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Asthma
A Case Study
Jaymie McAllister
NUR3026L: E.B.P. Case Study
BMC, UD Summer 2012
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Introduction
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Purpose:
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Present and explain a disease to enhance patient care and
promote disease awareness.
Topic:
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Asthma
Objectives:
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What is asthma?
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Presentation and triggers
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Pathophysiology
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Statistics
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Health Promotion
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What is Asthma?
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Asthma is a chronic lung disease that inflames and
narrows the airways.
Airway narrowing causes increased sensitivity to inhaled
agents
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Airway response to irritants results in even further airway
constriction and airway mucus production, making breathing
more difficult.
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Asthmatic Airway
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What Causes Asthma?
Atopy
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The inherited tendency to develop allergies
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Parents with asthma
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Respiratory infections during childhood
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Types of asthma
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Allergic
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Exercise-induced
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Cough-Variant
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Nocturnal
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Occasional
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Symptoms of Asthma
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Symptoms:
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Coughing (especially at night)
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Wheezing
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Shortness of breath
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Chest tightness, pain or pressure
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Bronchospasm
Symptoms vary among different people and depend on
the severity of the attack.
http://www.youtube.com/watch?v=VA9C_aCH7F0
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(Asthma wheezing)
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Triggers of Asthma
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Triggers can include:
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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
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Pathophysiology
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Triggers provoke airway response
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The airways under attack display:
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Hypersensitive inflammatory response
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:
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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-b9fb13f97362898e%40sessionmgr14&vid=3&hid=4.
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Asthma Statistics
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United States:
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Morbidity
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>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
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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
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
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Over 300 million people suffer from asthma worldwide and yearly there are nearly 250,000
asthma related deaths
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http://www.aaaai.org/about-the-aaaai/newsroom/asthma-statistics.aspx.
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http://www.dhhs.nh.gov/dphs/cdpc/asthma/documents/chapter3.pdf
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Diagnostics
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Asthma is difficult to distinguish between other diseases
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Diagnostic tests:
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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)
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Treatments
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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
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Examples:
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Corticosteroids (Nasonex)
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Long-acting beta agonists (Serevent)
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Leukotriene modifiers (Singulair)
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Theophylline (Theo-24)
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Combination therapies (Advair)
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Can be inhaled (2-4 puffs PRN), taken PO or injected and are sometimes taken in combination
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/
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Nursing Care Plan
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Nursing Diagnosis:
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Nursing Interventions:
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Ineffective breathing pattern related to decreased lung expansion.
 Patient presents with shortness of breath, wheezing and chest pain
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:
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Increase breathing efficiency
Increased airway expansion
Normalize vital signs
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NCLEX Question 1
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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
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Question 1 Rationale
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C; Inspiratory and expiratory wheezing are typical asthma
findings.
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NCLEX Question 2
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?
1)
A.
Take a full medical history
B.
Give inhaled quick-reliever drugs
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Apply a cardiac monitor
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Provide emotional support to the patient
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Question 2 Rationale
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B; A client having an acute asthma attack needs quickreliever drugs as soon as possible to increase the amount
of oxygen being delivered to the body tissues.
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Citations
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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
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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
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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/
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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.