Evelynn Gallardo

9/15/15

HPS Asthma
1. What factors may trigger an asthmatic episode?
Allergic reactions like dust, pollen, food, and animals. Infections of the common flu, Influenza,
cold air, emotional stress, excitement, pollution, drugs like Aspirin, Ibuprofen, cardiac drugs,
sleep, house hold items, and vigorous exercise.
2. What are the clinical manifestations of a child experiencing an exacerbation of asthma?
Coughing (usually dry cough), wheezing (usually on expiration), chest tightness or pain, and/or
difficulty breathing- SOB. If mild exacerbation, the child remains pink, but as asthma worsens,
cyanosis might result. Some children present with mild retractions, while others demonstrate
significant accessory muscle use and eventually head bobbing if not effectively treated. Child
may appear anxious and fearful, or be lethargic and irritable. Children with persistent severe
asthma may have a barrel chest and routinely demonstrate mildly increased work of breathing.
3. Explain the progression of asthma that is nonresponsive to treatment.
Status asthmaticus is respiratory distress despite vigorous treatment measures including albuterol
and epinephrine. This is considered a medical emergency that can result in respiratory failure
and death if left untreated.
4. Discuss the pathophysiology of asthma.
Includes complex interactions among inflammatory cells, mediators, and cells and tissue present
in the airways. Another component is bronchospasms obstruction:
Inflammatory response to stimuli,airway edema and accumulation and secretion of mucusospasm
of the smooth muscle of bronchi and bronchioles.
5. Discuss the actions, side effects, contraindications, and nursing implications of the
following medications in the treatment of asthma: albuterol, atrovent, epinephrine,
prednisolone, prednisone, solumedrol, magnesium sulfate, sodium bicarbonate.
Albuterol- Bronchiodilator, SE: chest pain, tremor, palpitations, Contraindications:
hypersensitivity to adrenergic amines, Implications: for inhaler shake well use a spacer for
children under 8.
Atrovent-Inhibits cholinergic receptors in bronchial smooth muscle/ bronchodilation, SE:
hypotension, sore throat, headache, Contraindications: avoid use during acute bronchospasm/
hypersensitivity to ipratropium, atropine, When ipratropium is administered concurrently with
other inhalation medications, administer adrenergic bronchodilators first, wait 5 mins between
medications.
Epinephrine- These drugs stimulate all the sympathetic receptors, SE: nervousness , nausea /
vomiting ,headaches , palpitations , hypertension. Contraindications: hypersensitivity to
adrenergic amines.
Prednisolone-suppression of inflammation and modification of the normal immune response.
SE: euphoria, hypertension, muscle wasting, Contraindicated: active untreated infections, known
alcohol or bisulfite hypersensitivity or intolerance.
Prednisone-suppression of inflammation and modification of the normal immune response. SE:
euphoria, hypertension, cushoid appearance, Contraindicated: active untreated infections, known
alcohol or bisulfite hypersensitivity or intolerance.

Evelynn Gallardo
9/15/15
Solumedrol- suppression of inflammation and modification of the normal immune response.
SE: hypertension, depression, euphoria. Contraindications: administration of live vaccines, active
untreated infections, known alcohol or bisulfite hypersensitivity or intolerance.
magnesium sulfate- muscle relaxant, SE: diarrhea, arrhythmias, decreased respiratory rate,
contraindicated: hypermagnesemia, heart block, hypocalcemia, has been considered as an
adjunct therapy for severe and life-threatening asthma exacerbation. Check dose, calculations
high alert accidental overdose may occur.
sodium bicarbonate- Adjusts the pH of mucus, decreasing the surface tension to facilitate
mucolytic action. Indication: tracheal irrigation. SE: metabolic alkalosis, edema.
Contraindicated: renal failure, excessive chloride loss, patients on sodium restricted diets, ensure
accurate dose.
6. Discuss the following treatment modalities for the treatment of asthma and note when
each is indicated: aerosolized medications by nebulizer, metered-dose inhaler, oxygen,
heliox therapy, and BiPap.
Aerosolized medications by nebulizer- Nebulizers are used to provide aerosol therapy to
patients too ill or too young to use handheld devices and in situations where large drug doses are
necessary. These devices also are required for some medications available only in liquid form,
including pentamidine, ribavirin, DNAase, hypertonic saline, and tobramycin
Metered-dose inhaler: A form of administering asthma medications. A spacer is an external
device that is attached to an MDI to allow for better drug delivery by enhanced actuation and
inhalation coordination. The inherent advantages of aerosol drug delivery are faster onset of
pharmacological action, since the drug is being delivered to the site needing therapeutic effect,
and a lower systemic bioavailability, which decreases potential adverse effects. This mode of
delivery is indicated when the drug can be converted into an aerosol form for inhalation.
Oxygen: Liberal use is indicated without worry of toxicity in the short term. The goal is to keep
saturation> than 90% (some sources recommend 92%) and/or arterial PO2 greater than 60 mm
Hg. Some guidelines recommend minimum saturations of 95% for children.
Heliox therapy: A combination of helium and oxygen. It can be used to decrease airway resistan
ce and thereby decrease the work of breathing. It should be used in acute exacerbations as an adj
unct to B-2 agonist and IV corticosteroid therapy to improve pulmonary function.
Effects are usually seen in 20 minutes.
Bilevel positive airway pressure (BiPap): May be helpful in older children with sleep-disorder
breathing whose condition persists after surgical intervention.
7. Discuss consent for treatment of a minor. How does the nurse proceed if the parent is
unreachable?
The child going into an asthma attack is no different from the adult who is having a heart attack i
n terms of needing medical assistance before the condition deteriorates to irreversible respiratory
failure and possible death. If parent is unreachable, the nurse should proceed with procedure.
Emergency consent protects healthcare workers who provide care to a patient that collapses in
the ED. Patients must not be able to make their wishes known, and a delay in providing care
would result in the loss of life or limb. The healthcare provider has no reason to know or believe
that consent would not be given were the patient able to deny consent.

Evelynn Gallardo
9/15/15