STATUS ASTHMATICUS DEFINITION Status asthmaticus is a life-threatening form of asthma in which rogressi!el" worsening reacti!

e airwa"s are unres onsi!e to usual a ro riate thera " that lea#s to ulmonar" insufficienc"$ %ATHO%H&SIO'O(& Status asthmaticus is a re!ersi)le* recurrent* #iffuse o)structi!e ulmonar" #isease rocess cause# )" airwa" inflammation an# h" er-reacti!it"$ The rimar" atho h"siolog" inclu#es+ , Smooth muscle s asm , Mucosal e#ema , Mucous lugging$ These changes in the airwa" cause airflow o)struction lea#ing to remature airwa" closure on e- iration which causes #"namic h" erinflation$ This #"namic h" erinflation or .air-tra ing/ also lea#s to !entilation 0 erfusion mismatching causing h" o-emia$ SI(N AND S&M%TOMS+ #"s nea whee1ing tightness in the chest ra i# ulse h" erresonant lung fiel#s #iminishe# )reath soun#s E!i#ence of c"anosis0h" o-emia

THE2A%EUTICA' MANA(EMENT Continous ne)uli1ation with an inhale# )eta-3-antagonist an# intra!enous corticosteroi#s ma" )e necessar" to re#uce s"m toms (i!e the o-"gen with humi#ification Monitor inta4e an# out ut Measure the s ecific gra!it" of urine In se!ere attac4s* en#otracheal intu)ation an# mechanical !entilation ma")e necessar" to maintain effecti!e res irations

DIA(NOTIC TEST FO2 STATUS ASTHMATICUS S irometr" Com lete %ulmonar" Function Testing Chest 5-2a" %ulse O-imetr" Arterial 6loo# (as 7A6(8

%OSSI6'E NU2SIN( DIA(NOSIS Ineffecti!e Airwa" Clearance+ 9hee1ing relate# to increase# ro#uction an# retaine# ulmonar" secretions Im aire# (as E-change+ C"anosis relate# to altere# #eli!er" of ins ire# O3 an# air tra ing secon#ar" to Status Asthmaticus

2ES%I2ATO2& DIST2ESS S&ND2OME -A #isease relate# to immaturit" of the lungs -Ma" also )e calle# h"aline mem)rane #isease 2IS: FACTO2S+ -%rematurit" -Maternal Dia)etes Mellitus -Stress #uring #eli!er" that ro#uces aci#osis in neonate -Infant )orn of CS -Meconium as iration %ATHO%H&SIO'O(& High ressure is re;uire# to fill the lungs with air for the fisrt time an# o!ercome the ressure of lung flui#$ If al!eoli colla se with each e- iration* as ha ens* when surfactant is #eficient* forceful ins irations re;uiring o timum ressure are still re;uire# to inflate them$ E!en !er" mature infants release a )olus of surfactant at )irth into their lungs from stress of )irth$ 6loo# then shunts throught the foramen o!al an# the #ucus arteriousus as it #i# #uring fetal life$ The lungs are oorl" erfuse#* affecting gas e-change$ As a result* the ro#uction of surfactant increase# further$ The oor o-"gen e-change that results lea#s to tissue h" o-ia* which causes the release of lactic aci#$ This* com)ine# with the increasing car)on #io-i#e le!el resulting from the formation of the h"aline mem)rane on the al!eolar surface* lea#s to se!ere aci#osis$ SI(NS AND S&M%TOMS Increase# res irator" rate 'a)ore# )reathing Fine Crac4les on ausculatation C"anosis Nasal Flaring E- irator" (runting Seesaw res irations Heart Failure %neumothora-

THE2A%EUTIC MANA(EMENT Surfactant 2e lacement O-"gen A#ministration <entilation E-tracor oreal Mem)rane O-"genation Nitiric O-i#e

SU%%O2TI<E CA2E An infant with res irator" #istress s"m toms must )e 4e t warm )ecause cooling increases aci#osis in all new)orns an# for the new)orn with res irator" #istress s"n#rome it ma" increase to lethal le!els DIA(NOSTIC TEST

Arterial )loo# gas 6ronchosco " Chest --ra" S utum cultures an# anal"sis Tests for ossi)le infections

%OSSI6'E NU2SIN( DIA(NOSIS Ineffecti!e 6reathing %attern+ Nasal Flaring relate# to tissue h" o-ia Im aire# (as E-change+ e- irator" grunting relate# to ina#e;uate surfactant le!els

ASSESSMENT

DIA(NOSIS

%'ANNIN(

INTE2<ENTION E<A'UATION

D"s nea 9hee1ing soun#s C"anosis %ulse 2ate= >3? ) m

Im aire# (as E-change+ C"anosis relate# to altere# #eli!er" of ins ire# O3 an# air tra ing secon#ar" to Status Asthmaticus

After @ hours of holistic nursing care that atient will )e a)le to+ >$8e-hi)it normal res irator" function as e!i#ence# )" res irations which are unla)ore# an# within normal limits

>$8A#minister humi#ifie# o-"gen )" tent* facemas4 or cannula$ 3$8 Closel" monitor o-"gen saturation an# A6( !ia ulse o-imetr" A$8Closel" monitor of o-"gen #eli!ere#$ B$8 Esta)lish I< infusion ?$8Ele!ate hea# of )e# an# osition client a ro riatel" C$8Monitor inta4e an# out ut D$A#minister me#ication as in#icate# 7E ine hrine8 @$8 :ee en!ironment allergen an# ollutant free

After @ hours of holistic nursing care that atient was a)le to+ >$8e-hi)it normal res irator" function as e!i#ence# )" res irations which are unla)ore# an# within normal limits

ASSESSMENT

DIA(NOSIS

%'ANNIN(

INTE2<ENTION E<A'UATION

 'a)ore# )reathing Fine Crac4les on auscultation C"anosis Nasal Flaring E- irator" (runting

Im aire# (as E-change+ e- irator" grunting relate# to ina#e;uate surfactant le!els

After @ hours of holistic nursing care that atient will )e a)le to+ >$8 #emonstrate im ro!e# !entilation an# a#e;uate o-"genation of tissues )" A6(Es within clientEs normal limits an# a)sence of s"m toms of res irator" #istress

>$8 Ele!ate hea# of )e# an# osition client a ro riatel" 3$8 A#minister o-"gen as or#ere# A$8 Do suctioning as in#icate# B$8 2e lace surfactant as or#ere# ?$8Encourage a#e;uate rest an# limit acti!ities to within clientEs tolerance C$8 E#ucate the arents a)out the #isease* treatments* an# roce#ures as well as what to e- ect$ D$8 Monitor for car)on #io-i#e narcosis @$8 Monitor a#e;uate In ut an# out ut $

After @ hours of holistic nursing care that atient was a)le to+ >$8 #emonstrate im ro!e# !entilation an# a#e;uate o-"genation of tissues )" A6(Es within clientEs normal limits an# a)sence of s"m toms of res irator" #istress