status asthmaticus.pptx respiratory problems

MSc nursing 2 nd year Government college of nursing Rajnandgaon Chhattisgarh

1. Status asthmaticus

2. Definition Status asthmaticus definition varies widelyAsthma attack that does not respond to initial bronchodilatory therapy and requires admission to the hospital for continued treatmentSevere asthma that leads to respiratory failure and need for mechanical ventilationSudden asphyxial asthma: acute dramatic onset of bronchospasm and symptoms which can quickly lead to asphyxia, cardiopulmonary arrest, and death in patients with otherwise only mild or no significant history of asthma

3. Cont.. High risk patients: history of ICU admissions, history of mechanical ventilation, seizures or syncope, PaCO2 >45 mmHg, more severe baseline history of asthma.African Americans 4.1 times more likely to require treatment in the ED for asthma, 2 times more likely to be hospitalized, and 7.6 times more likely to die compared with CaucasiansIntubation/mechanical ventilation rates for patients with asthma in the ICU vary by ICU (~2-10%)

4. Causes

5. Pathophysiology

6. Clinical manifestations Respiratory distress: upright, dyspneic, short phrasesRapid shallow breathing with use of accessory musclesCyanosis, gasping, exhaustion, decreased consciousnessInspiratory and expiratory wheezes or worse off, the silent chestMild hypoxemia

7. Cont.. Blood gas: A patient who is tachypneic and breathing hard should have hypocapnea and a mild respiratory alkalosis. A “normal” blood gas in a struggling asthmatic is very abnormal and an indication of potential impending respiratory failurePeak expiratory flow: >70% of predicted used for discharge from urgent care or ED, 40-69% of predicted for continued ED or hospital treatment, <40% of predicted for care with adjunct therapies, <25% life threatening

8. Cont.. Albuterol can sometimes cause transient hypoxemia when first initiated as if systemically absorbed, the Beta 2 effects also include pulmonary vasodilation, thereby countering the normal protective hypoxic pulmonary vasoconstriction that occurs, thereby leading to increased intrapulmonary shunt and hypoxemia. This is particularly the case if there is significant atelectasis or a focal consolidation (i.e. pneumonia)

9. Cont.. Lactic acidosis: Common (up to 83% in one study) in patients with status asthmaticus admitted to the PICU. The vast majority of lactic acidosis was Type B (associated with adrenergic stimulation) (Meert, PCCM 2012) Type A: Due to impairment in oxygen delivery. Associated with lactate/pyruvate ratio >25Type B: Due to adrenergic stimulation (i.e. high dose albuterol, epinephrine, etc.)

10. Diagnostic evaluation

11. Treatment

12. Nursing Management