topic 3 final part

Asthma definition

Chronic inflammatory airway disorder with REVERSIBLE airflow limitation

Most common trigger of asthma exacerbation

Upper respiratory infection

Asthma medication triggers

NSAIDs, beta-blockers (ACE inhibitors worsen cough)

Asthma late-phase response

4-6 hr later; symptoms recur/worsen

Severe asthma exacerbation

Dyspnea at rest, RR >30, HR >120, PEFR <=40%

Life-threatening asthma

Can't speak, profuse sweating, drowsy/confused, PEFR <25%

Asthma action plan red zone

Peak flow <50%, severe dyspnea, minimal speech

Silent chest

Wheezing stops in severe distress = almost no airflow; EMERGENCY, not improvement

Asthma O2 targets

PaO2 >=60, SpO2 >90%

Status asthmaticus treatment

High-flow O2, continuous nebulized SABA, ipratropium, IV magnesium, IV steroids

First-line asthma rescue drug

SABA (albuterol)

Frequent SABA use means

Poorly controlled asthma

LABA

Maintenance only, not rescue

Ipratropium

Anticholinergic bronchodilator, combined with SABA in exacerbations

Long-term asthma control foundation

Inhaled corticosteroids (budesonide, beclomethasone)

PE most common source

DVT

PE other emboli types

Fat (long-bone fractures), air, tumor

PE most common symptom

Sudden dyspnea

PE signs

Tachypnea, tachycardia, pleuritic chest pain, cough/hemoptysis, crackles

Massive PE signs

Sudden mental status change, hypotension, impending doom, arrest

PE risk factors

Immobility, recent surgery, prior VTE, cancer, obesity, oral contraceptives, smoking, long flights, pregnancy

PE first-line diagnostic test

CT pulmonary angiography

PE test if contrast allergy

V/Q scan

Most definitive PE test

Pulmonary angiography (invasive)

PE ABG

Hypoxemia + respiratory alkalosis (not diagnostic)

D-dimer

Not specific or sensitive enough to diagnose PE

PE primary treatment

Anticoagulation

Preferred anticoagulant for acute PE

LMWH (enoxaparin); no aPTT needed

Long-term PE anticoagulant

Warfarin (at least 3-6 months)

Massive PE treatment

Fibrinolytic (alteplase)

IVC filter

When anticoagulation contraindicated/ineffective; prevents new emboli, doesn't dissolve clots

Heparin monitoring

aPTT + platelets (HIT)

Warfarin monitoring

INR

PE nursing priorities

Semi-Fowler's, O2, IV access, monitor VS/ABGs, reduce anxiety

PE prevention

Early ambulation, SCDs, prophylactic heparin/LMWH, hydration

Anticoagulant teaching

Take exactly as prescribed; report bruising, hematuria, black stools; follow-up labs