Asthma Treatment, Symptoms, Pathophysiology, Nursing Interventions NCLEX Review Lecture

this is cereth registered nurse ari and calm and in this video i'm going to be covering asthma in this video is part of an index review series over the respiratory system and as always whenever you're done watching this video don't forget to access the free quiz to test you over this condition so let's get started so what is asthma it is a chronic lung disease that causes narrowing and inflammation of the airways and we're specifically talking about the smaller Airways like the bronchi and the bronchioles and in patients with asthma and these are chronically inflamed now remember with asthma there's no cure but it can be managed with medications which we're going to talk about a little bit later on and what happens is this patient can become triggered say for instance that one of the triggers that causes an asthma attack in them is pet dander so they get around pet dander it inflames all of these bronchi and bronchioles and it can send them into an asthma attack so the patient will start experiencing chest tightness difficulty breathing coughing wheezing and they will experience air trapping which eventually can lead to respiratory acidosis so how does this happen well to understand the pathophysiology of an asthma attack we need to talk about what we normally do with breathing so let's think about two anatomy and physiology so whenever we inhale we inhale air and it has oxygen in it and when we exhale we're exhaling the build-up of carbon dioxide in our blood to get rid of it because we don't want to keep carbon dioxide in our blood if it stays in our blood carbon dioxide is acidic it will cause us to enter into an acidotic condition so remember that so we breathe in the air it enters into our upper airway then it flows down through the lower airway which is our trachea into our bronchi and then that air goes down into even smaller Airways called the bronchioles and then after the bronchioles are these little air sacs Aveo life sacs and this is really the functional unit of your lungs this is where gas exchange happens if we took a bronchial we had had an alveolar sac you can see that there's a nice little capillary bed around it and what's happening is that oxygen that you're breathing in is crossing over into that capillary bed going in your blood and replenishing your organs and doing this job now what's also crossing over in the opposite direction is carbon dioxide and it's going to flow out and you're gonna breathe that out because you don't want that to build up in the body now let's look at what's going on in an asthma attack so ask yourself what surrounds these structures that bronchi and bronchioles smooth muscle these little areas right here in blue represent the smooth muscle now what does this smooth muscle do it can constrict and dilate when it constricts that narrows the lumen of that airway so not a lot of air is gonna flow through and it can dilate to allow air to flow through and we get patients drugs that can alter the way that that smooth muscle works hence bronchodilators which is the one of these big drugs that we get patients who have asthma now say that that patients trigger like we talked about earlier and they inhaled some pet dander and it has triggered an asthma attack so this allergen has came in and what's going to happen to that smooth muscle it's going to constrict it's gonna clamp down and the patient's gonna start to feel chest tightness they're also going to have difficulty breathing because they're not really moving a lot of air when those smooth muscles clamp down like that now let's think about what's inside these structures of the bronchi and the bronchioles well we have a mucosal lining which has these special cells in it called goblet cells now goblet cells are really helpful on the surface because whenever we breathe in that mucus because that goblet cells produce mucus it collects the irritants that we breathe in the bacteria things like that and prevents it from going any further in our airway but when an allergen like that pet dander that has triggered this patient's eyes McKenzie and they work in they're over stimulated so they start producing lots of mucus and this mucosal lining which is already inflamed is going to become even more inflamed so you got more inflammation and you have this excessive mucus production going on so what is all this going to lead to we're gonna have further decrease in our airflow because we have mucus in the way and we have severely inflamed mucosal lining now this patients going to start having a cough because of all this mucus and wheezing and why is that as air is flowing through this narrowed airway and it's coming into contact with this mucus that's in there it's going to produce this like musical whistling sound so you'll be able to hear that especially on expert ory whenever you're listening with your stethoscope expert ory wheezes [Music] but it can become so severe and asthma if this is a really severe asthma attack they can have it on both inspiration and expiration now think about what's going to be happening in these sacs is air really going to be moving out no it's going to be trapped so you're gonna have air trapping in there and one thing you're gonna notice with patients with asthma if you've ever seen a patient have an asthma attack they cannot fully exhale like that is one thing that they're really struggling with which makes sense with all these structures being involved so if we're we have air trapping gas exchange is not going on so just what carbon dioxide is not gonna leave this sac it's going to stay in the blood oxygen is not going to get in to the blood so we're gonna have decreased oxygen levels in our blood but we're gonna have increased carbon dioxide levels in our blood so what I say that carbon dioxide was it's like acidic it'll make our blood acidotic so the patient's going to start can experience a condition called respiratory acidosis now asthma attacks vary in severity among patients so as the nurse it's really important that you help the patient be able to identify triggers that's leading them into having an asthma attack now the cause of asthma itself is not known they think it may be a genetic factor or environmental but they do know that there are certain things that can trigger a person to have an asthma attack which include environmental factors like smoke this can be firsthand secondhand smoke pollen pollution perfumes pet dander dust mites pests like cockroach droppings cold and dry air can make those smooth muscles on the airways constrict down and mold another thing would be like body issues like the patient has a respiratory infection this can trigger an asthma attack GERD hormonal shifts especially in women and it can be caused by exercise so exercise induced asthma another thing is the intake of certain substances like drugs and for instance beta adrenergic blockers that are the non-selective and we've talked a lot about this in our cardiac videos in SEDs aspirin and preservatives like those sulfites so all these things depending on the patient can trigger an asthma attack and they need to be educated to avoid these things know another thing that the patient needs to be educated on are those early warning signs and symptoms that an asthma attack may be pending and these signs and symptoms can present about one to two days before a full-blown active asthma attack is happening and here we're going to compare the early versus active signs and symptoms so whenever you're talking to your patient about these early warning signs and symptoms they're also going to hopefully have an action plan which is developed by the physician and here's what a basic action plan looks like and they're based on zones and you have green zone a yellow zone and a red zone and based on the patient signs and symptoms and if you notice in the yellow we're starting to get in that early signs and symptom category the patient's asthma is getting worse because they have coffee and a wheeze maybe have chest tightness they're waking at night and they can't do their activities as normal and based on that they will take whatever they need to help control that asthma keep a full-blown asthma attack actually coming on now another thing they can do is use a peak flow meter device and these devices are just really awesome and helping a patient learn if their asthma is getting worse and helping them prevent them from actually having exacerbations of an asthma attack and here's what one of those devices look like and what the patient does is the patient will fully exhale as hard as they can on this device and will tell them how much airflow is actually coming out because remember with asthma we're having airflow issues and in the nursing intervention part we will talk how about how to use this and how to provide education on this but I just wanted you to get familiar with that because the action plan that you just seen goes along hand in hand with those patient signs and symptoms and using that peak flow meter okay so early signs and symptoms all of a sudden the patient is getting easily short of breath where they normally weren't or they're easily fatigued with physical activity so if these are happening the patient needs to know hey something is going on in my airway another thing is that they're getting that frequent call and it mainly starts to present at night and that's a excessive mucus production by those goblet cells and this will lead to them having issues sleeping so they're not gonna sleep good at night they're gonna look extremely tired which is going to lead to irritability also they may have signs and symptoms that's similar to developing a cold like they're sneezing along having a scratchy throat and tired and they may start to notice that they wheeze a little bit with activity then if they're using a peak flow meter device that they have noticed that based on their personal best reading that the reading is dramatically reduced so there's less airflow coming now what are those signs and symptoms of an active asthma attack that is literally going on and this patient is experiencing it there they will have the chest tightness and remember we went over while they're having the chest tightness that's smooth with muscles clamping down they have the wheezing and as a nurse if you listen with your stethoscope you can hear expert ory wheezes it's really severe you could hear it on both inventory and expert ory they will just have this coughing that won't stop and it's just coughs cough and gives me a difficulty breathing and especially exhaling increased respiratory rate of course and all of this hand if this is not treated and taken care of like with bronchodilators and getting some corticosteroids in after the bronchodilator giving them oxygen things like that this can progress to where those bronchodilators those short-acting bronchodilators the rescue inhalers won't even work like they're beyond the point about even working they're not gonna be able to speak to you talking just isn't happening they're trying to breathe also they can have chest retractions and what can what this is is the stomach will be sucked in the ribs will be pulled out it'll literally look like the skin is stretched over the rib cage the clavicle the collarbone will be protruding out and this is where they're like just not getting any air in and if you see that that is an emergency also cyanosis is going to appear you're really early you'll start seeing it in the signs and in the lips and it will be like this dusky blue color I know a lot of patients I've seen it's just like this little ring of blue forms around their lips sometimes it can be like this dark purple burgundy color and then it can progress to the skin this is where they are not getting oxygen to the tissues because remember that oxygen exchange is not happening in that capillary bed we're not having the airflow because of the air trapping also they'll become sweaty and when these are happening the patient needs medical treatment really fast and they may need to be intubated get mechanical ventilation IV corticosteroids and things like that now let's look at some more nursing interventions okay let's talk about if your patient is presenting with an asthma attack what are you going to do and of course depending on how actually severe this attack is because every patient can vary you'll have to tweak some of these but you of course first you want to do is get vital signs because you want a baseline of where your patient currently is that because you're going to be giving them treatment so you want to see if they're responding to these treatments is their oxygen saturation increasing is the respiratory rate going down into the normal range as their heart rate slowing down are they doing better so you want to do that also you'll want to keep calm and you'll want to help keep the patient calm you don't want to communicate to the patient in your nonverbal language that you're anxious you're scared because that's going to make the patient even more scared because they're already anxious because they can't breathe with positioning you want to keep them in high fowler's to assist them with breathing to make it easier for them in the order you'll want to give them bronchodilators and what type are we going to give are we gonna give short acting long acting we want to do short acting and we're gonna go over those here in a second in depth because we want something that's going to act fast and dilate those airway so this patient can breathe want to give them oxygen keep the oxygen saturation between 95 99 % we want to assess those lungs before we're going to give them medications because we're listening for that wheezing deering while they're maybe respiratory's they're giving them a nebulizer treatment and after we want to see how has that wheezing decrease are they breathing better so listening with our self to scope to that also assessing for cyanosis and the lips and the skin are they getting good oxygenation and those chest retractions that I was talking about if you see that that is not a good sign and their ease of speaking can they speak to you now or or they still they can't speak because they're so short of breath then assessing their peak flow meter and we're gonna talk about that here in a second more in detail but while all this is happening if your patient can communicate to you you want to get a baseline of what their peak slope numbers are because a lot of patients with asthma use these devices and they know what their personal best number is and based on what their personal best number is on a percentage you can see if they decrease and if they've been using their peak flow meter before they came to you what was the reading and whenever you're collecting there's you can compare the two also medications have they already taken a bronchodilator it hasn't not worked which is a big warning sign so you want to see what all they've tried before they've actually came in now let's talk about that peak flow meter okay what does it do again it shows how controlled their asthma is and if it's getting worse and I want to cover this because when you're taking care of patients with asthma you're going to come into contact with these devices and I want you to be familiar with them and how you but educate a patient on how to use them okay so this peak flow meter it looks like this and again remember you exhale fully on it the patient will and they will do that several times and they will measure their readings and it's used along with that action plan that we went over earlier and the less the patient know when they should use their short-acting bronchodilators cuz they have some issues going on in there because we want to prevent a full-blown asthma is hot and when it's actually time for them to get medical help now how does this flow meter do this well whenever a patient starting out using a flow meter in the beginning they need to figure out their personal best flow meter reading number and this will be the highest number that they reach over a period of time and this number will be used to compare against other reading numbers to make sure the patient's asthma is under good control so whenever you have a patient with asthma you want to ask them well what was your personal best peak flow meter reading because that's going to help give you a baseline of where they should be while you're providing care so to figure this out the patient will do this when their asthma is under good control not when they're having asthma attacks and issues with that so they want to do this when to figure out the personal best meter flow reading is whenever their asthma is under control and doing good so they will measure it once in the morning and once at night for three weeks usually and record the number before taking the medicine so they'll keep this little log of this and then whatever the highest number that they got there in that period is their best peak flow meter reading then just to keep their asthma in check to keep monitoring monitoring it they will need to check it at the same time either in the morning or night before taking their medication and compare it with their best reading and generally if it's less than 80% of their personal best they'll want to follow the action plan that they developed with their doctor so you're going to educate your patient how to follow the asthma action plan and you're gonna go over each zone with them the green the yellow and the red and explain to them those signs and symptoms what their peak flow meter reading is and what they need to do what medications they need to take and how often according to whatever the physician wrote you need a quiz the patient make sure that they understand how to do that because following these action plans and using the peak flow meter really helps decrease the patient of being admitted with this asthma exacerbation so really help preventing them having to even come to the hospital it's great along with teaching them those triggers that we just went over earlier and those warning signs however you may be thinking well how about they can avoid pet dander they can avoid pollen and all that stuff but are they supposed to really avoid exercise because they have exercise induced asthma and the answer is no they need to exercise they don't need to quit because exercising is good for overall health so they can do some things that can help prevent making an asthma attack - like warming up 10 to 15 minutes before exercising also taking the short-acting beta is before exercising so getting that Bronco dilator in there also if they choose to exercise outside on a cold windy day because cold air can cause that smooth muscle to constrict which can trigger an asthma attack so they need to breathe through their nose which will help warm the air before it actually comes down into the lungs instead of mouth breathing and use like a scarf or something over the mouth to prevent that cold air from getting in there also if they have a respiratory illness a cold something like that they want to push off exercising until they recover because remember rest for illnesses can aggravate asthma now let's look at our medications used to treat asthma and we're gonna put these in two categories we're gonna go over bronchodilators and anti-inflammatories so first let's cover bronchodilators what do bronchodilators do just like the name says they are going to dilate our bronchioles or bronchi the airway so that patient can get better air flow and oxygenation now we have several types of bronchodilators we're going to be talking about beta agonists anticholinergics and a drug called theophylline all can perform bronchodilation for us first let's talk about beta agnus these are generally given that inhale drought whenever you're having asthma issues and the first type of beta agonist is called the short acting beta agonist hence they work fast they give us fast relief and a common type of drug use is called albuterol so if you ever see albuterol think short-acting bronchodilators and this provides fast relief during an attack now it's not used for daily treatment so this patient isn't going to take this every day and as a nurse one thing you want to ask this patient who has some asthma ask them how often are you using your albuterol inhaler and they shouldn't be using it any more than two times a week and if they tell you they're using it more than two times per week need to report that to the physician because there needs to be an adjustment in that patients asthma plane because their asthma is poorly controlled okay another type of beta agonist is a long-acting so it takes it a little bit longer to act and some drugs are solu met or saw Liam meter all or symbicort and symbicort you will see this a lot is actually a combination it's a long-acting bronchodilator and a corticosteroid in one and one inhaler and these long-acting beta agonists are never used Salone they are used with corticosteroids and they are not for an acute attack so this is not what you're going to be giving a patient during an acute attack they need something that's going to work fast like albuterol now there are some side effects with these beta agonists they can increase the heart rate cause tachycardia so if your patient already has tachycardic if they're already tachycardic and they're running like 120s already and they need a treatment of something like this may want to pick something else like an anticholinergic bronchodilator which will really not affect the heart rate as much it can also cause the patient to feel jittery or nervous no a lot of times patients tell me I just had my nebulizer treatment I feel nervous and jittery and these can cause that and again the heart rate if throwing up you want to monitor their heart rate to make sure they don't have any dysrhythmias next we have the anticholinergic bronchodilators and these are inhaled as well and you have two categories of them just like how you had with a beta agonist you have short acting and long acting so with the short acting a common drug is a prett Ropin and this is used a lot of times when the patient can't tolerate those effects with the beta agonists that increase heart rate things like that so the long acting popular kind is tyo tropen and so it's a little bit longer acting compared to your short acting and because these are the anticholinergics they can cause dry mouth so let your patient know that and to help with that they can take sugarless candy which will help increase the production slava so their mouth is a house dry then we have a drug called theophylline and this is a pill it's oral and this drug is not used as much as those other ones it's not one the first-line treatments but I want to go over it because in the hospital you will encounter some patients who take this medication you want to be familiar with it it's not prescribed as much because there's issues with toxicity and you have to maintain these constant blood levels and the blood level you want for it the AUSA limb then remember that 10 to 20 micrograms per milliliter and some education pieces with this is that they need to avoid consuming products that have caffeine because caffeine has the same properties as the off limb and when you're throwing caffeine in the system along with the awful and you're just increasing the risk for toxicity so would caffeine with that now let's look at our anti-inflammatories okay we're gonna go over corticosteroids we're gonna go over the leukotriene modifiers and immunomodulator drugs okay so first corticosteroids what are they gonna do they're gonna help decrease the inflammation in a sense they're gonna suppress our immune system and there's various routes patients can take these what most common is the inhaled route so let's throw question out there you have a patient who's on a long-acting bronchodilator they need that and they also need or their corticosteroid inhaler so you have two inhalers you're gonna get which one are you gonna get first first you're gonna give the long-acting bronchodilator because that's gonna dilate the airways and then you're gonna wait five minutes and then give the corticosteroid because that corticosteroid can then get in the airway and do its job now in severe cases of asthma they may need it IV MPO route for a while and corticosteroids are long term treatment they are not used in an acute attack and it helps prevent those signs and symptoms of an asthma attack and some common drugs include fluticasone budesonide or beck low Methos and one thing you need to watch out with these inhaled corticosteroids is that they can cause thrush and to help decrease the patient from developing this whenever they're using their inhaler they need to use a spacer with that that dramatically increase decreases the chances of them getting thrush in the mouth and another thing is after they get done using the record Co steroid inhaler they need to gargle and rinse the mouth with water and spit that water out again these are used like I said five minutes after a bronchodilator if a bronchodilator was ordered with that and these medications can cause osteoporosis over time especially in women so if you have a woman who's postmenopausal and she's at risk for this because she has low estrogen levels which lead to bone thinning anyway so they need to make sure they're getting calcium and vitamin D and can also cause cataracts as well okay another type of anti-inflammatory is leukotriene modifiers and these are given orally an appeal and a common one is Monte Lucas and how these work is that they block the function of leukotriene and what does look at rheem do leukotriene causes our smooth muscle to constrict and it increases mucus production so what this drug does is it blocks that from happening so what's going to happen we're gonna have relaxed smooth muscles so if we're gonna breathe better and we're gonna get decreased production of mucus so you're not going to get that mucus in there blocking that lumen even more now this medication is not for an acute attack it's for long-term treatment another type of anti-inflammatory is ohm elysium AB and this is given sub-q and it blocks the role of the immunoglobulin IgE so whenever that's blocked because it plays a role in our immune response we have a decrease allergic reaction hence decrease asthma attacks now this drug is used in patients whose asthma is poorly controlled and not being affected by these other treatments we have went over so in a sense it's like one of those last resorts now it's not for quick relief and if your patient is taking this they need to receive no live vaccines another type of anti-inflammatory is crumblin and this has given and held like a nebulizer and it's a non-steroidal anti allergy type medication and what it does is is it stops mast cells from secreting histamine and we know that histamine plays a huge role in an allergic response so whenever you have decreased histamine you can calm everything down patient can breathe better you have decreased mucus production decreased swelling and inflammation it's not for long it's for long-term it's not for quick relief so patients having an asthma attack you don't want to just give them this instead this is like part of the long-term treatment now if a patient is receiving this sometimes they can complain a burning sensation of their nut in their nose or a bad taste in their mouth along with starting to sneeze they can get itchy watery eyes and things like that so if that happens just reassure the patient is a temporary side effect of this medication okay so that wraps up this in clicks review / asthma thank you so much for watching don't forget to take the free quiz and to subscribe to 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Channel: RegisteredNurseRN

Views: 1,255,184

Keywords: asthma, asthma attack, asthma treatment, asthma cough, asthma symptoms, asthma pathophysiology, asthma nursing, asthma nursing interventions, asthma nclex review, asthma nclex, asthma nursing lecture, asthma nursing care, asthma treatment nursing

Id: GVTXJwv8ndY

Length: 29min 57sec (1797 seconds)

Published: Sat Nov 11 2017