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Asthma, PE, Poisoning

Asthma, PE, Poisoning

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Published by: Realine Irabon Nolasco on Aug 19, 2011
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ASTHMA A chronic inflammatory disease of the airways causing hyper responsiveness, mucosal edema and mucous production.

PATHOPHYSIOLOGY: BRONCHOCONSTRICTION: During an asthma episode, inflamed airways react to environmental triggers such as smoke, dust, or pollen. The airways narrow and produce excess mucus, making it difficult to breathe. In essence, asthma is the result of an immune response in the bronchial airways The airways of asthmatics are "hypersensitive" to certain triggers, also known as stimuli (see below). In response to exposure to these triggers, the bronchi (large airways) contract into spasm (an "asthma attack"). Inflammation soon follows, leading to a further narrowing of the airways and excessive mucus production, which leads to coughing and other breathing difficulties

CLINICAL MANIFESTATIONS: a. b. c. d. e. Cough with or without mucous productions dyspnea sneezing exacerbation asthma attack ofeten occurs at night or early morning because of circardian variations that influence airway receptor thresholds.

Metal wood and vege dusts . Asthma exacerbations may begin abruptly but most frequently is preceeded by increasing symptoms over the previous days.Sera . Expiration requires effort and becomes prolonged. cimetadine) . Assess for comorbid conditions that accompany asthma . Hypoxemia. Generalized wheezing h.high pollen counts . widened pulse pressure k. j. Generalized chest tightness i.Laundry detergents .Diagnostic induced asthma .Secretion d.air pollution c. ASSESSMENT AND DIAGNOSTIC FINDINGS a. Diaphoresis. antibiotics.pet dander . Assess for occupation-related chemical compounds . g. Assess for patient’s family history b.Allergic bronchopulmonary asthma aspergillosis LABORATORY FINDINGS: a.secondary to ventilation-perfusion mismatch l.Industrial chemicals and plastics . e. tachycardia. Assess for environmental factors: . piperazine.late sign of poor oxygenation.Medications (aspirin. c.seasonal changes .f. b.GER . Central cyanosis. d. sputum and blood tests elevated level of eosinophils elevated level of immunoglobulin E Arterial Blood Gas Analysis and pulse oximetry reveals hypoxemia Normal PaCo2 value may signal impending respiratory failure PREVENTION .Animal insect dusts .mold .climate changes .

Quick acting beta2-adrenergic agonist medications are fast used prompt relief of airflow obstruction. Pharmacologic Therapy 2 General classes of Asthma medications: a.g fever. Peak flow monitoring: .used with anti-inflammatory medications to control asthma symptoms. Antibiotic Therapy Treatment for patients with acute asthma exacerbations with comorbid conditions. *CROMOLYN Na (Intal) *NEDOCROMIL (Tilade) -moderate anti-inflammatory agents used in children. Asthma Exacerbations are best managed by early treatment and education.potent bronchoconstrictors that dilate blood vessels and alter permeability. Long Actin Beta2-adregernic agonists. (e. c. purulent sputum) f. e. *THROPHYLIINE.most potent and effective anti-inflammatory medication.are the medication of choice for relief of acute symptoms and prevention of exercise-induced asthma.for relief of nighttime asthma.Patients with asthma must undergo tests to identify substances that precipitate the symptoms. b. b. MANAGEMENT OF EXACERBATIONS a. Long Actin Medications *CORTICOSTEROIDS. QUICK RELIEF MEDICATIONS: Short-acting Beta2-adrenergic agonists. they should rinse his/her mouth after administration to prevent thrush. COMPLICATIONS Status Asthmaticus Respiratory failure Pneumonia Atelectasis MANAGEMENT A. *LEUKOTRINE MODIFIERS/ INHIBITORS. B. Systematic corticosteroids to decrease airway inflammation in patients who fail to respond to inhaled beta-adrenergic medications. When the patient uses inhaled corticosteroids with spacer. Oxygen supplementation maybe required to relieved hypoxemia. d.

Wheezing ASSESSMENT AND DIAGNOSTIC FINDINGS Pulmonary Function. Nurses must use a calm approach.most accurate means of assessing acute airway obstruction . It also helps measure asthma severity and indicates current degree of asthma control.breath sounds .Prolonged exhalation . Attacks can occur with little or no warning and can progress rapidly to asphyxiation. a. NURSING MANAGEMENT Nursing management depends on the severity of symptoms. b.Peak flow meters the highest airflow during a forced expiarion. which is an important aspect of nursing care.vital signs c. c. Assess the patient’s respiratory status by: -monitoring the severity of symptoms .Engorged neck veins .Labored breathing . Aminister medications as prescribed and monitor patient’s response to the medications. SIGNS AND SYMPTOMS: . STATUS ASTHMATICUS a severe and persistent asthma that does not respond to conventional therapy. Administer fluid if the patient is dehydrated.pulse oximetry .peak flow .

Constantly monitor the patient for the first 12-24 hours until Status Ashtmaticus is controlled. Magnesium Sulfate-calcium antagonist. Assess patient’s skin turgor for signs of dehydration. g. Oxygen Therapy to trear dyspnea. Cardiac rhytm should be monitored. close monitoring of the patient b. BP. central cyanosis. treatment of Beta2. corticosteroids.adrenergic agonists – provide most rapid relief from bronchospasm. e.used to decrease the intense airway inflammation and swelling d. Provide a quiet room free from irritants to conserve patient’s energy. administred to induced smooth muscle relaxation causing bronchodilation. . and hypoxemia. short-acting inhaled Beta2. Sedative Medications are contraindicated. NURSING MANAGEMENT main focus is to actively assess the airway and patient’s response to treatment.adrenergic agonist c.MEDICAL MANGEMENT a. Administer IV Fluids as prescribed. -high flow supplemental Oxygen is best delivered using a partial or complete nonrebreather mask f.

Low doses of Heparin before surgery to reduce risk of postoperative Deep Venous thrombosis and Pulmonary embolism d.shows sinus tachycardia. Prevent deep venous thrombosis by: . D-dimer Assay: blood test for evidence of blood clots h. Spiral Computed CT Scan of the Lung g.early ambulation . Anticoagulant Therapy for patients older than 40 years old. Chest X-rays b.specific T-wave changes c.an invasive procedure. V/Q Scan.interval depression. Dyspnea. non. Allows for direct visualization under fluoroscopy of the arterial obstruction and accurate assessment of the perfusion deficit. d. f. MANIFESTATIONS: a. Peripheral Vascular Studies d.an obstruction of the pulmonary artery or one of its branches by a thrombus that originates somewhere in the venous system or in the right side of the heart. c.use of elastic compression stockings b. ECG.most common Tachypnea-most frequent Chest pain usually sudden and pleuritic Deep Venous Thrombosis. ASSESSMENT AND DIAGNOSTIC FINDINGS a. PREVENTION a. Arterial Blood Gas Analysis.shows hypoxemia and hypocapnia e. c.best nethod to diagnose Pulmonary Embolism. Pulmonary Angiography.active Leg exercise .sudden onset of pain or swelling and warmth of the proximal or distal extremity.PULMONARY EMBOLISM . PR. evaluating the different regions of the lung and allows comparison of the percentage of ventilation and perfusion in each area. skin discoloration and superficial vein distention. b. Sequential Compression devices are oten used to prevent Venous stasis through compression and relaxation of the calf muscles. MANAGEMENT .

and anti-arrhythmic agents Indwelling urinary catheter for massive embolism to monitor urine output. b.*Emergency Management is the primary concern.cupped catheter is introduced transvenously into the affected pulmonary artery. trauma f. Thrombolytic Therapy. recent labor and delivery e. severe hypertension *Surgical Management: a. . The removal of actual clot. . active bleeding c. Elevating Leg (above heart level) also increases venous flow. relieve pulmonary vascular vasoconstriction. e. f.to correct hypoxemia. a. *Pharmacologic Therapy A. Warfarin Na). d. CVA within past 2 months b. Surgical Embolectomy: for patients with massive Pulmonary Embolism or hemodynamic instability. Use of elastic compression stockings c. b. *General Management: a.Side effects: BLEEDING -Contraindications: a. c. Transvenous catheter embolectomy.resolves the thrombi or emboli more quickly and restores more normal hemodynamic functioning of the pulmonary circulation. Administer Nasal Oxygen immediately to relieve hypoxemia IV infusion lines inserted to establish routes of medications Perfusion Scan Hypotension is treated by a slow infusion of dobutamine Administer digitalis glycosides. Anti Coagulation Therapy (heparin.technique in which a vacuum. b.primary method for managing acute deep vein thrombosis and pulmonary Embolism Heparin.to prevent occurrence of emboli B. to stabilize the Cardiopulmonary system. Small doses of IV Morphine or sedatives to relieve patient anxiety. IV diuretics. g.used in treatment for patients who are severly compromised. . surgery within 10 days of the thrombotic event d. OxygenTherapy.

Assessing potential for Pulmonary Embolism d. Provide postoperative nursing care . Monitor for complications g. Relieving anxiety f. minimize risk of Pulmonary Embolism b.c. *Nursing Management a. Preventing thrombus formation by encouraging ambulation and active and passive leg exercise to prevent venous stasis in patients prescribed at bed rest. Maintaining oxygen therapy e.is another surgical technique used when Pulmonary Embolism recurs or when patient does not tolerate anticoagulant therapy. Interrupting the Inferior Vena Cava. c.

skin color: from pink or cherry red to cyanotic and pale. Carbon Monoxide Poisoning. f. . absorbed. Skin Contamination Poisoning (Chemical Burns) Severity of chemical burns are determined by the mechanism of action. Includes: a. Non phosphate detergents f. Administer 100% oxygen. CARBOXYHEMOGLOBIN. applied to the skin or produced within the body injures the body by its chemical action. d.POISONING POISON.appear intoxicated (from cerebral hypoxia) . C. keep patient as quiet as possible. A.dizziness . when ingested.carbon monoxide bound to hemoglobin. Swallowed Poisons. Bleach e. inhaled. Open all doors and windows b. It does not transport oxygen. do not give alcohol in any form or permit the patient to smoke. Button batteries B. carry patient to fresh air immediately.headache . prevent chilling. Wrap patient in blankets.palpitation .is any substance. Drain cleaners c.maybe corrosive. Toilet bowl cleaners d.may result of industrial or household incidents or attempted suicides. It exerts its toxic effects by binding to circulating hemoglobin and there by reducing the oxygen carrying capacity of blood. initiate CPR. Management: The goal of management is to reverse cerebral and myocardial hypoxia. Oven cleaners g. Lye b. MANIFESTATIONS .muscular weakness . General measures to apply: a. loosen all tight clothing c.confusion progressing rapidly to coma . It includes alkalines and acid agents that can cause tissue destruction after coming into contact with mucous membranes. e.

e. MANAGEMENT: a. lethargy b. Food poisoning A sudden illness that occurs after ingestion of contaminated food or drink. skin should be drenched immediately with running water from shower. gastric contents. Clear liquids are prescribed for 12-24 hours and diet is gradually progressed to low residue. hose or faucet. vomitus. c. b. Patient’s clothing should be removed. For mild nausea.serious form of Food poisoning. anuria f. BP. . bland diet.Assess for: a. serum and feces are collected for examination. amount and duration of exposure of the skin to the chemical.fluids and electrolytes should be assessed. carbonated drinks or tap water. Measures to control nausea are important to prevent vomiting. Prolonged lavage with generous amounts of tepid water is important. hypotension g. patient is encouraged to take sips of weak tea. except in case of lye and white phosporus. rapid pulse rate c. An anti-emetic medication is administered parenterally or prescribed if the patient cannot tolerate fluids or medications by mouth. . BOTULISM. d. ASSESSMENT AND DIAGNOSTIC FINDINGS: . b.food. level of conciousness. c. CVP and muscular activity. . fever d. delirium MANAGEMENT: a. monitor patient’s respiration. oliguria e.penetrating strength and concentration.

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