Unit 2D: Asthma

Asthma Study Notes

Overview

• Course: NURS 1500

• Unit: 2D

• Instructor: Dana Wyatt, EdD, RN, CNE

Objectives

• Explain the pathophysiology of asthma.

• Discuss the diagnostic testing for asthma.

• Discuss assessment findings for the client with asthma.

• Identify nursing interventions for asthma.

• Analyze the use of medications in the treatment of asthma.

• Identify patient teaching to facilitate disease management of asthma.

• Identify members of the interdisciplinary team in the care of the client with asthma.

Preparation for the Lecture

• Reference the Iggy textbook, chapter 24.

• Notetaking options: Print slides or a concept map for notes.

• Engage with the content: pause to answer questions presented in the recording.

Pathophysiology of Asthma

• Refer to textbook page 540 and read the section on Asthma Pathophysiology.

• Question 1: Write 5-10 words describing the pathophysiology of asthma.

Asthma Triggers

• Common triggers include:

  • Allergens: Pollens, dust mites, mold, dander.

  • Irritants: Smoke, strong odors, chemicals.

  • Aspirin/NSAIDs: Sensitivity that may exacerbate asthma symptoms.

  • Hyperresponsiveness: Triggered by exercise or upper respiratory infections.

• Question 2: Important patient education regarding triggers?

Assessment

• Question 3: What subjective history should be obtained from a client with asthma?

• Question 4: Signs of bronchoconstriction and inflammation during an asthma assessment.

Diagnostic Testing

• ABG (Arterial Blood Gas) tests:

  • PaO2: Partial pressure of oxygen in blood.

  • Early-stage: Decreased CO2 levels.

  • Later-stage: Increased CO2 levels.

• For allergic asthma:

  • Elevated eosinophils in blood.

  • Elevated Immunoglobulin E (IgE) levels.

• Pulmonary Function Tests:

  • Forced Vital Capacity (FVC): Total air forcibly exhaled.

  • Forced Expiratory Volume in the First Second (FEV1): Volume expired in the first second.

  • Residual Volume (RV): Volume remaining in lungs post-exhalation.

  • Peak Expiratory Flow Rate (PEFR): Measure of how fast air can be exhaled.

  • Peak Flow Meter: Portable device for measuring peak flow.

Nursing Interventions

Teaching for Self-Management

• Peak Flow Meter Use:

  • Used to gauge severity of symptoms, adjusting medication use, and assessing improvement.

  • Establish baseline PEF; record and compare subsequent results.

• Trigger Avoidance: Educate patients on avoiding known triggers.

• Medication Management: Instructions on medication adherence.

• Peak Flow Video available for visual aid.

Symptom Management

• Symptom Diary: Keep track of symptoms, trigger exposure, and PEFR.

• Asthma and Exercise:

  • Planned exercise can improve endurance.

  • Advise SABA (Short Acting Beta Agonist) use prior to exercise.

  • Caution against cold-air exercise.

• Emergency Signs: Recognize signs requiring urgent care.

Medication Management

• STEP System of Medication Management:

  • Develop an individualized asthma plan.

  • Utilize patient teaching resources (Table 24.1 on page 545).

• Categories of Medications:

  • Prevention Drugs (Controllers): Manage chronic symptoms and prevent flare-ups.

  • Rescue Drugs (Emergent): For immediate relief during an exacerbation.

  • MDI (Metered Dose Inhaler) vs. Nebulizer: Use as indicated; MDI or nebulizer delivery options.

  • Use of Spacer: Enhances delivery of medication to the lungs.

  • Cleaning Respiratory Equipment: Essential for preventing infection.

Medication Regimens

Bronchodilators

• Short Acting Beta Agonist (SABA):

  • Fast-acting, used for immediate relief.

  • Dosing: 1-2 puffs every 4-6 hours as needed.

  • Maintain availability: Patients should carry at all times.

  • Side Effects: Tachycardia, restlessness, tremors, insomnia.

  • Example Medications:

    • Albuterol (Proventil, Ventolin), Levalbuterol.

Long Acting Beta Agonist (LABA)

• Usage: Provide longer duration of bronchodilation.

• Not a quick-acting rescue drug.

• Example: Salmeterol (Serevent).

Anticholinergics

• Action: Induces bronchodilation by inhibiting parasympathetic nervous system.

• Example Medications:

  • Ipratropium (Atrovent).

  • Tiotropium (Spiriva).

• Side Effects: Dry mouth.

Methylxanthines (Xanthines)

• Primary Agent: Theophylline - causes bronchial smooth muscle relaxation.

• Side Effects:

  • Cardiac (e.g., tachycardia), increased renal blood flow (diuresis), CNS stimulation (nervousness, tremors).

• Toxicity: Monitor blood levels (5-15 mcg/ml).

• Administration: Theophylline orally; Aminophylline administered IV.

Corticosteroids

• Indicated for reducing airway inflammation; considered a controller drug.

• Routes: Inhaled and oral.

• Inhaled Steroid Side Effects:

  • Pharyngeal irritation, coughing, dry mouth, oral fungal infections.

• Systemic Steroid Side Effects:

  • Hyperglycemia, hypokalemia, GI bleeding, bruising, infections, poor wound healing, fluid retention.

• Examples:

  • Inhaled: Flovent (fluticasone), Beclovent (Beclamethasone), Azmacort (Triamcinolone), Pulmicort (budesonide).

  • Oral: Prednisone (Deltasone, prednisolone).

  • IV/IM: Decadron (dexamethasone), Solu-Medrol (methylprednisolone).

• Question 6: Explain local vs systemic effects of drugs.

Administration Considerations

• Question: If a patient is scheduled for both an albuterol and fluticasone inhaler, which should be used first?

• Question 7: Special considerations after using the second inhaler?

Leukotriene Modifiers

• Action: Blocks leukotrienes from binding to receptor sites, reducing inflammation and bronchoconstriction.

• Administration: Oral, typically at bedtime.

• Example Medications:

  • Montelukast (Singulair), Zafirlukast (Accolate).

• Question 8: How to instruct a patient on taking montelukast?

Antihistamines

• Purpose: Manage allergic asthma symptoms.

• Common Medications:

  • Zyrtec (cetirizine), Allegra (fexofenadine), Benadryl (diphenhydramine).

• Side Effect: Drowsiness; awareness of interactions with other CNS depressants.

Mast Cell Stabilizers

• Function: Stabilize mast cell membranes, preventing histamine release.

• Classification: Controller drug.

• Example Medications: Cromolyn, Nedocromil.

Medication Administration Techniques

• MDI Use: Review the ATI skills module on medication administration focusing on MDI use with and without spacers.

• DPI Use: Review in ATI skills module.

Asthma and Exercise

• Recommending a planned exercise regimen to build endurance.

• Use of SABA prior to exercise is advisable.

• Avoidance of cold air during exercise.

Thinking Questions

• Question 9: What assessment indicates an asthma exacerbation?

• Question 10: What educational measures should a client take during an exacerbation?

• Question 11: Which interdisciplinary team members are necessary for a hospitalized asthma patient and during discharge?

Status Asthmaticus

• Description: Severe, life-threatening acute airway obstruction characterized by:

  • Dyspnea

  • Wheezing

  • Neck vein distention

  • Use of accessory muscles for breathing

• Symptoms can intensify quickly and may not respond to standard therapy.

• Risks: Development of pneumothorax and cardiac/respiratory arrest.

Treatment Options

• Oxygen Therapy: Administering supplemental oxygen.

• SABA: Albuterol is commonly used.

• Ipratropium Administration: For additional bronchodilation.

• IV Fluids: Important for hydration and support.

• Epinephrine: Should be given IV or inhalation.

• Magnesium Sulfate: Administer 1-2 grams IV over 15-30 minutes for severe cases (monitor for cardiac dysrhythmias and hypotension).

• Corticosteroids: IV therapy for systemic inflammation reduction.

Next Steps

• Review SLAM/BAM medication table.

• Consult ATI Pharmacology 5.0 Respiratory System section, focusing on bronchodilators, case studies, and activities.

• Create a Concept Map for Asthma detailing diagnostic tests, interventions, medications, patient teaching, and potential complications.

• Proceed to the preclass recording for COPD.