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- a CHRONIC INFLAMMATORY DISEASE OF THE AIRWAY.
- Mast cell release of histamine leads to a bronchoconstrictive process, bronchospasm and obstruction.
- 1. PULMONARY FUNCTION TEST:
- assess presence and degree of disease and can determine the response of tx.
- 2. PEAK EXPIRATORY FLOW RATE MEASUREMENT:
- measure: max flow of air that can be forcefully inhaled in 1 sec; child uses a peak expiratory flowmeter to determine a "personal best" value that can be comparison at other times, such as during and after an asthma attack.
- 3. BRONCOPROVOCATION TESTING:
- to identify inhaled allergens.
- 4. SKIN TESTING:
- done to identify specific allergen.
- 5. EXERCISE CHALLENGES:
- to identify exercise-induced bronchospasm.
- 6. RADIOALLERGOSORBENT TEST:
- blood test to identify an allergen.
- 7. CHEST RADIOGRAPH:
- (+)hyperexpansion of the airways.
PRECIPITANTS TRIGGERING AN ASTHMA ATTACK:
- trees, shrubs, weeds, grasses, molds, pollen, air pollution, spores.
- dust, dust mites, mold, cockroach antigen
- tobacco smoke, wood smoke, odors, sprays
- Cold air
- Changes in weather or temperature
- Environmental changes: moving to a new home, starting a new school
- Colds and infections
- Animals: cats, dogs, rodents, horses
- Meds: aspirin, NSAIDS and beta blockers
- Strong emotions: fear, anger, laughing, crying
- Conditions: GERD, tracheoesophageal fistula
- Food additives: sulfite preservatives
- Foods: nuts, milk and other dairy products
- Endocrine factors: menses, pregnancy, thyroid dse
an acute asthma attack and the child displays resp distress despite tx; EMERGENCY!!! Can result to resp failure and death if not treated.
(+)dypnea, wheezing, breathlessness, chest tightness, and cough (PM or in the early AM or both).
- *ACUTE ASTHMA ATTACK:
- progressive worsening SOB, cough, wheezing, chest tightness, decrease in expiratory airflow secondary to bronchospasm, mucosal edema, and mucus plugging; air is trapped behind occluded or narrow airways, and hypoxemia may occur.
- ATTACK: begins with:
- feeling tired
- chest tightness
- BEFORE THE ATTACK:
- itching localized at the FRONT of the neck or OVER the upper part of the back.
- RESP SX:
- hacking, irritable nonproductive cough caused by bronchial edema.
- (+)frothy, clear, gelatinous sputum (rattling cough).
- (+) hyperresonance on percussion on the child's chest.
- (+)breath sound-coarse and loud with crackles, coarse rhonchi and inspiratory and expiratory wheezing; prolonged expiratory.
- (+)pale or flushed; lips may have a deep, dark red color that may progress to cyanosis (also seen in the nail beds and skin, esp around the mouth).
- (+) restlessness, diaphoresis, apprehension
- (+) speak short and broken phrases
- YOUNGER CHILDREN: tripod sitting position
- OLDER CHILDREN: sit upright with the shoulder in hunched-over position, the hands on the bed or on the chair, and the arms braced to facilitate the use of accessory muscles of breathing.
- **PT AVOID LYING DOWN.
- EXERCISE-INDUCED ATTACK:
- cough, SOB, chest pain or tightness, wheezing and endurance problems.
- SEVERE SPASM OR OBSTRUCTION:
- (-) breath sound and wheezing (silent chest), and cough is ineffective (represent a lack of air movement).
- VENTILATORY FAILURE and ASPHYXIA:SOB with air movt in the chest restricted to the point of absent breath sounds; (+) sudden increase in RR.
- ACUTE EPISODE:
- >assess airway patency and resp status
- >give: humidified O2 by nasal cannula or face mask
- >IV line
- >obtain blood sample to determine ABG levels.
- *if airway is not patent: endotracheal intubation; if patent airway: give O2.
- WOF: decreased wheezing or a silent chest (inability to move air).
- Quick-relief meds:
- short-acting beta agonist (bronchodilators)
- anticholinergics (acute bronchospasm)
- corticosteroids (antiinflammatory to tx reversible airflow obstruction)
- Long-term Control: achieve and maintain control of inflammation.
- corticosteroidsantiallergy meds
- long-acting beta agonist (long-acting bronchodilation)
- leukotriene modifiers (px bronchospasms and inflammatory cell infiltration)
- monoclonal antibody (blocks binding IgE to mast cell to inhibit inflammation)
- *NEBULIZER: medication is mixed with normal saline and nebulize with compressed air by a machine.
- *MDI (metered dose inhaler): if given a corticosteroid, use it with a spacer to px yeast infection.
**MONITOR GROWTH PATTERN OF A CHILD WHEN CORTICOSTEROID IS PRESCRIBED.
- strengthens the resp musculature and produces more efficient breathing pattern.
- *not recommended during an acute exacerbation.
Home care measures:
- eliminate allergens
- avoid extremes of environment temp in cold temp; breathe through the nose, not the mouth; cover the nose and mouth with a scarf.
- avoid exposure to individuals with resp infection.
- adequate rest, sleep and a balanced diet
- adequate OFI to liquify secretions
- keep immunizations up to date