Chapter 13 Asthma Anatomic Alterations of the Lungs



Yüklə 455 b.
tarix28.04.2017
ölçüsü455 b.


Chapter 13 Asthma

  •  


Anatomic Alterations of the Lungs

  • Smooth muscle constriction of bronchial airways (bronchospasm)

  • Excessive production of thick, whitish, tenacious bronchial secretions

  • Hyperinflation of alveoli (air-trapping)

  • Mucus plugging and, in severe cases, atelectasis



Etiology

  • Extrinsic asthma

    • Allergic or atopic asthma
  • Intrinsic asthma

    • Nonallergic or nonatopic asthma




Intrinsic Asthma (Nonallergic or Nonatopic Asthma)

  • Infections

  • Exercise and cold air

  • Industrial pollutants or occupational exposure

  • Drugs, food additives, and food preservatives

  • Gastroesophageal reflux

  • Sleep (nocturnal asthma)

  • Emotional stress

  • Premenstrual asthma





Additional Risk Factors

  • Residence in a large urban area, especially the inner city

  • Exposure to secondhand smoke

  • A parent who has asthma

  • Respiratory infections in childhood

  • Low birth weight

  • Obesity



Overview of the Cardiopulmonary Clinical Manifestations Associated with ASTHMA

  • The following clinical manifestations result from the pathophysiologic mechanisms caused (or activated) by Bronchospasm (see Figure 9-10) and Excessive Bronchial Secretions (see Figure 9-11)—the major anatomic alterations of the lungs associated with asthma (see Figure 13-1).



 

  •  



 

  •  



Clinical Data Obtained at the Patient’s Bedside

  • Vital signs

  • Increased respiratory rate

  • Increased heart rate, cardiac output, blood pressure



Clinical Data Obtained at the Patient’s Bedside

  • Use of accessory muscles of inspiration

  • Use of accessory muscles of expiration

  • Pursed-lip breathing

  • Substernal intercostal retractions

  • Increased anteroposterior chest diameter (barrel chest)

  • Cyanosis

  • Cough and sputum production



Clinical Data Obtained at the Patient’s Bedside

  • Pulsus paradoxus

  • Decreased blood pressure during inspiration

  • Increased blood pressure during expiration



Clinical Data Obtained at the Patient’s Bedside

  • Chest assessment findings

  • Expiratory prolongation

  • Decreased tactile and vocal fremitus

  • Hyperresonant percussion

  • Diminished breath sounds

  • Diminished heart sounds

  • Wheezing and rhonchi







Clinical Data Obtained from Laboratory Tests and Special Procedures



Pulmonary Function Study: Expiratory Maneuver Findings

  • FVC FEVT FEF25%-75% FEF200-1200

  •    

  • PEFR MVV FEF50% FEV1%

  •    



Pulmonary Function Study: Lung Volume and Capacity Findings



Arterial Blood Gases





Arterial Blood Gases





Oxygenation Indices



Abnormal Laboratory Tests and Procedures

  • Abnormal laboratory tests and procedures

    • Sputum examination
      • Eosinophils
      • Charcot-Leyden crystals (see next slide)
      • Casts of mucus from small airways
        • called Kirschman spirals
      • IgE level (elevated in extrinsic asthma)


Charcot-Leyden Crystals

  • Needle shaped crystals -

  • Represents breakdown products of eosinophils



Radiologic Findings

  • Chest radiograph

  • Increased anteroposterior diameter

  • Translucent (dark) lung fields

  • Depressed or flattened diaphragm





Table 13-1. Asthma Classification Based on Severity—Excerpts

  • Disease Symptoms

  • Step 4: Continual symptoms

  • Step 3: Daily symptoms

  • Step 2: Symptoms > than twice weekly

  • Step 1: Symptoms < than twice weekly



Table 13-2. Asthma Zone Management System—Excerpts

  • Green zone

    • 80% to 100% of personal best PEFR
  • Yellow zone

    • 50% to 80% of personal best PEFR
  • Red zone

    • <50% of personal best PEFR


General Management of Asthma

  • Environmental control

  • Respiratory care treatment protocols

    • Oxygen therapy protocol
    • Bronchial hygiene therapy protocol
    • Aerosolized medication protocol
    • Mechanical ventilation protocol
  • Medications commonly prescribed

    • Xanthines
    • Corticosteroids
    • Anti-inflammatory agents
    • Leukotriene inhibitors


General Management of Asthma

  • Monitoring



General Management of Asthma

  • Patient compliance

    • Asthma-symptom/medication-use diaries
    • Serum theophylline levels
    • Carboxyhemoglobin determinations
    • Total (circulating) eosinophil counts
    • No-show rates at physician offices
    • Rate of medication use
    • Frequency of emergency department visits and hospitalizations
    • Number of red zone days per months (see Table 13-2)


Classroom Discussion Case Study: Asthma



Kataloq: programs
programs -> Jlus implementation Committee Meeting Community Planning Division ls – Jacobs Conference Room Friday, September 13, 2013
programs -> Jlus implementation Committee Meeting Community Planning Division Lakeside Friday, January 11, 2013
programs -> Jlus implementation Committee Meeting Community Planning Division ls – Jacobs Conference Room Friday, September 25, 2015
programs -> Jlus implementation Committee Meeting Lakeside Offices Jane Jacobs Conference Room May 13, 2011
programs -> Jlus implementation Committee Meeting Community Planning Division cab boardroom Friday, December 14, 2012
programs -> April 11, 2014: jlus committee Endorses
programs -> Request for Contract Proposals
programs -> Рабочая программа дисциплины Иммунология Специальность 020501 Биоинженерия и биоинформатика Квалификация выпускника
programs -> Программа государственной итоговой аттестации Направление подготовки кадров высшей квалификации 06. 06. 01 Биологические науки

Yüklə 455 b.

Dostları ilə paylaş:




Verilənlər bazası müəlliflik hüququ ilə müdafiə olunur ©azkurs.org 2020
rəhbərliyinə müraciət

    Ana səhifə