Asthma for Certified Emergency Nursing (CEN)

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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)
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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.

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Adult 2 Final

Concepts Covered:

  • Immunological Disorders
  • Liver & Gallbladder Disorders
  • Upper GI Disorders
  • Neurological Emergencies
  • Emergency Care of the Neurological Patient
  • Central Nervous System Disorders – Brain
  • Peripheral Nervous System Disorders
  • Central Nervous System Disorders – Spinal Cord
  • Infectious Respiratory Disorder
  • Respiratory Disorders
  • Noninfectious Respiratory Disorder
  • Oncology Disorders
  • Hematologic Disorders
  • Oncologic Disorders
  • Cardiac Disorders
  • Acute & Chronic Renal Disorders
  • Renal Disorders
  • Urinary Disorders
  • Vascular Disorders
  • Emergency Care of the Cardiac Patient
  • Pregnancy Risks

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