Bronchoconstriction, inflammation, and increased mucus production narrows air passages and decreases the ability to bring air into the alveoli, decreasing the amount of oxygenation red blood cells are able to exchange. This can also lead to increased amounts of carbon dioxide (CO2) retention due to lack of ability to exhale the CO2.
Swelling and mucus aggregated from an irritant or “trigger” cause difficulty in breathing, wheezing lung sounds and hypoxia. Triggers include dust, pollen, smoke, infection, etc. Asthma can also be genetic, environmental, triggered by exercise or from allergies.
Decreased work of breathing, adequate ventilation and oxygenation, and perfusion of oxygen-rich blood to tissues.
Apply oxygen if O2 saturation is less than 90%, start at 2 liters nasal cannula (2L NC)
Get subjective data to determine if patient is receiving proper amounts of oxygen.
This is both a comfort measure as well as physiologically helpful. In other words, it can’t hurt the patient (at higher amounts and flows it could hurt the patient!). Eliminate hypoxia, move up by 1L if not improving after re-checking every few minutes, call respiratory therapy if they require more than 6L NC.
If wheezing they may need a bronchodilator.
If you hear crackles or rhonchi they may have pneumonia and potentially could use suctioning.
**Note – disappearing wheezes does not always mean improvement. It could mean the airway has closed tighter and therefore there isn’t even enough air for a wheeze. Check SpO2
Make sure the patient’s room does not have any triggers
Dust is near impossible to completely get rid of, however, other triggers like pollen (no flowers), animal dander (no visiting puppies), etc. can be eliminated.
Make sure the patient knows about their asthma triggers and help them problem solve how to eliminate the trigger from their life.
Opens lung bases and airway
Peak flow meters tell us how much air that patient can exhale. The smaller the number the less amount of air they are moving.
Safety! Plus you do not want to wait until the impending airway closure happens to try to secure their airway. Sometimes the patient will be sedated and intubated to try to correct any respiratory acidosis or alkalosis.
For more information, visit www.nrsng.com/cornell
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