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Bronchial Asthma
Bronchial Asthma
With bronchial asthma, you may have one or more of the following signs and symptoms:
Shortness of breath
Tightness of chest
Wheezing
Excessive coughing or a cough that keeps you awake at night
Because asthma symptoms don't always happen during your doctor's appointment, it's important for you
to describe your, or your child's, asthma signs and symptoms to your health care provider. You might also
notice when the symptoms occur such as during exercise, with a cold, or after smelling smoke. Asthma
tests may include:
Spirometry: A lung function test to measure breathing capacity and how well you breathe. You will
breathe into a device called a spirometer.
Peak Expiratory Flow (PEF): Using a device called a peak flow meter, you forcefully exhale into the tube
to measure the force of air you can expend out of your lungs. Peak flow monitoring can allow you to
monitor how well your asthma is doing at home.
Chest X-ray: Your doctor may do a chest X-ray to rule out any other diseases that may be causing
similar symptoms.
Bronchial Asthma
(continued)
Treating Bronchial Asthma
Once diagnosed, your health care provider will recommend asthma medication(which can include asthma
inhalers and pills) and lifestyle changes to treat andprevent asthma attacks. For example, long-
acting anti-
inflammatory asthmainhalers are often necessary to treat the inflammation associated with asthma.These
inhalers deliver low doses of steroids to the lungs with minimal side effects ifused properly. The fast-
acting or "rescue" bronchodilator inhaler works immediatelyon opening airways during an asthma attack.
If you have bronchial asthma, make sure your health care provider shows you howto use the inhalers pro
perly. Be sure to keep your rescue inhaler with you in case ofan asthma attack or asthma emergency. Wh
ile there is no asthma cure yet, thereare excellent asthma medications that can help with preventing asth
ma symptoms.Asthma support groups are also available to help you better cope with yourasthma.
Asthma Case Study
August 27, 2008 24 Comments
INTRODUCTION:
Asthma is a chronic, reversible, obstructive airway disease,
characterized by wheezing. It is caused by a spasm of the bronchial
tubes, or the swelling of the bronchial mucosa, after exposure to
various stimuli.
Asthma is the most common chronic disease in childhood. Most
children experience their first symptoms by 5 years of age.
ETIOLOGY:
Asthma commonly results from hyperresponsiveness of the trachea and
bronchi to irritants. Allergy influences both the persistence and the
severity of asthma, and atopy or the genetic predisposition for the development of an IgE-mediated response to
common airborne allergens is the most predisposing factor for the development of asthma.
CLASSIFICATION:
1. Extrinsic Asthma called Atopic/allergic asthma. An allergen or an antigen is a foreign particle which enters
the body. Our immune system over-reacts to these often harmless items, forming antibodies which are normally
used to attack viruses or bacteria. Mast cells release these antibodies as well as other chemicals to defend the body.
Common irritants:
Cockroach particles
Cat hair and saliva
Dog hair and saliva
House dust mites
Mold or yeast spores
Metabisulfite, used as a preservative in many beverages and some foods
Pollen
2. Intrinsic asthma called non-allergic asthma, is not allergy-related, in fact it is caused by anything except an
allergy. It may be caused by inhalation of chemicals such as cigarette smoke or cleaning agents, taking aspirin, a
chest infection, stress, laughter, exercise, cold air, food preservatives or a myriad of other factors.
Smoke
Exercise
Gas, wood, coal, and kerosene heating units
Natural gas, propane, or kerosene used as cooking fuel
Fumes
Smog
Viral respiratory infections
Wood smoke
Weather changes
ANATOMY AND PHYSIOLOGY:
The upper respiratory tract consists of the nose, sinuses, pharynx, larynx, trachea, and epiglottis.
The lower respiratory tract consist of the bronchi, bronchioles and the lungs.
The major function of the respiratory system is to deliver oxygen to arterial blood and remove carbon dioxide from
venous blood, a process known as gas exchange.
The normal gas exchange depends on three process:
Ventilation is movement of gases from the atmosphere into and out of the lungs. This is accomplished through
the mechanical acts of inspiration and expiration.
Diffusion is a movement of inhaled gases in the alveoli and across the alveolar capillary membrane
Perfusion is movement of oxygenated blood from the lungs to the tissues.
Control of gas exchange involves neural and chemical process
The neural system, composed of three parts located in the pons, medulla and spinal cord, coordinates respiratory
rhythm and regulates the depth of respirations
The chemical processes perform several vital functions such as:
regulating alveolar ventilation by maintaining normal blood gas tension
guarding against hypercapnia (excessive CO2 in the blood) as well as hypoxia (reduced tissue oxygenation
caused by decreased arterial oxygen [PaO2]. An increase in arterial CO2(PaCO2) stimulates ventilation;
conversely, a decrease in PaCO2 inhibits ventilation.
helping to maintain respirations (through peripheral chemoreceptors) when hypoxia occurs.
The normal functions of respiration O2 and CO2 tension and chemoreceptors are similar in children and adults.
however, children respond differently than adults to respiratory disturbances; major areas of difference include:
Poor tolerance of nasal congestion, especially in infants who are obligatory nose breathers up to 4 months of age
Increased susceptibility to ear infection due to shorter, broader, and more horizontally positioned eustachian
tubes.
Increased severity or respiratory symptoms due to smaller airway diameters
A total body response to respiratory infection, with such symptoms as fever, vomiting and diarrhea.
SIGNS AND SYMPTOMS:
1. Non Productive to Productive Cough
2. Dyspnea
3. Wheezing on expiration
4. Cyanosis
5. Mild apprehension and restlessness
6. Tachycardia and palpitation
7. Diaphoresis
PATHOPHYSIOLOGY:
CLINICAL MANIFESTATIONS:
1. Increased respiratory rate
2. Wheezing (intensifies as attack progresses)
3. Cough (productive)
4. Use of accessory muscles
5. Distant breath sounds
6. Fatigue
7. Moist skin
8. Anxiety and apprehension
9. Dyspnea
Steps of Clinical and Diagnostic as per National Asthma Education and Prevention Program
Mild Intermittent Asthma
Symptoms ? 2 times per week
Brief exacerbations
Nighttime symptoms ? 2 times a month
Asymptomatic and normal PEF (peak expiratory flow) between exacerbations
PEF or FEV, (forced expiratory volume in 1 second) ? 80% of predicted value
PEF variability < 20%
Mild Persistent Asthma
Symptoms > 2 times/week, but less than once a day
Exacerbations may affect activity
Nighttimes symptoms > 2 times a month
PEF/FEV ? 80% of predicted value
PEF variability 20%-30%
Moderate Persistent Asthma
Daily Symptoms
Daily use of inhaled short-acting ?2 - agonists
Exacerbations affect activity
Exacerbations ? 2 times a week
Exacerbations may last days
Nighttime symptoms > once a week
PEF/FEV > 60%-<80% of predicted value
PEF variability > 30%
Severe Persistent Asthma
Continual symptoms
Frequent exacerbations
Frequent nighttime symptoms
Limited physical activity
PEF or FEV ? 60% of predicted value
PEF variability > 30 %
LABORATORY AND DIAGNOSTIC FINDINGS:
Spirometry will detect:
a. Decreased for expiratory volume (FEV)
b. Decreased peak expiratory flow rate (PEFR)
c. Diminished forced vital capacity (FVC)
d. Diminished inspiratory capacity (IC)
NURSING MANAGEMENT:
1. Assess respiratory status by closely evaluating breathing patterns and monitoring vital signs
2. Administer prescribed medications, such as bronchodilators, anti-inflammatories, and antibiotics
3. Promote adequate oxygenation and a normal breathing pattern
4. Explain the possible use of hyposensitization therapy
5. Help the child cope with poor self-esteem by encouraging him to ventilate feelings and concerns. Listen actively as
the child speaks, focus on the childs strengths, and help him to identify the positive and negative aspects of his
situation.
6. Discuss the need for periodic PFTs to evaluate and guide therapy and to monitor the course of the illness.
7. Provide child and family teaching. Assist the child and family to name signs and symptoms of an acute attack and
appropriate treatment measures
8. Refer the family to appropriate community agencies for assistance.
Nursing Care Plan Brochial Asthma
June 14, 2008 26 Comments