SIGNS AND SYPTOMS ASTHMA

- cough, wheeze (sound of airflow through BACKGROUND INFORMATION

narrowed airways), sensation of chest tightness,
dyspnea (most common)
- diaphoresis, tachycardia, widen pulse pressure
can occur w/ hypoxemia & central cyanosis ( late
sign of poor oxygenation)
- hypoxemia is a secondary to a ventilation-
perfusion mismatch & readily responds to
supplemental oxygenation
PATHOPHYSIOLOGY
- exposure to allergen leads to airway inflammation,
bronchoconstriction, causing mucosal edema &
mucus production
- some ppl have exaggerated IgE response to certain
allergen, by attaching to IgE receptors on mast cell.
The IgE mast cell complexes remaing for ling time,
thus a 2 exposure to allergen triggers mast cel to - status asthmaticus: severe & persistent asthma that does not respond to
nd
- a chronic inflammatory disorder of the airway, leads
to varied degree of obstruction in the airways, leads
to recurrent episodes of wheezing, breathlessness,
sensation of chest tightness, cough, more so in the
morning & night
Key characteristic of asthma: episodic & reversible
airway obstruction
COMPLICATIONS

CAUSES degranulate conventional therapy

- enironmetnal exposures, triggering response
of the immune ssytem
ALLERGY is the STRONGEST predisposing factor for - respiratory failure, pneumonia, atelectasis, pneumothorax, acute cor
asthma pulmonale
EARLY-PHASE REPSONSE: charac. by bronchospasm, - airway obstruction during acute asthmatic episodes, often result in
hypoxemia, requiring O2 & monitoring pulse oximetry & ABG
this response is triggered when an allergen or
Fluid are administered, becoz ppl w/ asthma are frequently dehydrated from
irritant attaches to IgE receptors on mast cells found
diaphoresis & insensible fluid loss from hyperventilation
beneath the basement membrane of the bronchial
wall, mast cells are activated & releases granules,
phospholipids cellmembranes are disrupted. Both
process results in release of inflammatory mediators,
histamaines, bradykinin, leukotrienes,
prostaglandins, platelet activating factors, Diagnostic
chemotatctic factors, cytokines ( IL4, 5) -Acute episode: sputum & blood tests may disclose
- causing bronchial smooth muscle contriction, ↑ eosinopjilia (↑eosinophils)
vasodilation, permeability, epithelial damages - ABG & pulse oximetry reveal hypoxemia during
Clinical effects: bronchospasm, ↑ mucus acute attacks
secretion,edema formation, ↑ amount of tenacious - During an exacerbation, the FEV1 & FVC are
sputum, causing wheeze, cough, sensation of chest markedly ↓ but improve w/ bronchodilator
tightness, SOB administration( demonstrating reversibility)
 MEDICAL MANAGEMENT
- immediate intervention may be necessary,
becoz continuing and progressive dyspnea
leads to ↑anxiety, aggravating the situation
- short-acting beta 2-adrenergic agonists
( albuterol (Ventolin) are medications of choice
of relief of acute symptoms & prevention of
exercise- induced asthma
(used to relax smooth muscle)
COMPLICATIONS
- anticholinergics (ex/. Ipratropium bromide
(Atrovent) inhibit muscarinic cholinergic receptors
&↓intrinsic vagal tone of the airway
- may be used in pt who do not tolerate short acting
beta2 adrenergic agoanist
- Corticosteroids are most potent & effective
inflammatory medications currently available
- broadly effective in alleviating symptoms, &
improving airway function
Educate the adverse effect: cough & thrush
PATHOPHYSIOLOGY
-LATE-PHASE RESPONSE: peaks at 5-12 hours after exposure, last hours to days
Primary charac: inflammation, as opposed to bronchial smooth muscle contraction,
eosinophils, neutrophils inflammatory cells are involved, release mediators that
induce further inflammation & cause mast cells to degranulate, causing release of
histamine & other mediators & initiating self-sustaining cycles
- - reduced airway diameter, ↑airway resistance RT mucosal inflammation of the
airway, constriction of bronchial sooth muscle, excess production of mucus
hypertrophy of the bronchial smooth muscle cell, thickening of basement
membrane, hypertrophy of mucus glands, secretion of thick & tenacious
sputume, hyperinflation, air trapping of alveoli
ASTHMA
NURSING MANAGEMENT
- calm approach to provide care becoz pt & family are often
frightened & anxious
-obtain Hx of allergic rxn before adminstration of medications
- identifies medication the pt is currently taking
- Administers med as prescribed & monitors the pt’ response to those
medications. These meds may include an Ab if the pt has an
underlying respiratory infection
- administer fluids if the pt is dehydrated
- recognize & avoids asthma triggers
p. 2165 Drug therapies Table: 31.6