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Central Philippine University

College of Nursing
The First Nursing School in the Philippines
RESPONSES TO ALTERED VENTILATORY FUNCTION

ACUTE ASTHMA
 chronic inflammatory disease of the airways causes airway hyperresponsiveness,
mucosal edema, and mucus production.
 This inflammation ultimately leads to recurrent episodes of asthma symptoms: cough,
chest tightness, wheezing, and dyspnea

Airway obstruction can occur in two ways:

1. Inflammation
2. Airway hyperresponsiveness
 Severe airway obstruction can be fatal.
 Predisposing factor: Allergy

 Chronic exposure to airway irritants or allergens also increases the risk of asthma.
 Common allergens:
 Seasonal
 Perennial

 Common triggers for asthma symptoms and exacerbations include:

 Airway Irritants (e.g., air pollutants, cold, heat, weather changes, strong odors or
perfumes, smoke, occupational exposure)
 Foods (e.g., shellfish, nuts)
 Exercise
 Stress
 Hormonal Factors
 Medications
 Viral Respiratory Tract Infections
 Gastroesophageal Reflux

Classification of asthma severity (NAEPP - Natl. Asthma and Prevention Program)

SYMPTOMS NIGHT SYMPTOMS LUNG FUNCTIONS
MILD INTERMITTENT  Symptoms <2x/week Symptoms <2x a month
 Asymptomatic and normal FEV1 or PEF
PEF between > 80% Predicted
exacerbations
 Exacerbation’s brief (few PEF variability < 20%
hours to few days),
intensity may vary
MILD PERSISTENT  Symptoms >2x/week but >2x a month FEv1 or PEF
<1 time a day > 80% predicted
 Exacerbations may affect
activity PEF variability 20-30%
MODERATE  Daily symptoms > 1 time a week
PERSISTENT  Daly use of inhaled short- FEV 1 or PEF
acting beta2 agonist 60% to < 80% predicted
 Exacerbations affect
activity PEF variability > 30%
 Exacerbations >2x/ week;
may last for days
SEVERE PERSISTENT  Continual symptoms Frequent FEV 1 or PEF
 Limited physical activity < 60% predicted
 Frequent exacerbations PEF variability > 30%

NCM 4121 Medical-Surgical Nursing Responses to Altered Ventilatory Function


 Signs and symptoms of acute asthma
varies with bronchospasm:
1. Dyspnea or SOB associated with
wheezing
2. Wheezing - generalized
Additional assessment findings:
 Tachycardia
 Retractions
 Restlessness
 Anxiety
 Inspiratory/expiratory wheezing
 Hypoxemia
 Hypercapnea
 Cough
 Sputum production
 Expiratory prolongation
 Cyanosis
 Elevated Pulse paradoxus
(systolic blood pressure in
expiration exceeds that on
inspiration by more than
10mmhg)
DIAGNOSTIC STUDIES
Laboratory Assessment
1. ABG
 The arterial oxygen level (PaO2)
– may decrease during an asthma
attack.
 Early: the arterial carbon dioxide level
(PaCO2) may be decreased
 Later in an asthma episode - PaCO2
rises
2. Allergy testing
to ascertain precipitating allergens
3. Pulmonary Function Tests
the most accurate tests for asthma,
measured using spirometry.
4. FEV1(Forced Expiratory Volume) and
FVC (Forced Vital Capacity) and FEV1:
FVC ratio
An increase of at least 12% and 200mL in
FEV1 after inhaling a short-acting
bronchodilator indicates significant
reversibility and confirms the presence of
asthma.
NCM 4121 Medical-Surgical Nursing
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MEDICAL MANAGEMENT
Drug Therapy
Quick-Relief Medications
 Beta-agonist - bronchodilators -
increase bronchiolar smooth muscle
relaxation.
1. Short-acting inhaled
beta2-adrenergic agonists (SABA)
(e.g., albuterol [Proventil, Ventolin],
levalbuterol [Xopenex HFA], and pirbuterol
[Maxair])
- medications of choice for quick relief of
acute symptoms and relax smooth
muscle.
2. Anticholinergics
(e.g., Ipratropium [Atrovent])
- inhibit muscarinic cholinergic receptors
and reduce intrinsic vagal tone of the
airway.
3. Corticosteroids are the most potent and
effective anti-inflammatory medications
Oxygen Therapy
Supplemental oxygen – is often used during
an acute asthma attack.
Oxygen is delivered by mask, nasal cannula,
or endotracheal tube.
 Peak Flow Monitoring
 Peak flow meters - measure the
highest volume of airflow during a
forced expiration
 Volume may be measured in
color-coded zones:
GREEN ZONE
signifies 80% to 100% of personal best
YELLOW - 60% to 80%
RED - less than 60%.
If peak flow falls below the red zone, the
patient should take the appropriate
actions prescribed by their primary
provider.
Responses to Altered Ventilatory Function
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STATUS ASTHMATICUS The classic drug in this class is

Rapid onset, severe, and persistent asthma
that does not respond to conventional
therapy.
 The attacks can occur with little or no
warning and can progress rapidly to
asphyxiation.
PATHOPHYSIOLOGY
severe bronchospasm, with mucus plugging
leading to asphyxia.
 antagonist, may be given to induce
A ventilation–perfusion abnormality results in
hypoxemia.
  Maybe given as a single 2 g infusion
There is a reduced PaO2 and initial
respiratory alkalosis, with a decreased PaCO2
and an increased pH.

As status asthmaticus worsens, the PaCO2
increases and the pH decreases, reflecting
respiratory acidosis.
theophylline (Theo-Dur).
2. Supplemental oxygen and IV fluids for
hydration.
 Oxygen therapy
High-flow supplemental oxygen is best
delivered using a partial or complete non
rebreathing mask.
3. Magnesium sulfate, a calcium
smooth muscle relaxation
over 20 minutes - it may be helpful in
treating patients who present with
severely compromised pulmonary
function, who have not responded to
initial therapy, and with persistent
hypoxemia (GINA, 2015).

Clinical manifestations  Adverse effects of magnesium sulfate

- Extremely labored breathing, tachycardia,
diaphoresis, acute anxiety
- Wheezing
- Use of accessory muscles for breathing
- Distention (ENGORGED) of neck veins
- As obstruction worsens - wheezing
disappear - impending respiratory failure
 If the condition is not reversed, the
patient may develop pneumothorax
and cardiac or pulmonary arrest.
Nursing Alert!
Increasing PaCO2 - the first objective
indication of status asthmaticus
may include facial warmth, flushing,
tingling, nausea, central nervous
system depression, respiratory
depression, and hypotension.
NURSING MANAGEMENT
 Main focus of nursing management is to
actively assess the airway and the
patient’s response to treatment.
 The nurse should be prepared for the next
intervention if the patient does not
respond to treatment.

MEDICAL MANAGEMENT
Close monitoring of the patient and objective
reevaluation for response to therapy are key
in status asthmaticus.

Initially: Short-acting beta2-adrenergic

agonist and subsequently a short course of
systemic corticosteroids

1. Short- acting inhaled beta2-adrenergic

agonists

PMDI (Pressured Metered Dose Inhaler)

- with or without a spacer may be used
for nebulization of the medications.

 Methylxanthines
Drug Classification – Bronchodilators
NCM 4121 Medical-Surgical Nursing Responses to Altered Ventilatory Function