Asthma for Certified Emergency Nursing (CEN)

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Included In This Lesson

Study Tools For Asthma for Certified Emergency Nursing (CEN)

Asthma Medications (Cheatsheet)
Asthma Pathochart (Cheatsheet)
Asthma management (Mnemonic)
Asthma Implementation and Education (Picmonic)
Asthma Assessment (Picmonic)

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

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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.

View the FULL Transcript

When you start a FREE trial you gain access to the full outline as well as:

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