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1. What factors may trigger an asthmatic episode?

Factors that may trigger an asthmatic episode are: cigarette smoke, allergens
(outdoor and indoor), exercise, cold air exposure or sudden temperature
change, respiratory infections and colds, excitement/ stress, odors and
fumes, animals, medications, food, environmental change, and medical
conditions(GERD, transesophageal fistula).

2. What are the clinical manifestations of a child experiencing an exacerbation

of asthma?
Coughhacking, paroxysmal, irritative, and nonproductive
Becomes rattling and productive of frothy, clear, gelatinous sputum
Respiratory-Related SignsSOB, prolonged expiratory phase, audible wheeze, may have a malar
flush and red ears,
lips deep dark red color, may progress to cyanosis
of nail beds or circumoral cyanosis,
restlessness, apprehension,
prominent sweating as the attack progresses, Tripod
speaking with short panting broken phrases
ChestHyperresonance on percussion, coarse loud breath sounds, wheezing
through lung field, prolonged expiration, crackles, general inspiratory &
expiratory wheezing increasingly
high pitched
With repeated episodesBarrel chest, elevated shoulders, use of accessory muscles
Facial appearance: flattened malar bones, dark circles beneath eyes,
narrow nose,
prominent upper teeth
Difficulty volcalizing, dyspnea, changes is resp. rate and rhythm, chest
thighness, expiration required effort.
As exacerbation progresses, diaphoresis, tachycardia, and widened pulse
pressure and central cyanosis secondary to severe hypoxia may occur.
3. Explain the progression of asthma that is nonresponsive to treatment.
The child then is considered to be in status asthmaticus. The child will
display respiratory distress despite vigorous therapeutic measures, especially
the use of sympathominetics (albuterol,epinephrine). Respiratory distress
includes SOB, cyanosis, use of accessory muscles. The child signs and
symptoms will progressively get worse. The child may sweat profusely,
remain sitting upright, and refuses to lie down. Also, a child who suddenly
becomes agitated or an agitated child who suddenly becomes quiet may
have serious hypoxia. Such progression can occur with little to no warning
and can progress rapidly to asphyxiation. Infection, anxiety, nebulizer abuse,

dehydration, increased adrenergic blockage, and nonspecific irritants may

contribute to these episodes.
4. Discuss the pathophysiology of asthma.
Mast cells, macrophages, T lymphocytes, neutrophils, and eosinophils all play
a key role in the inflammation of asthma. When activated mast cells release
chemical mediators (including histamine, bradykinin, prostanoids, cytokines,
and leukotrienes) that perpetuate the inflammatory response causing
increased blood flow, vasoconstriction, fluid leak from the vasculature,
attraction of WBC to the area, mucus secretion, and bronchoconstriction. As
asthma becomes more persistent, the inflammation progress, and other
factors may be involved in airflow limitation. These include airway edema,
mucus hypersecretion, and the formation of mucus plug.
5. Discuss the actions, side effects, contraindications, and nursing implications
of the following medications in the treatment of asthma:
Albuterol: A- binds to beta2-adrenergic receptors in airway smooth muscle,
increases levels of cAMP. Selective for beta2 receptors in lungs. cAMP
decreases action og myosin and CA+, resulting in relaxation of airway
smooth muscle.
S/E- chest pain, palpitations, angina, arrhythmias
C- using medication with MAOIs may lead to HTN crisis
Safe dose range- Tablets: 6-12yrs 2mg pot id or qid max 24mg daily, 13 &
above 2-4mg pot id qid max 32mg daily, tablets er: 6-11yrs 4mg po q 12h
max 24mg daily, 12& older 4-8mg po 12h max 32mg daily.
Solution: 13 &
older 2.5mg tid or qid, 2-12yrs weighing more than 15kg 2.5mg tid or qid, 212 yrs weighing less than 15kg 0.63mg or 1.25 mg tid or qid not to exceed
2.5mg tid or qid. Inhalation aerosol: 4yrs & older 1-2 puffs q 4-6 h
Atrovent: A- Given by inhalation, the drug inhibits cholinergic receptors in
bronchial smooth muscle tissue, resulting in decreased concentrations of
cGMP. Decreased cGMP produces local bronchodilation. Given intranasally,
application inhibits secretions from glands lining the nasal mucosa.
S/E- bronchospasm, hypotension, palpitations
C- anticholinergic inhalers promote plugging of mucus in clients with
Safe dose range- MDI 2 puffs qid, Intranasal 2 sprays 2-3 times/day,
Nebulizer 250-500mcg q 20 min for 3 doses.
Epinephrine: A- Relaxes bronchial smooth muscle by stimulating beta2
receptors and alpha and beta receptors in the sympathetic nervous system.
S/E- cerebral hemorrhage, ventricular fibrillation
C- sulfite allergies, use cautiously in patients with long standing bronchial
asthma who have developed degenerative heart disease
Safe dose range- Children: 0.01mg/kg of 1:1000 solution subq to max of
0.5mg, repested q 4 h prn Infants: 0.05mg/kg sol subq may be repeated at
20-30min intervals Neonates: 0.01mg/kg

Prednisolone: A- decreases inflammation, mainly by stabilizing leukocyte

lysosomal membranes, suppresses immune response.
S/E- arrhythmias, thromboembolism,hypokalemia,hypocalcemia, pancreatitis
Safe Dose Range- 1-2mg/kg/day po in single or divided doses until child
reaches peak expiratory flow rate of 80% or personal best.
Prednisone: A-same as prednisolone
S/E- same as prednisolone
C- grapefruit juice, DM, cirrhosis, active hepatitis, diverticulitis
Safe dose range- 5-60mg po daily in single or as 2-4 divided doses.
Solumedrol: A- suppresses inflammation and the normal immune response
S/E- same as prednisone and prednisolone
C- same as prednisone and prednisolone
Safe Dose range- not less than 0.5mg/kg IM q 24 h
Magnesium Sulfate: A- replaces magnesium and maintains magnesium levels;
as an anticonvulsant reduces muscle contractions by interfering with release
of acetylcholine at myoneural junction
S/E- arrhythmias, respiratory paralysis
C- myocardial damage or heart block
Safe Dose RangeSodium Bicarbonate: A- restores buffering capacity of the body and
neutralizes excess acid.
S/E: metabolic alkalosis
C- pt w/ metabolic or resp alkalosis
Safe dose range- 2-5meq/kg Iv inflused over 4-8 hrs.
6. Discuss the following treatment modalities for the treatment of asthma and
note when each is indicated:
Aerosolized meds by nebulizer: provide therapy to pts too ill or roo young to
use hand-held devices and in situations where large drug doses are
MDI: usually rescue inhalers, used to keep asthma in check deliver long-term
control medications
Heliox therapy:

7. Discuss consent for treatment of a minor. How does the nurse proceed if the
parent is unreachable?