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NUR 112
Asthma / RSV
| Question | Answer |
|---|---|
| Asthma is a chronic inflammatory disease characterized by: | -recurrent episodes of wheezing -shortness of breath -airways in a persistent state of inflammation |
| what can cause an acute response (asthma attack) | triggers |
| what is an untreated asthma attack characterized by? | -limited expiration airflow -hypoxemia -hyperventilation |
| What do inflammatory mediators cause related to asthma? | Bronchoconstriction, airway edema, increased mucous production, and impaired CO2, O2 exchange |
| Describe the mild intermittent stage of asthma | Symptoms occur less than twice a week |
| Describe the mild persistent stage of asthma | Symptoms arise more than twice a week, but not daily |
| Describe the moderate persistent stage of asthma | Daily symptoms occur in conjunction with exacerbations twice a week |
| Describe the severe persistent stage of asthma | Symptoms occur continually, along with frequent exacerbations that limit physical activity |
| Describe an asthmatic airway (not during an attack) | Inflamed and thickened wall, with relaxed smooth muscles |
| Describe and asthmatic airway during an attack | Inflamed and thickened wall, tightened smooth muscles, air trapped in alveoli |
| Expected findings of asthma | Dyspnea, chest tightness, anxiety/stress |
| Physical assessment findings of asthma | Coughing, wheezing, mucus production, use of accessory muscles, tripod position, prolonged exhalation, poor O2 sats |
| Another term for status asthmaticus | Asthma attack |
| What is status asthmaticus? | Life threatening airway obstruction |
| S/S of status asthmaticus | Cyanosis, wheezing or diminished lung sounds, agitation, lethargy, dyspnea, pulses paradoxus |
| What is pulses paradoxus? | BP decreases with inhalation |
| Would status asthmaticus indicate a potential need for intubation? | Yes |
| Tests for status asthmaticus | Chest x-ray, ABG, CBC with diff, SPO2 |
| Diagnostic tests for asthma | Peak expiratory flow rate, allergy testing for allergic asthma, CBC with diff, ABG, pulmonary function study, chest x-ray, SPO2 monitoring |
| What does a PEFR measure? | Fastest airflow rate reached during exhalation |
| PEFR green zone percentage | 80-100% |
| PEFR green zone indication | Asthma is well maintained |
| PEFR yellow zone percentage | 50-79% |
| PEFR yellow zone indication | Caution and additional medication may be required |
| PEFR red zone percentage | <50% |
| PEFR red zone indication | Emergency medical intervention warranted |
| Are bronchodilators the BAM or SLM team? | BAM |
| BAM medications | Beta 2 agonists (SABA/ LABA) Anticholinergics Methylxanthines |
| Are Anti-inflammatory meds the BAM or SLM team? | SLM |
| SLM medications | Steroids Leukotrine antagonists Mast cell stabilizers |
| What med class is contraindicated for pts with asthma | BETA BLOCKERS!!!! YOU KNOW THISSS!!!!!!!!!!!!! |
| Example of a SABA | Albuterol |
| Key characteristics of SABA meds | used for rapid relief of acute attacks and prevention of exercise induced asthma |
| Side effects of SABA meds | Tremors and tachycardia |
| Example of LABA | Indacaterol (Aracapta Neohaler) *** Salmeterol |
| Key characteristics of SABA meds | Onset/ action may take up to 30 mins, — not for acute attacks!!!!! |
| Examples of anticholinergics | Ipratropium (Atrovent); tiotropium (Spiriva) |
| Action of anticholinergics | Block parasympathetic nervous system; bronchodilator and decreased secretions |
| Key characteristics of anticholinergics | Long acting and used to prevent bronchospasm |
| Example of methylxanthines | Theophylline |
| Action of Methylxanthines | CNS stimulant and bronchodilator (relaxes smooth muscles of bronchi) |
| Key characteristics of Methylxanthine | Last resort used for emergencies only |
| Therapeutic range for theophylline | 10-20 mcg/ML |
| S/S of theophylline toxicity | Hypotension, tachycardia, dysrhythmias, seizures, circulatory failure, and respiratory arrest |
| What other meds may reduce levels of theophylline | Barbiturates, anticonvulsants, and antimycobacterials |
| Corticosteroids common endings | -sone, -sonide, -solone |
| Key characteristics of corticosteroids | potent anti-inflammatory response, decrease edema and mucus production, and airway obstruction |
| Example of leukotriene modifiers | Montelukast (singular) |
| Action of leukotriene modifiers | Suppress effects of leukotrienes, result in reduction of inflammation, edema and mucus production |
| Key characteristics of leukotriene modifiers | -effects are not immediate (used for maintenance and control of asthma) -may increase levels of theophylline and warfarin |
| What are leukotriene modifiers an alternate for | Used if inhaled corticosteroids are not tolerated well or as adjunct therapy |
| Education for SABA | Always take before other medications (need to dilate airway before anything can reach it) |
| Education for steroids | They can suppress the immune system, so assess for oral or laryngeal candidiasis |
| General education for asthma meds | Avoid triggers and how to use inhalers and spacers |
| Major sign older adults experience with asthma | Cough |
| Key characteristics of Respiratory Syncytial Virus (RSV) | typical s/s are flu like; most common cause of respiratory infections in children under 2 and older adults |
| How is RSV spread? | droplets/ respiratory secretions |
| what can RSV turn into? | bronchiolitis |
| what is bronchiolitis? | lower respiratory tract illness, causing inflammation and obstruction of the bronchioles |
| patho of RSV: | virus infects squamous epithelial cells of the bronchioles and alveoli and large masses of cells develop. Large masses of debris clogs airways of the lower respiratory tract |
| Tests for RSV | ***real-time polymerase chain reaction (RT-PCR) - also CXR and ABG |
| RF for RSV | Prematurity Infants, toddlers not breastfed Chronic lung disease Congenital heart disease Reduced immunity Attend daycare Secondhand smoke Socioeconomically disadvantaged Live in crowded conditions |
| clinical manifestations of RSV | runny nose (rhinitis), fever, coughing, gradual buildup of thick secretions that block the airway if not cleared |
| worsening s/s of RSV | rapid breathing, excessive secretions, wheezing |
| what can happen if RSV is not treated? | nasal flaring, sternal retractions, lack of adequate oxygenation, cyanosis, periods of apnea |
| prevention of RSV | HAND HYGIENE! cleanliness of toys, not sharing anything with infected individuals |
| what age is RSV typically asymptomatic after? | 2 y/o |
Created by:
ginnyfoscue
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