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Jaymie McAllisterNUR3026L: E.B.P. Case StudyBMC, UD Summer 2012

Asthma A Case Study

+Introduction

Purpose: Present and explain a disease to enhance patient care and

promote disease awareness.

Topic: Asthma

Objectives: What is asthma? Presentation and triggers Pathophysiology Statistics Health Promotion

+What is Asthma?

Asthma is a chronic lung disease that inflames and narrows the airways.

Airway narrowing causes increased sensitivity to inhaled agents Airway response to irritants results in even further airway

constriction and airway mucus production, making breathing more difficult.

+Asthmatic Airway

+What Causes Asthma?

Atopy The inherited tendency to develop allergies

Parents with asthma

Respiratory infections during childhood

Types of asthma Allergic Exercise-induced Cough-Variant Nocturnal Occasional

+Symptoms of Asthma

Symptoms: Coughing (especially at night) Wheezing Shortness of breath Chest tightness, pain or pressure Bronchospasm

Symptoms vary among different people and depend on the severity of the attack.

http://www.youtube.com/watch?v=VA9C_aCH7F0 (Asthma wheezing)

+Triggers of Asthma Triggers can include:

Infections Colds, viruses, sinus infections, flu

Exercise Varying degrees depending on severity of asthma

Weather Sudden changes in temperature and humidity, the presence of

cold air Tobacco smoke Allergens

Dust, pollen, pets, mold, cockroaches, etc. Irritants

Strong odors, perfumes, smoke, air pollution Strong emotions such as laughing or crying Medications

+Pathophysiology Triggers provoke airway response

Hypersensitive inflammatory response

The airways under attack display: Hyperinflation of the lungs Muscle hypertrophy Lamina reticularis thickening Mucosal edema Epithelial sloughing Cilia cell disruption Mucus hypersecretion

Allergic airway responses present with immunoglobin E (IgE) response mechanisms

Asthma is characterized by the presence of: Increase numbers of eosinophils, neurtrophils, lymphocytes and plasma cells in

the bronchial tissues Activated by T-lymphocytes

Bronchial secretions Mucus

Kaufman, G. (August 18, 2011). Asthma: Pathophysiology, Diagnosis and Management . In Pubmed.gov. Retrieved July 7, 2012, from http://ehis.ebscohost.com.ezproxy.lib.usf.edu/eds/pdfviewer/pdfviewer?sid=54f5540b-4b13-4875-b9fb-13f97362898e%40sessionmgr14&vid=3&hid=4.

+Asthma Statistics United States:

1 in 12 people in the U.S. have asthma (8% of population) 1 in 10 children have asthma (10% of children in U.S) Asthma is more prevalent in non-Caucasian groups In 2008, there was a noted 50% increase in the number of African American children with

asthma since 2001 Largest increase of all ethnic groups

Morbidity >50% of Americans with asthma had an attack in 2008 185 children and 3,262 adults died from asthma related problems in 2007 alone.

Co-Morbidities Adults with asthma are 3 times more likely to develop serious depression Adults with asthma are 5 times more likely to develop COPD than adults without asthma. Higher risk of cardiovascular diseases and diabetes in adults 45+ than adults without

asthma.

International Over 300 million people suffer from asthma worldwide and yearly there are nearly 250,000

asthma related deaths

http://www.aaaai.org/about-the-aaaai/newsroom/asthma-statistics.aspx.

http://www.dhhs.nh.gov/dphs/cdpc/asthma/documents/chapter3.pdf

+Diagnostics

Asthma is difficult to distinguish between other diseases

Diagnostic tests: Family history Past Medical History Auscultation of lung sounds

Assess for wheezing HPI

Wheezing, shortness of breath, chest pain, coughing Peak Flow Meter

Measures rate of air leaving the lungs Also used to monitor response to treatments

Spirometry Measure amount and rare of air leaving the lungs

Complete Pulmonary Function Test Determines lung volume and diffusion capacity

Chest X-Ray Bronchoprovacative Challenge Testing

Select irritants are inhaled through a nebulizer to determine asthma triggers Arterial Blood Gas/Pulse Oximetry

Determine how well blood is being oxygenated Blood draws

Taken to determine the circulation of IgE immunoglobins (indicates allergic response)

+Treatments Prognosis:

“Asthma cannot be cured. The goal of treatment is to minimize its effects on your life so that most of the time you feel well and are able to do what you enjoy doing.”- Harvard Health Publications Group

Two main types of drug treatments: Quick Reliever Drugs

Taken during an asthma attack Work to quickly relax the muscles surrounding the bronchial tubes- tubes open

wider Examples:

Albuterol, dispended by an inhaler Controller Drugs

Taken regularly to control asthma Reduced need for quick-reliever drugs

Examples: Corticosteroids (Nasonex) Long-acting beta agonists (Serevent)

Leukotriene modifiers (Singulair) Theophylline (Theo-24) Combination therapies (Advair) Can be inhaled (2-4 puffs PRN), taken PO or injected and are sometimes taken in

combinationHarvard Health Publications Group. (July 5, 2012). Asthma in Adults. In Krames Signs and Symptoms FastGuides. Retrieved July 7, 2012, from http://go.galegroup.com.ezproxy.lib.usf.edu/ps/

+Nursing Care Plan Nursing Diagnosis:

Ineffective breathing pattern related to decreased lung expansion. Patient presents with shortness of breath, wheezing and chest pain

Nursing Interventions: Collaborative:

Administer medications quick reliever drugs, give oxygen, provide nebulizer and increase humidity

Encourage Pursed Lip Breathing and Coughing Helps patient concentrate on and potentially control breathing, and

coughing may reduce amount of impairing sputum. Adjust patient positioning to promote maximum breathing ability

Adjust head of bed upward

Expected outcomes: Increase breathing efficiency Increased airway expansion Normalize vital signs

+NCLEX Question 1

1. Which assessment finding would help to confirm a diagnosis of asthma for a patient suspected of having the disorder?

a) Cyanosis of the upper extremities

b) Increased expiratory volume

c) Inspiratory and expiratory wheezing

d) Normal breath sounds

+Question 1 Rationale

C; Inspiratory and expiratory wheezing are typical asthma findings.

+NCLEX Question 2

1) A 19-year old male presents to the emergency department with acute asthma. His respiratory rate is 44 breaths per minute, and he appears to be in acute respiratory distress which action should be taken first?

A. Take a full medical history

B. Give inhaled quick-reliever drugs

C. Apply a cardiac monitor

D. Provide emotional support to the patient

+Question 2 Rationale

B; A client having an acute asthma attack needs quick-reliever drugs as soon as possible to increase the amount of oxygen being delivered to the body tissues.

+Citations Asthma Statistics | AAAAI. (n.d.). The American Academy of Allergy Asthma and

Immunology | AAAAI. Retrieved July 19, 2012, from http://www.aaaai.org/about-the-aaaai/newsroom/asthma-

statistics.aspxCleveland

Clinic. (n.d.). Cleveland Clinic. Retrieved July 19, 2012, from http://my.clevelandclinic.org/disorders/asthma/hic_asthma_an_overview.aspx

Asthma attack - MayoClinic.com. (n.d.). Mayo Clinic. Retrieved July 19, 2012, from http://www.mayoclinic.com/health/asthma-attack/DS01068/

Campbell, J. (n.d.). Managed care opportunities for improving ast... [Am J Manag Care. 2011] - PubMed - NCBI. National Center for Biotechnology Information. Retrieved July 19, 2012, from http://www.ncbi.nlm.nih.gov/pubmed/21761959

Category. (n.d.). Asthma Tests - Diagnostic Tests in Asthma. Asthma- All About Your Asthma. Retrieved July 19, 2012, from http://asthma.about.com/od/adultasthma/tp/asthma_tests.htm

Harvard Health Publications Group. (July 5, 2012). Asthma in Adults. In Krames Signs and Symptoms FastGuides. Retrieved July 7, 2012, from http://go.galegroup.com.ezproxy.lib.usf.edu/ps/

Kaufman, G. (August 18, 2011). Asthma: Pathophysiology, Diagnosis and Management . In Pubmed.gov. Retrieved July 7, 2012,from http://ehis.ebscohost.com.ezproxy.lib.usf.edu/eds/pdfviewer/pdfviewer? sid=54f5540b-4b13-4875-b9fb-13f97362898e%40sessionmgr14&vid=3&hid=4.