02.02 Nursing Care and Pathophysiology for Asthma

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Outline

Pathophysiology: Asthma is a respiratory condition with chronic inflammation of the bronchioles and bronchoconstriction. This causes airway restriction. Asthma attacks are caused by triggers such as infections, allergens, exercise, and other irritants.

Overview

  1. Inflammatory disorder of airways
  2. Stimulated by triggers (infection, allergens, exercise, irritants)
  3. Status Asthmaticus – life-threatening condition
    1. Asthma unresponsive to treatment

Nursing Points

General

  1. Narrowed airways = ↓ gas exchange
    1. Inflammation of airways
    2. Bronchoconstriction
    3. Excessive mucus production

Assessment

  1. Symptoms
    1. Wheezing/crackles
    2. Restless/anxious
    3. Diminished breath sounds
    4. tachypnea
  2. Diagnostics
    1. Peak Flow Rate
      1. Volume of expired air
      2. Patient should track and know baseline
      3. Stable = 80-100% baseline
      4. Caution = 50-80% baseline
      5. Danger = <50% baseline
    2. Pulmonary Function Tests
    3. X-ray to rule out other causes

Therapeutic Management

  1. High-fowler’s or position of comfort
  2. Administer O2
  3. Medications
    1. Epi-Pen if allergic reaction
    2. Bronchodilators
    3. Corticosteroids
    4. Leukotriene Modulators

Nursing Concepts

  1. Oxygenation
    1. Listen to lungs
    2. Monitor SpO2
    3. Administer supplemental O2
  2. Gas Exchange
    1. Monitor ABG
    2. Monitor for s/s CO2 toxicity
      1. ↓ LOC
  3. Comfort
    1. Keep patient calm
    2. Encourage position of comfort

Patient Education

  1. Identify Triggers and Avoid
    1. Allergy tests
    2. Smoke / Secondhand smoke
      1. SMOKING CESSATION
    3. Keep a journal
  2. Proper use of Inhaler
    1. Shake 10-15 times
    2. Large breathe, exhale completely
    3. Mouthpiece in mouth, seal with lips
    4. Tilt head back to open airway
    5. Depress inhaler, slow, deep breath in
    6. Hold breath 5-10 sec
    7. Breathe out slow
    8. Repeat if 2nd puff ordered
    9. Use spacer if needed
  3. Peak Flow Test
    1. Daily testing – perform 3 times and record best effort
    2. Track in a journal
    3. Report to provider if in caution or danger zone
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Transcript

Hey guys, my name is Brad and welcome to nursing.com. And in today’s video, what we’re going to be discussing is asthma. We’re going to dive into some of the patho behind asthma, as well as some signs and symptoms that we may see in our patients, as well as how we’re going to treat. Without further ado, let’s dive in.

Regarding the patho of asthma and patients who have asthma, what they have are super, sensitive airways, right? Very, very, sensitive airways. Asthma is a genetically acquired condition. And in patients who have asthma, they have hypersensitivity of these airways, right? These bronchi, these bronchioles that come down and feed into these alveoli are very, very, sensitive. So what occurs in asthma is a patient breathes in some sort of irritants, right? Dust debris, we’ll get into some of the possible irritants, but they breathe in something. Let’s call it dust for this instance. Dust gets breathed into the lungs and because these lungs are so sensitive, they pick up on it immediately, and a cascade of events actually ends up occurring as a result, right? The first thing that happens is what we have is actual contraction of this bronchial smooth muscle, right? We actually have contraction of the smooth muscle, which causes narrowing of that inner lumen, right, causes tightening of the airways, constriction of the airways. The second thing that occurs, because these patient’s lungs, that are hypersensitive, view that dust or debris that they just inhale as a foreign attack on the lungs. They’re that sensitive. This is now a foreign attack on the lungs. What actually ends up occurring is we have an inflammatory response, an inflammatory cascade that rushes to the lungs to try and attack whatever this foreign body is, this dirt, this debris. And so we’re going to actually see inflammation of the airways in addition to that constriction. And the other thing that I left here is, actual hypersecretion of mucus within the airways as well, right? We’ve breathed, we’ve inhaled dust. We want to try and trap that dust, so we secrete extra mucus to try and trap that dust, our smooth muscle contracts and constricts those airways. And then we have an insult to our lungs. So we release an inflammatory cascade causing inflammation of our airways, right? Kind of a three-pronged reaction to the inhalation of some sort of irritant in these hypersensitive airways. So the importance of this slide is just for you guys, to be able to familiarize yourself with some of these triggers for asthma, right? There are a ton of different kinds. Smoke is a really, really big one, right? Heavy fragrance, fragrances, such as perfume. Pollen, right? This is a really, really big one that can trigger an actual asthma attack. Pet dander, dust, actually, cold air, also stress, can cause asthma attacks. The entire idea is that all of these end up triggering that very, very sensitive airway to produce that three-pronged attack, that three-pronged cascade of symptoms of pathophys that we just discussed.

Regarding some assessment findings in patients with asthma, remember, right, we have this incredibly narrow airway that is constricted, that is inflamed, because we’ve inhaled some sort of foreign body. And that is just absolutely dripping with mucus. So patients are going to have an incredibly difficult time getting air in, getting oxygen in. Therefore, they’re going to be short of breath. Therefore, they’re going to have low O2 Sats. Therefore, they’re going to be tachycardic, right? That heart is going to try and compensate by pumping oxygen containing blood up to the lungs. We’re trying to get 02, we’re starving for O2. Because we’re starving for 02 and we’re so short of breath, patients can become anxious. Patients can become confused, right? We may end up seeing decreased levels of consciousness as we have alterations in our blood pH. Make sure you check out our ABGs video if you’re a little bit unfamiliar on respiratory acidosis, respiratory alkalosis, it may make a little bit more sense. Also, adventitious lung sounds. Speaking of making sense, this makes sense that what we’re going to hear is wheezing. As we’re trying to pass air through an incredibly narrow pipe, that we’re going to hear crackles, as we’re trying to pass air through all of this thick mucus, peak expiratory flow, as well as chest x-rays that we’re going to be getting on our patients to keep an eye on the progression of their asthma. 

How are we going to treat our patients with asthma? Well, of course, if our patient has an asthma attack, if they have that hypersensitive reaction due to exposure to some allergen, of course remove the patient from the allergen. We want to make sure that we are giving patients rescue inhalers should they need them for instances where they have these acute flare ups of asthma attacks, right? Things such as albuterol, that’s going to be the most common rescue inhaler you’re going to be familiar with, right? The entire idea is these airways are so constricted, we need to dilate them. So let’s bronchodilate them with rescue inhalers, such as albuterol. And speaking of bronchodilators, that’s the next one, right? Things such as beta-2 agonists, right? Things that actually stimulate the beta-2 cells in the lungs themselves, in order to produce this bronchodilation.  Things such as formoterol, if I can spell that. Steroids, right? Remember that three-pronged attack that our lungs are being hit with in asthma. Not only are we having this bronchoconstriction, but we’re also having the inflammation from this inflammatory response from this pathogen that we’ve inhaled. So we want to give steroids to decrease this inflammation. Also, 02, again, that’s a no brainer. Patients starving for 02, we need to give them supplemental oxygen. And also making sure that we sit our patient up. You may also have heard it being called something like a tripod position. Basically sit that patient upright in bed to allow those lungs to fully expand, to allow them to get as much oxygen in as they can. 

Now, some education that we’re going to give our patient, how to properly use these inhalers, these rescue inhalers albuterol, making sure that they’re very familiar with how to use them, so that should an asthma attack occur, they’re more calm and prepared on how to use them. Medication adherence, those bronchodilators, those steroids, things that we’re going to use to try and treat that three-prong attack, right? Also, avoiding allergens, avoiding irritants, making sure that they’re familiar with what triggers their asthma. Peak expiratory flow recordings. Remember we mentioned peak expiratory flow. Basically, this is something that a patient’s going to do, periodically, to measure the amount of expiratory flow that they can actually exhale. And this is just the way in which patients are able to measure the severity of their asthma. And also educating them on signs and symptoms of asthma attacks as well as when to seek help. 

So summarizing some key points from asthma. Remember in patients who have asthma, they have super sensitive airways and it’s this hypersensitivity through the inhalation of some sort of foreign body, some sort of dust or debris that ends up leading to this three-pronged attack that causes so many problems for patients with asthma. Remembering and familiarizing yourself with those different triggers that cause the asthma attacks, knowing those various assessments are all related to that bronchoconstriction, that inflammatory response, as well as that hypersecretion of mucus inside of those airways, the therapeutic management focused on combating those three-pronged attack, those three things that are causing such issues in patients with asthma, as well as the education, which we just discussed. 

Guys, that was asthma. And I really hope that this information helps you as you move forward through nursing school, helps you as you move forward taking those exams, and helps you as you take care of those patients. Go out there and be your best selves today. And as always, happy nursing.

 

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