Asthma Case Study

University of Perpetual Help System DALTA Alabang Zapote Road, Pamplona, Las Pinas urban center College of treat A Case Study of Bronchial Asthma In Acute Exacerbation (BAIAE) Submitted by Angela Marie Ferrer BSN 3B July 17, 2012 Definition A condition of the lungs characterized by widespread narrowing of the business sector of workways referable to spasm of the smooth muscle, edema of the mucosa, and the social movement of mucus in the lumen of the bronchi and bronchioles.Bronchial asthma fight is a inveterate retr oversion inflammatory disorder with increase responsiveness of tracheobroncheal tree to various stimuli, resulting in paroxysmal con nerve traction of bronchial airline businesss which changes in severity over diddle periods of time, either spontaneously or under treatment. Causes Allergy is the strongest predisposing factor for asthma. degenerative exposure to air duct irritants or allergens can be seasonal such as grass, tree and weed pollens or perenni al under this be the molds, dust and roaches.Common spark offs of asthma symptoms and exacerbations include air way irritants like air pollutant, cold, heat, weather changes, strong odors and perfumes. Other contributing factor would include exercise, deform or emotional upset, sinusitis with post nasal drip, medicinal drugs and viral respiratory tract infections. Most people who have asthma be sensitive to a variety of triggers.A persons asthma changes depending on the environment activities, counsel practices and other factor. Factors that can contribute to asthma or airway hyperreactivity whitethorn include any of the fol ruggeding * Environmental allergens House dust mites, fleshly allergens (especially cat and dog), cockroach allergens, and fungi argon just about commonly reported. * viral respiratory tract infections * Exercise hyper airing * Gastroesophageal reflux disease * inveterate sinusitis or rhinitis Aspirin or nonsteroidal anti-inflammatory drug dose (NSAID) hypersensitivity, sulfite sensitivity * Use of beta-adrenergic receptor blockers (including ophthalmic preparations) * Obesity Based on a prospective cohort study of 86,000 patients, those with an elevated body upsurge index are more likely to have asthma. * Environmental pollutants, tobacco plant smoke * Occupational exposure * Irritants (eg, household sprays, paint fumes) * Various high gear and low molecular weight 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 maternal age increase the risk for asthma * Breastfeeding has non been definitely shown to be protective. * Both maternal smoking and prenatal exposure to tobacco smoke also increase the risk of developing asthma Clinical ManifestationThe three nigh common symptoms of asthma are cough, dyspnea, and respire. In some instances cough whitethorn be the only symptoms. An asthma attack often hands at night or early in the morning, perhaps because circadian variations that influence airway receptors thresholds. An asthma exacerbation may start abruptly but most much is preceded by increasing symptoms over the previous few days. There is cough, with or without mucus production. At generation the mucus is so tightly wedged in the narrow airway that the patient cannot cough it up.Prevention Patient with recurrent asthma should undergo campaign to identify the substance that areaicipate the symptoms. Patients are instructed to avoid the causative agents whenever possible. intimacy is the key to quality asthma care. Medical Management There are two general process of asthma medication quick assuagement medication for contiguous treatment of asthma symptoms and exacerbations and long playacting medication to achieve and maintain maintain and persistent asthma.Because of underlying pathology of asthma is inflammation, run into of persistent asthma is accomplish primarily with the regular use of anti inflammatory medications. * Long-acting control Medication Corticosteroid are the most potent and in effect(p) anti inflammatory currently available. They are broadly s top of the inninging effective in alleviating symptoms, improving air way flows, 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 unavoidable exposure to known triggers. These medications are contraindicated in discriminating 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 also effective in the legal community of exercise-induced asthma. * Quick relief medication Short acting beta adrenergic agonists are the medications of choice for relief of crisp symptoms and prevention of exercise-induced asthma.They have the rapid onset of acton. Anti-cholinergic may have an added benefit in distasteful exacerbations of asthma but they are use more frequently in COPD. Nursing Management The main focus of nursing wariness 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 approach is an important aspect of care especially for animated client and ones family. This requires a partnership between the patient and the health care providers to modulate the desire outcome and to formulate a plan which include * the purpose and action 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 amphetamine respiratory tract consi sts of the nose, sinuses, pharynx, larynx, trachea, and epiglottis. The lower respiratory tract consist of the bronchi, bronchioles and the lungs.The major function of the respiratory system is to deliver oxygen to arterial blood and bring carbon dioxide from venous blood, a process known as swagger exchange. The familiar gas exchange depends on three process * breathing is movement of gases from the atmosphere into and out of the lungs. This is accomplished through the mechanical acts of intake and expiration. * Diffusion is a movement of inhaled gases in the alveoli and across the alveolar capillary tube membrane * Perfusion is movement of oxygenated blood from the lungs to the tissues.Control of gas exchange involves neural and chemic process The neural system, composed of three parts located in the pons, medulla and spinal cord, coordinates respiratory rhythm and regulates the depth of respirations The chemical processes act several vital functions such as * regulati ng alveolar airing by maintaining normal blood gas tension * guarding against hypercapnia (excessive carbon dioxide in the blood) as well as hypoxia (reduced tissue oxygenation caused by collide with arterial oxygen PaO2. An increase in arterial CO2 (PaCO2) stimulates ventilation conversely, a decrease 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 serve differently than adults to respiratory disturbances major areas of difference include * Poor valuation account of nasal congestion, especially in infants who are obligatory nose breathers up to 4 months of age * Increased susceptibility to ear infection collectable to shorter, broader, and more horizontally positioned eustachian tubes. Increased severity or respiratory symptoms due to smaller airway diameters * A total body res ponse to respiratory infection, with such symptoms as fever, vomiting and diarrhea. Diagnostic procedures * General Physical question * Skin * Observe for the comportment of atopic dermatitis, eczema, or other manifestations of allergic scramble 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 wasting 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. * Chest Examination * End-expiratory wheezing or a prolonged expiratory phase is found most commonly, although inspiratory wheezing can be heard. * Diminished breath sounds and bosom of drawers hyperinflation (especially in children)may be observed during acute asthma exacerbations. The presence of inspiratory wheezing or stridor may trip an evaluation for an upper airway obstruction such as song cord dysfunction, vocal cord paralysis, thyroid enlargement, or a soft tissue stack (eg, malignant tumor). * Differential Diagnoses * Airway external Body Heart reverse 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 Aspiration Gastroesophageal Reflux Disease Laboratory Studies * store 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 immune serum glob ulin 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 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 macrocosm evaluated for asthma to exclude other diagnoses. * Sinus CT scanning may be serviceable to help exclude acute or chronic sinusitis as a contributing factor.. Pulmonary function testing (spirometry) * Spirometry assessmentsshould be obtained as the primary test to establish the asthma diagnosis. * Spirometry should be performed earlier o initiating treatment in order to establish the presence and observe the severity of baseline airway obstruction. * The assessment and diagnosis of asthma cannot be based on spirometry findings alone because many other diseases a re associated with preventative spirometry indices. * Spirometry measures the forced vital capacity (FVC), the maximal amount of air discontinue 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 blackball test result usuall y 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 observe * Peak-flow monitoring is designed for ongoing monitoring of patients with asthma because the test is unprejudiced to perform and the results are a quantitative and reproducible measure of air flow obstruction. It can be used for short-term monitoring, exacerbation management, and daily long-run monitoring. * Peak-flow monitoring should not be used as a stand-in 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 operose exertion at 85-90% of predicted maximal heart rate and measurement of postexercise spirometry for 15-30 minutes. The delineate cutoff for a positive test result is a 15% decrease in FEV1 after exercise. Eucapnic hyperventilation * Eucapnic hyperventilation with either cold or juiceless air is an alternate method of bronchoprovocation testing. * It has been used to evaluate patients for exercise-induced asthma and has been shown to micturate results similar to those of methacholine-challenge asthma testing. I. LABORATORY WORKS NAME OF TEST NORMALVALUE RESULTS logical implication Complete Blood CountPurpose CBC is ordered to aid in the sensing of anemias hydration status and as part of routine hospital admission test.The derived function WBC is necessary 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 continue to function during the chronic phase. II. DRUG STUDYName of the drug compartmentalisation Dosage/ Frequency Route Mechanism of Action Indication Nursing Responsibilities Generic nameDuavent ( ipratropium salbutamol) Brand nameDuaNeb Salbutamol Sulfate Nebule q 1 time of day 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 beat back care to ensure that the nebulizer mask fits the users face properly and that nebulized solution does not escape into the eyes. * Evaluate therapeutic response.