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Asthma Treatment Guidelines
Tests to measure lung function
You may also be given lung (pulmonary) function tests to determine how much air moves in and out as
you breathe. These tests may include:
Spirometry. This test estimates the narrowing of your bronchial tubes by checking how much air
you can exhale after a deep breath and how fast you can breathe out.
Peak flow. A peak flow meter is a simple device that measures how hard you can breathe out.
Lower than usual peak flow readings are a sign your lungs may not be working as well and that
your asthma may be getting worse. Your doctor will give you instructions on how to track and
deal with low peak flow readings.
Lung function tests often are done before and after taking a medication called a bronchodilator such as
albuterol, to open your airways. If your lung function improves with use of a bronchodilator, it's likely
you have asthma.
Additional tests
Other tests to diagnose asthma include:
Methacholine challenge. Methacholine is a known asthma trigger that, when inhaled, will cause
mild constriction of your airways. If you react to the methacholine, you likely have asthma. This
test may be used even if your initial lung function test is normal.
Nitric oxide test. This test, though not widely available, measures the amount of the gas, nitric
oxide that you have in your breath. When your airways are inflamed a sign of asthma you
may have higher than normal nitric oxide levels.
Imaging tests. A chest X-ray and high-resolution computerized tomography (CT) scan of your
lungs and nose cavities (sinuses) can identify any structural abnormalities or diseases (such as
infection) that can cause or aggravate breathing problems.
Allergy testing. This can be performed by a skin test or blood test. Allergy tests can identify
allergy to pets, dust, mold and pollen. If important allergy triggers are identified, this can lead to
a recommendation for allergen immunotherapy.
Sputum eosinophils. This test looks for certain white blood cells (eosinophils) in the mixture of
saliva and mucus (sputum) you discharge during coughing. Eosinophils are present when
symptoms develop and become visible when stained with a rose-colored dye (eosin).
Provocative testing for exercise and cold-induced asthma. In these tests, your doctor measures
your airway obstruction before and after you perform vigorous physical activity or take several
breaths of cold air.
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How asthma is classified
Tzz+o classify your asthma severity, your doctor considers your answers to questions about symptoms
(such as how often you have asthma attacks and how bad they are), along with the results of your
physical exam and diagnostic tests.
Determining your asthma severity helps your doctor choose the best treatment. Asthma severity often
changes over time, requiring treatment adjustments.
Asthma is classified into four general categories:
Asthma
classification
Signs and symptoms
Mild intermittent
Mild symptoms up to two days a week and up to
two nights a month
Mild persistent
Symptoms more than twice a week, but no more
than once in a single day
Moderate
persistent
Symptoms once a day and more than one night a
week
Severe persistent
Symptoms throughout the day on most days and
frequently at night
Medications
Long-term asthma control medications, generally taken daily, are the cornerstone of asthma treatment.
These medications keep asthma under control on a day-to-day basis and make it less likely you'll have an
asthma attack. Types of long-term control medications include:
Inhaled corticosteroids. These anti-inflammatory drugs include fluticasone (Flonase, Flovent
HFA), budesonide (Pulmicort Flexhaler, Rhinocort), flunisolide (Aerospan HFA), ciclesonide
(Alvesco, Omnaris, Zetonna), beclomethasone (Qnasl, Qvar), mometasone (Asmanex) and
fluticasone furoate (Arnuity Ellipta).
You may need to use these medications for several days to weeks before they reach their maximum
benefit. Unlike oral corticosteroids, these corticosteroid medications have a relatively low risk of side
effects and are generally safe for long-term use.
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Leukotriene modifiers. These oral medications including montelukast (Singulair), zafirlukast
(Accolate) and zileuton (Zyflo) help relieve asthma symptoms for up to 24 hours.
In rare cases, these medications have been linked to psychological reactions, such as agitation,
aggression, hallucinations, depression and suicidal thinking. Seek medical advice right away for any
unusual reaction.
Long-acting beta agonists. These inhaled medications, which include salmeterol (Serevent) and
formoterol (Foradil, Perforomist), open the airways.
Some research shows that they may increase the risk of a severe asthma attack, so take them only in
combination with an inhaled corticosteroid. And because these drugs can mask asthma deterioration,
don't use them for an acute asthma attack.
Combination inhalers. These medications such as fluticasone-salmeterol (Advair Diskus),
budesonide-formoterol (Symbicort) and formoterol-mometasone (Dulera) contain a long-
acting beta agonist along with a corticosteroid. Because these combination inhalers contain
long-acting beta agonists, they may increase your risk of having a severe asthma attack.
Theophylline. Theophylline (Theo-24, Elixophyllin, others) is a daily pill that helps keep the
airways open (bronchodilator) by relaxing the muscles around the airways. It's not used as often
now as in past years.
Quick-relief (rescue) medications are used as needed for rapid, short-term symptom relief during an
asthma attack or before exercise if your doctor recommends it. Types of quick-relief medications
include:
Short-acting beta agonists. These inhaled, quick-relief bronchodilators act within minutes to
rapidly ease symptoms during an asthma attack. They include albuterol (ProAir HFA, Ventolin
HFA, others) and levalbuterol (Xopenex).
Short-acting beta agonists can be taken using a portable, hand-held inhaler or a nebulizer a machine
that converts asthma medications to a fine mist so that they can be inhaled through a face mask or a
mouthpiece.
Ipratropium (Atrovent). Like other bronchodilators, ipratropium acts quickly to immediately
relax your airways, making it easier to breathe. Ipratropium is mostly used for emphysema and
chronic bronchitis, but it's sometimes used to treat asthma attacks.
Oral and intravenous corticosteroids. These medications which include prednisone and
methylprednisolone relieve airway inflammation caused by severe asthma. They can cause
serious side effects when used long term, so they're used only on a short-term basis to treat
severe asthma symptoms.
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If you have an asthma flare-up, a quick-relief inhaler can ease your symptoms right away. But if your
long-term control medications are working properly, you shouldn't need to use your quick-relief inhaler
very often.
Keep a record of how many puffs you use each week. If you need to use your quick-relief inhaler more
often than your doctor recommends, see your doctor. You probably need to adjust your long-term
control ---medication.
Allergy medications may help if your asthma is triggered or worsened by allergies. These include:
Allergy shots (immunotherapy). Over time, allergy shots gradually reduce your immune system
reaction to specific allergens. You generally receive shots once a week for a few months, then
once a month for a period of three to five years.
Omalizumab (Xolair). This medication, given as an injection every two to four weeks, is
specifically for people who have allergies and severe asthma. It acts by altering the immune
system.
Bronchial thermoplasty
This treatment which isn't widely available nor right for everyone is used for severe asthma that
doesn't improve with inhaled corticosteroids or other long-term asthma medications.
Generally, over the span of three outpatient visits, bronchial thermoplasty heats the insides of the
airways in the lungs with an electrode, reducing the smooth muscle inside the airways. This limits the
ability of the airways to tighten, making breathing easier and possibly reducing asthma attacks.
Treat by severity for better control: A stepwise approach
Your treatment should be flexible and based on changes in your symptoms, which should be assessed
thoroughly each time you see your doctor. Then your doctor can adjust your treatment accordingly.
For example, if your asthma is well-controlled, your doctor may prescribe less medicine. If your asthma
isn't well-controlled or is getting worse, your doctor may increase your medication and recommend
more-frequent visits.
Asthma action plan
Work with your doctor to create an asthma action plan that outlines in writing when to take certain
medications or when to increase or decrease the dose of your medications based on your symptoms.
Also include a list of your triggers and the steps you need to take to avoid them.
Your doctor may also recommend tracking your asthma symptoms or using a peak flow meter on a
regular basis to monitor how well your treatment is controlling your asthma.
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Activity Learning Outcomes
Through this assignment, the student will demonstrate the ability to:
1. Identify and articulate advanced assessment health history and physical examination
techniques which are relevant to a focused body system (CO 1)
2. Differentiate normal and abnormal findings with regard to a disease or condition that
impacts the body system (CO 2)
3. Adapt advanced assessment skills if necessary to suit the needs of specific patient
populations (CO 4)
4. This paper will be appraised on the quality of the information, inclusion of at least
one evidence-based scholarly source, use of citations, use of Standard English
grammar, and organization based on the required components (see the paper
headings and content details below).
1. Scholarly sources: Only scholarly sources are acceptable for citation and reference in
this course. These include peer reviewed publications, government reports, or sources
written by a professional or scholar in the field. Your textbook and lesson are not
considered to be an outside scholarly source. For the discussions and reflection posts,
reputable internet sources such as websites by government agencies (URL ends in .gov)
and respected organizations (often ends in .org) can be counted as scholarly sources. The
best outside scholarly source to use is a peer-reviewed nursing journal. You are encouraged to
use the Chamberlain library and search one of the available data bases for a peer-reviewed
journal article. The following sources should not be used: Wikipedia, Wikis, or blogs. These
web sites are not considered scholarly as anyone can add to these. Please be aware that .com
websites can vary in scholarship and quality. For example, the American Heart Association is a
.com site with scholarship and quality. It is the responsibility of the student to determine the
scholarship and quality of any .com site. Ask your instructor before using any site if you are
unsure. Points will be deducted from the rubric if the site does not demonstrate scholarly
sources must be published with the last 5 years. Instructor permission must be
obtained BEFORE the assignment is due if using a source that is older than 5 years.
2. The length of the paper is to be no less than 1,500 words, excluding title page and
reference list.
3. Create this assignment using Microsoft (MS) Word. You can tell that the document is
saved as a MS Word document because it will end in “.docx.”
4. APA format (6th edition) is required in this assignment, explicitly for in-text citations
and the reference list. Use 12-point Times New Roman font with 1 inch margins and
double spacing. See the APA manual for details regarding proper citation.
5. Organize the headings and content of
1. Infant/pediatric
2. Pregnancy
3. Geriatric
5. Identify one major disease or disease process that may significantly impact this
body system. One disease process or condition that may significantly
hinder conducting a Health History interview. (This is the assignment)
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Organize the headings and content of your paper using the outline below:
6. Select a body system relevant to the lesson(Overall Health Assessment)
select the Health History as the topic of the paper.
7. Discuss the physiology (structure and function) of the body system including
details about the major organ systems (if applicable). NOTE:provide an overview
of interviewing techniques.
Construct relevant health history questions (subjective data) pertaining to the body
system. NOTE: construct relevant health history questions for all body systems as
included on the review of systems (ROS).
Provide an overview of the objective data and expected normal physical examination
findings for this body system. NOTE: provide the expected normal subjective findings
for each body systems on the ROS.
Explain special physical assessment examination techniques or procedures specific to
assessing this body system. NOTE: explain advanced interview techniques.
Explain special physical assessment examination techniques or procedures
specific to assessing this body system. NOTE: Explain advanced interview
techniques.
Analyze and discuss how you might adapt your physical assessment skills or
interviewing techniques to accommodate each of the following specific
populations:
Infant/pediatric
Pregnancy
Geriatric
o Identify one major disease or disease process that may significantly
impact this body system. NOTE: If writing the assignment for Week 1,
identify one disease process or condition that may significantly hinder
conducting a Health History interview.
o Synthesis and discuss the expected abnormal physical examination
findings that may be associated with this disease or disease process.
o Summarize the key points.
o References in correct APA format
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Reference list of Books:
Bickley, L. S., & Szilagyi, P. G. (2016). Bates' Guide to Physical Examination and History
Taking (12
th
ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 1: Foundations of Health Assessment
Chapter 2: Evaluating Clinical Evidence
Chapter 3: Interviewing and the Health History
Chapter 4: Beginning the Physical Examination: The Health History (pages 112-119)
Phillips, A., Frank, A., Loftin, C., & Shepherd, S. (2017). A detailed review of systems: An
educational feature. The Journal for Nurse Practitioners, 13(10), 681-686.
Feel Free to use Epocrates.com
Username: Asteriawins
PW: student92020
Also https://chamberlain.instructure.com/courses/50954/modules/items/6693938
Sign in: Asteriawins
Pw: Student#92020

Unformatted Attachment Preview

Asthma Treatment Guidelines Tests to measure lung function You may also be given lung (pulmonary) function tests to determine how much air moves in and out as you breathe. These tests may include: • Spirometry. This test estimates the narrowing of your bronchial tubes by checking how much air you can exhale after a deep breath and how fast you can breathe out. • Peak flow. A peak flow meter is a simple device that measures how hard you can breathe out. Lower than usual peak flow readings are a sign your lungs may not be working as well and that your asthma may be getting worse. Your doctor will give you instructions on how to track and deal with low peak flow readings. Lung function tests often are done before and after taking a medication called a bronchodilator such as albuterol, to open your airways. If your lung function improves with use of a bronchodilator, it's likely you have asthma. Additional tests Other tests to diagnose asthma include: • Methacholine challenge. Methacholine is a known asthma trigger that, when inhaled, will cause mild constriction of your airways. If you react to the methacholine, you likely have asthma. This test may be used even if your initial lung function test is normal. • Nitric oxide test. This test, though not widely available, measures the amount of the gas, nitric oxide that you have in your breath. When your airways are inflamed — a sign of asthma — you may have higher than normal nitric oxide levels. • Imaging tests. A chest X-ray and high-resolution computerized tomography (CT) scan of your lungs and nose cavities (sinuses) can identify any structural abnormalities or diseases (such as infection) that can cause or aggravate breathing problems. • Allergy testing. This can be performed by a skin test or blood test. Allergy tests can identify allergy to pets, dust, mold and pollen. If important allergy triggers are identified, this can lead to a recommendation for allergen immunotherapy. • Sputum eosinophils. This test looks for certain white blood cells (eosinophils) in the mixture of saliva and mucus (sputum) you discharge during coughing. Eosinophils are present when symptoms develop and become visible when stained with a rose-colored dye (eosin). • Provocative testing for exercise and cold-induced asthma. In these tests, your doctor measures your airway obstruction before and after you perform vigorous physical activity or take several breaths of cold air. How asthma is classified Tzz+o classify your asthma severity, your doctor considers your answers to questions about symptoms (such as how often you have asthma attacks and how bad they are), along with the results of your physical exam and diagnostic tests. Determining your asthma severity helps your doctor choose the best treatment. Asthma severity often changes over time, requiring treatment adjustments. Asthma is classified into four general categories: Asthma classification Signs and symptoms Mild intermittent Mild symptoms up to two days a week and up to two nights a month Mild persistent Symptoms more than twice a week, but no more than once in a single day Moderate persistent Symptoms once a day and more than one night a week Severe persistent Symptoms throughout the day on most days and frequently at night Medications Long-term asthma control medications, generally taken daily, are the cornerstone of asthma treatment. These medications keep asthma under control on a day-to-day basis and make it less likely you'll have an asthma attack. Types of long-term control medications include: • Inhaled corticosteroids. These anti-inflammatory drugs include fluticasone (Flonase, Flovent HFA), budesonide (Pulmicort Flexhaler, Rhinocort), flunisolide (Aerospan HFA), ciclesonide (Alvesco, Omnaris, Zetonna), beclomethasone (Qnasl, Qvar), mometasone (Asmanex) and fluticasone furoate (Arnuity Ellipta). You may need to use these medications for several days to weeks before they reach their maximum benefit. Unlike oral corticosteroids, these corticosteroid medications have a relatively low risk of side effects and are generally safe for long-term use. • Leukotriene modifiers. These oral medications — including montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo) — help relieve asthma symptoms for up to 24 hours. In rare cases, these medications have been linked to psychological reactions, such as agitation, aggression, hallucinations, depression and suicidal thinking. Seek medical advice right away for any unusual reaction. • Long-acting beta agonists. These inhaled medications, which include salmeterol (Serevent) and formoterol (Foradil, Perforomist), open the airways. Some research shows that they may increase the risk of a severe asthma attack, so take them only in combination with an inhaled corticosteroid. And because these drugs can mask asthma deterioration, don't use them for an acute asthma attack. • Combination inhalers. These medications — such as fluticasone-salmeterol (Advair Diskus), budesonide-formoterol (Symbicort) and formoterol-mometasone (Dulera) — contain a longacting beta agonist along with a corticosteroid. Because these combination inhalers contain long-acting beta agonists, they may increase your risk of having a severe asthma attack. • Theophylline. Theophylline (Theo-24, Elixophyllin, others) is a daily pill that helps keep the airways open (bronchodilator) by relaxing the muscles around the airways. It's not used as often now as in past years. Quick-relief (rescue) medications are used as needed for rapid, short-term symptom relief during an asthma attack — or before exercise if your doctor recommends it. Types of quick-relief medications include: • Short-acting beta agonists. These inhaled, quick-relief bronchodilators act within minutes to rapidly ease symptoms during an asthma attack. They include albuterol (ProAir HFA, Ventolin HFA, others) and levalbuterol (Xopenex). Short-acting beta agonists can be taken using a portable, hand-held inhaler or a nebulizer — a machine that converts asthma medications to a fine mist — so that they can be inhaled through a face mask or a mouthpiece. • Ipratropium (Atrovent). Like other bronchodilators, ipratropium acts quickly to immediately relax your airways, making it easier to breathe. Ipratropium is mostly used for emphysema and chronic bronchitis, but it's sometimes used to treat asthma attacks. • Oral and intravenous corticosteroids. These medications — which include prednisone and methylprednisolone — relieve airway inflammation caused by severe asthma. They can cause serious side effects when used long term, so they're used only on a short-term basis to treat severe asthma symptoms. If you have an asthma flare-up, a quick-relief inhaler can ease your symptoms right away. But if your long-term control medications are working properly, you shouldn't need to use your quick-relief inhaler very often. Keep a record of how many puffs you use each week. If you need to use your quick-relief inhaler more often than your doctor recommends, see your doctor. You probably need to adjust your long-term control ---medication. Allergy medications may help if your asthma is triggered or worsened by allergies. These include: • Allergy shots (immunotherapy). Over time, allergy shots gradually reduce your immune system reaction to specific allergens. You generally receive shots once a week for a few months, then once a month for a period of three to five years. • Omalizumab (Xolair). This medication, given as an injection every two to four weeks, is specifically for people who have allergies and severe asthma. It acts by altering the immune system. Bronchial thermoplasty This treatment — which isn't widely available nor right for everyone — is used for severe asthma that doesn't improve with inhaled corticosteroids or other long-term asthma medications. Generally, over the span of three outpatient visits, bronchial thermoplasty heats the insides of the airways in the lungs with an electrode, reducing the smooth muscle inside the airways. This limits the ability of the airways to tighten, making breathing easier and possibly reducing asthma attacks. Treat by severity for better control: A stepwise approach Your treatment should be flexible and based on changes in your symptoms, which should be assessed thoroughly each time you see your doctor. Then your doctor can adjust your treatment accordingly. For example, if your asthma is well-controlled, your doctor may prescribe less medicine. If your asthma isn't well-controlled or is getting worse, your doctor may increase your medication and recommend more-frequent visits. Asthma action plan Work with your doctor to create an asthma action plan that outlines in writing when to take certain medications or when to increase or decrease the dose of your medications based on your symptoms. Also include a list of your triggers and the steps you need to take to avoid them. Your doctor may also recommend tracking your asthma symptoms or using a peak flow meter on a regular basis to monitor how well your treatment is controlling your asthma. Activity Learning Outcomes Through this assignment, the student will demonstrate the ability to: 1. Identify and articulate advanced assessment health history and physical examination techniques which are relevant to a focused body system (CO 1) 2. Differentiate normal and abnormal findings with regard to a disease or condition that impacts the body system (CO 2) 3. Adapt advanced assessment skills if necessary to suit the needs of specific patient populations (CO 4) 4. This paper will be appraised on the quality of the information, inclusion of at least one evidence-based scholarly source, use of citations, use of Standard English grammar, and organization based on the required components (see the paper headings and content details below). 1. Scholarly sources: Only scholarly sources are acceptable for citation and reference in this course. These include peer reviewed publications, government reports, or sources written by a professional or scholar in the field. Your textbook and lesson are not considered to be an outside scholarly source. For the discussions and reflection posts, reputable internet sources such as websites by government agencies (URL ends in .gov) and respected organizations (often ends in .org) can be counted as scholarly sources. The best outside scholarly source to use is a peer-reviewed nursing journal. You are encouraged to use the Chamberlain library and search one of the available data bases for a peer-reviewed journal article. The following sources should not be used: Wikipedia, Wikis, or blogs. These web sites are not considered scholarly as anyone can add to these. Please be aware that .com websites can vary in scholarship and quality. For example, the American Heart Association is a .com site with scholarship and quality. It is the responsibility of the student to determine the scholarship and quality of any .com site. Ask your instructor before using any site if you are unsure. Points will be deducted from the rubric if the site does not demonstrate scholarly 2. 3. 4. 5. sources must be