Asthma

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Author:
japanice27
ID:
306850
Filename:
Asthma
Updated:
2015-08-26 06:20:05
Tags:
ASTHMAPEDIA
Folders:
pedia
Description:
review about asthma in a pediatric patient
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  1. ASTHMA
    • a CHRONIC INFLAMMATORY DISEASE OF THE AIRWAY.
    • Mast cell release of histamine leads to a bronchoconstrictive process, bronchospasm and obstruction.
  2. LAB TEST:
    • 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.
  3. PRECIPITANTS TRIGGERING AN ASTHMA ATTACK:
    • ALLERGENS:
    • trees, shrubs, weeds, grasses, molds, pollen, air pollution, spores.
    • dust, dust mites, mold, cockroach antigen

    • IRRITANTS:
    • tobacco smoke, wood smoke, odors, sprays

    • Exercise
    • 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
  4. STATUS ASTHMATICUS:
    an acute asthma attack and the child displays resp distress despite tx; EMERGENCY!!! Can result to resp failure and death if not treated.
  5. ASSESSMENT:
    (+)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: 
    • irritability
    • restlessness
    • headache
    • 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.



  6. INT:
    • 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).
  7. MEDS:
    • 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.
    • corticosteroids
    • antiallergy meds 
    • NSAIDS
    • 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.  
  8. CHEST PHYSIOTHERAPY:
    • strengthens the resp musculature and produces more efficient breathing pattern.
    • *not recommended during an acute exacerbation.
  9. ALLERGEN CONTROL:`
    identify allergens
  10. 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

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