asthma by mehreen

2.  At the end of this presentation the audience
will be able to:
 Explain the anatomy and physiology of
respiratory system .
 Define asthma.
 Describe the types of asthma.
 Discuss the pathophysiology of asthma.
 Elucidate the causes of asthma.
 Enlist the sign and symptoms of asthma.
 Discuss the diagnostic evaluation and
medical treatment of asthma.
 Explain the nursing care plan for asthmatic
patient.

4.  Most common disease of child hood
approximately 5% to 10% in school age
Childs.
 Prevalence is highest in African American
males from urban settings.
 In younger children the incidence is greater
in boys.
 Incidence is equal in boys and girls during
adolescence.

5. ASTHMA

6. • Inflammation
mediated by
systemic IgE
production
Atopic
(Extrinsic
asthma)
• Inflammation
mediated by
local IgE
production
Non-Atopic
(Intrinsic
asthma)

7.  Genetic factors childhood asthma
_ certain genes identified
_ family history
 Environmental factors later onset
asthma
_ hygiene hypothesis > reduced
_ early exposure to Bacteria /viruses

8.  Respiratory infections
 Irritants (air pollution , cold air,
cigarette smoke)
 Exercise
 Inhaled Allergens (dust mites
,molds, weed pollen ,grass etc)
 Changes in weather
 Medications such as aspirin , beta
blockers
 Gastro-esophageal reflex

9.  Asthma is primarily an
inflammatory condition of the
lungs.
 Bronchospasm is secondary to
inflammation.
 Every asthma attack has these
pathologic components:
1. Bronchospasm
(bronchoconstriction or smooth
muscle contraction)
2. increase mucus production.

10.  Edema and inflammation of the airways
mucosa.
 Infiltration of inflammatory cells
(eosinophil's ,neutrophils ,basophils ,
macrophages)
 Desquamation of epithelial and inflammatory
cells.

12.  Wheezing
 Chest tightness
 Dyspnea
 Persistent cough
 Tachypnea
 Exercise intolerance
 Nasal flaring (use of
accessory muscles)

13.  Abdominal pain and vomiting from severe
cough.
 Hypoxemia , respiratory alkalosis leading to
respiratory acidosis and possibly metabolic
alkalosis

14. 1. Infections_bronchiectasis , pneumonia ,
bronchiolitis
2. Atelectasis ,pneumothorax
,pneumomediastinum
3. Dehydration
4. Cardiac arrhythmias
5. Respiratory failure and death

15.  Eosinophillia in peripheral blood , nasal
secretions and sputum
 Complete blood count:
polymorphonuclear leukocytosis during
infection.
 Pulmonary function studies:
Diminished maximal breathing capacity.
 Peak expiratory flow rate (PEFR)
decreased.

16.  Arterial blood gases:
 respiratory acidosis and later
metabolic acidosis
 Examination of sputum shows
Curschmann spirals(mucus plugs, casts
from small bronchi) and charcot-
leyden (from breakdown of
esinophills)

17.  Chest X-ray
 Hyper-inflated and hyper-lucent
lungs
 Bronchiolar edema
 Routine skin testing to determine
allergic causes
a. Serum IgE - elevated if allergic
causes
b. Radio-allergo-sorbent test (RAST)
– assay for allergen specific IgE

18.  Manage symptoms and avoid attack
 Avoid contact with triggers
 Vacuuming
 Remove carpets/rugs
 Changing environment
e.g. drying out room

19.  Bronchodilators
 Short – acting
- Beta adrenoceptor agonists(albuterol
(ventoline , neubulizers solutions))
 Anticholinergics (atropine)
In severe attack
 Daily corticosteroids (by i/v,oral
,inhalation.
 long acting beta adrenocepter agonists
 Leukotriene Antagonists
 NSAIDS (CROMOLYN)
- It stabilize the mast cell membrane to
prevent the release of inflammory
substances)

20.  Adequate hydration
 Adequate oxygenation
 Appropriate treatment of any existing
infection
 Correction of acid-base balance
 Relief of fatigue

22.  Assess the patient breathing pattern
for prolong expiratory phase of
respiration
 Assess the wheezing sounds
(may be audible from a distance in
severe attack)
 Assess nasal flaring for accessory
muscle use for breathing.
 Assess level of anxiety and
apprehension.

23. I. Ineffective breathing pattern
related to bronchospasm .
II. Ineffective airway clearance
related to thick secretionand
airway narrowing.
III. Fluid volume deficit related to
hyperventilation and decreased
oral intake.
IV. Anxiety related to difficult
breathing and medical
interventions

24.  Promoting effective breathing pattern:
 Give high Fowler's position to allow
maximum lung expansion.
a. Elevate head opf the bed 90 degree.
 Administer oxygen if oxygen saturation is <
94%
 Institute pulse oximetry and cardiac and
respiratory monitoring

25.  Use humidity with or without oxygen to
help liquefy secretions and reduce
mucosal inflammation and edema.
 Use aerosolized bronchodilators or
inhaler with spacer device with
bronchodilators

26.  Provide a quiet room where the the child can
be closely observed.
 Explain the purpose of oxygen
 Equipment before oxygen is administered
and allow the child to feel and touch the
equipment.
 Encourage the parent to remain with child.
 Talk quietly and calmly to the child.

27.  Administer IV fluids as ordered
 Encourage moderate oral fluid intake.
a. Determine the Childs fluid preferences.
b. Avoid iced fluids ,which may provoke
bronchospasm

28.  Basis Of Pediatrics By Dr Pervez Akbar
Khan (8th Edition)
 Sandra Nettina:the Lippincott Of Nursing
Practice ,6th Ed