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
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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