Asthma for Certified Emergency Nursing (CEN)
Included In This Lesson
Study Tools For Asthma for Certified Emergency Nursing (CEN)
Outline
Asthma
Definition/Etiology:
- Chronic reactive airway disease with airway hyperreactivity, inflammation, and reversible airflow obstruction
- Can be life-threatening. Status asthmaticus is a severe, refractory asthma attack
Common Triggers:
- Allergy induced
- Environment, (pollution, smoke, cold/dry air, seasonal changes)
- Medications (ASA, NSAIDs, beta blockers)
- Food additives, sulfites, tetrazine
- Illness – URI, GERD
- Exercise
- Menses
Pathophysiology:
Very complex – involves airway inflammation, constriction/obstruction, overresponsive bronchi
Clinical Presentation:
- Chest tightness, cough, increased work of breathing
Wheezing (expiration=early; inhalation=late)- may be audible without stethoscope
Assessment:
- Crackles on auscultation
- Prolonged expiratory time
- Lower lobe breath sounds diminished
Signs of hypoxia – impending respiratory failure
- Silent chest
- Restlessness, somnolence, decreased respiratory effort, bradycardia, periodic apnea
Collaborative Management:
- Peak expiratory flow rate (PEFR)
- sit upright with legs dangling
- Inhale fully, seal circumference of the mouthpiece and exhale fully
- Note position of flow meter
- Repeat 3 times and base treatment decisions on best of the readings
Findings:
- 70–90% of predicted value or personal best, use inhalers
- Less than 70% of predicted value or personal best: seek medical attention
- 40–69% of predicted value or personal best: moderate exacerbation
- Less than 40% of predicted value or personal best: severe exacerbation
Meds:
- Short-acting beta agonists – relax smooth muscles, bronchodilation
- Anticholinergics – inhibits contraction of bronchial smooth muscle, limits mucus
- Corticosteroids – anti-inflammatory, limits mucus
- Magnesium sulfate – inhibits smooth muscle contraction, decreases histamine
Medications Delivery:
- Metered dose inhaler (MDI)
- use of spacer recommended; increases delivery from 15-85%
- Dry power inhaler
- Nebulizer
Evaluation | Patient Monitoring | Education:
- Avoid known allergens/triggers
- Use hypoallergenic bedding, wash in hot water
- Air purifiers, carpet removal
- Keep cats and dogs outside of the house
- Remain inside with air conditioning during the early morning and midday
- Take medication as directed, pretreat before exercise
- Smoking cessation
Linchpins: (Key Points)
If you treat late, you may have to intubate
- Position of comfort
- Progression prevention and airway management
- Severity of exacerbation determines clinical presentation and aggression of treatment
- Medication administration
- Trigger management
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Emergency Nurses Association. (2017) Emergency Nursing Core Curriculum, 7th Edition. PA: Saunders
- Egging, D. (2017). Respiratory Emergencies and Thoracic Trauma. In CEN Online Review. Emergency Nurses Association.