<p> Evelynn Gallardo 9/15/15HPS Asthma</p><p>1. What factors may trigger an asthmatic episode?Allergic reactions like dust, pollen, food, and animals. Infections of the common flu, Influenza, cold air, emotional stress, excitement, pollution, drugs like Aspirin, Ibuprofen, cardiac drugs, sleep, house hold items, and vigorous exercise.2. What are the clinical manifestations of a child experiencing an exacerbation of asthma?Coughing (usually dry cough), wheezing (usually on expiration), chest tightness or pain, and/or difficulty breathing- SOB. If mild exacerbation, the child remains pink, but as asthma worsens, cyanosis might result. Some children present with mild retractions, while others demonstrate significant accessory muscle use and eventually head bobbing if not effectively treated. Child may appear anxious and fearful, or be lethargic and irritable. Children with persistent severe asthma may have a barrel chest and routinely demonstrate mildly increased work of breathing.3. Explain the progression of asthma that is nonresponsive to treatment. Statusasthmaticusisrespiratorydistressdespitevigoroustreatmentmeasuresincludingalbuterolandepinephrine.Thisisconsideredamedicalemergencythatcanresultinrespiratoryfailureanddeathifleftuntreated.</p><p>4. Discuss the pathophysiology of asthma. Includescomplexinteractionsamonginflammatorycells,mediators,andcellsandtissuepresentintheairways. Anothercomponentisbronchospasms obstruction: Inflammatoryresponsetostimuli,airwayedemaandaccumulationandsecretionofmucusospasmofthesmoothmuscleofbronchiand bronchioles.5. Discuss the actions, side effects, contraindications, and nursing implications of the following medications in the treatment of asthma: albuterol, atrovent, epinephrine, prednisolone, prednisone, solumedrol, magnesium sulfate, sodium bicarbonate. Albuterol- Bronchiodilator, SE: chest pain, tremor, palpitations, Contraindications: hypersensitivity to adrenergic amines, Implications: for inhaler shake well use a spacer for children under 8.Atrovent-Inhibits cholinergic receptors in bronchial smooth muscle/ bronchodilation, SE: hypotension, sore throat, headache, Contraindications: avoid use during acute bronchospasm/ hypersensitivity to ipratropium, atropine, When ipratropium is administered concurrently with other inhalation medications, administer adrenergic bronchodilators first, wait 5 mins between medications. Epinephrine- These drugs stimulate all the sympathetic receptors, SE: nervousness , nausea / vomiting ,headaches , palpitations , hypertension. Contraindications: hypersensitivity to adrenergic amines. Prednisolone-suppression of inflammation and modification of the normal immune response. SE: euphoria, hypertension, muscle wasting, Contraindicated: active untreated infections, known alcohol or bisulfite hypersensitivity or intolerance. Prednisone-suppression of inflammation and modification of the normal immune response. SE: euphoria, hypertension, cushoid appearance, Contraindicated: active untreated infections, known alcohol or bisulfite hypersensitivity or intolerance. Solumedrol- suppression of inflammation and modification of the normal immune response. SE: hypertension, depression, euphoria. Contraindications: administration of live vaccines, active untreated infections, known alcohol or bisulfite hypersensitivity or intolerance.</p><p> magnesium sulfate- muscle relaxant, SE: diarrhea, arrhythmias, decreased respiratory rate, contraindicated: hypermagnesemia, heart block, hypocalcemia, has been considered as an adjunct therapy for severe and life-threatening asthma exacerbation. Check dose, calculations high alert accidental overdose may occur. sodium bicarbonate- Adjusts the pH of mucus, decreasing the surface tension to facilitate mucolytic action. Indication: tracheal irrigation. SE: metabolic alkalosis, edema. Contraindicated: renal failure, excessive chloride loss, patients on sodium restricted diets, ensure accurate dose.6. Discuss the following treatment modalities for the treatment of asthma and note when each is indicated: aerosolized medications by nebulizer, metered-dose inhaler, oxygen, heliox therapy, and BiPap.Aerosolized medications by nebulizer- Nebulizers are used to provide aerosol therapy to patients too ill or too young to use handheld devices and in situations where large drug doses are necessary. These devices also are required for some medications available only in liquid form, including pentamidine, ribavirin, DNAase, hypertonic saline, and tobramycinMetered-doseinhaler:Aformofadministeringasthmamedications. A spacer is an external device that is attached to an MDI to allow for better drug delivery by enhanced actuation and inhalation coordination.The inherent advantages of aerosol drug delivery are faster onset of pharmacological action, since the drug is being delivered to the site needing therapeutic effect, and a lower systemic bioavailability, which decreases potential adverse effects. This mode of delivery is indicated when the drug can be converted into an aerosol form for inhalation.Oxygen: Liberal use is indicated without worry of toxicity in the short term. The goal is to keep saturation> than 90% (some sources recommend 92%)and/or arterial PO2greater than 60 mm Hg.Some guidelines recommend minimum saturations of 95% for children.Helioxtherapy:Acombinationofheliumandoxygen.Itcanbeusedtodecreaseairwayresistanceandtherebydecreasetheworkofbreathing.ItshouldbeusedinacuteexacerbationsasanadjuncttoB-2 agonistandIVcorticosteroidtherapytoimprovepulmonaryfunction.Effectsareusuallyseenin20minutes.Bilevelpositiveairwaypressure(BiPap):Maybehelpfulinolderchildrenwithsleep-disorderbreathingwhoseconditionpersistsaftersurgicalintervention.7. Discuss consent for treatment of a minor. How does the nurse proceed if the parent is unreachable?Thechildgoingintoanasthmaattackisnodifferentfromtheadultwhoishavingaheartattackintermsofneedingmedicalassistancebeforetheconditiondeterioratestoirreversiblerespiratoryfailureandpossibledeath.Ifparentisunreachable,thenurseshouldproceedwithprocedure. Emergency consent protects healthcare workers who provide care to a patient that collapses in the ED. Patients must not be able to make their wishes known, and a delay in providing care would result in the loss of life or limb. The healthcare provider has no reason to know or believe that consent would not be given were the patient able to deny consent.</p>
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