ASTHMA

                                                                        ASTHMA

What is Asthma ?

Asthma is a lower respiratory tract pulmonary obstructive disease which is also called as "Reactive Airway Disease".

Definition :

Asthma is the chronic inflammatory disease of the airways characterized by variable & recurring symptoms & bronchospasm.

Pathophysiology :

Allergens are responsible for obstruction of airways by either inflammation of airway lining or constriction of bronchial smooth muscles due to activation of mast cells & histamine in immune system charecterized by mucus secretion & episodes of bronchospasm.

Etiology & risk factors :

• Heridatory
• Environemntal triggers
• Allergens
• Air pollution 
• Upper respiratory tract infections
• Occupational factors Psychological factors
• Idiopathic

Types :

• Extrinsic asthma : Also called as Atopic  asthma caused by allergens such as pollens, animal dander, dust. Often accompanied by allergic rhinitis O eczema & is usually heridatory.
• Intrinsic Asthma : Also known as non- atopic, caused by non allergic factors such as respiratory tract infections, exposure to cold air, changes in air humidity or respiratory irritants.

Sign & Symptoms :

• Wheezing
• Shortness of breath
• Dyspnea
• Tachypnea = RR> 20 breaths/min
• Chest tightness
• Cough
• Tachycardia HR> 100 beats/min
• Hypoxia
• Cyanosis
• Anxiety

Medical & Nursing Management:

• Short acting beta adrenergic blockers for bronchodilation : Terbutaline, Albuterol, Levalbuterol
• Long acting beta adrenergic blockers for bronchodilation : Salmetrol, Formetrol
• Leukotrin modulators to reduce inflammatory response in lungs & to reduce exacerbations : Zafirlukast, Montelukast
• Anticholinergic Drugs
• Ipatropium inhaler or Tiotropium HandiHaler
• Antacids, PPIs : ranitidine, pantoprazole
• Mast cell stabilizers : Cromolyn, Nedocromil
• Steroids : Hydrocortisone, Methylprednisolone IV
• Omalizumab subcutaneously
• Fowler's position to patient
• Explain patient about use of inhaler
• Encourage deep breathing & coughing exercise
• Vital signs to be monitored
• Avoid exposure of allergens
• Nebulization

 

Distinctive facts :

• Ix- ABG analysis, CXR, PFT, CBC, Sputum analysis
• "Silent chest " important feature of asthma.
• Metered dose inhalers in combination with asthma spacer & dry powder inhaler
• Complications include : Status Asthmaticus

 Prognosis :

• Avoiding triggers reduces the level of incidence.
• Proper use of inhalers can improve the prognosis
• Patient who do not use medications properly may die during asthma attack

ANGINA PECTORIS

                                                              ANGINA PECTORIS

What is Angina ?

Angina Pectoris is a disease marked by brief sudden attacks of chest pain or discomfort caused by deficient oxygenation of the heart muscles usually due to impaired blood flow to the heart.

Pathophysiology :

Atherosclerosis leads to narrowing of the coronary artery resulting in inadequate blood flow to heart muscles causing chest pain.

Etiology & risk factors :

• Age > 55 years for men & >65 years for women
• Smoking
• Hypertension
• Diabetes
• Renal dysfunction 
• Obesity

Types:

Stable Angina : Most common.

•  Pain occurs due to emotional stress , heavy exercise. 
• Usually resolved at rest or nitrate therapy.

Unstable Angina: Does not resolved by rest if occured due to semotional & physical stress. 

less effective in response to nitroglycerine.

Prinzmental Angina : also called as Vasospastic Angina

• Usually occurs at rest & is not triggered by stressors. 
• Mostly occurs at night.

Medical & Nursing Management :

• Note for PQRST.

P-Place of pain

Q- Quality of pain  { stabbing, squeezing etc}

R- Radiating pain elsewhere in the body

S- Severity of pain on painscore

T- Timing of lasting of pain

• Nitroglycerine- sublingual or patch
• Beta blockers - Propanolol, Atenolol, Nadolol
• Aspirin for antiplatlet effect
• Analgesic- Morphine IV to reduce chest pain
• 2-4 litres of oxygen
• Semi-Fowler's position of the patient
• Notify physician if HR<60 bpm & BP < 90/60 mm Hg

Distinctive Facts :

• Ix- ECG, Coronary Angiography, PET scan, Echocardiogram, PT/INR, Cholesterol pannel
• Surgery : PTCA< Coronary artery stenting, CABG
• Duke trademill score

 

Prognosis :

• Often managed by lifestyle modification
• Health education is very important to reduce complications & for good prognosis

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APPENDICITIS

Appendicitis

Definition:

An inflammation of vermiform appendix

Pathophysiology

Obstruction of lumen due to food, adhesions and lymphoid hyperplasia leads to favourable growth media of bacterial flora leads to infection

Etiology :

Obstructive agents and infective agents

Bacteria such as e coli, coliforms, bacteroids

S/S

Flank pain, retrocecal pain, rebound tenderness, pain at Mc Burney's point, anorexia, vomiting

Medical & nursing management:

Antibiotics - ampicillin, gentamicin

Maintain bed rest, IV fluids, NPO status

Appendectomy

Distinctive facts:

McBurney's triad - pain, vomiting, fever

Positive rovsing sign, obturator sign and psoas sign

Prognosis: With an early operation, the chance of death from appendicitis is very low.

Complications:

Perforation , peritonitis

TONSILLITIS

Tonsillitis :

Def- inflammation of tonsils caused by bacteria or virus

Pathophysiology: entry of pathogens will trigger the mast cells that causes inflammation of tonsils and related symptoms

Etiology - virus- adeno virus, Corona virus , influenza virus, rhino virus

Bacteria- streptococcus pneumoniae, mycoplasma pneumoniae, bordetell partusis, corynebacterium diphtherie, treponema pallidum

S/s : sore throat, wide swollen tonsils, white spots, hoarseness of voice, dysphagia

Medical/nursing mgt:

• Antibiotics- azithromycin, amoxicillin
• Analgesics- acetaminophen, ibuprofen
• Warm water gargles
• Side lying position to facilitate secretion removal
• Tepid sponge bath for managing fever

Distinctive facts:

• Ix- throat swab, CBC
  
• White spots are present in bacterial tonsillitis characterized by gray furry tongue
• Complications can cause quinsy ( peritonsilar abscess)
• Tonsillectomy a surgical management

Prognosis:

• Prognosis is good and mortality is rare
• However complication of rheumatic fever may occur if not treated appropriately

CORONA Respiratory Mask - N95

What is PPE- N-95?

• N95 respirators and surgical masks (face masks) are examples of personal protective equipment that are used to protect the wearer from airborne particles and from liquid contaminating the face.
•  It filters at least 95% of airborne particles
• It is an example of a mechanical filter respirator, which provides protection against particulates but not against gases or vapors.
• These masks are significant as compared to others in terms of filter efficiency.
• It is intended to help reduce wearer exposure to certain airborne particles including those generated by electrocautery, laser surgery, and other powered medical instruments. 
• As a surgical mask it protects against splash & spatter of the blood & other infectious agents.

What are the features of N-95 respirator?

• Approved by NIOSH -National Institute for Occupational Safety & Health.
• Meets CDC guidelines for Mycobacterium tuberculosis exposure control.
• 99% BFE (Bacterial Filtration Efficiency).
• Fluid resistant.
• Braided headbands, cushioning nose foam, and light weight construction for comfortable wear.

Origin of N-95:

N95 respirators were originally designed for industrial use in sectors such as mining, construction, and painting.They have also been shown to be effective against engineered nanoparticles.

these masks are useful against oil components such as lubricants, cutting fluids or glycerine.

Use in health care:

• These masks are used in health care in response to COVID-19.
• N95  are certified to protect the wearer from inhalation of infectious particles including Mycobacterium tuberculosis, severe acute respiratory syndrome (SARS), pandemic influenza, and Ebola.

Disposal :

Disposable filtering facepiece respirators such as N95 masks are not approved for routine decontamination and reuse as standard of care.

Ultraviolet Germicidal Irradiation (UVGI) Process for Decontamination can be used

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Electrolye Imbalance (Hyponatremia) & Nursing Intervnetions

HYPONATREMIA: 

What is Sodium ? 

• Major ECF cation 
• Daily requirement = 100 mEq = 6 gm salt for a normal human being 
• Normal value in adult plasma : 135-145 mEq/L 

What is hyponatremia ? 

• Plasma NA+  < 135 mEq/L 

Types of hyponatremia: 

1] Pseudo hyponatreia : associated with normal or increased tonicity

2] Isotonic hyponatremia :extra cellular fluids expands along with isotonic fluids with no NA in it 

Eg : hyperproteinemia, hyperlipidemia

3] Hypertonic hyponatremia : shift of water into ECF along witrh Na  

Eg hyperglycemia , mannitol use

4] Hypo tonic hyponatremia: most common hyponatremia as per clinical point of view 

Occurs due to : 

i] impaired renal water excretion 

ii] excess intake of water 

It is of 3 types : 

i] hypovolemic : total water & total sodium loss eg vomiting, diarrhea, NG suction, burns, sweating 

ii] euvolemic : hyponatremia with normal ECF content eg ADDISON’S disease, diabetes incipidus 

iii] hypervolemic : increase fluid & sodium  eg CCF, liver failure, kidney failure 

Sign & Symptoms : SALT LOSS 

S- Seizures & Stupor 

A-Abdominal cramping, attitude changes (confusion) 

L-Lethargic 

T-Tendon reflexes diminished, trouble concentrating (confused) 

L-Loss of urine & appetite 

O-Orthostatic hypotension, overactive bowel sounds 

S-Shallow respirations (happens late due to skeletal muscle weakness) 

S-Spasms of muscles 

NURSING IMPLICATIONS: 

• Watch cardiac, respiratory, neuro, renal, and GI status:

•  
  

• Hypovolemic Hyponatremia: give IV sodium chloride infusion to restore sodium and fluids (3% Saline hypertonic solution….harsh on the veins…given in ICU usually through central line very slowly…must watch for fluid overload)
  

• 
  

• Hypervolemic Hyponatremia: Restrict fluid intake and in some cases administer diuretics to excretion the extra water rather than sodium to help concentrate the sodium. If the patient has renal impairment they may need dialysis.
  

• 
  

• If patient takes Lithium remember to monitor drug levels because lithium excretion will be diminished and this can cause lithium toxicity. 

• Instruct to increase oral sodium intake and some physicians may prescribe sodium tablets. Food rich in sodium include: bacon, butter canned food, cheese, hot dogs, lunch meat, processed food, table salt

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• Caused by SIADH or antidiuretic hormone problems: fluid restriction or treated with an antidiuretic hormone antagonists called Declomycin which is part of the tetracycline family (don’t give with food especially dairy or antacids…bind to cations and this affect absorption).