Page 82 - Critical Care Nursing Demystified

Chapter 2 CARE OF THE PATIENT WITH CRITICAL RESPIRATORY NEEDS 67

is usually triggered by a known allergen causing an allergic reaction (extrinsic
asthma) or an unknown cause usually triggered by a viral or bacterial infec-
tion (intrinsic). Attacks can also be precipitated by infection and not taking
asthma control medications. Airways inflammation causes narrowing of the
air passages resulting in increased work to get oxygen to the alveolar level. As
the patient becomes more and more fatigued, hypercarbia and hypoxemia
result, leading to a decreased blood supply to the tissues. When a patient has
an acute asthmatic attack unrelieved with fast-acting medications, it is called
status asthmaticus.

Prognosis
Most patients manage their asthma at home with medications. Life-threatening
attacks are rare, but they require immediate medical intervention. Asthma is
generally controlled on long-term asthma medications (maintenance) to control
inflammation (like steroids), and patients are taught to adjust their medications
according to their peak flow meter’s daily values.

Hallmark Signs and Symptoms Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.

Asymptomatic between attacks; below may indicate ARF!
Shortness of breath at rest and inability to speak in sentences or phrases
Orthopnea
Changes in the level of responsiveness like lethargy or confusion
Wheezing due to bronchoconstriction is a hallmark sign of airway closure

Absence of wheezing with no airway movement is an ominous symptom!
Bradycardia
Chest tightness
Cough
Signs of ARF

NURSING ALERT
Airways must be open for wheezing to occur. If a patient suddenly stops wheezing and
still appears to be in distress, mobilize the rapid response team as the patient has a
total airway obstruction. If airways swell enough, emergency endotracheal intubation
maybe impossible, making an emergency tracheotomy imperative to open the airway.