Presentation on theme: "NUR3026L: E.B.P. Case Study BMC, UD Summer 2012"— Presentation transcript:
1 NUR3026L: E.B.P. Case Study BMC, UD Summer 2012 AsthmaA Case StudyJaymie McAllisterNUR3026L: E.B.P. Case StudyBMC, UD Summer 2012
2 Introduction Purpose: Topic: Objectives: Present and explain a disease to enhance patient care and promote disease awareness.Topic:AsthmaObjectives:What is asthma?Presentation and triggersPathophysiologyStatisticsHealth Promotion
3 What is Asthma?Asthma is a chronic lung disease that inflames and narrows the airways.Airway narrowing causes increased sensitivity to inhaled agentsAirway response to irritants results in even further airway constriction and airway mucus production, making breathing more difficult.
5 What Causes Asthma? Atopy Parents with asthma The inherited tendency to develop allergiesParents with asthmaRespiratory infections during childhoodTypes of asthmaAllergicExercise-inducedCough-VariantNocturnalOccasional
6 Symptoms of Asthma Symptoms: Coughing (especially at night)WheezingShortness of breathChest tightness, pain or pressureBronchospasmSymptoms 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, fluExerciseVarying degrees depending on severity of asthmaWeatherSudden changes in temperature and humidity, the presence of cold airTobacco smokeAllergensDust, pollen, pets, mold, cockroaches, etc.IrritantsStrong odors, perfumes, smoke, air pollutionStrong emotions such as laughing or cryingMedications
8 Pathophysiology Triggers provoke airway response Hypersensitive inflammatory responseThe airways under attack display:Hyperinflation of the lungsMuscle hypertrophyLamina reticularis thickeningMucosal edemaEpithelial sloughingCilia cell disruptionMucus hypersecretionAllergic airway responses present with immunoglobin E (IgE) response mechanismsAsthma is characterized by the presence of:Increase numbers of eosinophils, neurtrophils, lymphocytes and plasma cells in the bronchial tissuesActivated by T-lymphocytesBronchial secretionsMucusKaufman, 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 groupsIn 2008, there was a noted 50% increase in the number of African American children with asthma since 2001Largest increase of all ethnic groupsMorbidity>50% of Americans with asthma had an attack in 2008185 children and 3,262 adults died from asthma related problems in 2007 alone.Co-MorbiditiesAdults with asthma are 3 times more likely to develop serious depressionAdults 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.InternationalOver 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 historyPast Medical HistoryAuscultation of lung soundsAssess for wheezingHPIWheezing, shortness of breath, chest pain, coughingPeak Flow MeterMeasures rate of air leaving the lungsAlso used to monitor response to treatmentsSpirometryMeasure amount and rare of air leaving the lungsComplete Pulmonary Function TestDetermines lung volume and diffusion capacityChest X-RayBronchoprovacative Challenge TestingSelect irritants are inhaled through a nebulizer to determine asthma triggersArterial Blood Gas/Pulse OximetryDetermine how well blood is being oxygenatedBlood drawsTaken 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 GroupTwo main types of drug treatments:Quick Reliever DrugsTaken during an asthma attackWork to quickly relax the muscles surrounding the bronchial tubes- tubes open widerExamples:Albuterol, dispended by an inhalerController DrugsTaken regularly to control asthmaReduced need for quick-reliever drugsCorticosteroids (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 combinationMy 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 albuterolPatients chest pain was treated with two sublingual doses of nitro…surprising bc nitro can cause bronchospasmHarvard 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 painNursing Interventions:Collaborative:Administer medications quick reliever drugs, give oxygen, provide nebulizer and increase humidityEncourage Pursed Lip Breathing and CoughingHelps patient concentrate on and potentially control breathing, and coughing may reduce amount of impairing sputum.Adjust patient positioning to promote maximum breathing abilityAdjust head of bed upwardExpected outcomes:Increase breathing efficiencyIncreased airway expansionNormalize vital signs
13 NCLEX Question 1Which assessment finding would help to confirm a diagnosis of asthma for a patient suspected of having the disorder?Cyanosis of the upper extremitiesIncreased expiratory volumeInspiratory and expiratory wheezingNormal breath sounds
14 Question 1 RationaleC; Inspiratory and expiratory wheezing are typical asthma findings.
15 NCLEX Question 2A 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 historyGive inhaled quick-reliever drugsApply a cardiac monitorProvide emotional support to the patient
16 Question 2 RationaleB; 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 CitationsAsthma Statistics | AAAAI. (n.d.). The American Academy of Allergy Asthma and Immunology | AAAAI. Retrieved July 19, 2012, fromClinic. (n.d.). Cleveland Clinic. Retrieved July 19, 2012, fromAsthma attack - MayoClinic.com. (n.d.). Mayo Clinic. Retrieved July 19, 2012, fromCampbell, 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, fromCategory. (n.d.). Asthma Tests - Diagnostic Tests in Asthma. Asthma- All About Your Asthma. Retrieved July 19, 2012, fromHarvard Health Publications Group. (July 5, 2012). Asthma in Adults. In Krames Signs and Symptoms FastGuides. Retrieved July 7, 2012, fromKaufman, 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.