Asthma (Severe)

Definition/Etiology:

• Asthma = AIRWAYS only (difference from COPD which has damage at alveoli)
• Definition – Intermittent airflow obstruction that is IMPROVED with bronchodilators and steroids.
  • Characterized by varying degrees of obstruction from inflammation and mucus.
• Etiology – Cellular Inflammation (like eosinophils) that are triggered.
  • Age < 45 Years Old
  • Cigarette smoke
  • Allergy Triggers
    • Seasonal Allergies
    • Dust/Mold/Pollen
    • COCKROACHES
  • Infection

Pathophysiology:

• Inflammation
  • Irritation and swelling
  • Airway Walls get thick
• Bronchoconstriction
  • Muscles around the airway get irritated and squeeze = even more narrow
  • Breathing through straw
• Mucous Production
  • Lots of mucus = clogged airways
• Remember, asthmatic patients cannot remove straw. No air in and no air out.
• Status Asthmaticus
  • Progress rapidly
  • No not respond to treatments

Noticing: Assessment & Recognizing Cues:

• Subjective Cues
  • SOB and restless
  • Diaphoretic
  • Cannot Speak
• Objective Cues
  • Vitals
    • ↑ Resp/min and ↓ 02 Sat
    • ↑ HR
  • Lungs
    • Use of accessory muscles
    • Cough
    • Wheezes
      • EXPIRATORY
      • BOTH
      • SILENT CHEST

Interpreting: Analyzing & Planning:

• Labs
  • ABGs
    • CO2>45
• Diagnostics
  • CXR -Rule out other issues
  • PFTs – Diagnosis
    • Completed by Pulmonology for accurate asthma diagnosis
  • Peak Flow – Patient’s Response to treatment
    • Patient’s need to know personal beter
    • Blow hard and fast in meter to measure a number that correlates with how open the lung’s airways are.
    • Number should IMPROVE AFTER BRONCHODILATOR.

Responding: Patient Interventions & Taking Action:

• ABCs
  • Start with 100% O2 via NRB
  • Titrate down to target Sp02
    • Adults 93-95%
• Pharmacological Interventions “Stepwise”
  • First – BRONCHODILATORS
    • (SABA) Short-acting Bronchodilators – Albuterol
    • (SAMA) Short-acting muscarinic-antagonist – Atrovent
      • Combination – Duoneb
  • Steroids second – decrease inflammation
    • Oral corticosteroids – Prednisone
  • Magnesium – muscle relaxant
• Non-Pharmacological
  • High-Fowler’s Positioning
• Adjunct Medical Therapy
  • RT & Pulmonologist

Reflecting: Evaluating Patient Outcomes:

• Oxygenation & Gas Exchange
• Symptom Management
• Patient Education – Avoid triggers

Linchpins (Key Points):

• Notice – Triggers & Narrowed Airways
• Interpret – Peak Flow Test & PFT
• Respond – 02, Bronchodilators & Steroids
• Reflect – Patient’s Oxygenation, Gas Exchange and Comfort