Asthma Case Study

University of Perpetual Help spatter DALTA Alabang Zapote Road, Pamplona, Las Pinas City College of Nursing A consequence Study of Bronchial bronchial asthma attack In Acute Exacerbation (BAIAE) Submitted by Angela Marie Ferrer BSN 3B July 17, 2012 commentary A condition of the lungs characterized by usual delineateing of the demarcation passages due to spasm of the down muscle, edema of the mucosa, and the armorial bearing of mucus in the lumen of the bronchi and bronchioles.Bronchial bronchial asthma attack attack attack is a inveterate relapsing seditious disorder with growing responsiveness of tracheobroncheal tree to various stimuli, get outing in paroxysmal conshargonion of bronchial channelize passages which changes in severity over short periods of time, all spontaneously or under discussion. Ca maps allergy is the strongest predisposing chemical element for asthma. Chronic exposure to air mien irritants or allergens can be seasonal worker such as grass, tree and raft pollens or perennial under this be the molds, dust and roaches.Common triggers of asthma symptoms and irritations embarrass air way irritants like air pollutant, cold, heat, persist changes, strong odors and perfumes. Other contri aloneing factor would include exercise, stress or ruttish upset, sinusitis with post nasal drip, medical specialtys and viral respiratory tract infections. Most people who fetch asthma be sensitive to a variety of triggers.A persons asthma changes depending on the environment activities, heed practices and an another(prenominal)(prenominal) factor. Factors that can contribute to asthma or skyway hyperreactivity whitethorn include whatsoever of the following * Environmental allergens Ho hold dust mites, animal allergens ( in particular cat and dog), cockroach allergens, and kingdom Fungi ar most greensly reported. * viral respiratory tract infections * commit hyperventilation * gastroesophageal reflux disease * Chronic sinusitis or rhinitis Aspirin or nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity, sulfite sensitivity * reh atrial auriclese of beta-adrenergic receptor blockers (including ophthalmic preparations) * Obesity ground on a prospective age bracket study of 86,000 patients, those with an elevated body weed index argon more(prenominal) than possible to go for asthma. * Environmental pollutants, tobacco booby * Occupational exposure * Irritants (eg, household sprays, create fumes) * Various gamy and low molecular weight compounds A variety of high and low molecular weight compounds be associated with the development of occupational asthma, such as insects, meants, latex, gums, diisocyanates, anhydrides, wood dust * Emotional factors or stress * Perinatal factors Prematurity and increase maternal age increase the luck for asthma * Breastfeeding has not been definitely shown to be protective. * Both maternal smoking and antepartum exposure to tobacco smoke simila rly increase the risk of developing asthma Clinical ManifestationThe three most common symptoms of asthma are cough, dyspnea, and reedy. In few instances cough may be the except symptoms. An asthma attack often occurs at night or primaeval in the morning, possibly because circadian variations that influence air passage receptors thresholds. An asthma exacerbation may get abruptly but most often is preceded by increasing symptoms over the introductory few days. There is cough, with or without mucus production. At times the mucus is so tightly wedged in the narrow airway that the patient cannot cough it up.Prevention forbearing with recurrent asthma should undergo scrutiny to identify the substance that participate the symptoms. Patients are instructed to avoid the causative agents whenever possible. Knowledge is the advert to quality asthma mission. Medical steering There are two general process of asthma medication energetic relief medication for immediate word of asth ma symptoms and exacerbations and long acting medication to achieve and defy control and unyielding asthma.Because of underlying pathology of asthma is inflammation, control of stubborn asthma is accomplish primarily with the cycle per secondical use of anti inflammatory medications. * long-acting control Medication Corticosteroid are the most potent and effective anti inflammatory currently available. They are more often than not effective in alleviating symptoms, improving air way functions, and decreasing peak menses variability. Cromolyn sodium and nedocromil are mild to be moderate anti-inflammatory agents that are use more comm entirely in children.They in addition are effective on a prophylactic basis to prevent exercise-induced asthma or unavoidable exposure to know triggers. These medications are contra pointd in bully asthma exacerbation. Long acting beta-adrenergic agonist is use with anti-inflammatory medications to control asthma symptoms, particularly those that occur during the night these agents are withal effective in the prevention of exercise-induced asthma. * strong relief medication Short acting beta adrenergic agonists are the medications of plectrum for relief of acute symptoms and prevention of exercise-induced asthma.They rich person the rapid onset of acton. Anti-cholinergic may have an added benefit in severe exacerbations of asthma but they are use more a great deal in COPD. Nursing focal point The main focus of breast feeding management is to actively assess the air way and the patient response to treatment. The immediate nursing care of patient with asthma depends on the severity of the symptoms. A calm approaching is an important aspect of care especially for anxious client and ones family. This requires a partnership between the patient and the health care providers to catch the desire outcome and to formulate a plan which include * the purpose and action of individually medication * trigger to avoid and how to do so * when to seek assistance the disposition of asthma as inveterate inflammatory disease Anatomy and Physiology The top(prenominal) respiratory tract consists of the nose, sinuses, pharynx, larynx, trachea, and epiglottis. The lower respiratory tract consist of the bronchi, bronchioles and the lungs.The major(ip) function of the respiratory system is to deliver oxygen to arterial blood and remove carbon dioxide from venous blood, a process known as gas interchange. The pattern gas exchange depends on three process * cellular respiration is run of gases from the atmosphere into and out of the lungs. This is elegant through the mechanical acts of rapture and expiration. * airing is a movement of inhaled gases in the alveoli and crossways the alveolar capillary membrane * Perfusion is movement of oxygenated blood from the lungs to the tissues.Control of gas exchange involves skittish and chemical process The neural system, unruffled of three parts located in the pons, medulla and spinal electric cord, coordinates respiratory rhythm and regulates the depth of respirations The chemical processes perform several(prenominal) vital functions such as * adjust alveolar ventilation by maintaining normal blood gas tension * guarding against hypercapnia (excessive carbon dioxide in the blood) as healthy as hypoxia (reduced tissue oxygenation ca apply by rock-bottom arterial oxygen PaO2. An increase in arterial CO2 (PaCO2) stimulates ventilation conversely, a decrease in PaCO2 inhibits ventilation. assisting to maintain respirations (through peripheral chemoreceptors) when hypoxia occurs. The normal functions of respiration O2 and CO2 tension and chemoreceptors are similar in children and adults. however, children respond differently than adults to respiratory disturbances major areas of difference include * Poor tolerance of nasal congestion, especially in infants who are obligatory nose breathers up to 4 months of age * Increased susceptibi lity to ear infection due to shorter, broader, and more horizontally positioned eustachian tubes. Increased severity or respiratory symptoms due to smaller airway diameters * A total body response to respiratory infection, with such symptoms as fever, vomiting and diarrhea. diagnostic procedures * General Physical Examination * grate * Observe for the front line of atopic dermatitis, eczema, or other manifestations of allergic skin conditions * Evidence of respiratory distress manifests as * increased respiratory rate, * increased watch rate, * diaphoresis, and * use of supplemental muscles of respiration. * Marked weight loss or severe wasting may delegate severe emphysema. * Pulsus paradoxus * This is an exaggerated fall in systolic blood pressure during inspiration and may occur during an acute asthma exacerbation. * Depressed sensorium * This finding suggests a more severe asthma exacerbation with impending respiratory failure. * Chest Examination * End-expiratory wheezin g or a prolonged expiratory phase is found most commonly, although inspiratory wheezing can be heard. * otiose breath sounds and thorax hyperinflation (especially in children)may be detect during acute asthma exacerbations. The presence of inspiratory wheezing or stridor may motivate an evaluation for an upper airway obstruction such as vocal cord dysfunction, vocal cord paralysis, thyroid enlargement, or a quiet tissue mass (eg, malignant tumor). * derived function Diagnoses * Airway Foreign tree trunk pump Failure Allergic and Environmental Asthma pneumonic Embolism Alpha1-Antitrypsin Deficiency pulmonary Eosinophilia Aspergillosis Sarcoidosis Bronchiectasis Sinusitis, Chronic * Bronchiolitis Tracheomalacia COPD URTI Churg-Strauss Syndrome Vocal corduroy Dysfunction Cystic Fibrosis Foreign Body Aspiration Gastroesophageal Reflux malady Laboratory Studies * Blood eosinophilia greater than 4% or 300-400/L * Eosinophil counts greater than 8% may be observed in patients with concomitant atopic dermatitis. * This finding should prompt an evaluation for allergicbronchopulmonary aspergillosis,Churg-Strauss syndrome, oreosinophilic pneumonia * Total serum immunoglobulin E levels greater than 100 IU are frequently observed in patients experiencing allergic reactions, but this finding is not specific for asthma * British Thoracic Society recommends use sputum eosinophilia determinations to guide therapy Imaging Studies In most patients with asthma, chest radiography findings are normal or may indicate hyperinflation. * Chest radiography should be considered in all patients being evaluated for asthma to suspend other diagnoses. * Sinus CT examine may be useful to help exclude acute or chronic sinusitis as a contributing factor.. Pulmonary function interrogation (spirometry) * Spirometry assessmentsshould be obtained as the primary essay to erect the asthma diagnosis. * Spirometry should be performed prior o initiating treatment in order to establish th e presence and determine the severity of baseline airway obstruction. * The assessment and diagnosis of asthma cannot be based on spirometry findings alone because more other diseases are associated with obstructive spirometry indices. * Spirometry vizors the force vital capacity (FVC), the maximal cadence of air expired from the point of maximal inhalation, and the FEV1. A reduced ratio of FEV1 to FVC, when compared with predicted values, demonstrates the presence of airway obstruction. Optimally, the initial spirometry should also includemeasurements before and subsequently inhalation of a short-acting bronchodilator in all patients in whom the diagnosis of asthma is considered. * Reversibility is demonstrated by an increase of 12%and 200 mL after the administration of a short-acting bronchodilator methacholine- or histamine-challenge testing * Bronchoprovocation testing with either methacholine or histamine is useful when spirometry findings are normal or near normal, espec ially in patients with intermittent or exercise-induced asthma symptoms. Bronchoprovocation testing helps determine if airway hyperreactivity is present, and a negative test resultant usually excludes the diagnosis of asthma. * Methacholine is administered in incremental doses up to a maximum dose of 16 mg/mL, and a 20% decrease in FEV1, up to the 4 mg/mL level, is considered a positive test result for the presence of bronchial hyperresponsiveness. Peak-flow supervise * Peak-flow monitoring is designed for ongoing monitoring of patients with asthma because the test is simple to perform and the results are a quantitative and reproducible measure of airflow obstruction. It can be use for short-term monitoring, exacerbation management, and daily long-term monitoring. * Peak-flow monitoring should not be used as a substitute for spirometry to establish the initial diagnosis of asthma. * Results can be used to determine the severity of an exacerbation and to help guide therapeutic dec isions as part of an asthma action plan. Exercise testing * Testing involves 6-10 minutes of gruelling exertion at 85-90% of predicted maximal heart rate and measurement of postexercise spirometry for 15-30 minutes. The defined cutoff for a positive test result is a 15% decrease in FEV1 after exercise. Eucapnic hyperventilation * Eucapnic hyperventilation with either cold or dry air is an alternate manner of bronchoprovocation testing. * It has been used to evaluate patients for exercise-induced asthma and has been shown to do results similar to those of methacholine-challenge asthma testing. I. LABORATORY works NAME OF TEST NORMALVALUE RESULTS SIGNIFICANCE neck Blood CountPurpose CBC is ordered to fear in the detection of anemias hydration status and as part of routine hospital doorway test.The differential WBC is necessary for ascertain the type of infection. RBC 4-6 x 10/LHct 0. 37- 0. 47Hgb 110- 160 gm/LWBC 5-10 x 10 /LLymphocytes0. 25-0. 35Segmenters 0. 50-0. 65Eosino phil 0. 01-0. 06 5. 480. 481598. 20. 250. 580. 07 Increased segmenters (mature neutrophils) reflect a bacterial infection since this are the bodys first line of defense against acute bacterial invasion. Lymphocytes are decreased during early acute bacterial infection and only increase late in bacterial infections but continue to function during the chronic phase. II. DRUG STUDYName of the drug Classification loony toons/ Frequency Route Mechanism of do Indication Nursing Responsibilities Generic conjure upDuavent ( ipratropium salbutamol) Brand nameDuaNeb Salbutamol Sulfate Nebule q 1 hour Oral nebulization The combination of ipratropium and albuterol is used to prevent wheezing, difficulty breathing, chest tightness, and coughing. Management of reversible bronchospasms associated with obstructive airway diseases, bronchial asthma Take care to ensure that the nebulizer mask fits the users face right on and that nebulized solution does not escape into the eyes. * gues s therapeutic response.