(^94) Medical-Surgical Nursing Demystified
frequent attacks, a mild exposure to a known trigger will often be sufficient to
exacerbate an attack. Patients who do not respond to medications or who use med-
ications improperly may die during an asthma attack.
HALLMARK SIGNS AND SYMPTOMS
- Wheezing initially present on expiration continues throughout respiratory
cycle as inflammation progresses. Air has difficulty moving through the nar-
rowed airways, making noise. Not all asthmatics will have wheezing. - Asymptomatic between asthma attacks. Symptoms resolve when there is no
inflammation present. - Difficulty breathing (dyspnea) as airways narrow due to inflammation. This
is typically progressive as inflammation increases. - Respiration greater than 20 breaths per minute (tachypnea) as the body
attempts to get more oxygen into the lungs to meet physiologic needs. - Use of accessory muscles to breathe as the body tries harder to get more air
into the lungs. - Tightness in the chest due to narrowing of the airways (bronchoconstriction).
- Cough.
- Tachycardia—heart rate greater than 100, as the body attempts to get more
oxygen to the tissues.
INTERPRETING TEST RESULTS
- Decreased oxygen and increased carbon dioxide present in arterial blood gas
due to inability to move adequate air, which results in inadequate gas exchange. - Decreased force on expiration [either forced expiratory volume in the first
second (FEV 1 ) or peak expiratory rate flow (PERF)] during attack shown in
pulmonary function test. Narrowed airways make it more difficult for the
patient to exhale, prolonging time of exhalation and decreasing force of exha-
lation. Patients can check expiratory effort at home on a peak flow meter. - Hyperinflated lungs shown in chest x-ray due to air trapping.
- Pulse oximetry shows diminished oxygen saturation.
- CBC—elevated eosinophils.
- Sputum—positive for eosinophils.