Obtain a good history how many times they have

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: