1. NUR3026L: E.B.P. Case Study BMC, UD Summer 2012
Asthma
A Case Study
Jaymie McAllister
NUR3026L: E.B.P. Case Study
BMC, UD Summer 2012

2. Introduction Purpose: Topic: Objectives:
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

3. 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.

4. Asthmatic Airway

5. What Causes Asthma? Atopy Parents with asthma
The inherited tendency to develop allergies
Parents with asthma
Respiratory infections during childhood
Types of asthma
Allergic
Exercise-induced
Cough-Variant
Nocturnal
Occasional

6. 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.
(Asthma wheezing)

7. 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

8. 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

9. Asthma Statistics United States: Morbidity Co-Morbidities
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
(May 2011). Asthma Statistics. American Academy of Allergy Asthma and Immunology . Retrieved July 8, 2012, from

10. 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)

11. 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
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 combination
My patient was taking 2 puffs of albuterol a day and was given nitroglycerin upon arrive to ER for chest pain.
Placed on caffiene free diet bc of albuterol
Patients chest pain was treated with two sublingual doses of nitro…
surprising bc nitro can cause bronchospasm
Harvard Health Publications Group. (July 5, 2012). Asthma in Adults. In Krames Signs and Symptoms FastGuides. Retrieved July 7, 2012, from

12. Nursing Care Plan Nursing Diagnosis: Nursing Interventions:
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

13. NCLEX Question 1
Which assessment finding would help to confirm a diagnosis of asthma for a patient suspected of having the disorder?
Cyanosis of the upper extremities
Increased expiratory volume
Inspiratory and expiratory wheezing
Normal breath sounds

14. Question 1 Rationale
C; Inspiratory and expiratory wheezing are typical asthma findings.

15. 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?
Take a full medical history
Give inhaled quick-reliever drugs
Apply a cardiac monitor
Provide emotional support to the patient

16. 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.

17. Citations
Asthma Statistics | AAAAI. (n.d.). The American Academy of Allergy Asthma and Immunology | AAAAI. Retrieved July 19, 2012, from
Clinic. (n.d.). Cleveland Clinic. Retrieved July 19, 2012, from
Asthma attack - MayoClinic.com. (n.d.). Mayo Clinic. Retrieved July 19, 2012, from
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
Category. (n.d.). Asthma Tests - Diagnostic Tests in Asthma. Asthma- All About Your Asthma. Retrieved July 19, 2012, from
Harvard Health Publications Group. (July 5, 2012). Asthma in Adults. In Krames Signs and Symptoms FastGuides. Retrieved July 7, 2012, from
Kaufman, G. (August 18, 2011). Asthma: Pathophysiology, Diagnosis and Management . In Pubmed.gov. Retrieved July 7, 2012,from sid=54f5540b-4b b9fb-13f e%40sessionmgr14&vid=3&hid=4.