Asthma (Severe) for Progressive Care Certified Nurse (PCCN)
Included In This Lesson
Outline
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
- Vitals
Interpreting: Analyzing & Planning:
- Labs
- ABGs
- CO2>45
- ABGs
- 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
- First – BRONCHODILATORS
- 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
Transcript
References
- AACN, and Tonja Hartjes. AACN Core Curriculum for Progressive and Critical Care Nursing. Available from: Pageburstls, (8th Edition). Elsevier Health Sciences (US), [Insert Year of Publication].
- Agache, I., Akdis, C. A., Akdis, M., Canonica, G. W., Casale, T., Chivato, T., … & Jutel, M.(2021). EAACI Biologicals Guidelines—Recommendations for severe asthma. Allergy, 76(1), 14-44.
- Dennison, R. D., & Farrell, K. (2015]). Pass PCCN!. Elsevier Health Sciences (US).
- Kupchik, N. (2020). Ace The Pccn! you can do it!: Study guide. Nicole Kupchik Consulting, Inc.
NCLEX
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