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status asthmaticus and acute resp failure
Terms in this set (37)
Severe life threatening acute episode of airway obstruction that intensifies once it begins and IS NOT responding to routine therapy
Features of status asthmaticus
Inflammation of brochial mucosa, constriction of bronchiolar smooth muscles, thick secretions in airways, brochospasm
Status asthmaticus can lead to
Resp failure bc the resp muscles have increased oxygen consumption and the patient eventually tires out
Acute resp failure
Results from inadequate gas exchange
2 reasons for resp failure
Hypoxemia and hypercapnia
Insufficient oxygen transferred to blood. Decreases arterial O2 and saturation. PaO2 falls below 50
Inadequate CO2 removal... Increases arterial CO2. PaCO2 climbs above 50.
Acute resp failure is the result of
One or more diseases involving lungs or other body system
Who is at risk for status asthmatics?
Climate change, low socioeconomic status, family hx, smokers, noncompliance, those who OVER USE THEIR RESCUE INHALER BC of bronchospam
How asthmatics breathe
Emptying airway takes longer BC airways narrowed.
The more SOB the faster they breathe & less time there is to exhale.
Lungs will retain or trap air (hyperinflation)
Patho of status asthmaticus
INITIALLY RESP ALKALOSIS (from blowing off CO2 & hyperventilating).
PaCO2 begins to increase (trapped) & pH falls.
Leads to resp failure if not tx.
1st objective indication of status asthmaticus
Rising PaCO2 in a patient with an acute asthma attack
INITIAL physical sx of status asthmaticus
SOB, anxious, wheezing, pursed lip breathing, use of accessory muscles, diaphoresis, sitting up right, pursed lip breathing
Later sx of status asthmaticus
Choppy sentences, refractory hypoxemia, decreased LOC, diminished breath sounds
Degree of wheezing is NOT a reliable indicator of...
Degree of airway obstruction
Pulmonary function tests
Measures amt of airway obstruction. Base long term tx off of these results. Want pt to have rested well the night before and not have used bronchodiator in 6-8 hrs.
Peak flow meter
Indicator of current status. Use DAILY.
Potential complications with status asthmaticus
Atelectasis (alveoli collapse)
Medical mgmt of status asthmaticus
Oxygen: max 6L without resp consult.
Beta adrenergic agonists: RESCUE inhalers. Teach to use as RX and won't work if overused.
Corticosteroids: solumederol (IV push) inflammation and edema of airways. Prednisolone.
Aminophylline: WEAK bronchodilator, NOT crisis, MAINTENANCE.
Epinepherine: inhibits histamime release, decreases congestion and dry out bronchioles
Mechanical ventilation & status asthmaticus
Goal: oxygenate, rest And correct pH
Nursing responsibilities and status asthmaticus
Assess: often! Can turn quickly
Meds: on time as ordered
Environment: low stimulus
Pharmacology for status asthmaticus
SABA, Corticosteroids, anticholinergics, LABA
Short acting beta 2 adrenergic antagonists
Quick onset of 15-30 min, can last 4-6 hours.
DO NOT TX UNDERLYING INFLAMMATION
Ipratropium bromide (Atrovent).
Affect muscles around the bronchi (large airways).
Work by stopping muscles from tightening.
Also used for patients who don't tolerate SABAs well.
Medication of choice for relief of acute sx and PREVENTION of EXERCISE INDUCED asthma.
Doesn't increase HR as much as albuterol
Patient teaching with Corticosteroids
If to be uses with a SABA, take SABA 1st, wait 3-5 min, then the steroid and rinse mouth out after to prevent thrush. If thrush occurs tx with nystatin.
Decrease inflammation. Effective in alleviating sx which improves airway fxn.
Start with inhaled form (use spacer if needed) first.. An oral form can be added later if higher dose needed.
Meds: prednisone (PO), Methylprednisolone (IVP), Triamcinolone (inhaler), fluticasone (inhaler), beclomethasone
Therapeutic range for theophylline
10-20. Levels must be checked regularly to reduce risk of toxicity.
Not for acute distress.
Therapeutic range 10-20.
Caution: multiple drug interactions (tagament, phenytoin)
Allergy to check for with theophylline & aminophylline
Caffeine BC it's a xanthine derivative
Derivative of theophylline.
Less potent and shorter acting than theophylline.
NOT for acute situations.
S&S of aminophylline
Mgmt of asthma
Best managed by early tx and education.
Teach pt to learn triggers.
Use supplemental oxygen as ordered.
SABA medications are 1st used for prompt relief of airflow obstruction.
Other LABA meds
Prevent spasms and help control exercise induced asthma.
Used in conjunction with patients that require frequent use of rescue inhaler.
Salmeterol and fluticasone: advair inhaler
Treatment of acute resp failure
Treat underlying condition and restore ventilatory fxn.
S&S of acute resp failure
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