Asthma

The nurse is admitting a pregnant patient following an acute asthma attack. Which patient statement indicates the need for teaching regarding asthma and medication use?

"I have not been taking my asthma medication because I am pregnant."

A patient with asthma asks the nurse why they have an asthma attack every time they play with their dog. Which response from the nurse is appropriate?

"Pets can be an allergen, which can trigger an asthma attack."

A patient's healthcare provider has directed the patient to obtain peak flowmeter readings throughout the day over the next several weeks to establish baseline flow readings. The patient asks why it is necessary to take readings so often. How should the nurse respond?

"The readings will be used to evaluate the severity of future airway obstruction."

Long-term goals for asthma patients

- Improve ability to function - Improve ability to participate in activities of daily living (ADLs), exercise - Improve quality of life

Risk Factors of Asthma

.Genetic factors Exposure to certain infections early in life such as; - Respiratory syncytial virus -Parainfluenza virus - Adenovirus Mycoplasma - Chlamydia Air pollution Allergies Obesity Maternal smoking Premature birth

A patient has a chronic cough but does not show symptoms of wheezing or dyspnea. The nurse suspects that the patient has asthma. Which other symptom displayed by the patient contributed to the nurse's suspicion of asthma?

Chest tightness

The nurse is teaching the mother of a child who has recently been diagnosed with asthma. The nurse should explain that which type of asthma attack is triggered by the loss of heat or moisture from the bronchial surface?

Exercise-induced

A patient with asthma is having difficulty breathing while lying supine. The patient can talk in phrases without experiencing shortness of breath and has a moderately elevated respiratory rate. Which level of an asthma attack did the patient have based on these assessment findings?

Mild

Assesment included

Observation and patient interview Current symptoms, duration of attack, what relieves symptoms and their effect, precipitating factors, meds, allergies, pisture of patient Physical exam LOC, skin color, vitals, RR, breath sounds, apical pulse, lung sounds, use of accessory muscles, palpation of chest for symmetry

drugs used for continued asthma manage- ment and relief of an acute attack can be administered by

a metered-dose inhaler (MDI), dry powder inhaler (DPI), or nebulizer. The advantages of administering medications locally by inhalation include rapid onset and reduced systemic effects. In an MDI, a chemical propellant is used to deliver the medication when the canister is depressed. In contrast, a DPI contains no propellant. Instead, the medicaton is released by inhaling rapidly through the mouthpiece.

Summerize an acute Asthma attack

inflammatory mediators are released from sensitized airways, causing activation of inflammatory cells. This progression leads to bronchoconstriction, airway edema, and impaired mucociliary clearance. Airway narrowing limits airflow and increases the work of breathing; trapped air mixes with inhaled air, impairing gas exchange

What is the nurses Immediate priority

maintain oxygenation, patent airway

Asthma

the persistent inflammation of the lungs characterized by recurrent episodes of shortness of breath, difficulty breathing, chest tightness or pressure, coughing (especially at at night), and wheezing. Most "attacks" need treatment

The nurse is teaching a patient who was recently diagnosed with asthma about allergy testing results that indicate the patient is allergic to dust mites. Which expected outcome is appropriate for this patient following the teaching?

The patient uses furniture covers and a mattress pad to cover the bed to prevent exposure.

The nurse is planning care for a patient who is diagnosed with asthma. Which expected outcome is appropriate for this patient?

The patient will verbalize triggers for asthma attacks.

Which is the purpose of pulmonary function tests when diagnosing asthma?

To evaluate the degree of airway obstruction

List common causes of an asthma attack

Common allergens: pollens, weeds, dust mites stuffed animals, animal dander Other triggers: - Exposure to aspirin, other nonsteroidal anti-infammatory drugs (NSAIDs) - Exercise induced - Exposure to hot or cold air - Viral infection - Stress Occupational asthma from exposure to respiratory irritants in workplace . Affects 25 million Americans

Manifestation of Severe persistent Asthma

Continuous symptoms occur with frequent exacerbations Physical activity is limited. Symptoms include shortness of breath, labored and painful breathing, chest tightness, coughing, wheezing, tachypnea, tachycardia, difficulty speaking without pausing for breathing, and extreme fatigue.

The nurse is teaching a patient with asthma about how to prevent asthma attacks. Which patient statement indicates that further teaching is required?

"I will dust my house weekly."

The nurse is teaching a patient who is suspected of having allergic asthma about upcoming testing. Which patient statement indicates that the teaching was effective?

"A scratch test will tell me how severe my allergy is."

A 5-year-old patient who was diagnosed with asthma is being discharged after a brief hospitalization. The nurse is completing the discharge teaching with the parents. Which parent statement requires further teaching? 1. "I will buy detergents and soaps that are free of perfumes and dyes." 2. "I will pursue allergy testing for my child with an allergy specialist." 3. "I will keep my child inside during sudden changes in temperature." 4."I will always step outside of the house to smoke."

"I will always step outside of the house to smoke."

List nursing implementations to promote effective gas exchange

- Administer nebulizer treatments, humidification as ordered - Increase fluid intake - Assess ABG results, pulse oximetry - Place in Fowler, high-Fowler, or orthopneic position - Administer oxygen as ordered - Frequently assess respiratory status

An 8-year-old child is admitted to the hospital for asthma. Which diagnostic test should the nurse expect to be ordered for this patient?

Allergy skin testing

An older adult patient with a history of allergies presents with manifestations of wheezing and difficulty breathing after a stroll in their backyard. Physical assessment findings include tachypnea, use of accessory neck muscles, prolonged expiration, intercostal retractions, decreased breath sounds, and expiratory wheezes. Which condition should the nurse suspect? ANSWER 1. Exercise-induced asthma 2. Lobar pneumonia with asthma symptoms 3. An allergic hypersensitivity caused the acute asthma attack 4. Cor pulmonale due to acute asthma

An allergic hypersensitivity caused the acute asthma attack

The nurse is assessing an elderly patient suspected of having asthma. Which is one of the most common symptoms of asthma in this age group?

Cough

Common manifestations of asthma

Coughing, wheezing, shortness of breath, chest tightness, tachypnea, tachycardia, anxiety and apprehension

A patient with asthma is taking an inhaler that blocks parasympathetic input to bronchial smooth muscles. Which class of medication is this patient taking for asthma control?

Anticholinergic

What is the most common serious chronic childhood illness

Asthma Effects > 9 % of children

Lifespan Considerations in Older adults with asthma

Asthma often underdiagnosed, undertreated -Difficult to differentiate symptoms from other common age-related respiratory conditions -Respiratory comorbidities in older adults differ from those at other ages Factors in development of asthma include -Allergic factors play less of a role -Mostly from age-related lung and immune changes, environmental exposure, other health conditions Higher morbidity than other age groups Coexisting health alterations and medications used to treat them complicate management of asthma Memory problems, socioeconomic conditions present problems Effective patient teaching, evaluation of self-management protocols essential

The nurse is completing a focused physical examination of a patient with asthma. Which assessments should be included for this exam?

Auscultation of the lungs and assessment of level of consciousness

Prevention of Asthma

Avoiding allergens and environmental triggers Modifying home environment Wearing mask while exercising in cold weather Early treatment of respiratory infections Adherence to medication regimens

Which advice should the nurse include when teaching parents of a child with asthma about triggers?

Avoiding secondhand smoke

A nurse is reinforcing teaching with a client on the purpose of taking a bronchodilator. Which of the following statements by the client indicates the teaching was effective? A. "This medication can decrease my immune response." B. " I take this medication to prevent asthma attacks . " C. "I need to take this medication with food." D. "This medication has a slow onset to treat my symptoms."

B. " I take this medication to prevent asthma attacks . "

A patient with asthma is prescribed an anticholinergic agent. Which rationale describes using this type of medication?

It blocks parasympathetic input to bronchial smooth muscles.

A nurse is assessing a client with asthma. Which of the following is a risk factor associated with this disease? A. Gender B. Environmental allergies C. Alcohol use D. Race

B. Environmental allergies

1. A nurse in th emergency department caring for a client who was admitted with an acute asthma attack. Which of the following indicates the client's respiratory status is declining? (Select all that apply A . Sao , 95 % B. Wheezing C. Retraction of sternal muscles D. Pink mucous membranes E. Premature ventricular complexes (PVCs)

B. Wheezing C. Retraction of sternal muscles E. Premature ventricular complexes (PVCs)

A nurse is completing discharge teaching with a client who has a new prescription for prednisone (Deltasone) for asthma. Which of the following client statements indicates a need for further teaching? A. "I will drink plenty of fluids while taking this medication." B. " I will tell the doctor if I have black , tarry stools . " C. "I will take my medication on an empty stomach." D. "I will monitor my mouth for canker sores."

C. "I will take my medication on an empty stomach."

A nurse working on a medical-surgical unit admits a client. Two hours after admission, the client's Sa0, is 91 % and he is exhibiting audible wheezes and use of his accessory muscles , which of the following medications should the nurse expect to administer? A. Antibiotic B. Beta-blocker C. Antiviral D. Beta, agonist

D. Beta, agonist

Pharmacologic Therapy

Daily drugs for long-term control - Anti-inflammatory agents - Long-acting bronchodilators Leukotriene modifiers - Quick relief medications - Short-acting adrenergic stimulants - Anticholinergic drugs - Methylxanthines

The nurse is caring for a patient with asthma. Which manifestation noted during patient assessment should the nurse associate with the classification of moderate persistent asthma?

Daily symptoms and exacerbations that can last for days

Manifestation of Mild persistent Asthma

Daytime symptoms occur more than twice a week but less than once per day Nighttime symptoms occur more than twice a month. Exacerbations may affect activity Typical symptoms include shortness of breath, labored breathing, and fatigue.

Manifestation of Mild intermittent asthma

Daytime symptoms occur no more than twice a week. Nighttime symptoms occur no more than twice per month. Peak flow rates between attacks are normal. Attacks (or flares) last hours to a few days. Typical symptoms include shortness of breath, labored breathing, and fatigue.

After teaching an 8-year-old child how to use an inhaler, the nurse observes that the child places the mouthpiece between the teeth, closes the lips, breathes in gently and deeply, and then presses down on the canister to release the medication into the spacer. Which action by the nurse would be most appropriate?

Having the child demonstrate again while providing instructions to correct the errors from their first demonstration

A new staff nurse is developing a plan of care for a patient with asthma. Which nursing intervention in the plan of care indicates the need for the preceptor nurse to intervene?

Increasing external stimuli

Lifespan Considerations in Children

Interferes with ability to sleep, concentrate in school, play - Frustrating, frightening for child and parents - Nurse plays essential role . Assessing parents' understanding of asthma management Patient teaching on use of asthma medication, avoidance of triggers . Education on danger of secondhand smoke for those with asthma Written action plan that parents, other caregivers can follow - Inhalers are relatively inefficient, present challenges for infants, young children - Children age grater than or equil 7 can usually use MDis, coordinate medication release, inspiration - Children ages 4-7 may prefer to use holding chamber or spacer - Children <4 years: spacer with mask attachment - Nebulizers easier for young children to use - Teach child and parents use of PEFR meter

A hospitalized patient is recovering from an acute asthma attack. Which nursing intervention is most appropriate during the recovery period?

Limiting the number of visitors

The nurse is providing discharge teaching to an asthmatic patient. Which lifestyle alterations should the nurse suggest to improve asthma management?

Maintaining a healthy weight

Clinical therapies for severe persitent asthma

Medications include LABA inhalers, inhaled corticosteroids, and antileukotrienes (if allergens are triggers). Immunotherapy may be tried if triggers include allergens Cromolyn sodium or theophyline may be prescribed. Oral corticosteroids may be prescribed for use during exacerbations lasting more than 1-2 days. Steroids and beta-agonists delivered via nebulizer may be prescribed and used daily or as needed during exacerbations

Clinical therapies for moderate persistant asthma

Medications include LABAs, inhaled corticosteroids and antileukotrienes (if allergens are triggers). Immunotherapy may be tried if triggers include allergens. Cromolyn sodium or theophylline ( long - acting bronchodilators) may be prescribed. A nebulizer may be prescribed for use during exacerbations Oral corticosteroids may be prescribed for use during exacerbations lasting more than 1-2 days.

Clinical Therapies for mild intermittent asthma

Medications include bronchodilators or beta-agonists usually via inhaler or nebulizer. A beta-agonist is usually prescribed for use before anticipated exposure (e.g., exercise) A short course of oral corticosteroids may be prescribed if the attack lasts beyond 1 day or is related to an infection or other disease process that may extend recovery time. Inhaled corticosteroids usually take a few days to work and may not be prescribed for intermittent asthma except during periods of exposure to known triggers (e.g., ragweed). If triggers include allergens, oral antihistamine may be prescribed

Clinical therapies for mild persistent asthma

Medications include bronchodilators or beta-agonists. A LABA may be prescribed for daily use regardless of whether the patient is symptomatic. Inhaled corticosteroids are prescribed for daily use to prevent symptoms during likely periods of exacerbation. If triggers include allergens, antileukotrienes may be prescribed.

A patient with asthma reports, "I have symptoms daily that sometimes persist into the night." Which classification of asthma is this patient experiencing?

Moderate persistent

Clinical Manifestations

Onset may be abrupt or insidious Attack may subside rapidly or persist for hours or days With more severe attacks: use of accessory muscles for respirations, retraction, loud wheezing, distant breath sounds Activity intolerance and fatigue if episode lasts more than a few minutes

Diagnostic Tests

PEFR Allergic asthma : scratch or patch testing , IgE testing Complete blood count (CBC) with differential if infection suspected - Arterial blood gas (ABG) to monitor acid-base balance - Pulmonary function studies - Chest x-ray - Oxygen saturation monitoring - Transcutaneous oxygen and carbon dioxide monitoring

The nurse is teaching a patient who is newly diagnosed with asthma about possible asthma triggers. Which triggers should the nurse instruct the patient to avoid?

Pets, smoke, stuffed animals

The nurse is teaching an 8-year-old patient with asthma how to use an inhaler with a spacer. Which information should the nurse include?

Place the mouthpiece of the spacer in your mouth and form a tight seal with the lips.

The nurse is caring for a patient experiencing an asthma attack. Which nursing intervention is most appropriate to address the patient's shortness of breath?

Placing the patient in a high Fowler position

The nurse is evaluating the oxygenation status of a patient during an asthma attack. Which diagnostic tool would be the most useful for gathering this information?

Pulse oximeter

Manifestation of Moderate persistent Asthma

Symptoms occur daily. A short-acting bronchodilator (e.g., albuterol inhaler) is used daily. Nighttime symptoms occur more than once a week. Exacerbations may last for days. Exacerbations affect activity. Symptoms of exacerbations include shortness of breath, labored and painful breathing, and chest tightness; symptoms may include coughing, weezing, tachypnea, tachycardia, and fatique

The nurse is performing an assessment for a patient with a history of asthma. Which finding indicates that the asthma is worsening and requires the nurse to take immediate action?

Use of accessory muscles in breathing

A nurse is caring for a client with asthma and has a prescription for prednisone (Deltasone). Use the ATI Active Learning Template: Medication to complete this item to include at least three nursing interventions.

Use the ATI Active Learning Template: Medication Nursing Interventions/Client Education o Watch the client for decreased immune function. o Monitor for hyperglycemia. o Advise the client to report black, tarry stools. • Observe the client for fluid retention and weight gain. This can be common • Monitor the client's throat and mouth for aphthous lesions (cold sores). o Omalizumab can cause anaphylaxis.

hyperresponsiveness

an exaggerated bronchoconstrictor response and airway obstruction from overproduction of mucus and edema of the airway mucosa

Expected outcomes may include

patient Maintains oxygen saturation > 90% - Demonstrates proper use of medications - Lists common triggers, strategies to avoid them - Lists symptoms requiring immediate notification of primary provider - Responds appropriately to asthma flare-ups Maintains optimal nutrition to promote health - Lists symptoms requiring immediate notification of primary provider

Peak expiratory fow reading (PEFR)

provides objective assessment of lung function expiratory Traffic signal colors indicate Green : 80-100 % of personal best , asthma is under control Yellow : 50-80 % ; caution , need treatment Red : < 50 % ; immediate need for bronchodilator -Further medical treatment if level does not improve to yellow range immediately after use of bronchodilator

Status asthmaticus

severe, prolonged form of asthma that is difficult to treat.

Hyperventilation

unusually fast respiration, or overbreathing, causes the PaCO2 (the amount of pressure exerted by dissolved carbon dioxide) to fall, leading to respiratory alkalosis.