Med-Surg Respiratory System, part 4: Asthma

August 23, 2021 Updated: October 26, 2021 7 min read

In this article, we'll explain the key points you need to know about Asthma for the NCLEX and for your Med-Surg exams.

The Med-Surg Nursing video series follows along with our Medical-Surgical Nursing Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

What is Asthma?

Asthma is a chronic inflammatory disorder of the airway, and it is intermittent and reversible.

When studying diseases and disorders of the respiratory system, it's important to remember that asthma is reversible while COPD is not reversible.

In someone with asthma, a trigger like an allergen, or cold air, can cause inflammation and airway hyperresponsiveness, which leads to bronchoconstriction and airway obstruction. Asthma, like anything that prevents the ability to breathe properly, can be dangerous if not treated.

Signs & symptoms

Signs and symptoms of asthma include dyspnea (difficulty breathing), wheezing, chest tightness, coughing, tachypnea (rapid breathing), use of accessory muscles, prolonged expiration (exhaling), and confusion.

A sign of severe or prolonged asthma is a barrel chest. A barrel chest is a chest resembling the shape of a barrel, meaning that it is rounded and bulging outward. This is due to the lungs being hyperinflated for an extended period of time.

Labs and diagnostics

In order to diagnose asthma, pulmonary function tests can be done. These tests include FVC, FEV1, PEF.

An arterial blood gas test can also be done to assess for partial pressure of oxygen (PaO₂) under 80 mmHg. Oxygen saturation (SpO₂) can also be tested and the expected range for asthma would be under 92%.

Treatment

The main treatment for asthma is bronchodilators which can include control therapy as well as reliever drugs. Anticholinergics, anti-inflammatories, and leukotriene antagonists may also be prescribed.

These drugs are some of the many important drugs of the respiratory system covered in our Pharmacology Flashcards.

Bronchodilators

A patient with asthma will likely be prescribed bronchodilators. A bronchodilator dilates the bronchioles to allow air to pass through.

There are two important bronchodilators to know about for asthma, and they function differently—albuterol and salmeterol.

Albuterol is for acute asthma attacks, so it is considered a reliever drug.

Salmeterol is a long-acting bronchodilator and it is used as a control therapy. A patient prescribed salmeterol would take it daily and it would help with the long-term control of asthma.

Want some mnemonics to help you remember the difference between albuterol and salmeterol? We've got some fun Cool Chicken hints for you in our Pharmacology Flashcards!

Anticholinergics

Anticholinergics that may be prescribed for asthma include ipratropium, which goes by the brand name Atrovent. It works by blocking acetylcholine receptors in the airway smooth muscle, which causes bronchodilation.

Anti-inflammatories

Corticosteroids that may be prescribed for asthma include beclomethasone, mometasone, budesonide, or fluticasone. These are inhaled/nasally administered drugs that work to decrease inflammation locally.

Leukotriene antagonists

Leukotriene receptor antagonists include the drugs montelukast and zafirlukast which work to decrease the effect of leukotrienes, which reduces airway inflammation and bronchoconstriction.

All of these medications and their differences are covered in depth in our Pharmacology Flashcards wherein we cover the key medication facts you need to know for the NCLEX and in clinical practice!

Patient teaching

There are some important teaching tips to remember for patients with asthma.

Peak flow meter

Patients can monitor their asthma using a peak flow meter. A peak flow meter is a device that sort of looks like an old-school thermometer or a rain gauge, that a patient blows air into to measure their peak air flow. The device will alert a patient to their airway narrowing before they even have symptoms. If they get an alert that their airways are in trouble, they can take their reliever drug (e.g., albuterol) to head off any issues.

Patients should use the peak flow meter 3 times and record the highest number, not the average.

Avoiding environmental triggers

Patients should identify and avoid environmental triggers and irritants to the extent possible.

Exercise-induced asthma

For exercise-induced asthma, patients should use a bronchodilator 30 minutes before exercise.

Emergency inhaler

Patients should always carry an emergency inhaler with them in case they need to use it.

You can also educate patients on the difference between short and long-acting asthma medications (described above) and proper use of a metered-dose inhaler (MDI) or dry powder inhaler (DPI).

Status asthmaticus

Status asthmaticus is a life-threatening complication of asthma wherein airway obstruction is unresponsive to the usual therapies described above. Status asthmaticus can lead to an accumulation of air in that pleural cavity, which is called a pneumothorax, and cardiac and respiratory arrest.

Status asthmaticus signs and symptoms

The signs and symptoms of status asthmaticus include extremely labored breathing, gasping or the inability to speak, decreased levels of consciousness due to lack of oxygen to the brain, neck vein distension, pulsus paradoxus (decrease in systolic blood pressure during inspiration), cyanosis (turning blue).

Status asthmaticus treatment

Status asthmaticus can be treated with bronchodilators, epinephrine, or corticosteroids.

In addition to the bronchodilators described earlier in this article, epinephrine and corticosteroids are also covered in our Pharmacology Flashcards which contains the key meds you need to know for the NCLEX.

Status asthmaticus nursing care

If a patient is experiencing status asthmaticus, the nursing care steps you should take are to administer oxygen, prepare for emergency intubation and mechanical ventilation.

Emergency intubation and mechanical ventilation are covered in our Fundamentals of Nursing Flashcards.


Full Transcript

Hi, I'm Cathy with Level Up RN. In this video, we are going to talk about asthma. And at the end of the video, I'm going to give you guys a quick little quiz to test your knowledge of some of the facts I'll be covering in this video. And if you haven't already done so, I invite you to subscribe to our channel because we have hundreds of free videos to help nursing students and nurses.

Okay. Let's talk about asthma. Asthma is a chronic inflammatory disorder of the airway. It is intermittent and reversible. So this is differentiated from COPD, which I'll talk about in my next video, which is not reversible.

So the pathophysiology behind asthma is that we have a trigger, so it could be an allergen or it could be cold air, and it causes inflammation and airway hyperresponsiveness which in turn causes bronchoconstriction and airway obstruction.

So signs and symptoms of asthma include dyspnea, so difficulty breathing, wheezing, chest tightness, coughing, tachypnea, use of accessory muscles, prolonged expiration. And then with severe and prolonged asthma, some patients may present with a barrel chest.

In terms of how we diagnose asthma. We would perform pulmonary function tests, so PFTs. We can also run ABGs, so arterial blood gases. The patient's SpO2 may be decreased with an ABG. Also, the patient may have a decreased oxygen saturation. So their SpO2 may be below 92%.

Now let's talk about the treatment of asthma.

Your patient with asthma will be prescribed bronchodilators. So this will include control therapy as well as reliever drugs, and we'll talk more about that in a minute.

In addition, they may be prescribed anticholinergics, anti-inflammatories, and leukotriene antagonists.

So there's a number of teaching points that you're going to want to provide your patient with asthma.

They should keep tabs on their asthma using a peak flow meter. So the peak flow meter will alert them to airway narrowing before they even have symptoms. So if they get that alert like your airways are possibly in trouble, they can take their reliever drug to kind of head off any issues. So when they use their peak flow meter, they need to use it three times and record the highest number out of those three attempts. Not the average number.

You also want to counsel your patient to identify and avoid environmental triggers as well as irritants.

And then for exercise-induced asthma, they should take their bronchodilator 30 minutes before they're going to exercise.

And then you want to educate your patient on the difference between their short-acting asthma medication and their long-acting asthma medication.

So albuterol is a short-acting bronchodilator and that's what we would use as a reliever drug. So albuterol is for acute asthma attacks, so we have all A's there.

And then salmeterol is a long-acting bronchodilator and it is used as a control therapy, so the patient would take it daily and this helps with long-term control of asthma. So you definitely need your patient to know the difference between those two medications, and it's going to be important for you to know that as well as the nurse.

And then lastly, you want to advise your patient to always carry an emergency inhaler with them wherever they go.

A life threatening complication of asthma is status asthmaticus which is airway obstruction that is unresponsive to usual therapy, and it can lead to a pneumothorax as well as cardiac and respiratory arrest.

Signs and symptoms of status asthmaticus can include extremely labored breathing, gasping or inability to speak, decreased level of consciousness, cyanosis, neck vein distention, and something called pulsus paradoxus which is a decrease in systolic blood pressure during inspiration.

So treatment of status asthmaticus will include bronchodilators, epinephrine, and corticosteroids.

As the nurse, you're going to administer oxygen and prepare the patient for emergency intubation and mechanical ventilation.

Okay. Time for a quiz. I have three questions for you. First question. Prolonged expiration is a symptom of asthma. True or false? The answer is true. Second question. When using a peak flow meter, your patient should record the average number after three attempts. True or false? The answer is false. They should record the highest number after three attempts. Question number three. What type of bronchodilator should your patient use as a reliever drug during an acute asthma attack? The answer is a short-acting bronchodilator such as albuterol. So hopefully you did well on that quiz. If not, definitely go back and review our flashcards or watch the video again. I hope this helped a bunch. Take care and good luck studying.


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