MedSurge Exam 2 Review

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MedSurge Exam 2 Review
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  1. Bronchoscopy
    Pre & Post Care
    Bronchoscopy - direct visualization of larynx, trachea and bronchi through bronchosope (fiber optic)

    • Pre Care
    • *Assess for pregnancy and hypersensitivity to anestetic
    • *Instruct - no eat for drink 8-12 hrs before
    • *Vital Signs
    • * Administer ordered meds

    • Post Care
    • *Assess for complications - laryngeal edema, bronchospasm, pneumothorax (air in thorax), cardiac dysryhthmias, bleeding
    • *Look for respiratory distress - dyspnea, decreased breath sounds, low O2 sat
    • *Assess gag reflex before food or drink
    • *Instruct - no smoke 6-8 hrs after
  2. Sputum
    How to Obtain Sample
    Proper Suctioning procedure
    • How to obtain sample
    • -early morning is best -secretions pool overnight
    • -fluid before helps liquify secretions
    • 1. Provide mouth care
    • 2. Instruct to breath deeply several time
    • 3. Cough deeply & expectorate into container
    • 4. Label & send to lab

    • Proper suctioning
    • 1. Provide mouth care
    • 2. Use sterile mucous trap - aseptic technique - attach trap between suction catheter & tubing
    • 3. Preoxygenate as needed
    • 4. No suction during insertion - suction for no longer than 10 seconds while withdrawing
    • 5. Clear suction catheter with normal saline
  3. Acute Rhinitis
    Acute Rhinitis = common cold (inflammation of nasal cavity)

    • URI, viral contagious, infectious disease
    • Spread by airborne droplet sprays by infected person: breathing, talking, coughing, sneezing orby direct hand contact

    • S/S: Red, swollen (boggy) nasal membranes with congestion or coryza (clear watery discharge)
    • Low grade fever, muscle aches, HA, Sneezing / coughing

    • TX: rest, fluids, warm salt water gargles
    • Frequent handwashing
    • Analgesics, decongestants & antihistamines
  4. Chronic (Allergic) Rhinitis
    • Seasonal vs. Perennial
    • S/S: nasal inflammation with coryza (perfuse nasal drainage)
    • Watery eyes, itching, sneezing
    • Bronchospasm, stridor/wheezes

    • TX: ****Management:
    • Nasal decongestant sprays are not recommended more than 5 days due to rebound effect
    • Oral decongestants & antihistamines
    • Nasal corticosteroids (Flonase, Beconase,Rhinocort)
    • Cromolyn – mast cell stabilizer/antihistamine
    • Allergen desensitization/allergy shots
  5. Influenza
    • Contagious, viral respiratory disease
    • short incubation 18 to 72 hours
    • Most deaths occur >60 years of age with underlying disease (cardiac, plum., diabetic)
    • Avian “Bird” Flu (H5N1) SE Asia
    • S/S: Fatigue, malaise, muscle ache
    • Fever/Chills
    • Coryza discharge & sore throat
    • Cough (dry then productive)
    • Substernal burning

    • TX: Deaths preventable if vaccination (flu shot)
    • OTC analgesics (Tylenol)
    • Prophylaxis Amantadine or Rimantadine up to 48 hrs.
    • Antiviral agents (Relenza, Tamiflu, Ribavirin)
    • Antitussives for cough
    • Most common complication=pneumonia
  6. Sinusitis
    S/S & Tx
    Inflammation of sinus mucous membranes

    • S/S: moving head pain- worse in morning - lessens throughout day as sinuses drain
    • HA / sinus tenderness /pain cheeks or teeth
    • Fever
    • Nasal congestion/discharge with N/V or bad breath
    • Sinus x-rays opaque instead of translucent with air

    • TX: Antibiotics x 10 days
    • Decongestant sprays (Pseudoephedrine)
    • Mucolytics like Guaifenesin to liquefy secretions
    • Steam or saline nose drops
    • Surgery- NS irrigation with 16 ga. Needle
    • Endoscopic sinus surgery with drainage window/antrectomy
    • Sphenoethmoidectomy esp. if polyps
  7. Sinusitis
    Nursing Care
    Postop Nursing Dx
    • Nursing Care:
    • Heath Promotion
    • *prevent sinusitis by promoting nasal drainage
    • -encourage increased fluid intake
    • -us of nasal decongestants as needed

    • *patient with URI blow nose with both nares open
    • *saline spray can promote drainage and reduce risk of obstriction and infection

    Postop Nursing Dx:

    • Pain - assess pain, use analgesics as needed
    • - apply ice packs to nose
    • - Fowler's or high-Fowlers for 24 to 48 hours (elevation minimizes swelling and promotes comfort)

    • Imbalanced Nutrition: Less than Body Requirements
    • -clear liquid diet progressing to soft foods - ensure
    • -monitor I & O and weight
    • -Elevate HOB during meals
  8. Pharyngitis/ Tonsillitis
    70% viral; 15-20% beta-hemolyticstreptococcal (strep throat), chlamydia,or gonorrhea

    • S/S: If tonsils, then red or pus & edematous
    • Sore throat/unable to swallow (dysphagia)
    • Fever/malaise/myalgia (muscle pain)
    • Enlarged lymph nodes

    • TX: Antibiotics x 10 days (PCN, erythromycin) Anti-pyretics (not ASA if surgery) & analgesics
    • Warm saline gargles or ice collar
    • Needle aspiration (I&D) or tonsillectomy
    • Complications are rheumatic fever or acute glomerulonephritis
  9. Laryngeal Infections:
    Epiglottitis
    Laryngitis
    • Epiglottitis
    • H. influenza
    • S/S: red, swollen epiglottis blocks airway, dysphagia,drooling, sore throat

    TX: IV antibiotics,Decadron, freq.oximeters, maintainairway, No tongueblades

    Laryngitis

    Viral URI or stress voice

    S/S: hoarseness oraphonia, sore throat,dry cough

    TX: voice rest, avoid ETOH & tobacco,steam or warm gargles, antiseptic throat lozenges
  10. Epistaxis
    • Nose Bleed
    • Anterior - most common
    • Posterior
    • TX:
    • -anterior -pressure on septum, ice packs, vasoconstrictors,
    • nasal packing -nasal tampon or 0.25 inch petroleum gauze left in for 24 to 72 hours
    • -posterior- nasal packing - left in for 2 to 5 days ,balloon catheter -inserted, inflated, left in place 2 to 3 days surgery - preferred to posterior packing - cauterize the vessel

    • Nursing Care for Nasal Packing
    • Monitor 02 sat
    • VS
    • Inspect mouth and oropharynx
    • Elevate HOB
    • Deep, slow breathing thourgh mouth
    • Check for blood at back of mouth and frequent swallowing
    • Cold compress to nose
    • rest
    • adequeate oral fluid intake
    • frequent oral hygiene
  11. Broken Nose
    Rhinoplasty
    postop care
    S/S: black eyes/periorbital ecchymosis, crepitus,epistaxis, nose deformed, rhinorrhea for CSF

    TX: maintain airway,ice for swelling,rhinoplasty or septoplasty coughing, straining

    • Rhinoplasty - surgical reconstruction of nose
    • postop care - nasal packing left in plase for up to 72 hrs
    • -temp plastic splint molded to shape of nose is removed in 3 to 5 days

    • -ice packs - comfort & reduce swelling
    • - Elevate HOB
    • - No blow nose for 48 hrs after packing removed
    • - avoid vigorous coughing or straing at stool
    • - clean teeth pfrequently
    • -increase fluid intake
    • -bruising around eyes and nose will last for several days
  12. Obstructive Sleep Apnea
    • Intermittent absence of air flow thru mouth/nose during sleep (tongue & soft palate block pharynx)
    • Risk factors: males>females, middle age, obesity, largeneck size, ETOH or CNS depressants

    • S/S: Diagnosis by sleep study (polysomnography, EEG) Loud, cyclic snoring with periods of apnea Choking/gasping/thrashing around during sleep
    • Frequent awakening, insomnia, excessive daytime sleepiness, depression or impaired intellect
    • Morning headaches (hypercapnia, vasodilation)

    • TX: Wt. reduction & ETOH abstinence
    • nCPAP=Nasal Continuous Positive Airway Pressure;nasal mask to prevent airway collapse
    • BiPAP=Bilevel Positive Airway Pressure (higher pressure on inspiration, tolerated better)
    • Surgery:tonsils/adenoids, uvulopalatropharyngoplasty

    Machines dry mucous membrane - use in-line humidifier or room hymidifier
  13. Laryngeal Tumors:
    Benign Polyps
    Malignant Cancer of Larynx
    Benign Polyps (papillomas) – bilat. wart-like growths on vocal cords, HPV, hoarseness or breathy tone;

    TX: corticosteroids to shrink or polypectomy

    • Malignant Cancer of Larynx: (squamous cell)
    • Risk factors: males>females; > 50 years old,tobacco, alcohol, exposure to chemicals, African Amer.

    • S/S: Early detection important
    • Painless growth in mouth
    • Ulcer that does not heal/change in denture fit
    • Hoarseness or change in voice
    • Lump in neck
    • Dyspnea and/or dysphagia
    • Pain is a late symptom (sometimes earache)

    DX: by biopsy (TNM grading)
  14. Areas of Larynx Cancer (3)
    Glottis/vocal cords – 60%, hoarseness or change in voice, well differentiated & slow growing with late metastasis as limited lymphatic supply

    Supraglottis/false vocal cords – 35%,dysphagia, lump in throat, halitosis, early metastasis as rich lymphatic supply

    Subglottis/below vocal cords – 5% asymptomatic til tumor obstructs airway
  15. Nursing Interventions of radiation Tx of larynx
    • Nurse can suggest interventions to reduce side effects:
    • Dry mouth (xerostomia)
    • -Medication to increase production of saliva (Salagen) pilocarpine hydrochloride
    • -Squirt or water bottle
    • -Increase fluid intake
    • -Chewing sugarless gum or candy
    • -Nonalcoholic mouth rinse
    • -Artificial saliva
    • -Avoid commercial mouthwashes and hot or spicy foods because they are irritating
  16. Surgeries for Larynx CA
    Cordectomy-superficial tumor involving one cord; voice rest

    Hemilaryngectomy-removal of one vocal cord part larynx; temporary tracheostomy-voice preserved but quality is breathy and hoarse

    Total laryngectomy- perm. separate trachea &esophagus so no aspiration; stoma or trach

    Radical neck-+ lymph nodes but no metastasis; tissue from mandible to clavicle so deformity
  17. Laryngectomy Post-op nursing care
    • -monitor airways and respiratory status
    • -Encourage deep breath & cough
    • -Elevate HOB
    • -Humidification of inspired gasses
    • -Adequate fluid intake
    • -Suction using sterile technique
    • -Trach care PRN
    • -Teach to protect stoma from particles in air by cover with gauze or stoma protector
    • -instruct to support head when moving in bed
    • -call light in reach- answer call light promptly
    • -Encourage family member presence
    • -Spend time with pt
  18. Care of pt with new tracheostomy
    • Care should be taken not to dislodge during the first few days when stoma is not mature (healed)
    • Replacement tube of equal or lesser size is kept at the bedside
    • Tracheostomy ties are not changed for at least 24 hours after insertion
    • First tube change is performed by the physician usually no sooner than 7 days
    • Accidentally dislodged-replace it immediately.
  19. Client teaching - Trach care
    • Tube should be changed approximately once a month
    • When a tracheostomy has been in place for several months, the tract will be well formed
    • Teach the patient to change the tube using clean technique at home
  20. Trach stoma care
    • Washed daily
    • Scarf, crocheted shield to protect
    • Plastic collar when bathing
    • Swimming contraindicated
    • Oral intake in dry weather
    • Medic Alert bracelet
    • Decreased smell and taste (smoke/carbon monoxide detectors should be used in home)

    • -humidifier to add humidity to inspired air
    • -increase fluid intake (moist mucosa)
    • -remove secretions around stoma to prevent skin breakdown
  21. Trach suctioning
    • Assess need to suction
    • Explain procedure to patient
    • Check suction source (neg. 80-120 mm Hg)
    • Sterile technique
    • Preoxygenate (100% vent. or MRB, or 3-4 deep breaths) Insert without suction on
    • Withdraw catheter in rotating manner applying pressure intermittently
    • Limit suctioning to 10 seconds
    • Re-oxygenate, repeat suctioning if needed
  22. Acute Bronchitis
    Acute inflammation of bronchi (v. COPD)

    • S/S: paroxysms of cough (dry then productive)
    • Pleuritic substernal chest pain
    • Moderate fever
    • General malaise

    • TX: Broad spectrum antibiotic (50% bacterial)
    • Increase fluids to thin secretions
    • Antipyretics (ASA, Tylenol); analgesics
    • Antitussive (Robitussin) esp. at night for rest
    • Smoking cessation
  23. Pneumonia
    • Acute inflammation of lung parenchyma (functioning part of the lung)
    • Caused by:
    • Bacteria
    • Viruses
    • Mycoplasma
    • Fungi
    • Parasites
    • Chemicals (irritating gases or aspiration of gastric contents)

    • The normal protective mechanisms of the respiratory system are unable to adequately protect against the affecting agent
    • Antigen-antibody response with organisms releasing endotoxins that damage bronchial & alveolar membranes resulting in inflammation & edema
  24. Risk factors for Pneumonia
    • ↓ Decreased Consciousness (depresses cough & epiglottal reflexes)
    • Intubation(interferes with cough & normal mucus production)
    • Air pollution / Smoking
    • Viral URI (influenza, cytomegalovirus, adenovirus)
    • Changes of Aging
    • Chronic Diseases(leukemia, alcoholism, DM, COPD) Altered Oro-Pharyngeal Flora(secondary to antibiotic therapy)
  25. Classifications of Pneumonia
    • infectous
    • noninfectous
    • community acquired
    • hospital acquired
    • opportunistic
  26. Community acquired pneumonia
    • Streptococcus Pneumoniae (#1) - 66% gram +
    • Haemophilus Influenzae (#2)
    • Mycoplasma Pneumoniae - "walking pneumonia"
    • Respiratory viruses (Influenza)
    • Chlamydia Pneumoniae
    • Legionella Pneumophila
  27. Hospital acquired Pneumonia
    • Staphylococcus Aureus G(+)
    • Pseudomonas Aeruginosa G(-) difficult to get out
    • Klebsiella G(-)
    • Escherichia coli (E-Coli) enteric G(-)

    G(-) tend to be more damaging to lung fields due to acidotic pH
  28. OPPORTUNISTIC PNEUMONIA
    • Opportunistic Pneumonia due to altered immune system esp. HIV/AIDS
    • Pneumocystis carinii
    • Mycobacterium tuberculosis
    • Cytomegalovirus (CMV)
    • Fungi
  29. Pneumonia lung patterns
    • Lobar pneumonia - entire lobe- exudate in alveoli -consolidation of lung tissue occurs
    • Bronchopneumonia - patchy consolodation- exudate in bronchi & bronchioles
    • Interstitial pneumonia - inflammatory response in interstitum (CT)

    Miliary pneumonia -immunocomprimised - inflammatory lesions as pathogen spreads to lungs via bloodstream
  30. Acute bacterial pneumonia
    Streptococcus pneumoniae (community acquired)
    • Sudden onset
    • Chills/fever
    • Tachycardia & tachypnea
    • Productive cough (purulent or rust-colored)
    • Pleuritic chest pain (worse with coughing &deep resp.) Pulmonary consolidation
    • Dullness of percussion
    • ↑ fremitus
    • Bronchial breath sounds - (abnormal in LL)
    • Crackles/Rhonchi
    • Elderly with fever, tachypnea &altered mentation (agitation)
  31. Primary atypical pneumonia
    • Mycoplasma Pneumoniae or Viral; “Walking” Pneumonia)
    • -community acquired
    • More gradual onset
    • Dry hacking nonproductive cough
    • Headache
    • Myalgia (muscle aches)
    • Sore throat (pharyngitis)
    • Lack of alveolar exudate & consolidation
  32. LEGIONNAIRE’S DISEASE
    • Legionella Pneumophila
    • Gradual onset (2-10 days after exposure)
    • Fever/chills
    • Dry cough
    • Dyspnea
    • Headache
    • Muscle aches (myalgias & arthralgias)
    • Anorexia & diarrhea
    • VERY sick (high mortality)
  33. ASPIRATION PNEUMONIA
    • Aspiration of gastric contents into lung resulting in chemical & bacterial pneumonia
    • Acid pH causes severe inflammatory response
    • Pulmonary edema
    • Respiratory failure
    • Lung abscess/gangrene
  34. DIAGNOSTIC TESTS FOR PNEUMONIA
    • Sputum
    • Gram Stain
    • Culture & Sensitivity
    • CBC (leukocytosis & shift left, immature)
    • ABG’s with paO2 < 70 – 80% (hypoxemia)
    • Pulse Oximeter < 95%
    • Chest x-ray (fluid, atelectasis, consolidation)
    • Bronchoscopy to remove sputum
  35. COMPLICATIONS OF PNEUMONIA
    • Atelectasis - collapsed or nonfunctioning portion
    • Lung abscess/empyema - puss is lung
    • Pleurisy/pleural effusion - pleural inflammation
    • Pericarditis/endocarditis - inflammation of smooth muscle
    • Meningitis - bacterial infection of meningies (covers brain)
    • Peritonitis - inflammation of peritoneum
    • Respiratory failure or ARDS
  36. Prevention of pneumonia
    • vaccination recommended for
    • -over age 65
    • -those with cardiac, respiratory conditions, diabetes mellitus, alcoholism, other chronic diseases
    • -immunocompromised
  37. PNEUMONIA MEDICAL INTERVENTIONS
    • Antibiotics
    • Antipyretics
    • Bronchodilators
    • Steroids
    • Oxygen therapy
    • Chest physiotherapy - percussion & vibraton
    • Fluids (3L/day)
    • Expectorants/Mucomyst
    • Immunizations for pneumococcal &influenza
  38. NURSING INTERVENTIONS FOR PNEUMONIA
    • Push Fluids/monitor IV’s
    • Monitor VS esp. respirations
    • Provide humidified O2
    • Postural Drainage - positioning to promote drainage
    • Suction PRN
    • Encourage Rest
    • Administer Meds (antibiotics,bronchodilators)
    • High Fowlers to present aspiration
    • Check gag reflex
    • Do not overmedicate with Narcotics

    • Client Education
    • Teach prevention
    • Emphasize need to finish all meds
    • Adequate rest
    • Encourage vaccine
    • Deep breathing exercises(X 6 wk after Hosp. Discharge)
    • Return to M.D. if fever, SOB,dyspnea, sleepiness, confusion
  39. Postural drainage
    uses gravity to facilitate removal of secretions from a particular lung segment

    pt is positioned with the segment to be drained superior to or above th trachea or mainstream bronchus

    required various positions

    Broncodilators adminsitered prior to postural drainage

    -perform before meals to avoid nausea & vomiting
  40. Medications for Pneumonia
    • Broad spectrum antibiotic
    • -macrolides
    • -PCN
    • -Cephalosporin (2nd or 3rd gen)
    • -fluoroquinolone

    • Bronchodilators
    • -sympathomimetic drugs - albuterol
    • -metaproterenol - alupent
    • -methylxanthines - theophylline (needs blood test for toxicity)

    • Liquify Secretions
    • -acetylcysteine -Mucomyst
    • -potassium iodide
    • -guaifenesin (mucinex)
  41. MYCOBACTERIUM TUBERCULOSIS = “TB”
    Chronic pulmonary and extrapulmonary infectious disease acquired by inhalation of a dried-droplet nucleus containing a tuberclebacillus

    • Airborne - from a person who expels the organism while:talking,coughing,singing,sneezing
    • TB Pathophysiology:
    • Macrophages Tubercle
    • granulomas Caseation
    • necrosis Calcification
    • fibrosisReactivation

    Private room & HEPA filtered respirator
  42. Risk factors for TB
    • Close contact
    • IV drug users
    • Alcoholics
    • Living in crowded,substandard housing
    • Immigrants from areas with high incidence
    • Medically underserved
    • Institutionalized
    • Health care workers
    • Immunocompromised
    • Preexisting medicalconditions:diabetes, chronic renal failure, silicosis,malnourishment
  43. S/S TB
    • low grade fever
    • fatigue
    • anorexia
    • weight loss
    • night sweats
    • chest pain
    • persistent cough(purulent to bloodtinged/rusty)
  44. PPD/Mantoux test
    PPD - purified protein derivitive of tuberculin - attracts macrophages to area - inflammatory response

    results read in 48 to 72 hours & recorded as diameter of induration (raised area, not erythema)

    <5mm Negative Response

    • 5-9mm Negative for most people but pos for ppl
    • - - in close contact with infective TB
    • - - abnormal CXR
    • - - HIV
    • - - organ transplant

    • 10 - 15mm Negative for most - pos for ppl
    • - -birth in high-incidence country
    • - - African Am, Hispanic, Asian
    • - - Injected drug use
    • - - residence of care facilities

    > 15mm - positive for all ppl
  45. TB MEDICATIONS
    • (MIN. 6 MONS.)
    • Prophilactic - INH can be used alone (min 6 mo)
    • Active infection - concurrent use of at least to antibiotics

    • INH/Isoniazid - used prophilactally -use vit B6 & monitor liver function
    • -peripheral neuropathy
    • -hepatitis
    • Rifampin - dont skip doses - contact lenses should not be worn (will be discolored)
    • -heptitis
    • -color body fluids orange-red

    • Pyrazinamide (PZA) - monitor uric acid levels & avoid other hepatotoxins ASA & ETOH
    • -Hyperuricemia
    • -Hepatotoxicity

    • Ethambutol (EMB) - monitor visual acuity
    • -optic neuritis

    • Streptomycin - autiometric examination & monitor renal function (BUN & CRE)
    • -ototoxicity, vertigo
    • -nephrotoxicity
    • Calmette-Guerin (BCG) vaccine =3rd world countries to reduce symptoms of TB - PPD will be positive - CXR to rule out
  46. RISK FACTORS FOR LUNG CA
    • Smoking
    • *80-90% of lung CA due to smoking
    • *Causes changes in bronchial epithelium
    • *More men then women
    • *More African Americans/Blacks
    • *Cigs contain 43 known carcinogens
    • *Dose response relationship

    • Age > 50 years
    • Ionizing Radiation
    • Inhaled Irritants (asbestos, radon, nickel,iron, uranium, hydrocarbons, arsenic, &air pollution)
    • Genetic predisposition
  47. SIGNS & SYMPTOMSOF LUNG CA
    • Early Signs & Symptoms
    • Usually non-specific & occur late after metastasis Chronic cough
    • Chest pain
    • SOB
    • Wheezing
    • Hemoptysis

    • Later S & S
    • Anorexia
    • Wt. loss
    • Fatigue
    • N & V
    • Hoarseness
    • Dysphagia

    • Very Late S & S
    • Mediastinal involvement
    • Bone metastasis
    • Brain metastasis
    • Liver metastasis
    • Neuromuscular
  48. RESP. NURSING DIAGNOSES
    • Ineffective breathing pattern R/T hypo or hyperventilation.
    • Ineffective Airway Clearance R/T accumulation of secretions.
    • Impaired Gas Exchange
    • Altered Tissue Perfusion R/T Hypoxemia
    • Activity Intolerance/Fatigue R/T Hypoxemia, COPD
    • Acute pain R/T Inflammation or Chronic Pain R/T Lung Cancer
    • Risk for Infection R/T Spread of TB
    • Knowledge Deficit R/T TB Medications
    • Fear/Anxiety R/T Suffocation and Inability to Breath
    • Ineffective Therapeutic Regimen Management R/T TB Medications
    • Decisional Conflict R/T Smoking
    • Hyperthermia R/T Pneumonia
    • Anticipatory Grieving R/T Cancer DX.
    • Compromised Individual or Family Coping R/T Role Relationship Changes
    • Imbalanced Nutrition, Less than Required
    • Low self esteem R/T Interstitial Pulmonary
  49. Chest tubes after lung CA surgery
    • closed drainage system
    • -monitor q hour, then q 2 to 4 or 8 hrs as indicated

    Notify healthcare porvider if chest tube output exceeds 70 mL / hour or is bright red, warm, and free flowing (indicates intrathoradcic hemorrhage)
  50. MEDICAL CARE OF LUNG CA
    • Chemotherapy (combination chemo esp. small cell due to rapid growth of lung CA & dissemination)
    • Radiation (cure vs. palliative)
    • Surgical Intervention (small cell usually metastasized – no surgery) - non-small cell - surgery only real chance for cure
    • Pain management
  51. ASTHMA
    • Chronic inflammatory disorder with obstruction of airways and episodes of wheezing, SOB, tight chest, & coughing
    • 11 million asthma attacks per yr. in US
    • Increased since 1980s & now stable

    • ANA controls smooth muscles of airway
    • Parasympathetic/cholinergic-bronchoconstrict Sympathetic/beta adrenergic-bronchodilate
  52. ASTHMA PATHOPHYSIOLOGY
    • Early Phase: stimulus/trigger causes release of chemical mediators (histamine, prostaglandins,& leukotrienes) Increase parasympathetic system causing bronchoconstriction & spasm
    • Increase capillary permeability with edema & mucusproduction

    Late Phase: 4-12 hrs. after trigger, basophils & eosinophils activated with increased bronchoconstriction, air trapping and decreased oxygen exchange resulting in resp. alkalosis
  53. ASTHMA SIGNS & SYMPTOMS
    • Chest tightness
    • Wheezing,
    • Dyspnea
    • Cough / cough-variant asthma
    • Nasal flaring
    • Tachypnea with prolonged expiration
    • Tachycardia
    • Use of accessory muscles & intercostal retractions Restless, anxiety/feeling of suffocation
  54. ASTHMA – DANGER SIGNAL !
    Signs of Impending Respiratory Failure

    Decreased Breath Sounds Decreased wheezing
  55. ASTHMA DIAGNOSTIC TESTS
    • Pulmonary Function Tests before & after bronchodilator therapy
    • Increased residual volume (RV)
    • Decreased vital capacity (VC)

    Bronchial Provocation

    • ABG’s –Early resp. alkalosis due to hyperventilation & use of accessory muscles
    • Later resp. acidosis due to exhaustion & hypoventilation

    Skin Testing to ID specific allergens

    • Peak Expiratory Flow Rate (PEFR) meter
    • green 80-100%
    • Yellow 50 -80 %
    • Red <50 %
  56. ASTHMA MEDICAL MANAGEMENT
    • Bronchodilators (used for acute asthma - stimulate sympathetic receptor & cause smooth mucle relaxation)
    • Sympathomimetics
    • *Epinephrine; Isuprel
    • *Metered-Dose Inhalers (Salmeterol, Albuterol) *Terbutaline (Brethine)
    • Xanthine Derivatives
    • *Aminophylline IV
    • *Theophylline PO
    • Anticholinergics (Atropine, Combivent)

    • Anti-inflammatory agents (prevent & treat acute episodes- decrease release of inflammatory mediators so decrease inflammatory response and airway edema)
    • Corticosteroids (Decadron, Azmacort, AeroBid)
    • Mast cell stabilizers (Nasalcrom/Cromolyn &Nedocromil)

    • Leukotriene modifiers (blocks effects leukotrienes (bronchoconstrictors) which participate in inflammatory respnse )
    • (Accolate, Zyflo, Singulair)maintenance & not acute attack; hepatotoxic

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