Asthma is a chronic inflammatory disorder of the airways.
Chapter 28 :: Patient With Asthma
Asthma is a chronic inflammatory disorder of the airways. There are 3 components of asthma: inflammation, increased mucous production, and bronchospasm. These components lead to recurrent episodes of wheezing, breathlessness, chest tightness, and cough, particularly at night or in the early morning. These episodes are associated with widespread but variable airflow obstruction that is usually reversible, either spontaneously or with treatment. The clinical course of asthma is unpredictable, ranging from periods of adequate control to exacerbations with very poor control of symptoms.
The goal of asthma treatment is to achieve and maintain control of the three components. Prevention of acute asthmatic attacks includes teaching patients to avoid personal triggers for asthma, prompt recognition and treatment of upper respiratory tract infections and sinusitis, and pretreatment or long-term control drug therapy for exercise-induced asthma. The classification of severity of asthma at initial diagnosis helps determine which types of medications are best suited to control the asthma symptoms. Drugs used to prevent or treat asthma symptoms include (1) ?-adrenergic agonists to control bronchospasm, (2) corticosteroids, leukotriene modifiers, and methylxanthines to control inflammatory response, and (3) anticholinergics to decrease mucus production.
Describe the pathophysiology of asthma.
Evaluate results of diagnostic testing in a patient with asthma.
Identify relevant assessment data for a patient with an acute asthma exacerbation.
Prioritize nursing care of a patient with an acute asthma exacerbation.
Appropriately delegate nursing care of a patient with an acute asthma exacerbation.
Describe the interprofessional care of a patient with asthma.
Formulate an individualized teaching plan for a patient with asthma.
C.J., a 20-year-old female college student, is admitted to the emergency department (ED) with a severe asthma attack after engaging in a tennis match. She is accompanied by her tennis partner, who drove her to the ED. On an initial assessment you see that she is sitting in an upright position, using her accessory muscles to breathe. She appears restless and anxious. Her vital signs are T 98.4°F (36.9°C), HR 128 beats/min, R 34/min, BP 160/82. Auscultation indicates faint wheezing on inspiration and expiration, and her expirations are prolonged. Hyperresonance is noted upon percussion. C.J. manages to tell you that she has a long history of asthma but that this is the worst attack she has ever experienced. She cannot identify any triggers that she may be sensitive to and has never been tested for allergens. She does not smoke or use alcohol. She had been using a bronchodilator metered-dose inhaler about once a day but has misplaced it. She also has a peak flow meter but has never used it.
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