ATI PN 2 FINAL REVIEW RESPIRATORY-S/S OF ASTHMA
Respiratory
-S/S of asthma
ATI p 125-127, Med-Surg p 900
EXPECTED FINDINGS
●● Dyspnea
●● Chest tightness
●● Anxiety or stress
PHYSICAL ASSESSMENT FINDINGS
●● Coughing
●● Wheezing
●● Mucus production
●● Use of accessory muscles
●● Prolonged exhalation
●● Poor oxygen saturation (low SaO2)
●● Barrel chest or increased chest diameter
Obtain history regarding current and previous asthma
exacerbations.
●● Onset and duration
●● Precipitating factors (stress, exercise, exposure
to irritant)
●● Changes in medication regimen
●● Medications that relieve symptoms
●● Other medications taken
●● Self-care methods used to relieve symptoms
RISK FACTORS
●● Older adult clients have decreased pulmonary reserves
due to physiologic lung changes that occur with the
aging process.
◯◯ Older adult clients are more susceptible to infections.
◯◯ The sensitivity of beta-adrenergic receptors decreases with age. As the beta receptors
age and lose sensitivity, they are less able to respond to agonists, which relax smooth
muscle and can result in bronchospasms.
●● Family history of asthma
●● Smoking
●● Secondhand smoke exposure
●● Environmental allergies
●● Exposure to chemical irritants or dust
●● Gastroesophageal reflux disease (GERD)
The most common indicators of asthma in adults include wheezing (high-pitched whistling
sounds on expiration), cough, difficulty breathing, recurrent chest tightness, and history of
obstructive symptoms that occur or worsen at night or in the presence of triggers. There
,may be breathlessness, increased respiration, tachycardia, pulsus paradoxus,
hyperexpansion of the thorax, use of accessory muscles to breathe, appearance of hunched
shoulders, chest deformity, increased nasal secretion, mucosal swelling, and nasal polyps.
The patient may be cyanotic and use a tripod position to breathe.
Monitoring Signs and Symptoms
Global Assessment
“Has your asthma been better or worse since your last visit?”
Recent Assessment
“In the past two weeks, how many days have you:
Had problems with coughing, wheezing, shortness of breath, or chest tightness
during the day?”
Awakened at night from sleep because of coughing or other asthma symptoms?”
Awakened in the morning with asthma symptoms that did not improve within 15
minutes of inhaling a short-acting inhaled beta2 agonist?”
Had symptoms while exercising or playing?”
Monitoring Pulmonary Function
Lung Function
“What is the highest and lowest your peak flow has been since your last visit?”
“Has your peak flow dropped below ______ L/min (80% of personal best) since your last
visit?”
“What did you do when this occurred?”
Peak Flow Monitoring Technique
“Please show me how you measure your peak flow.”
“When do you usually measure your peak flow?
Monitoring Quality of Life and Functional Status
“Since your last visit, how many days has your asthma caused you to:
Miss work or school?”
Reduce your activities?”
, (For caregivers) Change your activity because of your child’s asthma?”
“Since your last visit, have you had any unscheduled or ED visits or hospital stays?”
Monitoring Exacerbation History
“Since your last visit, have you had any episodes or times when your asthma symptoms
were a lot worse than usual?”
If yes, “what do you think caused the symptoms to get worse?”
If yes, “what did you do to control the symptoms?”
“Have there been any changes in your home or work environment (e.g., new smokers or
pets)?”
Monitoring Pharmacotherapy
Medications
“What medications are you taking?”
“How often do you take each medication?”
“How much do you take each time?”
“Have you missed or stopped taking any regular doses of your medications for any reason?”
“Have you had trouble filling your prescriptions (e.g., for financial reasons or not on
formulary)?”
How many puffs of your short-acting inhaled beta2 agonist (quick-relief medicine) do you
use per day?”
“How many [name short-acting inhaled beta2 agonist] inhalers [or pumps] have you been
through in the past month?”
“Have you tried any other medicines or remedies?”
Side Effects
“Has your asthma medicine caused you any problems, such as”
“Shakiness, nervousness, bad taste, sore throat, cough, or upset stomach?”
Inhaler Technique
, “Please show me how you use your inhaler.”
Monitoring Patient-Provider Communication and Patient Satisfaction
“What questions have you had about your asthma daily self-management plan and action
plan?”
“What problems have you had following your daily self-management plan? Your action
plan?”
“Has anything prevented you from getting the treatment you need for your asthma from me
or anyone else?”
“Have the costs of your asthma treatment interfered with your ability to get asthma care?”
“How satisfied are you with your asthma care?”
“How can we improve your asthma care?”
“Let’s review some important information:”
“When should you increase your medications? Which medication(s)?”
“When should you call me [your physician or nurse practitioner]? Do you know the
after-hours phone number?”
“If you can’t reach me, what ED would you go to?”
-Asthma pt positions
NURSING CARE
●● Position the client to maximize ventilation (high -Fowler’s).
●● Administer oxygen therapy as prescribed.
●● Monitor cardiac rate and rhythm for changes during an acute attack (can be irregular,
tachycardic, or with PVCs).
●● Initiate and maintain IV access.
●● Maintain a calm and reassuring demeanor.
●● Provide rest periods for older adult clients who have dyspnea. Design room and
walkways with opportunities for rest. Incorporate rest into ADLs.
●● Encourage prompt medical attention for infections and appropriate vaccinations.
●● Administer medications as prescribed.
-What are the fast-acting inhalers
Quick-relief medications are used only during acute exacerbations and should not be used
on a regular schedule. They promote prompt reversal of acute airflow obstruction and relief
of accompanying symptoms by direct relaxation of bronchial smooth muscle. Frequent use
Respiratory
-S/S of asthma
ATI p 125-127, Med-Surg p 900
EXPECTED FINDINGS
●● Dyspnea
●● Chest tightness
●● Anxiety or stress
PHYSICAL ASSESSMENT FINDINGS
●● Coughing
●● Wheezing
●● Mucus production
●● Use of accessory muscles
●● Prolonged exhalation
●● Poor oxygen saturation (low SaO2)
●● Barrel chest or increased chest diameter
Obtain history regarding current and previous asthma
exacerbations.
●● Onset and duration
●● Precipitating factors (stress, exercise, exposure
to irritant)
●● Changes in medication regimen
●● Medications that relieve symptoms
●● Other medications taken
●● Self-care methods used to relieve symptoms
RISK FACTORS
●● Older adult clients have decreased pulmonary reserves
due to physiologic lung changes that occur with the
aging process.
◯◯ Older adult clients are more susceptible to infections.
◯◯ The sensitivity of beta-adrenergic receptors decreases with age. As the beta receptors
age and lose sensitivity, they are less able to respond to agonists, which relax smooth
muscle and can result in bronchospasms.
●● Family history of asthma
●● Smoking
●● Secondhand smoke exposure
●● Environmental allergies
●● Exposure to chemical irritants or dust
●● Gastroesophageal reflux disease (GERD)
The most common indicators of asthma in adults include wheezing (high-pitched whistling
sounds on expiration), cough, difficulty breathing, recurrent chest tightness, and history of
obstructive symptoms that occur or worsen at night or in the presence of triggers. There
,may be breathlessness, increased respiration, tachycardia, pulsus paradoxus,
hyperexpansion of the thorax, use of accessory muscles to breathe, appearance of hunched
shoulders, chest deformity, increased nasal secretion, mucosal swelling, and nasal polyps.
The patient may be cyanotic and use a tripod position to breathe.
Monitoring Signs and Symptoms
Global Assessment
“Has your asthma been better or worse since your last visit?”
Recent Assessment
“In the past two weeks, how many days have you:
Had problems with coughing, wheezing, shortness of breath, or chest tightness
during the day?”
Awakened at night from sleep because of coughing or other asthma symptoms?”
Awakened in the morning with asthma symptoms that did not improve within 15
minutes of inhaling a short-acting inhaled beta2 agonist?”
Had symptoms while exercising or playing?”
Monitoring Pulmonary Function
Lung Function
“What is the highest and lowest your peak flow has been since your last visit?”
“Has your peak flow dropped below ______ L/min (80% of personal best) since your last
visit?”
“What did you do when this occurred?”
Peak Flow Monitoring Technique
“Please show me how you measure your peak flow.”
“When do you usually measure your peak flow?
Monitoring Quality of Life and Functional Status
“Since your last visit, how many days has your asthma caused you to:
Miss work or school?”
Reduce your activities?”
, (For caregivers) Change your activity because of your child’s asthma?”
“Since your last visit, have you had any unscheduled or ED visits or hospital stays?”
Monitoring Exacerbation History
“Since your last visit, have you had any episodes or times when your asthma symptoms
were a lot worse than usual?”
If yes, “what do you think caused the symptoms to get worse?”
If yes, “what did you do to control the symptoms?”
“Have there been any changes in your home or work environment (e.g., new smokers or
pets)?”
Monitoring Pharmacotherapy
Medications
“What medications are you taking?”
“How often do you take each medication?”
“How much do you take each time?”
“Have you missed or stopped taking any regular doses of your medications for any reason?”
“Have you had trouble filling your prescriptions (e.g., for financial reasons or not on
formulary)?”
How many puffs of your short-acting inhaled beta2 agonist (quick-relief medicine) do you
use per day?”
“How many [name short-acting inhaled beta2 agonist] inhalers [or pumps] have you been
through in the past month?”
“Have you tried any other medicines or remedies?”
Side Effects
“Has your asthma medicine caused you any problems, such as”
“Shakiness, nervousness, bad taste, sore throat, cough, or upset stomach?”
Inhaler Technique
, “Please show me how you use your inhaler.”
Monitoring Patient-Provider Communication and Patient Satisfaction
“What questions have you had about your asthma daily self-management plan and action
plan?”
“What problems have you had following your daily self-management plan? Your action
plan?”
“Has anything prevented you from getting the treatment you need for your asthma from me
or anyone else?”
“Have the costs of your asthma treatment interfered with your ability to get asthma care?”
“How satisfied are you with your asthma care?”
“How can we improve your asthma care?”
“Let’s review some important information:”
“When should you increase your medications? Which medication(s)?”
“When should you call me [your physician or nurse practitioner]? Do you know the
after-hours phone number?”
“If you can’t reach me, what ED would you go to?”
-Asthma pt positions
NURSING CARE
●● Position the client to maximize ventilation (high -Fowler’s).
●● Administer oxygen therapy as prescribed.
●● Monitor cardiac rate and rhythm for changes during an acute attack (can be irregular,
tachycardic, or with PVCs).
●● Initiate and maintain IV access.
●● Maintain a calm and reassuring demeanor.
●● Provide rest periods for older adult clients who have dyspnea. Design room and
walkways with opportunities for rest. Incorporate rest into ADLs.
●● Encourage prompt medical attention for infections and appropriate vaccinations.
●● Administer medications as prescribed.
-What are the fast-acting inhalers
Quick-relief medications are used only during acute exacerbations and should not be used
on a regular schedule. They promote prompt reversal of acute airflow obstruction and relief
of accompanying symptoms by direct relaxation of bronchial smooth muscle. Frequent use
