ASTHMA

Presented by Cynthia Adame Introduction to MSN 5200 Daniel Hatch / Merrill Laurentz

INTRODUCTION
Brief description of the disease and impact on a specific community

ASTHMA
CHRONIC DISORDER OF THE AIRWAY Catamenial Cardiac Exercise-induced Occupational
(Papadakis, 2012)

Impact on Community Cost of Asthma for the Working Adult United States
United States Asthmatic Non-Asthmatic Difference $18 Billion Yearly $10 Billion Direct Cost $8 Billion Indirect Cost
o o Absence of work 1.2 Short-term disability days 2.2

$1143 $262 $574 $1783 $3,762

$710 $103 $268 $692 $1,773

$433 $159 $306 $1091 $1988

Inpatient Cost ER Visits Outpatient Cost *Prescription Cost Total (Shenolikar, 2011)

PATHOPHYSIOLOGY
Functional changes that occur with the body systems response to the illness / disease.

PREDISPOSING: OBESITY AND ATOPY

ATOPY: Exposure to inhaled allergen Smoke House dust-mites Cockroaches Cat dander Seasonal pollens TRIGGERS: Exercise Upper respiratory tract infections

Contributing Factors

Gastroesophageal Reflux
Changes in the weather Stress Pollution

(Papadakis, 2012, p. 243)

Functional Changes Within the Body System

Inflammatory cell infiltration with Eosinophils, Neutrophils, and Lymphocytes especially T-lymphocytes Goblet cell hyperplasia sometimes with plugging of small airways with thick mucus Collagen deposition beneath basement membrane Hypertrophy of bronchial smooth muscle Airway edema Mast cell activation Denudation of airway epithelium (Papadakis, 2012, p. 243)

PATIENT PRESENTATION
Subjective findings, Objective findings, Guideline for diagnosis

SUBJECTIVE FINDINGS
Cough Difficulty breathing Chest tightness Wheezing Excess sputum production Nighttime awakenings Interference with normal activity (Papadakis, 2012, p. 244)

OBJECTIVE FINDINGS
Nasal mucosal swelling, increased nasal secretions, and nasal polyps are often seen Eczema, atopic dermatitis Wheezing during normal breathing Hunched shoulders and use of accessory muscles, suggest an increased work of breathing

Chest exam: normal in mild cases

Diminished lung sounds, airflow too limited in Severe cases

ABG: Mild asthma normal but respiratory alkalosis is normal.

Severe: Hypoxia develops and PaCo2 returns to normal. If you see increase PaCo2 and respiratory acidosis this may indicate impending respiratory failure and the need for mechanical ventilation

Chest x-ray normal or show hyperinflation, bronchial wall thickening and diminished peripheral lung shadows (Papadakis, 2012, p. 248)

Gold Standards for Diagnosis

Episodic or chronic symptoms of airflow obstruction Reversibility of airflow obstruction
Require oral systemic corticosteroids Respond to a short acting B2 agonist

Symptoms frequently worse at night Prolonged expiration and diffuse wheezes on physical exam

Limitation of airflow on pulmonary function testing

Or a positive bronchoprovocation challenge (Papadakis, 2012, p. 243)

INTERVENTIONS
Pharmacological and Non-Pharmacological

PHARMACOLOGIC INTERVENTION
LONG-TERM CONTROL MEDICATIONS
Long-acting Bronchodilators Leukotriene Modifiers QUICK-RELIEF MEDICATIONS MEDIATOR INHIBITORS ANTICHOINGERICS

VACCINATION OMALIZUMAB DESENSITIZATION - Allery shots

IV MAGNESIUM SULFATE (SEVERE) OXYGEN

HERBS: Garlic, Ginger, Echinacea, Turmeric, Honey, Omega 3s

NON-PHARMOCOLOGIC INTERVENTION
WASH YOUR HANDS Yoga Apps Rest Manage the stressor Removal of the trigger Dietician consult

PATIENT EDUCATION PREVENTION

Prevention, Plan, and Control

Patient Education
1. Identify environmental causes 2. Identify occupational causes 3. Control of environmental factors

4. Control of comorbid conditions that affect asthma

5. Pharmacological Agents and devices 6. Resources 7. Written Asthma Action Plan
Your name Emergency Contact Information Healthcare provider information Asthma severity classification A list of triggers

(Sumino, 2012)

CONCLUSION

Why did I choose Asthma?

Asthmatics Caregivers Policy & Procedure

QUESTIONS ?

References
Merriam-Webster, T. E. (2013). 2013 Merriam-Webster Inc. Retrieved from MerriamWebster: http://www.merriam-webster.com/dictionary Papadakis, M. M. (2012). 2013 Current medical diagnosis & treatment (Fifty-second ed.). New York: McGraw-Hill Professional Publishing.

Shenolikar, R. S. (2011). Costs of asthma among US working adults. The American Journal of Managed Care, 17(6), 409-416.
Sumino, K. H. (2012). Asthma clinical trials of american lung association/ asthma clinical research center (ALA-ACRC): what we have learned in 12 years? Springer Science + Business Media, 251-258.