In Class

🌬 Asthma (Adult & Paediatric)

Patho: Chronic inflammation → bronchoconstriction + mucus
Triggers: Allergens, smoke, cold air, exercise, infections
Symptoms: Wheezing, SOB, cough, chest tightness
Assessment: PEFR, ABG, auscultation (wheezing)

Mnemonics:

• ASTHMA

  • A – Accessory muscle use

  • S – SOB (shortness of breath)

  • T – Tight chest

  • H – High-pitched wheeze

  • M – Mucus

  • A – Anxiety

Nursing Care:

• O2 if < 92%

• Administer bronchodilators (e.g. albuterol)

• Corticosteroids (e.g. prednisone)

• Position upright

• Educate on inhaler use & trigger avoidance

😤 COPD: Chronic Bronchitis vs. Emphysema

Chronic Bronchitis = "Blue Bloater"
Emphysema = "Pink Puffer"

Chronic Bronchitis Mnemonic – BLUE:

• B – Big mucus (productive cough)

• L – Lung sounds: wheeze/crackles

• U – Underoxygenated (cyanosis)

• E – Edema (cor pulmonale)

Emphysema Mnemonic – PINK:

• P – Pursed lips

• I – Increased CO2 retention

• N – No cyanosis early

• K – Keep using accessory muscles

Nursing Care (Same for both):

• Administer O2 cautiously (target 88–92%)

• Bronchodilators + steroids

• Encourage fluids

• Smoking cessation

• Pulmonary rehab

🦠 Pneumonia

Patho: Infection → alveoli fill with fluid
Causes: Bacteria, viruses, fungi, aspiration
Symptoms: Fever, chills, cough, sputum, SOB, chest pain

Mnemonic: PNEUMONIA

• P – Productive cough

• N – Neuro (confusion in elderly)

• E – Elevated WBC

• U – Unusual breath sounds (crackles)

• M – Mild to high fever

• O – Oxygen ↓

• N – Nausea

• I – Increased HR/RR

• A – Activity intolerance

Nursing Care:

• Assess respiratory status

• Antibiotics/antivirals

• Fluids + nutrition

• Incentive spirometry

• Monitor ABGs, vitals, sats

💧 Acute Pulmonary Oedema

Patho: Fluid in alveoli due to left heart failure
Symptoms: Sudden SOB, pink frothy sputum, crackles, anxiety

Mnemonic: FLASH

• F – Frothy sputum

• L – Lung crackles

• A – Anxiety

• S – Sweating

• H – Hypoxia

Nursing Care:

• Sit upright

• High-flow O2

• Administer diuretics (furosemide)

• Morphine for anxiety/SOB

• Monitor ECG, BP, sats

🩸 Pulmonary Embolism (PE)

Patho: Blood clot in pulmonary artery
Causes: DVT, immobility, surgery
Symptoms: Sudden SOB, chest pain, cough, hemoptysis

Mnemonic: PE SMART

• P – Pleuritic chest pain

• E – Elevated HR

• S – SOB

• M – Mild fever

• A – Anxiety

• R – Respiratory alkalosis (early)

• T – Tachypnea

Nursing Care:

• O2 therapy

• Anticoagulants (heparin/warfarin)

• Thrombolytics if severe

• Bed rest

• Monitor ABG, ECG, vitals

CASE STUDY 1

1. Most likely asthma risk factor in Jason’s history:

Answer: Family history of asthma and allergies

• His brother has asthma and both parents have pollen allergies, indicating a genetic predisposition, which is one of the strongest risk factors for pediatric asthma.

🧠 Mnemonic: "FAMILY TRAP"

• Family history

• Allergies

• Male gender (higher risk in young children)

• Infections (brother had URI)

• Low birth weight (2.7kg is borderline)

• Young age (under 5)

2. Main immunoglobulin in asthma pathophysiology:

Answer: IgE

• IgE is involved in hypersensitivity reactions and activates mast cells, leading to inflammation, bronchospasm, and mucus production.

🧠 Mnemonic: "I Get Excited (IgE) = Allergies & Asthma"

3. Common acute asthma symptoms and mechanisms:

Symptoms Jason showed:

• Non-productive cough, shortness of breath, wheezing, nasal flaring, prolonged expiration, flushed cheeks, laboured breathing

Mechanisms:

• Bronchospasm → tight chest, wheeze

• Mucosal edema → SOB

• Mucus hypersecretion → cough

• Air trapping → prolonged expiration

• Hypoxia → flushed/pale skin, tachycardia

🧠 Mnemonic: "WHEEZE"

• Work of breathing ↑

• Hyperinflated lungs

• Expiration prolonged

• Edema of airway

• Zip in air (air trapping)

• Eosinophils ↑ in allergy/asthma (immunological cause)

4. Sign of ventilatory failure:

Answer: Increased CO₂ (hypercapnia) and signs of exhaustion

• Jason’s pCO₂ = 47 mmHg, pH = 7.32 → shows respiratory acidosis → possible impending ventilatory failure

• Signs: lethargy, decreasing LOC, fatigue, shallow breathing

5. Elevated white blood cell count suggests:

Answer: Infection or inflammation

• WBC = 20 x 10⁹/L and neutrophils ↑ → likely viral or bacterial infection triggered the asthma attack.

6. Blood gas interpretation:

• pH = 7.32 (low)

• pCO₂ = 47 mmHg (high)

• Respiratory acidosis due to CO₂ retention → indicates hypoventilation or worsening asthma

🧠 Mnemonic: "ROME" for ABGs

• Respiratory

• Opposite (pH ↓, CO₂ ↑ = respiratory acidosis)

7. How asthma can lead to pneumonia:

Answer:

• Mucus stasis + air trapping → reduced clearance of microbes

• Infection risk ↑ → secretions become a breeding ground → may progress to pneumonia

8. Rationale for physician’s orders:

🧠 Mnemonic for Meds: "BROC-AID"

• Bronchodilators (Ventolin, Alupent)

• Respiratory support (O₂, humidifier)

• Oral fluids

• Corticosteroids

• Avoid triggers

• IV fluids/meds

• Diet advancement as tolerated

CASE STUDY 2

1. What cause could have contributed to Sean’s disease? Other causes of emphysema?

Main cause (Sean’s case):

• Chronic smoking for 40 years (20/day) → #1 risk factor for emphysema.

Other causes (etiologies):

• Alpha-1 antitrypsin deficiency (genetic, early-onset)

• Air pollution

• Occupational exposure (e.g., dust, fumes)

• Long-standing untreated asthma

🧠 Mnemonic: "S A M P"

• Smoking (primary cause)

• Alpha-1 antitrypsin deficiency

• Mist (occupational exposure)

• Pollution

2. Pathophysiology process leading to Emphysema:

1. Smoke/toxins → damage alveolar walls and activate inflammatory enzymes

2. These enzymes, especially elastase, break down elastin → loss of alveolar elasticity

3. Alveolar sacs merge (forming large air spaces) → ↓ surface area for gas exchange

4. Air trapping occurs → hyperinflated lungs → barrel chest

5. Gas exchange becomes inefficient → hypoxia & CO₂ retention

🧠 Mnemonic: "E-M-P-H-Y-S-E-M-A"

• Enlarged alveoli

• Merged air sacs

• Protease overactivity

• Hyperinflation

• Yawning for air (SOB)

• Surface area ↓

• Elastic recoil ↓

• Mucus may accumulate

• Air trapping

3. Why does Sean have tachypnoea (↑ RR = 28/min)?

• Reduced alveolar surface area → ineffective gas exchange

• Body compensates by breathing faster to increase oxygen intake and CO₂ removal.

• Also, hyperinflation reduces lung compliance, making breathing more laborious.

4. Clinical signs that indicate Sean has Emphysema:

✅ Key signs:

• Barrel chest (↑ anterior-posterior diameter)

• Tachypnoea (28/min)

• Prolonged expiration

• Reduced breath sounds (due to air trapping)

• Expiratory wheeze

• No cyanosis yet (early stage or “pink puffer” presentation)

🧠 Mnemonic: "PINK PUFFER"

• Pink (not cyanotic)

• Increased chest (barrel chest)

• No cough or minimal sputum

• Keeping weight low (weight loss)

• Pursed lip breathing

• Use of accessory muscles

• Flat diaphragm (on x-ray)

• Frequent SOB

• Enlarged alveoli

• Reduced breath sounds

5. Why is expiration prolonged in COPD (esp. emphysema & chronic bronchitis)?

• Loss of elastic recoil in alveoli → air cannot be pushed out efficiently

• Air trapping increases → takes longer time to fully exhale

• Narrowed airways + thick mucus (in chronic bronchitis) further block airflow

• Patient tries to breathe against resistance, especially during expiration.

🧠 Mnemonic: "LATE"

• Lost recoil

• Air trapping

• Thick mucus (chronic bronchitis)

• Expiration prolonged