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RCP 115 ch 14


Asthma is characterized by? - Chronic airway inflammation. - Symptoms vary over time and intensity. - Includes varible expiratory air flow limitation
Some common respiratory symptoms of Asthma? - Wheezing - SHOB - Chest tightness - Cough
What are some different types of asthma? - Asthma with obisity - Allergic asthma - Non- allergic asthma - Late- onset asthma - Asthma with fixed air flow limitation
What two organizations update clinical guidelines for asthma, that are developed and disseminated on a regular basis? 1) The National Asthma Education and Prevention (NAEPP). 2) The Golbal Initiative for Asthma (GINA).
What organization was the first evidence- based asthma guidelines published in 1991? National Asthma Education and Prevention Program (NAEPP).
NAEPP was under the coordination of what organization for the first evidence- based asthma guidelines? National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health.
The NAEPP guidelines are structured around what four components? 1) Assessment and monitoring of asthma. 2) Patient education. 3) Control of factors contributing to the asthma severity. 4) Pharmacologic treatments.
What two organizations launched The Global Initiative for Asthma? -National Heart, Lung, and Blood INstitute (NHLBI) of the National Institutes of Health. - World Health Organization (WHO).
GINA's Specific Goals: - Increased awareness of asthma and its public health consequences. - Promote identification of reasons for the increased prevalence of asthma - Promote study of the association between asthma and the environment - Reduce asthma morbidity and mortality
GINA's Specific Goals (continued) Improve management of asthma - Improve availability and accessibility of effective asthma therapy.
What are the anatomic alterations of the lungs? - Smooth muscle constriction of bronchial airways - Excessive production of thick, whitish bronchial secretions - Mucus plugging - Hyperinflation of alveoli - Severe cases, atelectasis by mucus plugging - Bronchial wall inflammation leading fibros
About how many million adults and children have asthma? - 18.4 million adults (7.6%). - 6.2 million children (8.4%)
What are the host factors that put people at risk for asthma? - Genetics - Obesity - Sex
What are the environmental factors that put people at risk for asthma? - Allergens- outdoor and indoor air pollution. - Infections - Occupational - Tobacco smoke - Diet
What are some ther risk factors in asthma? - drugs - food additives and preservatives - exercise- induced bronchoconstriction - gastroesophageal reflux - sleep (nocturnal asthma) - emotional stress - perimenstrual asthma - allergic bronchopulmonary aspergilosis
Perimenstrual Asthma (catamenial asthma) - premenstrual and menstrual periods - often peak 2-3 days before menstruation begins
Allergic bronchopulmonary aspergillosis (ABPA) - exaggerated response of the immune system - hypersensitivity response
The presence of any of these signs and symptoms should increase the suspicion of asthma? - Wheezing - Symptoms occur or worsen at night, awakening the patients - Symptoms occur or worsen in a seasonal pattern - The patient also has eczema, hay fever, or a family history of asthma or atopic diseases
Diagnosis of asthma; Wheezing- history of any of the following; - cough - recurrent wheeze - recurrent difficult breathing - recurrent chest tightness
Asthma syptoms occur or worsen in the presence of: - animals with fur - aerosol chemicals - changes in temperature - domestic dust mights - drugs (ASA, B-blockers) - Exercise - pollens - respiratory (viral) infections - smoke - strong emotional expression
Diagnostic and Monitoring Tests for Asthma: FEV1; after inhaling a bronchodilato- - Adults; > 12% (or > or = 200mL) - children; >13%
Diagnostic and Monitoring Tests for Asthma: PEFR: Daily variability; -adults; >10% - children; >13%
Diagnostic and Monitoring Tests for Asthma: FEV1/ FVC ratio is reduced; - Normal is more than 0.75- 0.80 in adults. - Normal is greater than 90% in children
Diagnostic and Monitoring Tests for Asthma: FEV1; after 4 weeks of anti inflammatory therapy; increases by greater than 12% and (or >= 200mL) - or PEFR by greater than 20% on the same peak expiratory flowmeter.
What are some other Diagnostic Tests for Asthma - bronchial provocation test (inhale methacoline) - allergy tests - exhaled nitic oxide
Bronchial provocation test assessing airway hyper responsiveness
The diagnosis of asthma in special populations - cough- variant asthma (non stop cough that doesn't go away) - occupational and work- aggravated asthma - athletes - pregnant women - elderly - smokers and ex- smokers - pts already taking comtroller meds. - obese pts.
The following clinical manifestations result from the pathophysiologic mechanisms caused (or activated) by - bronchospasm - excessive bronchial secretions
The physical examination for asthma - v/s - increased anteroposterior chest diameter - cyanosis - cough + sputum production - pulsus paradoxus - use of accessory muscles of inspiration and expiration - pursed lip breathing - substernal intercostal retractions
The physical examination; vital signs - Increased; -RR (tachypnea) - HR (pulse) - B/P
Pulsus Paradoxus - decreased B/P insiration - increased B/P expiration
What are some findings that you would find in the chest assessment of asthma? - Expiratory prolongation (I:E ratio >113) - decrease tactile + vocal fremitus - Hyperresonant percussion - diminished heart sounds - wheezing - crackles
PFT findings; Moderate to Severe Asthma Episode (OBSTRUCTIVE Lung Patho) Forced Expiratory Volume and Flowrate Findings: FVC. FEVt FEV1/FVC ratio. FEF 25%- 75% ↓. ↓. ↓. ↓ FEF50%. FEF 200-1200. PEFR. MVV ↓ ↓ ↓. ↓
PFT findings; Moderate to Severe Asthma Episode (OBSTRUCTIVE Lung Patho) Lung Volume and Capacity Findings; Vt. IRV. ERV. RV. VC N or ↑. N or ↓. N or ↓. ↑. ↓. IC FRC. TLC. RV/TLC ratio N or ↓. ↑. N or ↑. N or ↑
ABGs Asthmatic Episode: Mild to Moderate Stages: Acute Alveolar Hyperventilation with Hypoxemia (Acute Respiratory Alkalosis) pH. PaCO2. HCO3. PaO2. SaO2/SpO2 ↑. ↓. ↓ ↓ ↓ (normal)
ABGs Asthmatic Episode: Severe Stage; Acute Ventilatory Failure with Hypoxemia; (Acute Respiratory Acidosis) pH. PaCO2 HCO3. PaO2. SaO2/SpO2 ↓. ↑. ↑. ↓. ↓ (normal)
Abnormal Laboratory Tests and Procedures; - Sputum examination: - Eosinophilia - Charcot- Leyden crystals - Cast of mucus from small airways (Kirschman Spirals) - IgE level (elevated in extrinsic asthma).
What are some radiologic findings? (chest radiograph) - increase anteroposterior diameter (barrel chest) - translucent (dark) lung fields - depressed or flattened diaphragm
What are some long- term goals for asthma management? - symptom control - risk reduction of future exacerbations
What are some control- based asthma management program? - controller medications - reliever (rescue) medications - add- on therapies for patients with severe asthma
What is the Stepwise management approach? - STEP 1: as needed reliever inhaler. - STEP2: low dose controller medication. Plus needed reliever medications. - STEP 3 + 4: - 1 or 2 controllers, plus as- needed reliever medication - STEP 5: higher level care and/or add- on treatment
What are the general management of asthma? - nonpharmacologic interventions - indications for referral for expert evaluation - management of asthma exacerbations - special populations
What are some respiratory care treatment protocols? - aerosolized medication protocol - oxygen therapy protocol - mechanical ventilation protocol
Created by: tracyb34
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