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Asthma Handout I. Asthma A.

Pathophysiology:
-Chronic inflammatory disorder of the airway -What is happening in the persons airway? -Edema -Inflammation -Tenacious secretions, -Smooth muscle spasms (wheezing and bronchospasm) -Decreased expiratory airflow -Causes/Triggers: -Allergy -Environmental allergens (dust mites and roaches) -Smoke (any form) -Dust -Pets -Exercise -Change in the weather (cold air) -Strong emotions -Change in environment (moving to new home or new school) -Food -Medication

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B. S/S:
-Recurrent episodes of wheezing -Cant catch their breath, dyspnea -Cough -Fatigue -Chest tightness/pain -Retraction in infants -Hyperressonance of chest with percussion -Course and loud breath sounds -Repeated episodes = barrel chest -Symptoms usually worse at night. -Symptoms of acute asthma attack: Child may start to c/o itching in front of the neck or the upper back. Child will start out feeling restless and c/o of a HA. Child will also be tired, irritable, hacking non productive cough, chest is starting to get tight as secretions increase the cough becomes rattling and productive (clear frothy sputum). -Attack becoming more severe: Try to breathe more deeply, expiratory phase is prolonged, audible wheezing, appears pale, and may become cyanotic, restless, anxious expression, sweating, younger children assume the tripod sitting position, whereas the older child will sit up with shoulders hunched over with hands on legs or bed to facilitate use of accessory muscles.

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C. Dx:
-Hard to diagnose asthma in infants (many conditions can cause wheezing and retractions). -Chronic cough with no signs of infection or diffuse wheezing during expiration is enough to diagnose asthma. -Pulmonary function test: Helps to determine the presence and degree of lung disease and response to respiratory therapy. -Spirometry function test reliable for children older than 5 or 6 years. -Peak expiratory flow rate (PEFR): Max airflow that can be forcefully that can be exhaled in one second. -Each childs PEFR based on age, race, height and gender.

D. Tx:
-Chest Physiotherapy -Percussion, vibration, squeezing the chest and breathing exercises (blowing a pin wheel) -Do not administer this therapy during an acute episode -Monitor O2 sat -Allergy shots (Allergy proof the house)
Only administer allergy shots if emergency equipment is available in case of anaphylactic shock.

-Small frequent meals to prevent abdominal distention which will prevent the diaphragm from expanding -Encourage fluids to thin secretions, but no cold fluids because that could induce a bronchospasm -Evaluate participation in exercise activities on an individual basis. -Humidified O2 -Refer to Respiratory System Medications

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