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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Concepts Covered:

  • Pregnancy Risks
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  • Central Nervous System Disorders – Brain
  • Respiratory Disorders
  • Noninfectious Respiratory Disorder
  • Oncology Disorders
  • Adult
  • Labor Complications
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  • Studying
  • Disorders of the Thyroid & Parathyroid Glands
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  • Urinary Disorders
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  • Fundamentals of Emergency Nursing
  • Emergency Care of the Trauma Patient
  • Neurological Emergencies
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  • EENT Disorders
  • Urinary System
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  • Terminology
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Study Plan Lessons

Bicarbonate (HCO3) Lab Values
Barriers to Health Assessment
AVPU Mnemonic (The AVPU Scale)
Asthma
Asthma for Certified Emergency Nursing (CEN)
Artificial Airways
Alkaline Phosphatase (ALK PHOS) Lab Values
Airway Suctioning
Advanced Cardiovascular Life Support (ACLS)
Abruptio Placenta for Certified Emergency Nursing (CEN)
Absolute Neutrophil Count (ANC) Lab Values
Wound Infections for Certified Emergency Nursing (CEN)
Wound Dressing Maintenance for Certified Perioperative Nurse (CNOR)
Wound Classification for Certified Perioperative Nurse (CNOR)
What to Expect In Clinical
Vitamin D Lab Values
Vitals (VS) and Assessment
Vent Alarms
Using Nursing Care Plans in Clinicals
Urine Culture and Sensitivity Lab Values
Urinary Retention for Certified Emergency Nursing (CEN)
Tuberculosis for Certified Emergency Nursing (CEN)
Triage in the ER
Triage
Trauma Survey
Transition To Practice
Transient Ischemic Attack (TIA) for Certified Emergency Nursing (CEN)
Transfer of Care Documentation for Certified Perioperative Nurse (CNOR)
Transfer and Stabilization for Certified Emergency Nursing (CEN)
Time Management
Thromboembolic Disease- Deep Vein Thrombosis (DVT) for Certified Emergency Nursing (CEN)
Threatened/Spontaneous Abortion for Certified Emergency Nursing (CEN)
Thought Disorders (Psychosis, Schizophrenia) for Certified Emergency Nursing (CEN)
Surgical Wound Classification Documentation for Certified Perioperative Nurse (CNOR)
The Medical Team
Stroke for Certified Emergency Nursing (CEN)
Stroke Concept Map
Sodium and Potassium Imbalance for Certified Emergency Nursing (CEN)
Shift change and Patient handoff
Sepsis for Certified Emergency Nursing (CEN)
Sepsis Concept Map
Seizure Management in the ER
Seizure Disorders for Certified Emergency Nursing (CEN)
Sensory Terminology
SBAR Practice Scenarios
Safety Checks
Routine Neuro Assessments
Red Cell Distribution Width (RDW) Lab Values
Renal Failure for Certified Emergency Nursing (CEN)