comparison to white americans

Who is twice as likely to get asthma?

hispanic/latino in comparison to white americans

What is 20% more likely to get asthma?

Native Americans more than white americans

What are questions to ask about asthma history?

dyspnea, chest tightness, cough, and wheezing

What should be asked about asthma symptoms?

timing, frequency, and duration

What are common cues for asthma?

nightime awakening and activity limitations

What should be assessed for asthma history?

triggers, medication use, and response

What should be asked about past medical history for asthma?

pervious ED visits, hospitalization, and intubation

What are physical cues for asthma?

expiratory wheezing and pronlonged expiration

What are physical symptoms of asthma?

cough, dypnsea, and chest tightness

What can result physically from asthma?

increased RR and work of breathing

What is phsycially excessively used in asthma?

acccessory muscle use and retractions

What is difficult during asthma?

speaking between breaths

What are signals of hypoxemia?

restlessness, agitation, tachycardia

What is spirometer?

measures expiratory airflow

What is bronchodilator testing?

assesses improvement

What is peak flow?

monitors changes

What is pulse oximetry?

assess oxygen saturation

What is peak expiratory flow?

measures how quickly to patient can force air out

What should the PEF be compared to?

patient’s personal best

What are the steps of PEF?

full breath, seal lips, and blow harda and fast

What are treatment goals for asthma?

control and prevent episodes, reduce severe exacerbations

What do we want to improve for asthma?

airglow and gas exchange

What do we want to minimize for asthma?

symptoms and activity limitations

What do we want to support during asthma?

effective self-management

What is maintenance treatment?

provides ongoing asthma control

What is reliever treatment?

addresses symptoms quickly

What may persist when asthma syptoms are absent?

airway inflammation

What should asthma treatment include?

inhaled corticosteroid

What do some prescribed combination inhalers serve?

maintenance and reliver roles (both)

What is important for medication compliance?

continue the prescribed regimen even when feeling well

What are SABAs?

rapid bronchodilation

What are types of SABAs?

albuterol and levalbuterol

What is the delivery of SABAs?

inhaler or nebulizer, depending on formulation

What is the MOA of SABAs?

relax bronchial smooth muscle for rapid symptom relief

What do SABAs not control?

underlying airway inflammation

What should be assessed when taking SABAs?

respiratory response

What should be monitored when taking SABAs?

tachycardia, palpiations, tremor

What requires reassessment for SABAs?

increasing reliever use or reduced relief

What are types of inhaled corticosteroids?

fluticasone, budesonide, beclomethasone

What is the delivery of inhaled corticosteroids?

inhaler; selected formulations also use a nebulizer

What are inhaled corticosteroids?

reduce inflammation and help prevent exacerbations

What is the result of an ICS alone?

does not rapidly relieve bronchospasm

What is education when taking inhaled corticosteroidss?

rinse and spit after use; inspect the mouth daily

What is oral cadidiasis risk?

report white patches or coating lesions, or persistent soreness

What are LABAs and combination inhalers?

used for asthma

What are types of LABAs and combination inhalers?

budesonide-formoterol and salmemotrol/fluticasone; delivered by inhaler

What are LABAs?

provide prolonged bronchodilation

What is the result of certain prescribed ICS-formoterol regimens?

provide maintenance and/or relief

What is important to know about LABAs/ICS?

not every inhaler is a reliever

What are types of leukotriene modifiers?

motelukast and cromolyn

What is the delivery of leukotriene modifiers?

taken orally

What are leukotriene modifiers?

block leukotriene effects that contribute to inflammation and bronchoconstriction

What are leukotreine modifiers used for?

prevention and ongoing asthma control

What are leukotreine modifiers for ongoing control?

take once daily as prescribed, even when well

What is important to note about leukotriene modifiers?

not PRN treatment for an acute asthma attack

What must be reported for leukotriene modifiers?

mood, behavior, sleep changes

What is the role of ipratorpoum inhaler or nebulizer?

additional bronchodilation during selected exacerbations

What is the nursing emphaiss for impratoropium (inhaler or nebulizer)?

assess repiratory response

What is the role of selected LAMAs inhaler?

add-on maintenance treatment

What is the nursing emphasis of selected LAMAs inhaler?

not a rescue treatment

What is the role of systemic coritcosteroids (oral or IV, by drug)?

reduce inflammation during significant exacerbations

What is the nursing emphaiss of systemic corticosteroids (oral or IV, by drug)?

monitor glucose, mood/sleep, and infection

What is the role of biologics (injection or infusion, drug)?

targeted treatment for selected severe asthma

What is the nursing emphasis of biologics (injection or infusion, drug)?

specialist care; not acute relief

What is the availability of ipratropium?

inhaler or nebulizer

What is the availability of selected LAMAs?

inhaler

What is the availability of systemic corticosteroids?

oral or IV

What is the availability of biologics?

injections or infusion

What are signs to recognize a severe exacerbation?

marked work of breathing, difficulty speaking, hypoxemia, impending respiratory failure, severely reduced flow

What is marked work of breathing?

accessory muscle use and retractions

What is difficulty speaking?

only a few words between breaths

What is hypoxemia?

falling SpO2, restlessness, or agitation

What is impending respiratory failure?

exhaustion, confusion, or drowsiness

What is severly reduces airflow?

diminished breath sounds or a silent chest

What does less wheezing signigy?

does not always mean improvement

What are priority nursing actions for acute asthma?

assess severity while initiating treatment

What is positioning for acute athma?

upright and summon help as indicated

What must be administered for acute asthma?

rapid-acting inhaled bronchodilator (SABA)

What mmust be provided for acute asthma?

oxygen when indicated

What must be given when prescribed for acute asthma?

systemic corticosteroid

What is reassessed for effectivenss after acute asthma treatment?

is air moving more?

What is reasesses for comfortability after acute asthma treatment?

can the patient speak more?