MS chapter 32 part 2
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. What would you like to do?
For a pt with asthma, the nurse needs to teach the pt to assess their symptom severity at least twice daily. What device will the pt use to test this?
A peak flow meter
Describe the steps involved using a peak flow meter.
- Pt establishes a baseline peak expiratory flow (PEF)
- This goes on twice daily for 2-3 weeks
- After the pt has their baseline, all other recordings are compated to it
- Some meters are color coded to help interpret the results
Interpret what the different colors (green, yellow, red) of the Peak flow meter indicate when a pt with asthma compares their reedings with hteir baseline?
- Green- this zone indicates that the pt is 80% or above the baseline (personal best). this is the ideal range
- Yellow- is a range between 50% and 80% of personal best. Pt needs to take a rescue drug
- Red- range below 50% of pt's personal best and indicates serious respiratory obstuction. A pt in this this range needs to immediately use the rescue drug and seek emergency help.
These type of drugs used for asthma therapy change airway responsiveness to prevent asthma attacks from occuring.
Preventive therapy drugs. These are used every day, regardless of symptoms.
This type of drug used for asthma therapy is used to actually stop an attack once it has started.
Pharmacologic management of adult patiens with asthma is based on the ___ ___ for severity and treatment.
The step system.
What 4 types of drugs are used for Asthma drug therapy?
- Preventative therapy drugs
- Rescue drugs
- Anti-inflammatory agents
Type of asthma drug that increases bronchiolar smooth muscle relaxation.
What are the 4 types of bronchodilators used in Asthma drug therapy?
- Shor acting beta 2 agonists
- Long-acting beta 2 agonists
- cholinergic antagonists
This type of bronchodilator provides rapid short term releif and are most useful when the attack begins. Inhaled from either an MDI or a DPI and is delivered directly to the site of action.
- Short-acting beta 2 agonists (SABAs)
- ex) albuterol
This type of bronchiodilator needs time to build up an effect but effects are longer lasting. These drugs are useful in preventing an asthma attack but have no value during an acute attack. They are delivered by inhaler directly to the site of action
- Long acting beta 2 agonists (LABAs)
- ex) Salmeterol
This type of bronchiodilator blocks the parasympathetic nervous system which allows the sympathetic nervous system to dominate, resulting in increased bronchiodilation and decreased pulmonary secretions.
- Cholinergic antagonists
- ex) ipratropium (atrovent)
This type of bronchiodilator is used when other types of management are ineffective. The drugs are taken in pill form and have many side affects. Blood levels of this drug need to be monitored closely.
- ex) Theo-Dur).
What are the 4 types of anti-inflammatory agents used in Asthma drug therapy?
- Leukotriene antagonists
This anti-inflammatory agent used for asthma decreases inflammatory and immune response in many ways including preventing the synthesis of mediators
Corticosteroids. Can be inhaled or taken orally. Used for prevention not to reverse symptoms of an attack
This anti-inflammatory agent is useful in preventing asthma attacks and should be taken on a scheduled basis. They contain nedocromil (Tilade) which inhibits the release of inflammatory mediators from cells.
NSAIDs. Inhaled Nsaids are not useful in reversing symptoms of an asthma attack.
This type of anit-inflammatory agent is useful in preventing asthma by blocking the leukotriene receptor. An example of this drug is Singulare
This type of anti-inflammatory agent is used to help prevent asthma attacks by preventing allergens from binding to receptor sites on mast cells, and basophils. It is given as an injection.
This type of treatment for asthma assists in maintaining cardiac health, enhancing skeletal muscle strength, and promoting ventilation and perfussion.
- Excercise and activity.
- aerobic excercise
Oxygen therapy is another type of treatment for asthma that is delivered via a mask, nasal cannula, or endotracheal tube. What mixture is often given to help improve oxygen therapy?
Heliox. (a mixture of helium and o2). It can help o2 delivery to the alveoli.
A severe, life threatening, acute episode of airway obstruction that intesifies once it begins and often does not respond to common therapy. Pt
What are symptoms of Status asthmaticus
- estremely labored breathing and wheezing
- use of accessory muscles
- distention of neck veins
If Status Asthmaticus is not reversed, what is the pt at risk for?
- pt may develop a pneumothorax
- cardiac or respiratory arrest.
What does treatment involve for a pt experiencing Status Asthmaticus
IV fluids, potent systemic bronchodilator, steroids, epinepherine, and oxygen.
This condition ivolves two major changes: loss of lung elasticity and hyperinflation of the lung.
With Emphysema, what are the two major changes that occur?
Loss of lung elasticity and hyperinflation of the lung.
What main symptom do pts experience with emphysema?
Dyspnea, casuing the need for an increased respiratory rate.
With emphysema, an increased amount of air becomes trapped in the lungs. What is this caused by?
loss of elastic recoil in the alveolar walls, overstretching and enlargement of the alveoli into bullae. and collapse of small airways (bronchioles.)
Regarding Emphysema, how does smoking cause air trapping of the lungs?
Smoking increases the amt of proteases which break down elastin in higher numbers. High protease levels cause the aveolar sacs to lose their elasticity and the small airways to collapse or narrow.
Most Pts with emphysema also have___ ____ at the same time.
This type of COPD is an inflammation of the bronchi and bronchioles caused by chronic exposure to irritants, especially tobacco smoke. The irritant triggers inflammation, with vasodilation, congestion, mucosal edema, and bronchospasm.
Chronic bronchitis. affects only the airways, not the aveoli
With Chronic Bronchitis, the chronic inflammation causes an increase in the number and size of mucous glands which. This causes what to happen?
Production of large amounts of thick mucous.
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