Question

The team has been activated to assess a 13 year old asthmatic patients, the patient can't speak in complete sentences, breath sound diminished, RR 46, HR 140, spo2 85% on room air. Base on your information how would you treat this patient, what lab or other diagnosis tool would you need to do the job. And what education material and plan would you provide the patient with before discharge as a respiratory therapist

Answer 1

ASTHMA

Definition:

Asthma is a chronic inflammatory disorder of the airways. This inflammation causes an increase in airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and cough, particularly at night or in the early morning.

Triggers of Asthma Attacks

Etiology is idiopathic.

1. Allergens; Allergic asthma maybe seasonal and related to allergies such as tree or weed pollen.
2. Exercise; Asthma that is induced or exacerbated during physical exertion is called exercise induced asthma.
3. Air pollutants; Exhaust fumes, perfume, Oxidants, sulfer dioxide, cigarette smoke, aerosol sprey
4. Viral upper respiratory infections
5. Sinusitis
6. Stress
7. Drugs; Aspirin, Nonsteroid antiinflammatory drugs, beta Adrenergic blockers.
8. Occupational exposure; metal salts, wood and vegetable dusts, industrial chemical and plastic, pharmaceutical agents.
9. Food additives; sulfites, monosodium glutamate, tartrazine.
10. Hormones/ menses

11. Gastroesophageal reflux disease.

Diagnostic studies

​​​​Diagnostic

• history and physical examination
• Pulmonary function studies including response to bronchodilator therapy
• Peak expiratory flow rate.
• Chest X-ray
• Measurements of ABGs or oximetry
• Allergy skin testing (if indicated)
• Blood level of eosinophils and IgE (if indicated)
• Nitric oxide levels

Collaborative Therapy

1. ​​​Mild intermittent or persistent Asthma
2. Identification and avoidance/elimination of triggers.
3. Desensitization (immunotherapy) if indicated
4. Patient and family teaching to drug therapy
5. Drug therapy
6. Asthma action plan
7. Status Asthmaticus
8. SaO₂ monitoring
9. ABGs
10. Inhaled beta₂ Adrenergic agonists or anticholinergic agents
11. O₂ by mask or nasal prongs
12. IV or oral corticosteroid
13. IV fluids
14. IV magnesium
15. Intubation and assisted ventilation

Drug therapy

Long term control medications

• Antiinflammatory drugs
• Corticosteroids
• Cromolyn and nedocromal
• Leukotriene modifiers
• Omalizumab
• Bronchodilator
• Long acting inhaled beta₂ Adrenergic agonists
• Long acting oral beta₂ Adrenergic agonists
• Theophylline

Quick Relief Medications

1. Bronchodilator
2. Short acting inhaled beta₂ Adrenergic agonists
3. Anticholinergic
4. Antiinflammatory drugs
5. Corticosteroids.