obtain a good history, how many times they have symptoms in the day and how many times they have symptoms in the night, how many exacerbation per year and limitations Lowest level is Intermittent : may be using inhaler once or twice a year; not really affecting them; then the levels increase into persistent mild , Persistent moderate and Persistent severe -As the symptoms increase, the medications change Goal of treatment= to achieve and maintain control of asthma
Classifications give guidelines on how to treat, but focus is on assessment of severity at diagnosis and initial treatment and monitoring control of the disease (make sure we’re helping them function with little limitations). Medications for asthma control: Long term control and short term control Long term control Quick relief Anti-inflammatory drugs: Bronchodilators: Corticosteroids-inhaled or oral Leukotriene modifiers (Ex: singulair=once a day to prevent inflammation) Anti-IgE Short acting inhaled B2 adrenergic agonists (Ex. Proventil, Albuterol) Anticholinergic Bronchodilators: Anti-inflammatories: Long acting B2-adrenergic agonists (Ex: Atrovent, Serovent) Long acting oral B2-adrenergic agonist Methylxanthines (rarely used, Theophylline, unless really severe cases) Corticosteroids-systemic (Given IV push, Solumedrol) -Teaching includes knowing when and when not to take what medication. Remember to rinse out mouth after inhaled corticosteroid use to prevent the development of thrush. Teach how to use dry powder inhaler, aerosol, nebulizer. Nursing management of asthma -Teach patient to identify triggers and avoid their known personal triggers and if it cannot be avoided, teach the patient how to premedicate prior to exposure of known trigger -Acute management- ASSESSMENT (listen to lungs, BS present, location of breath sounds, absence, etc.)! Aggressive breathing treatments and medications, provide a calm environment -Discharge teaching: review inhaler/spacer use-have patient demonstrate technique -Develop an action plan-when to take meds, when to call the doctor, and trigger avoidance plan -If using peak flow meter-have patient demonstrate technique and verbalize what numbers mean -Review all medications -Teach, Teach, TEACH! COPD (Chronic Obstructive Pulmonary Disease) Two diseases that fall under the COPD umbrella are emphysema and chronic bronchitis Chronic bronchitis occurs when there is inflammation, an increase in mucus production and structural changes; differences in asthma, changes are not reversible Emphysema occurs when there is destruction and enlargement of air sacs (alveoli-where gas exchange occurs) lose space and lose opportunity for gas exchange ; can’t produce the oxygen needed Risk factors: Smoking is the #1 risk factor; genetics= AAT deficiency, occupation hazards, air pollution and infection Develops slowly over a period of time; one of the first common symptoms is a chronic intermittent cough; if seen early can prevent some structural changes. Dyspnea is progressive with exertion, can’t take a deep breath anymore, gradually interferes with ADLs Advanced:
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- Fall '16
- Denise Cauble
- Nursing, Chronic obstructive pulmonary disease, sputum