Care of Patients with Asthma  Leukotriene modifiers.
Anti Leukotrienes are
By: Mari, Lean & Ruiz, Lord Ian
 Definition
What is Asthma?
- Asthma is a chronic inflammatory disease of the
airways that causes increased responsiveness of the
trachea and bronchi to various stimuli, results in
widespread narrowing of the airways that improves
either spontaneously or with therapy.
- An intense, unrelenting bronchospasm that does not
respond to the usual modes of therapy may result to
status asthmaticus (severe, prolonged asthma)
2 types of asthma
- Extrinsic asthma is caused by external agents such as
dust, lint, insecticides, mold spores, foods, pollen,
danders, or feathers. This type is best understood as an
allergic reaction to specific allergens. Exposure to an
allergen can cause an attack.
- Intrinsic asthma indicates that the specific causes
cannot be identified. It may be precipitated by many
situations, such as a common cold, upper respiratory
infection, or even exercise. This type usually begins in
humans over 35 years of age and develops into a
lifelong condition.
Pathophysiology ( see chart B1)
a. Assessment and Diagnostic tests
 Bronchiectasis is not readily diagnosed because
the symptoms can be mistaken for those of
simple chronic bronchitis. A definite sign is
offered by the prolonged history of productive
cough, with sputum consistently negative for
tubercle bacilli. The diagnosis is established by a
compound tomography (CT) scan, which
demonstrates either the presence or absence of
bronchial dilation.
b. Complications and Prevention
 Complications of asthma may include status
asthmaticus, respiratory failure, pneumonia, and
atelectasis. Airway obstruction, particularly
during acute asthmatic episodes, often results in
hypoxemia, requiring the administration of
oxygen and the monitoring of pulse oximetry
and arterial blood gases. Fluids are administered
because people with asthma are frequently
dehydrated from diaphoresis and insensible fluid
loss with hyperventilation.
c. Medical Management
Pharmacologic Therapy
 Short-acting beta2 –adrenergic agonists. These
are the medications of choice for relief of acute
symptoms and prevention of exercise-induced
asthma.
 Anticholinergics. Anticholinergics inhibit
muscarinic cholinergic receptors and reduce
intrinsic vagal tone of the airway.
 Corticosteroids. Corticosteroids are most
effective in alleviating symptoms, improving
airway function, and decreasing peak flow
variability.
potent bronchoconstrictors that also dilate blood
vessels and alter permeability.
 Immunomodulators. Prevent binding of IgE to
the high affinity receptors of basophils and mast
cells.
Peak flow Monitoring
 Peak flow meters. Peak flow meters measure
the highest airflow during a forced expiration.
 Daily peak flow monitoring. This is
recommended for patients who meet one or more
of the following criteria: have moderate or severe
persistent asthma, have poor perception of
changes in airflow or worsening symptoms, have
unexplained response to environmental or
occupational exposures, or at the discretion of
the clinician or patient.
 Function. If peak flow monitoring is used, it
helps measure asthma severity and, when added
to symptom monitoring, indicates the current
degree of asthma control.
CAUSES OF ASTHMA
▹ Family History
▹ Environment and Occupation
▹ Other Medical Conditions
▹ Race and Ethnicity
▹ Sex
Environment and Occupation
- Exposure to cigarette smoke during pregnancy or in a
child’s first few years
- Exposure to different microbes in the environment
- Exposures that occur in the workplace, such as
chemical irritants or industrial dusts
- Poor air quality from pollution or allergens
- Exercise
- Stress/ Emotional Upset
Other Medical Conditions
▹ Allergies.
▹ Obesity. Although the reasons are unclear, some
experts point to low-grade inflammation in the body
that occurs with extra weight.
▹ Respiratory infections and wheezing. Young
children who often have respiratory infections caused
by viruses.
Race and Ethnicity
African Americans and Puerto Ricans are at higher risk of
asthma than people of other races or ethnicities.
Sex
Among children, more boys than girls have asthma. Among
teens and adults, asthma is more common among women than
men.
CLINICAL MANIFESTATIONS
 cough (with or without mucus production), dyspnea,
and wheezing
  attacks often occur at night or early in the morning
 Generalized chest tightness and dyspnea
 Expiration requires effort and becomes prolonged
 diaphoresis, tachycardia, and a widened pulse
pressure may occur along with hypoxemia and
central cyanosis
II. Nursing Management
NURSING PROCESS: ASSESSMENT
▹ Assess the patient’s respiratory status by monitoring
the severity of the symptoms.
▹ Assess the level of oxygen saturation through the
pulse oximeter
▹ Monitor the patient’s vital signs.
▹ Assess history.
▹ Assess respiratory status.
▹ Assess medications
NURSING PROCESS: DIAGNOSIS
▹ Ineffective airway clearance related to increased
production of mucus and bronchospasm.
▹ Impaired gas exchange related to altered delivery of
inspired O2.
▹ Anxiety related to perceived threat of death.
NURSING PROCESS: PLANNING
▹ Maintenance of airway patency.
▹ Expectoration of secretions.
▹ Demonstration of absence/reduction of congestion
with breath sounds clear, respirations noiseless,
improved oxygen exchange.
▹ Verbalization of understanding of causes and
therapeutic management regimen.
▹ Demonstration of behaviors to improve or maintain
clear airway.
▹ Identification of potential complications and how to
initiate appropriate preventive or corrective actions.
allergen contacts such as dust, animal dander, feathers,
and pollen.
4. Teach the patient adaptive breathing techniques and
breathing exercises such as pursed-lip breathing and
positioning.
5. Teach the patient and family effective coughing
techniques.
6. Teach the importance of consuming large quantities of
fluid to liquefy secretions.
7. Teach relaxation techniques.
8. Provide the patient and family with information regarding
the care, cleaning, and maintenance of inhalation
equipment being used in the hospital or to be used at
home.
9. Provide the patient and family with respiratory related
health information such as pollution indexes, secondary
infection exposure, and community support groups.
10. Teach the patient to obtain vaccine for influenza and
pneumococcal pneumonia.
11. Teach the patient the signs and symptoms to report to the
physician, e.g., changes in sputum characteristics,
excessive fatigue, increased cough, increased SOB, fever,
chills, chest discomfort, and wheezing.
12. Teach the patient to avoid contact with people who have
respiratory infections.
PS. Some parts of the discussion are not found in the
powerpoint and handout. Please just take notes
Notes:

NURSING PROCESS: IMPLEMENTATION AND

EVALUATION

- Would depend on situation

DISCHARGE AND HOME CARE GUIDELINES

▹ Collaboration
▹ Health Education
▹ METERED DOSE INHALERS (WITH
SPACER
▹ NEBULIZER
▹ Compliance to therapy
▹ Home Visits/ Continuing Care

Health Education: Patient Teaching

1. Teach about prescribed medications such as

bronchodilators and corticosteroids: name, dosage,
purpose, time of administration, and side effects.
2. Provide the patient and family with information about
asthma as a disease, how to assess an asthmatic response,
what to do during the process of care, and criteria for
requesting professional assistance and acute emergency
care.
3. Assist the patient and family to examine secondary factors
that may precipitate asthmatic episodes, such as emotional
stress, fatigue, or environmental changes or specific