Acute Pulmonary Disease (Asthma)

Group Members:
Bejerano, Meileen A. Pangilinan, Myra Nathalie Q. Bue, Winnie Lyn M. Amerin, Dayamae Areez S.

Slide 1

Acute Pulmonary Disease (Asthma)

Contents:
1 Definition 2 Incidence 3 Anatomy and Physiology 4 Pathophysiology 5 Signs and symptoms 6 Diagnostic Exams 7 Medical and Surgical Treatment 8 Nursing Diagnosis and Responsibilities

Slide 2

DEFINITION OF ASTHMA

Asthma is a disease affecting the airways that carry air to and from your lungs. People who suffer from this condition (long-lasting or recurrent) are said to be asthmatic. The inside walls of an asthmatic's airways are swollen or inflamed. This swelling or inflammation makes the airways extremely sensitive to irritations and increases your susceptibility to an allergic reaction.

As inflammation causes the airways to become narrower, less air

can pass through them, both to and from the lungs. Asthma is an incurable illness. However, with good treatment

and management there is no reason why a person with asthma

cannot live a normal and active life.

Slide 3

14

INCIDENCE

12 10 8 6

4
2 0 Age Sex Ethnicity Source: National Health Interview Survey, National Center for Health Statistics, Center for Disease Control and Prevention

Asthma affects people of all ages, but it most often starts during childhood. In 2011, 235300 million people globally have been diagnosed with asthma and it caused 250,000 deaths. An estimated 75% of admissions for asthma are avoidable and as many as 90% of the deaths from asthma are thought to be preventable.

ANATOMY & PHYSIOLOGY

Figure A shows the location of the respiratory structures in the body. Figure B is an enlarged view of the airways, alveoli (air sacs), and capillaries (tiny blood vessels). Figure C is a closeup view of gas exchange between the capillaries and alveoli. CO2 is carbon dioxide, and O2 is oxygen.

BREATHING

GAS EXCHANGE PROCESS IN THE LUNGS

Moving the air into and out of the lungs also called ventilation

EXTERNAL RESPIRATION
GAS TRANSPORT BY BLOOD

Exchanging gases between the air in the lungs and the blood.

Transport of Oxygen to the body cells and the return of CO2

INTERNAL RESPIRATION CELLULAR RESPIRATION

Exchanging gases between the blood and the body cells

Using the O2 in cell processes and the production of C02

Respiratory System Parts and Functions Airways: Channel for air Nose and linked air passages (called nasal cavities) Mouth Larynx or voice box Trachea or windpipe Bronchial tubes or bronchi, and their branches Epiglottis :Covers your windpipe when you swallow. This prevents food and drink from entering the air passages that lead to your lungs. Lungs and Blood Vessels: Gas Exchange Process Lungs > Bronchi > Bronchioles ? Alveoli > Capillaries Capillaries: connect to a network of arteries and veins that move blood through your body. Pulmonary artery: Deliver blood rich in carbon dioxide (and lacking in oxygen) to the capillaries that surround the air sacs. Five main sections (Lobes): 3 Lobes ( R lung), 2 Lobes (L lung) Diaphragm: Separates chest cavity from abdominal cavity. Main muscle for breathing. Intercostal muscles: Between ribs Abdominal muscles

ANATOMY & PHYSIOLOGY

PATHOPHYSIOLOGY

Figure A shows the location of the lungs and airways in the body. Figure B shows a cross-section of a normal airway. Figure C shows a cross-section of an airway during asthma symptoms.

The exact cause of asthma isn't known. Researchers think some genetic and environmental factors interact to cause asthma, most often early in life. These factors include:

CAUSES OF ASTHMA

Atopy: An inherited tendency to develop allergies Parents who have asthma

Certain respiratory infections during childhood

Contact with some airborne allergens: Allergens from dust, animal fur, cockroaches, mold, and pollens from trees, grasses, and flowers Exposure to irritants: cigarette smoke, air pollution, chemicals or dust in the workplace, compounds in home dcor products, and sprays (such as hairspray) Medicines such as aspirin or other nonsteroidal anti-inflammatory drugs and nonselective beta-blockers Sulfites in foods and drinks Viral upper respiratory infections, such as colds Physical activity, including exercise Other health conditions can make asthma harder to manage. Examples of these conditions include a runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea. These conditions should be treated as part of an overall asthma care plan.

TYPES OF ASTHMA ACCORDING TO SEVERITY

MILD ASTHMA
Symptoms: Symptoms > 2 X/wk but <1 X/day Exacerbations may affect activity Nighttime symptoms > 2 X/mo Lung Function Test: FEV1 or PEF > 80% predicted PEF variability 20-30%

SEVERE ASTHMA
Symptoms: Continual limited physical activity Frequent exacerbations

MODERATE ASTHMA
Symptoms: Daily symptoms Daily use of inhaled short-acting beta2 agonist Exacerbations affect activity; > 2 X/wk; may last days Nighttime symptoms >1 time/wk Lung Function Test:

Frequent nighttime symptoms Lung Function Test: FEV1 or PEF < 60% of predicted PEF variability >30%

FEV1 or PEF > 60%- < 80% predicted

PEF variability >30%

as asthma becomes more severe, the

GENERAL SIGNS & SYMPTOMS

Signs
The patient will usually appear pink. Cyanosis is a serious sign. Their respiratory rate is raised. Tachycardia is usual and may be increased by use of beta2 agonists. Accessory muscles of respiration are employed (best assessed by palpation of the neck muscles) and the chest appears hyper-inflated. In normal breathing, the ratio of the duration of inspiration to expiration is about 1:2 but,

expiratory phase becomes relatively more prolonged. Wheeze is usually expiratory, but may

also be inspiratory in more severe

asthma.

Symptoms
Shortness of breath may develop over hours or days but is usually progressive rather than sudden. Often there has been a recent increase in use of reliever inhalers, with decreasing response. Possible respiratory tract infection or exposure to an allergen or trigger.

DIAGNOSTIC EXAMS

Medical and Family Histories Physical Exam: looking for signs of asthma or allergies. These signs include wheezing, a runny nose or swollen nasal passages, and allergic skin conditions (such as eczema). Lung Function Test: using a test called spirometry to check how your lungs are working. Other Tests: Allergy testing : find out which allergens affect you, if any. Bronchoprovocation: a test to measure how sensitive your airways are. Using spirometry, this test repeatedly measures your lung function during physical activity or after you receive increasing doses of cold air or a special chemical to breathe in. A Chest X ray or an EKG (Electrocardiogram): These tests will help find out whether a foreign object in your airways or another disease might be causing your symptoms.

EMERGENCY TREATMENT

O2 (sa O2 90-95), Inhaled short-acting bronchodilator for all pts. (3 tx Q 20 min, continuous therapy an option) Consider anti-cholinergics Oral systemic corticosteroids (unresponsive to initial beta2 agonist therapy, moderateto-severe asthma, people who are on steroids) Systemic steroids administered when admitted Intubation shouldnt be delayed once ARF is identified

NURSING DIAGNOSIS AND RESPONSIBILTIE S

Nursing Diagnosis:
Ineffective airway clearance related to airway spasm Goal: Lungs clear sound will be heard upon auscultation. Interventions: A. Airway management: 1. Monitor the chest wall retraction 2. Monitor respiration rate 3. Give a semi-Fowler position 4. Clear the airway (if secretions are present): 5. Listen to lung sounds 6. Encourage the patient to drink warm 7. Monitor oxygen delivery 8. Evaluation of lung sounds after suction

Nursing Diagnosis:
Ineffective breathing pattern related to fatigue due to increased work of breathing. Goal: Client will demonstrate effective breathing pattern. Interventions: 1. Monitor the frequency, rhythm and depth of breathing. 2. Position the client's chest semiFowler position. 3. Distract people from thinking about the state of anxiety and teach how to breathe effectively. 4. Minimize gastric distention. 5. Assess breathing during sleep. 6. Reassure the client and give support when dyspnea.

NURSING DIAGNOSIS AND RESPONSIBILTIE S

Nursing Diagnosis:
Impaired gas exchange related to CO2 retention Goal: The client will maintain adequate gas exchange and oxygenation. Interventions: 1. Monitoring of respiratory status every 4 hours, the results of GDA, income and output. 2. Place client in semi-Fowler position. 3. Give intravenous therapy as directed. 4. Give oxygen via nasal cannula, then adapt the results of PaO 2. 5. Give the medication that has been prescribed and observe if there are signs of toxicity.

Nursing Diagnosis:
Activity intolerance related to imbalance of oxygen supplied to the needs Goal: The client will show tolerant state of activity, with the expected outcomes Interventions: Energy management: Determine the causes of fatigue Monitor respiratory (dyspnea, pallor) Help clients choose activities Recommend to increase the intake of nutrients Monitor response of breathing during activity, assess abnormal response in respiration, blood pressure, pulse.

NURSING DIAGNOSIS AND RESPONSIBILTIE S

Nursing Diagnosis:
Knowledge deficit: about asthma, related to lack of information sources. Goal: Increase patient knowledge about Asthma Interventions: 1. Assess the things that have been known to patients 2. Assess the patient's condition before health education, do not provide health education, while patients in the state of attack. 3. Education: Explain the meaning of asthma Explain the trigger factor Describe the things that need to be avoided: stress, excessive cold weather activity Explain how the handler during an asthma attack at home Evaluate what has been delivered

Nursing Diagnosis:
Anxiety related to crisis situations: changes in health status Goal: The patient can control anxiety and increase coping Interventions: 1. Lower levels of anxiety: Listen to patients attentively Explain each will perform maintenance procedures Instruct the patient to accompany the family as a support system during an asthma attack 2. Teach termination worried if stress can not be avoided: Turning his attention upward Respiratory control by drawing a deep breath (relaxation) Position your body relax Make a relaxed mood, relaxed facial expression.