Asthma Case Study

University of Perpetual Help System DALTA Alabang Zapote Road, Pamplona, Las Pinas City College of attending for A Case Study of Bronchial Asthma In Acute aggravation (BAIAE) Submitted by Angela Marie Ferrer BSN 3B July 17, 2012 Definition A condition of the lungs characterized by widespread dwindling of the air ducts due to spasm of the smooth muscle, edema of the mucosa, and the presence of mucus in the lumen of the bronchi and bronchioles.Bronchial bronchial asthma attack attack attack is a continuing relapsing inflammatory distemper with increased responsiveness of tracheobroncheal corner to various stimuli, allowing in paroxysmal abbreviation of bronchial air passages which changes in severity over short periods of time, either spontaneously or under intercession. Ca holds Allergy is the fondest predisposing factor for asthma. degenerative exposure to airway irritants or entirelyergens tail be seasonal such as grass, tree and weed pollens or perennial under this ar the molds, patter and roaches.Common triggers of asthma symptoms and irritations allow in air way irritants like air pollutant, cold, heat, weather changes, strong odors and perfumes. Other contri hardlying factor would include exercise, stress or turned on(p) upset, sinusitis with post nasal drip, medications and viral respiratory portion transmissions. Most tribe who have asthma be sensitive to a variety of triggers.A individuals asthma changes depending on the environment activities, man seasonment practices and other factor. Factors that can contri only ife to asthma or airway hyperreactivity may include each of the following * environmental allergens Ho theatrical role dust mites, animal allergens (especially cat and dog), rope allergens, and fungi are most commonly reported. * Viral respiratory tract transmissions * Exercise hyperventilation * Gastroesophageal reflux disease * Chronic sinusitis or rhinitis Aspirin or nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity, sulfite sensitivity * engage of beta- sympathomimetic receptor blockers (including ophthalmic preparations) * Obesity Based on a future cohort study of 86,000 patients, those with an elevated body mass index are more likely to have asthma. * Environmental pollutants, tobacco tummy * occupational exposure * Irritants (eg, household sprays, paint fumes) * Various high and low molecular(a) saddle compounds A variety of high and low molecular weight compounds are associated with the development of occupational asthma, such as insects, plants, latex, gums, diisocyanates, anhydrides, wood dust * Emotional factors or stress * Perinatal factors Prematurity and increased matriarchal age increase the risk for asthma * Breastfeeding has non been definitely shown to be protective. * Both maternal smoking and prenatal exposure to tobacco smoke excessively increase the risk of developing asthma Clinical ManifestationThe lead most common symptoms of asthma are exp ectorate, dyspnea, and asthmatic. In some instances coughing may be the only symptoms. An asthma attack often occurs at night or early in the morning, possibly because circadian variations that make for airway receptors thresholds. An asthma irritation may begin abruptly but most frequently is preceded by increasing symptoms over the previous a couple of(prenominal) 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 Patient with recurrent asthma should undergo test to identify the warmheartedness that participate the symptoms. Patients are instructed to avoid the causative agents whenever possible. Knowledge is the key to smell asthma plow. Medical Management There are two habitual process of asthma medication quick relief medication for prompt treatment of asthma symptoms and exacerbations and long acting medication to achieve and hold open control and persiste nt asthma.Because of underlying pathology of asthma is inflammation, control of persistent asthma is accomplish primarily with the regular use of anti inflammatory medications. * long-acting control Medication Corticosteroid are the most potent and good anti inflammatory currently available. They are broadly effective in alleviating symptoms, improving air way functions, and decreasing peak flow variability. Cromolyn sodium and nedocromil are mild to be moderate anti-inflammatory agents that are use more commonly in children.They also are effective on a prophylactic basis to prevent exercise-induced asthma or required exposure to known triggers. These medications are contraindicated in penetrating asthma exacerbation. ache acting beta-adrenergic agonist is use with anti-inflammatory medications to control asthma symptoms, oddly those that occur during the night these agents are also effective in the ginmill of exercise-induced asthma. * Quick relief medication Short acting bet a adrenergic agonists are the medications of choice for relief of acute symptoms and prevention of exercise-induced asthma.They have the quick onset of acton. Anti-cholinergic may have an added benefit in severe exacerbations of asthma but they are use more frequently in COPD. Nursing Management The main focus of nursing management is to actively mensurate 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 prelude is an important aspect of care especially for anxious client and virtuosos family. This requires a partnership between the patient and the health care providers to determine the desire outcome and to formulate a plan which include * the purpose and do of each medication * trigger to avoid and how to do so * when to seek assistance the nature of asthma as chronic inflammatory disease Anatomy and Physiology The upper respiratory tract consists of the nose, sinuses, pharynx, larynx, trachea, and epiglottis. The get respiratory tract consist of the bronchi, bronchioles and the lungs.The major function of the respiratory arranging is to deliver oxygen to arterial blood and remove carbon dioxide from venous blood, a process known as throttle valve exchange. The usual gas exchange depends on three process * Ventilation is driving of gases from the airwave into and out of the lungs. This is accomplished through the mechanical acts of inspiration and expiration. * Diffusion is a movement of inhaled gases in the alveoli and across the alveolar capillary membrane * Perfusion is movement of oxygenated blood from the lungs to the tissues.Control of gas exchange involves nervous and chemical process The neural system, composed of three parts located in the pons, medulla and spinal anaesthesia cord, coordinates respiratory rhythm and regulates the depth of respirations The chemical processes perform several racy functions such as * regulating alveolar ventilation by maintaining expression blood gas tension * guarding against hypercapnia (excessive carbonic acid gas in the blood) as well as hypoxia (reduced tissue oxygenation caused by devolved arterial oxygen PaO2. An increase in arterial CO2 (PaCO2) stimulates ventilation conversely, a drop in PaCO2 inhibits ventilation. helping 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 susceptibility 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 infect ion, with such symptoms as fever, vomiting and diarrhea. Diagnostic procedures * General Physical Examination * Skin * check for the presence of atopic dermatitis, eczema, or other manifestations of supersensitized skin conditions * Evidence of respiratory distress manifests as * increased respiratory rate, * increased heart rate, * diaphoresis, and * use of accessory muscles of respiration. * Marked weight loss or severe atrophy may indicate 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. * tit Examination * End-expiratory wheeze or a prolonged expiratory phase is found most commonly, although inspiratory wheezing can be heard. * Diminished breath sounds and pectus hyperinflation (especially in children)may be observed during acute asthma exacerbat ions. The presence of inspiratory wheezing or stridor may prompt an evaluation for an upper airway handicap such as vocal cord dysfunction, vocal cord paralysis, thyroid gland enlargement, or a soft tissue mass (eg, malignant tumor). * differential gear Diagnoses * Airway Foreign Body Heart Failure Allergic and Environmental Asthma Pulmonary Embolism Alpha1-Antitrypsin Deficiency Pulmonary Eosinophilia Aspergillosis Sarcoidosis Bronchiectasis Sinusitis, Chronic * Bronchiolitis Tracheomalacia COPD URTI Churg-Strauss Syndrome Vocal Cord Dysfunction Cystic Fibrosis Foreign Body inspiration Gastroesophageal Reflux Disease Laboratory Studies * crinkle eosinophilia great 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 fr equently observed in patients experiencing allergic reactions, but this finding is not specific for asthma * British Thoracic golf-club recommends using 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 debar other diagnoses. * Sinus CT scanning may be reclaimable to help exclude acute or chronic sinusitis as a contributing factor.. Pulmonary function examination (spirometry) * Spirometry assessmentsshould be obtained as the aboriginal test to establish the asthma diagnosis. * Spirometry should be performed prior o initiating treatment in order to establish the presence and determine the severity of baseline airway obstruction. * The assessment and diagnosis of asthma cannot be based on spirometry findings alone because many other diseases are associated with obstructive spiro metry indices. * Spirometry measures the forced vital capacity (FVC), the maximum amount 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 after 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, especially in patients with intermittent or exercise-induced asthma symptoms. Bronchoprovocation testing helps determine if airway hyperreactivity is present, and a negative test result usually excludes the diagnosis of asthma. * Methac holine 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 substantiating test result for the presence of bronchial hyperresponsiveness. Peak-flow monitoring * Peak-flow monitoring is knowing 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 used 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 decisions as part of an asthma action plan. Exercise testing * Testing involves 6-10 minutes of strenuous 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 flick method of bronchoprovocation testing. * It has been used to evaluate patients for exercise-induced asthma and has been shown to produce results similar to those of methacholine-challenge asthma testing. I. LABORATORY WORKS NAME OF TEST NORMALVALUE RESULTS SIGNIFICANCE Complete Blood CountPurpose CBC is ordered to aid in the detection of anemias hydration status and as part of routine hospital admission test.The differential WBC is required for determining 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. 65Eosinophil 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 maintain to function during the chronic phase. II. DRUG STUDYName of the drug Classification Dosage/ frequency Route Mechanism of Action Indication Nursing Responsibilities Generic figDuavent ( ipratropium salbutamol) Brand nameDuaNeb Salbutamol Sulfate Nebule q 1 hour Oral nebulization The compounding of ipratropium and albuterol is used to prevent wheezing, difficulty breathing, chest tightness, and coughing. Management of two-sided bronchospasms associated with obstructive airway diseases, bronchial asthma Take care to check into that the nebulizer mask fits the users face properly and that nebulized solution does not escape into the eyes. * appreciate therapeutic response.