versus

by: Kathleen DeSouza & Rennette Garcia

PATHOPHYSIOLOGY OF ASTHMA
 Asthma is a chronic lung disease that involves
inflammation of the bronchial airways
 Results in increased mucus production and widespread
airway narrowing
 Classified as extrinsic or intrinsic
 Extrinsic factors are characterized by symptoms that are
triggered by an allergic reaction
 Intrinsic factors are not understood but often triggered
by an upper respiratory tract or bronchial infection
 Some complications include death, decreased ability to
exercise or take part in other activities, lack of sleep due
to nighttime symptoms, permanent changes in the
function of the lungs, persistent cough
 Clinical manifestations include the following:
 Mild asthma
 Acute asthma attack
 Status asthmaticus
CAUSES, RISK FACTORS &
SIGNS/SYMPTOMS OF ASTHMA
 The cause of asthma is relatively unknown, but some researchers say it can be a combination of factors.
 Some factors are atophy, parents who have asthma, certain respiratory infections during childhood and
contact with some airborne allergens or exposure to some viral infections in infancy/early childhood
when the immune system is developing.
 Asthma is more common in women and African-Americans.
 Allergy is the strongest predisposing factor for asthma.
 Symptoms of asthma include wheezing, breathlessness, chest tightness, and cough.
 Nurses should watch for a “hunched over” position in a patient. It is an indication that the patient is
attempting to get more air.
 Assessing for signs of cyanosis is also extremely important.
NURSING CARE INTERVENTIONS OF
ASTHMA
 Overall goal of treatment is to control the disease
 Create an Asthma Action Plan
 Control & recognize asthma triggers
 Administration of prescribed medication
 Adequate fluid intake
 Rest period
 Effective breathing techniques
 Place patient in high Fowler’s position
 Provide oxygen therapy (as needed)
 Monitor vital signs & electrolytes
 Correct usage of peak flow meter
 Relaxation techniques
 Avoid foods that trigger attacks
 Dairy products
 Processed foods
 Nuts
 Fast food
DIAGNOSTIC TESTS FOR ASTHMA
 ABGs
 Pulmonary function test
 Chest radiographic examination
 Sputum culture
 Spirometry
 Allergy testing
DRUGS USED TO TREAT ASTHMA
 DRUGS USED TO TREAT ASTHMA
Drug Side Effects Nursing Intervention
Short-acting/Long-acting beta-adrenergic agonists
albuterol (Proventil), levabuterol (Xopenex), formoterol
Tachycardia, tremors, nervousness, Baseline vital signs, pulse ox, and mental status. Assess for
(Foradil), salmeterol (Diskus)
anxiety dysrhythmias and palpitations before administration.

Anti-cholinergic bronchodilating agents

Baseline vital signs and pulse ox. Assess respiratory status.
GI irritation, sore throat,
ipratropium bromide (Atrovent) Check for history of closed-angle glaucoma. Assess for
tachycardia, nausea
allergy to atropine.
Corticosteroids (inhaled)
mometasone furoate (Asmanex Twisthaler), fluticasone Hoarseness, dry mouth, fungal
Inspect oral cavity for signs of any type of infection.
(Flovent) infections (thrush)
Anti-leukotriene agents
montelukast (Singulair), zafirlukast (Accolate) Nausea, dyspepsia, headache Baseline vital signs, pulse ox, and pulmonary function tests.
Expectorants
Assess frequency and type of cough and characteristics of
bronchial secretions during therapy. Maintain fluid intake of
guaifenesin (Robitussin, Mucinex) GI upset, headache
1500-2000 ml/day to decrease viscosity of secretions.

Immunomodulator Agent
Assess for lung sounds and respiratory function. Assess for
omalizumab (Xolair) Injection site reaction
allergic reactions and injection site reactions.
Saline Solutions
hypotonic solutions (0.4%, 0.65% sodium chloride),
hypertonic solution (1.8% sodium chloride), isotonic n/a Record characteristics of cough before beginning therapy.
solution (0.9% sodium chloride)
PATHOPHYSIOLOGY OF EMPHYSEMA
EMPHYSEMA
A chronic, irreversible disease of the lungs
characterized by abnormal enlargement as well as
destruction of the tissue lining of the walls of the
alveoli.

 Classified as a Chronic Obstructive Pulmonary Disease (COPD)

 Shortness of breath occurs as air is trapped in the lungs due to
lack of supportive tissue, decreasing oxygen and increasing
carbon dioxide in the blood
 Chemicals released during inflammatory response form bullae.
 Barrel Chest (thoracic cage expansion)

 Flattening (diaphragm contraction)

 Weight loss and emaciation occur, possibly due to increased

work of breathing.
 Heart and liver
 Right sided cardiovascular muscle thickens (hypertrophy)

 Jugular vein distension

 Edema in sacral and perineal area and lower extremities s

disease progresses
 Enlargement of the liver with ascites

 Major causes:
 Smoking

 Alpha 1-anitrypsin deficiency (A1AD), a hereditary cause

NURSING CARE INTERVENTIONS OF
EMPHYSEMA
 Aimed at decreasing the patients anxiety and promoting
optimal air exchange.
 Elevating the head of the bed to facilitate breathing.
 Administering 1-2 L of oxygen via nasal cannula.
 It is important in COPD patients to use a low-flow

setting because this prevents weakening the brain’s

regulatory center which may cause respiratory failure.
 Increasing oral intake of fluids and using a humidifier may
liquefy secretions, aiding in their removal.
 Ensuring a high protein, high calorie diet divided into 5 or 6
small meals per day and drinking 2-3 L/day of fluids aids in the
maintenance of adequate nutritional status.
 Assisting the patient to quit smoking is very important. Teach
the patient the importance of reducing exposure to irritants,
effective breathing techniques, and relaxation control.
DIAGNOSTIC TESTS FOR EMPHYSEMA
 Pulmonary Function Testing
 Spirometry- Measuring tidal volume, total lung capacity.

Residual volume is increased.

 Pulse Oximetry
 Arterial Blood Gases
 PaO2 is decreased, PaCO2 is increased

 Complete Blood Count

 Increased erythrocytes (RBC’s), hematocrit, and hemoglobin
DRUGS USED TO TREAT EMPHYSEMA
Bronchodilators-enlarge the bronchioles for greater oxygenation and ease of secretion clearance.
Corticosteroids- Decrease pulmonary inflammation and obstruction (anti-inflammatory). Usually prescribed in an acute
exacerbation due to many side effects in long term therapy.
Oxygen therapy
Diuretics may be used for fluid removal as edema occurs in the lower extremities.

Drug Side Effects Nursing Intervention

Anticholinergics

• Record baseline vital signs and pulse

ipratropium (Atrovent)
Dry mouth, throat irritation, tachycardia, oximetry.
urinary retention, exacerbation of pulmonary
symptoms
• May not use ipratropium if patient has
closed-angle glaucoma.

Beta-adrenergic agonists

• Record baseline vital signs and pulse

albuterol (Proventil) oximetry.
Tachycardia, headache, dizziness, tremors,
salmeterol (Serevent) • Obtain baseline mental status.
nausea, vomiting
terbutaline (Brethine) • Notify physician if patient is experiencing
palpitations or dysrhythmias.

Anti-inflammatory agents

Anti-inflammatory agents: Hoarseness, dry mouth, fungal infections • Inspect oral cavity for presence of infection
flunisolide (AeroBid) (thrush)
fluticasone (Flovent HFA)
 COMPARISON & CONTRAST
Asthma Emphysema Similarities
•Classified as a COPD
Walls of alveoli remain
Pathophysiology Walls of alveoli degenerate •Bronchial airways become
intact
inflamed and constricted

Main predisposing factor is Main predisposing factor is May be caused by a hereditary

Causes
an allergy smoking factor

 Assist patient with various

Assist patient in Assess for signs of gasping for air
breathing techniques as
Nursing Care identifying asthma to initiate steps to facilitate
dyspnea eventually occurs at
“triggers” breathing
rest

ABG’s, pulmonary function

Diagnostic Tests Allergy testing Complete blood count
testing, pulse oximetry

Diuretics for lower extremity Beta adrenergic agents,

Medications  Immmunomodular agents
edema anticholinergics, corticosteroids
COMPARISON & CONTRAST

Asthma Emphysema
 REFERENCES
Christensen, B. L. & Kockrow, E. O. (2006). Foundations of Adult Health Nursing. Care of the Patient with a
Respiratory Disorder, 49, 1692-1697 ,1699-1702.
Clayton,B. D. , Stock, Y. N., Cooper, S. E. (2010). Basic Pharmacology for Nurses (15 th Edition). Drugs Used to
Treat Lower Respiratory Disease, 31, 478-499, 480-496.
Atropine Side Effects. (n.d.). Retrieved from http://www.drugs.com/sfx/atropine-side-effects.html#ixzz0pF9354s8
Asthma Facts and Figures. (n.d.). Retrieved from http://www.aafa.org/display.cfm?id=8&sub=42#_ftn1
Ladock, James. (n.d.). Retrieved from
http://www.healthguidance.org/entry/12597/1/Foods-to-Avoid-When-You-Have-Asthma.html
http://en.wikipedia.org/wik:/Emphysema. May 25,2010 16:26