Respiratory System

Asthma

PREPARED BY: MARICEL ABALONA, RN MN

 Asthma

is a chronic inflammatory disorder of the airways that results in intermittent and

reversible airflow obstruction of the bronchioles.
✓ The obstruction occurs either by inflammation or airway hyperresponsiveness.
✓ Asthma can occur at any age.
✓ The cause of asthma is unknown.

Manifestations of asthma:
✓ Mucosal edema
✓ Bronchoconstriction
✓ Excessive mucus production
✓ Asthma diagnoses are based on symptoms and classified into one of the
following four categories.
a. Mild intermittent – Symptoms occur less than twice a week.
b. Mild persistent – Symptoms arise more than twice a week but not
daily.
c. Moderate persistent – Daily symptoms occur in conjunction with
exacerbations twice a week.
d. Severe persistent – Symptoms occur continually, along with frequent
exacerbations that limit the client’s physical activity and quality of life.
RISK FACTOR THAT TRIGGER
ASTHMA
❖ Environmental factors, such as
changes in temperature (especially
warm to cold) and humidity
❖ Air pollutants
❖ Strong odors (perfume)
❖ Seasonal allergens (grass, tree, and
weed pollens) and perennial
allergens (mold, feathers, dust,
roaches, animal dander, foods treated
with sulfites)
❖ Stress and emotional distress
❖ Medications (aspirin, NSAIDS,
beta-blockers, cholinergics)
❖ Enzymes, including those in
laundry detergents
❖ Chemicals (household cleaners)
❖ Sinusitis with postnasal drip
❖ Viral respiratory tract infection
SIGNS & SYMPTOMS:

✓ Dyspnea
✓ Prolonged exhalation
✓ Chest tightness
✓ Poor oxygen saturation
✓ Anxiety and/or stress
(low SaO2)
✓ Coughing
✓ Barrel chest or increased
✓ Wheezing
chest diameter
✓ Mucus production
✓ Use of accessory muscles
DIAGNOSTIC
TEST/PROCEDURES:
A. ABGs
• Hypoxemia (decreased PaO2 less than 80 mm Hg)
• Hypocarbia (decreased PaCO2 less than 35 mm Hg – early in attack)
• Hypercarbia (increased PaCO2 greater than 45 mm Hg – later in attack)

B. Sputum cultures
• Bacteria can indicate infection.

C. Diagnostic Procedures
Pulmonary function tests (PFTs) are the most accurate tests for diagnosing
asthma and
its severity.

D. A Chest X-ray is used to diagnose changes in the client’s chest structure over
time.
NURSING
CONSIDERATIONS/
RESPONSIBILITY
Nursing Care:
❖ Position the client to maximize ventilation (high-Fowler’s = 90˚).
❖ Administer oxygen therapy as prescribed.
❖ Monitor cardiac rate and rhythm for changes during an acute attack (can be irregular,
tachycardic, or with PVCs).
❖ Maintain a calm and reassuring demeanor.
❖ Provide rest periods for older adult clients who have dyspnea. Design room and
walkways with opportunities for rest. Incorporate rest into ADLs.
❖ Administer medications as prescribed.
NURSING
CONSIDERATIONS/
RESPONSIBILITY
Medications
A. Bronchodilators (inhalers)
• Short-acting beta2 agonists, such as albuterol (Proventil, Ventolin), provide
rapid relief of acute symptoms and prevent exercise-induced asthma.
• Anticholinergic medications, such as ipratropium (Atrovent), block the
parasympathetic nervous system. This allows for the sympathetic nervous
system effects of increased bronchodilation and decreased pulmonary
secretions. These medications are long-acting and used to prevent
bronchospasms.
• Methylxanthines, such as theophylline (Theo-24), require close monitoring of
serum medication Levels due to a narrow therapeutic range. Use only when
other treatments are ineffective.
• Long-acting beta2 agonists, such as salmeterol (Serevent), primarily are used
for asthma
attack prevention.
NURSING
CONSIDERATIONS/
RESPONSIBILITY

Medications
B. Anti-Inflammatory Agents
• These are used to decrease airway inflammation, and they include:
✓ Corticosteroids, such as fluticasone (Flovent) and prednisone
(Deltasone)
✓ Leukotriene antagonists, such as montelukast (Singulair),
✓ mast cell stabilizers, such as cromolyn sodium (Intal), and
monoclonal antibodies, such as omalizumab (Xolair)