Signs & Symptoms -Asthma is illustrated by outbursts of shortness of breath, wheezing, and coughing and the production of thick, tenacious sputum. -Only as the attack begins to subside can the client expectorate large quantities of thick, stringy mucus. The skin is usually pale. -During a severe attack, the nurse may observe cyanosis of the client’s lips and nail beds.
Definition/Pathophysiology/Etiology -Asthma is usually a reversible obstructive disease of the lower airway. Inflammation of the airway and hyper responsiveness of the airway to internal or external stimuli are characteristics of asthma. -Acute asthma results from increasing airway obstruction caused by bronchospasm and bronchoconstriction, inflammation and edema of the lining of the bronchi and bronchioles and production of thick mucus that can plug the airway. Because alveoli cannot expel air, they hyperinflate and trap air in the lungs. The client breathes faster, blowing off excess CO2. Other pathiohysiologic changes include interference with gas exchange, poor perfusion, possible atelectasis. -Allergic asthma causes the immunoglobin E (IgE) inflammatory process.
-Symptomatic treatment is given at the time of the attack. -If the history and diagnostic test indicate allergy as the causative factor, treatment includes avoidance of the allergen, desensitization, or antihistamine therapy. -Oxygen may be nessacry is cyanosis occurs.
-Rescue therapy medications treat acute episodes of asthma. Maintence therapy is a daily regimen designed to prevent and control symptoms/
Diagnostics -Chest auscultation reveals expiratory and sometimes inspiratory wheezes and diminished breath sounds. Results of pulmonary function studies may be abnormal with total lung capacity and functional residual volume increased secondary to trapped air. The forced expiratory volume and forced vital capacity are decreased. – During acute attacks, blood gases shows hypoxemia.
-The partial pressure of carbon dioxide (PaCO2) level may be elevated if the asthma gets worse, but usually the PaCO2 is decreased because of the rapid respiratory rate. -A normal PaCO2 level in the latter part of an asthma attack may indicate inpending respiratory failure.
-The nurse administers oxygen if indicated and puts the client in a sitting position. -Increased fluid intake makes secretions less tenacious and replaces the fluid s lost through perspiration. -The nurse checks the intravenous site frequently for signs of extravasation. This monitoring is especially important during an acute attack because restlessness can result in catheter dislodgement. -The nurse determines whether the client has a peak flow meter and obtains one for the client if needed. The peak flow meter measures the peak expiratory flow rate (PEFR), which is the highest flow during forced expiration. -The nurse tells the client to seek care if reading fall below baseline and teaches the correct use of inhalers. -The nurse should help the client indentify triggering events.