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 cover

asthma

. This video is part of an index

review

series on the respiratory system and as always, when you're done watching this video, don't forget to access the free quiz to test you on this condition, so let's get started. What is

asthma

? It is a chronic lung disease that causes narrowing and inflammation of the airways and we are talking specifically about the smaller airways, such as the bronchi and bronchioles, and in patients with asthma and these have chronic inflammation now remember that asthma has no cure, but it can be controlled with medications that we will talk about a little later and what happens is that this patient can be triggered, let's say, for example, that one of the triggers that causes an asthma attack is pet dander. , so they avoid pet dander, it inflames all these bronchi and bronchioles and can send them into an asthma attack, so the patient will start to experience chest tightness, difficulty breathing, cough, wheeze and we experience trapping of air which can eventually lead to respiratory acidosis, so how does this happen?

To understand the

pathophysiology

of an asthma attack, we need to talk about what we normally do with breathing, so let's think about both anatomy and physiology, so that every time we inhale, we inhale air. and it has oxygen and when we exhale, we exhale the carbon dioxide buildup in our blood to get rid of it because we don't want to keep the carbon dioxide in our blood if it stays in our blood. is acidic, it will cause us to go into an acidotic condition, so remember that when we breathe air, it enters our upper airways, then flows down through the lower airways, which is our trachea, into our bronchi and then that air descends to uniform levels.

The smaller airways are called bronchioles and then after the bronchioles are these little air sacs Aveo life sacs and this is really the functional unit of the lungs, this is where gas exchange occurs. If we take a bronchus, we had an alveolar sac, you can see there's a nice little capillary bed around it and what happens is the oxygen that you're breathing crosses into that capillary bed, goes into your blood and replenishes your organs and does this work. Now, what also crosses in the opposite direction is carbon dioxide. and it's going to flow and you're going to exhale it because you don't want it to build up in the body.

Now let's look at what happens in an asthma attack, so ask yourself what surrounds these structures that the bronchi and bronchioles smooth out. muscle these small areas here in blue represent the smooth muscle now what does this smooth muscle do? It can contract and dilate when it contracts, that narrows the lumen of that airway, so not much air will flow and it can dilate to allow. air flow and we get patients medications that can alter the way the smooth muscle works, so bronchodilators, which is one of these big medications that we get, patients who have asthma now say that patients become active like we talked about before and they inhale it. some pet dander and it's triggered an asthma attack, so this allergen has come in and what's going to happen to that smooth muscle is going to contract, it's going to contract and the patient is going to start feeling tightness in the chest is also going to have difficulties. breathing because they don't actually move much air when those smooth muscles contract like that.

Now let's think about what's inside these structures of the bronchi and bronchioles. We have a mucosal lining that has these special cells called goblet cells. Now goblet cells are really useful on the surface because every time we breathe in that mucus, because those goblet cells produce mucus, they pick up the irritants that we breathe in bacteria and prevent them from going further into our airways, but when an allergen like that dander of pet that has triggered this patient McKenzie's eyes and they work, they are over stimulated, so they start producing a lot of mucus and this mucosal lining that is already inflamed will become even more inflamed, so you have more inflammation and you have this.

Excess mucus production is occurring, so what will all this lead to? We are going to have a further decrease in our airflow because we have mucus in the way and we have the mucosal lining severely inflamed. Now these patients are going to start coughing because of everything. this mucus and wheezing and the reason is that as the air flows through these narrow airways and comes into contact with this mucus that's there, it will produce a sound similar to a musical whistle, so you will be able to hear it, especially in expert experience whenever you're listening with your expert stethoscope or wheezing, but it can become so severe and asthma, if it's a really severe asthma attack, they can have it on both inhalation and expiration.

Now think about what's going to happen in these bags. Does the air really come out? to move out, no, it's going to be trapped, so there's going to be air trapped in there and one thing you'll notice with asthma patients, if you've ever seen a patient have an asthma attack, they can't exhale completely like that. It's one thing they're really struggling with and it makes sense with all these structures involved, so if we have air trapping the gas exchange doesn't happen, so the carbon dioxide isn't going to come out of this sac, it's going to stay there. oxygen from the blood is not going to enter the blood, so we will have reduced levels of oxygen in the blood, but we will have elevated levels of carbon dioxide in the blood, so what I am saying is that carbon dioxide is like acid.

We will make our blood acidotic so that the patient who is going to start may experience a condition called respiratory acidosis. Now asthma attacks vary in severity between patients, so as a nurse, it is very important that you help the patient identify the triggers that lead them to have asthma. attack now the cause of asthma itself is unknown, they think it may be a genetic or environmental factor, but they do know that there are certain things that can cause a person to have an asthma attack, which include environmental factors such as smoke, this can be first hand, second hand. smoke, pollen, pollution, perfumes, pet dander, dust mites, pests like cockroach droppings, cold, dry air can cause those smooth muscles in your airways to contract and mold, otherwise body problems like that the patient has a respiratory infection, this can trigger an asthma attack, hormonal GERD.

The changes, especially in women, can be caused by exercise, which is why exercise induces asthma. Another thing is the intake of certain substances such as medications and, for example, beta adrenergic blockers that are non-selective and we have talked a lot about this in our cardiac videos. in EDS, aspirin and preservatives like sulfites, so all of these things, depending on the patient, can trigger an asthma attack and they need to be educated to avoid these things. Another thing that the patient should be educated about are the early warning signs and

symptoms

that an asthma attack may be pending and these signs and

symptoms

may occur approximately one or two days before a full-blown active asthma attack occurs. and here we are going to compare early versus active signs and symptoms so that whenever you talk to inform your patient about these early warning signs and symptoms; hopefully you will also have an action plan developed by the doctor and this is what a basic action plan looks like and it is based on zones and you have a green zone and a yellow zone. and a red zone and depending on the patient's signs and symptoms and if you notice in yellow we are starting to get into that category of early signs and symptoms, the patient's asthma is getting worse because he drinks coffee and he is wheezing, maybe he has chest tightness .

They wake up at night and can't do their normal activities, and based on that, they will take what they need to help control their asthma and maintain a full-blown asthma attack. Now, another thing you can do is use a pickaxe. flow meter device and these devices are really amazing and they help the patient know if their asthma is getting worse and help them prevent them from actually having exacerbations of an asthma attack and this is what one of those devices looks like and what it does the patient is The patient will exhale completely as hard as they can into this device and it will tell you how much airflow is actually coming out because remember with asthma we have problems with airflow and in the

nursing

intervention part we will talk about how to use it and how. to provide education on this, but I just wanted to familiarize you with that because the action plan that you just saw goes hand in hand with the patient's signs and symptoms and using that peak flow meter is fine, so the first signs and symptoms suddenly the patient has trouble breathing easily where they normally wouldn't or gets easily fatigued with physical activity, so if this happens the patient needs to know, hey, something is going on in my airway, other thing is that he is having that. frequent call and it starts to occur mainly at night and that is an excessive production of mucus by those goblet cells and this will cause them to have problems sleeping, so they will not sleep well at night, they will look extremely tired, which will cause irritability, they may also have signs and symptoms similar to developing a cold, such as sneezing, a scratchy throat, and tiredness, and they may begin to notice that they are breathing a little hard with activity and then if they use a spout . flow meter device that have noticed that, based on their personal best reading, the reading is drastically reduced, so less air flow is arriving.

What are those signs and symptoms of an active asthma attack that is literally happening and this patient is experiencing it? They will have chest tightness and remember we went over while they have chest tightness that is mild with tight muscles, they have wheezing and as a nurse if you listen with your stethoscope you can hear expert oral wheezing it is very serious you can hear it. Both in inventory and in experience, they will just have this cough that won't stop and it's just coughing, coughing and it makes me have difficulty breathing and especially when exhaling, increased respiratory rate of course, and all this if this is not treat and take care of yourself.

It's like with bronchodilators and applying some corticosteroids after the bronchodilator gives them oxygen. Things like that can progress to the point where those bronchodilators, those short-acting bronchodilators, rescue inhalers don't even work, like they're beyond the point of working. They won't be able to talk to you talking it's just not happening, they are trying to breathe they may also have chest retractions and what could it be, this is their stomach will be suctioned, their ribs will be pulled out, it literally looks like the skin is stretched over the ribcage , the clavicle, the clavicle will protrude and this is where they just don't get air in and if you see that that is an emergency, cyanosis will also appear. very early you will start to see it on the signs and on the lips and it will be like this dark blue color.

I know a lot of patients that I've seen, it's like this little blue ring that 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 don't get oxygen to the tissues because remember that oxygen exchange does not occur in that capillary bed, we have no airflow due to trapped air as well. They will sweat and when this happens, the patient needs medical

treatment

very quickly and they may need to be intubated, get mechanical ventilation, intravenous corticosteroids and things like that. Now let's look at some more

nursing

interventions

, okay, let's talk about if your patient shows up.

With an asthma attack, what are you going to do and of course depending on the severity of the attack? Because every patient can vary, you're going to have to modify some of these, but of course the first thing you want to do is get the vital signs because you want a baseline of where your patient is currently, because you're going to give them

treatment

, you want see if you are responding to these treatments, if your oxygen saturation increases, if your respiratory rate drops to the normal range as your heart rate is slowing. Are you doing better?

So you want to do that. You will also want to stay calm and you will 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 afraid because that will make the patient even more scared because he's already anxious because he can't breathe with the position. You want to keep him in high Fowler's position to help him breathe and make entry easier. the order that you will want to give them bronchodilators and what type we are going to give them we are going to give them short action long action we want to do short action and we will go over them here in a second in depth because we want something that will act quickly andwill dilate those airways so this patient can breathe.

We want to give him oxygen. Maintain oxygen saturation between 95 and 99%. We want to evaluate those lungs before we give him medications because we're hearing those wheezing. While they are breathing, they are giving them a nebulizer treatment and after we want to see how the wheezing decreases, they breathe better, so let's listen to ourselves to evaluate that and also evaluate the cyanosis and the lips and the skin are receiving 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 they can talk to you now or they still can't talk because they are so short of breath and then evaluate their peak flow meter and we will talk about that here in a second in more detail, but while all of this is happening, if your patient can communicate with you, you want to get a baseline of what their peak slope numbers are. because a lot of asthma patients use these devices and they know what their personal best number is and based on what their personal best number is in a percentage, you can see if they decrease and if they have been using their peak flow meter before it got to you what the reading was and each time you are collecting, you can compare the two and also the medications.

Have you already taken a bronchodilator? It hasn't worked, which is a big red flag, so you want to see everything they've tried. before they actually get in now let's talk about that peak flow meter what does it do? It shows how controlled your asthma is and whether it is getting worse. I want to cover this because when caring for patients with asthma. You are going to come into contact with these devices and I want you to become familiar with them and how to educate the patient on how to use them. So this peak flow meter looks like this and again remember to exhale completely into it. the patient will do it and they will do it several times and it will measure their readings and it will be used in conjunction with the action plan that we went over earlier and the less the patient will know when they should use their short acting bronchodilators because they have some problems.

Because we want to prevent full-blown asthma, it's hot and when it's really time to seek medical help, how does this flow meter work? Whenever a patient starts using a flow meter at first, they need to calculate their personal best flow meter reading number and this will be the highest number they reach over a period of time and this number will be used to compare with other numbers. reading to make sure the patient's asthma is under good control, so whenever you have A patient with asthma might want to ask you what your personal best peak flow meter reading was because that will help you have a baseline of where you should be while providing care, so to figure this out, the patient will do this when their asthma is under good control, not when they have asthma attacks and problems with that, so they want to do this to determine the best flow meter reading when your asthma is under control and you are doing well, to measure it once. in the morning and once at night for three weeks usually and record the number before you take the medication so they keep this little record of this and then whatever the highest number they got in that period is going to be their best reading of the peak flow meter. just to keep your asthma under control to continue to control it, they will need to monitor it at the same time, whether in the morning or at night, before you take your medication and compare it to your best reading and generally if it is less than 80% of your personal level.

The best part is that they will want to follow the action plan they developed with their doctor, so you will educate your patient on how to follow the asthma action plan and go over each zone with them: green, yellow, and red. and explain to them those signs and symptoms, what their peak flow meter reading is and what they should do, what medications they should take and how often, based on what the doctor wrote, you need a test, the patient makes sure they understand how do it. That's because following these action plans and using the peak flow meter really helps decrease the number of patients that come in with this asthma exacerbation, so it really helps prevent them from having to go to the hospital.

It's great, as well as teaching them the triggers we just went over earlier. and those warning signs, however, you may be thinking well, what if they can prevent pet dander? They can avoid pollen and all that, but are they really supposed to avoid exercise because they have exercise-induced asthma and the answer is no, they need to exercise? You don't need to stop because exercise is good for your overall health, so you can do some things that can help prevent an asthma attack, such as warming up 10 to 15 minutes before exercising and also taking beta short-acting before you exercise, so get Bronco.

They also have a dilator if they choose to exercise outside on a cold, windy day because cold air can cause smooth muscle to contract, which can trigger an asthma attack, so they need to breathe through their nose, which It will help warm the air before it sinks. into your lungs instead of breathing through your mouth and wearing it like a scarf or something over your mouth to keep cold air from getting in there. Also if they have a respiratory illness, a cold, something like that, they want to stop exercising until they recover because they remember to rest. because diseases can aggravate asthma now let's look at our medications used to treat asthma and we will put them into two categories, we will go over bronchodilators and anti-inflammatories, so first let's cover bronchodilators, what do bronchodilators do just as the name says?

They will dilate our bronchioles or bronchi, the respiratory tract so that the patient can obtain better air flow and oxygenation. Now we have several types of bronchodilators, we are going to talk about beta agonists, anticholinergics and a drug called theophylline, they can all do bronchodilation for us. First, let's talk about beta agnus. These are usually inhaled when you have asthma problems and the first type of beta agonist is called short acting beta agonist so they work fast, give us quick relief and a common type of medication use. It's called albuterol, so if you ever see albuterol, think short-acting bronchodilators and this provides quick relief during an attack.

Now it's not used for daily treatment, so this patient is not going to take this every day and as a nurse, one thing you want to ask this patient who has some asthma, ask him how often does he use his inhaler? albuterol and you should not use it more than twice a week and if it tells you that you are using it more than twice a week, you should do so. Report that to the doctor because an adjustment needs to be made in the patient's asthma plan because his asthma is poorly controlled. Well, another type of beta agonist is long-acting, so it takes a little longer to work and some medications are solutions. or I saw Liam put everything in or symbicort and symbicort you will see a lot this is actually a combination it is a long acting bronchodilator and a corticosteroid in one and an 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 they are going to give a patient during an acute attack.

They need something that works fast like albuterol. Now there are some side effects with these beta agonists. They can increase your heart rate. The rate causes tachycardia, so if your patient already has tachycardia and is already running like 120 and needs treatment for something like this, you might want to choose something else, like an anticholinergic bronchodilator that won't really affect the heart. No, many times patients tell me that I just received my nebulizer treatment. I feel jittery and jittery and this can cause that and again if you vomit you want to monitor your heart rate. their heart rate to make sure they don't have any arrhythmias.

Then we have the anticholinergic bronchodilators and these are also inhaled and there are two categories of them, like the ones I had with a beta agonist: they have short acting and long acting, so with the common short acting medication it is a nice Ropin and it is used a lot times when the patient can't tolerate those effects with beta agonists that increase heart rate, things like that, so the popular long-acting type is tyo tropen and that's why it's a little bit longer acting compared to the short and because these are anticholinergics they can cause dry mouth so let your patient know and to help them you can take sugar free sweets which will help increase slava production to make your mouth a house. dry so we have a medication called theophylline and this is a pill it is oral and this medication is not used as much as the others it is not one of the first line treatments but I want to go over it because in the hospital you will find some Patients who take this medication should be familiar with it, it is not prescribed as much because there are toxicity problems and you have to keep these blood levels constant and the blood level you want for the AUSA limb, then remember that 10 to 20 micrograms per milliliter and some educational pieces with this is that they should avoid consuming products that have caffeine because caffeine has the same properties as the extremity and when you add caffeine to the system along with the horrible, you are only increasing the risk. for toxicity so would caffeine with that now let's look at our anti-inflammatories okay we'll go over corticosteroids we'll go over leukotriene modifiers and immunomodulatory medications okay first the corticosteroids what are they going to do?

They will help reduce. inflammation in a sense is going to suppress our immune system and there are several routes that patients can take, the most common is the inhaled route, so let's ask a question: you have a patient who is taking a long-acting bronchodilator, does he need it and You also need your corticosteroid inhaler, so you have two inhalers, you'll get which one you'll get first, you'll give them the long-acting bronchodilator first because that will dilate the airways and then you'll wait five minutes and then give the corticosteroid because that corticosteroid can get into the airways. respiratory and do their job now, in severe cases of asthma, they may need it intravenously MPO for a while and corticosteroids are a long-term treatment, they are not used in an acute attack and they help. prevent those signs and symptoms of an asthma attack and some common medications include fluticasone budesonide or beck low Methos and one thing to keep in mind with these inhaled corticosteroids is that they can cause thrush and help slow the development of this by the patient whenever they do.

While using their inhaler they need to use a spacer which drastically increases the chances of them getting thrush in their mouth and another thing is that after they finish using the record costeroid inhaler they need to gargle and rinse their mouth with water and spit that water again these are used like I said five minutes after a bronchodilator if a bronchodilator was prescribed with that and these medications can cause osteoporosis over time especially in women so if you have a postmenopausal woman and she's at risk for this because it has low levels of estrogen, which causes thinning of the bones anyway, so you have to make sure you get calcium and vitamin D and it can also cause cataracts.

Well, another type of anti-inflammatory is leukotriene modifiers and these are administered orally. a common one is Monte Lucas and how they work is that they block the function of leukotrienes and what does seem to be that leukotrienes cause our smooth muscle to contract and increases mucus production, so what this medication does is block that to It doesn't happen, so what's going on? If this happens, we will have relaxed smooth muscles, so if we are going to breathe better and we are going to have less mucus production, then we are not going to have that mucus there blocking that light even more, now this medicine is not for an acute attack it is for long term treatment, another type of anti-inflammatory is ohm elysium AB and it is administered sub-q and it blocks the role of immunoglobulin IgE, so whenever it is blocked because it plays a role in our immune response, it has a lower allergic reaction, therefore, reducing asthma attacks.

Now this medication is used in patients whose asthma is poorly controlled and they are not affected by these other treatments that we have gone over, so in a sense it is like one of those last resorts, now it is not for quick relief. and if your patient is taking this, they do not need to receive live vaccines, another type of anti-inflammatory is crumblen and it is administered and maintained as a nebulizer and it is a non-steroidal anti-allergy medication and what it does is stop the mast. cells secrete histamine and we know that histamine plays a very important role in an allergic response, so as long as there is a decrease in histamine it can calm everything down, the patient canbreathe better, mucus production has decreased, swelling and inflammation have decreased, it's not for a long time, it's for a long time.

It is not for quick relief, so patients who have an asthma attack are not better off just giving this, but rather it is as part of long-term treatment. Now, if a patient receives this, they may sometimes complain of a burning sensation in the nut. nose or a bad taste in the mouth in addition to starting to sneeze, they may get itchy, watery eyes and things like that, so if that happens, just reassure the patient, it's a temporary side effect of this medication, okay, this concludes in a click

review

. asthma Thank you very much for watching, don't forget to take the free quiz and subscribe to our channel to see more videos.