哮喘英语讲稿

更新时间:2023-06-08 07:06:50 阅读: 评论:0

Asthma
1 Definition
Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. The episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment.
2 Do you know … (asthma facts)
Asthma is one of the most common chronic dias worldwide.
An increasing prevalence of asthma and incorrect treatment increa the mortality of asthma.
3 Etiology and Pathogenesis (what cau asthma?)
(1) Etiology
Host factors
Genetic predisposition
Obesity
Sex
Environmental factors ( Factors that Exacerbate Asthma)
Environmental factors include allergens, respiratory infections, diet, drugs, and exercis.
(2) Pathogenesis
变态反应 allergic reaction
气道炎症airway inflammation 
气道高反应性airway hyperresponsiveness AHR
神经-受体平衡失调neuroceptor dyquilibrium
4 Clinical findings
(1) Symptoms
The typical symptoms of asthma are recurrent episodes of cough, wor particularly at night; shortness of breath, chest tightness, wheezing (means there are high-pitched whistling sounds when breathing out, especially in children), and sputum production. The symptoms occur or worn at night or in the early morning, awakening the patient. That is often reversible either spontaneously or with treatment.
cough-variant asthma 咳嗽变异性哮喘
exerci-induced bronchoconstriction  运动性哮喘
软件服务合同模板 (2) Physical examination
The most common physical finding in asthma is diffusing, expiratory wheezing, an incread respiratory rate and prolonged expiration.
寂静胸(silent chest:occasionally, in vere asthma exacerbations, wheezing may be abnt owing to verely reduced airflow and ventilation.
5 Laboratory examination
(1 )Measurement of lung function
PEF↓ FEV1↓
diumal variation in PEF >20%
bronchial provocation test :>20% decrea in FEV1 15 minutes after inhalation of a specific agents or after 6 minutes of exerci.
    bronchial relaxation test :>15% increa in FEV1 15 minutes after inhalation of short acting β2 agonist .
(2 )Measurement of allergic status
  Skin tests with allergens or measurement of specific IgE in rum: The prence of allergies increas the probability of a diagnosis of asthma, and can help to identify risk factors that cau asthma symptoms in individual patients.
闸坡大角湾(3) Other laboratory examinations
  Arterial blood gas analysis
  Sputum studies
  Chest X-ray
6 Diagnosis
(1) Asthma diagnosis
  History and patterns of symptoms
  Physical examination
  Spirometry to demonstrate reversibility
  Exclude other caus of wheezing
(2) Asthma staging
  Acute Asthma Exacerbation 急性发作期
  Chronic asthma persistent 慢性持续期
  Asthma paracmasis 缓解期
7 并发症( Complication
Complications of asthma include airway infection, exhaustion, cor pulmonale肺源性心脏病/呼吸衰竭respiratory failure、气胸古诗阅读pneumothorax
8 Therapy
allergen avoidance
main curative
Medications to treat asthma can be divided into two categories: relievers and controllers.
Inhaled glucocorticosteroids are the most effective controller medications currently available.
1 β2-agonist 通过对气道平滑肌表面的β 2 受体的兴奋,舒张气道平滑肌。控制哮喘急性发作的首选药物。
short-Acting β2 -Agonists510分钟起效,维持 46孕妇可以吃什么小时。如沙丁胺醇(salbutamol)、特布他林(terbutaline
  Long-Acting β2 -Agonists:可维持12小时。如福莫特罗(furmoterol)、沙美特罗( salmaterol)、班布特罗(bambuterol)
2 Theophylline 抑制磷酸二酯酶,提高平滑肌细胞内的 cAMP 浓度外;刺激肾上腺分泌肾上腺素,增加呼吸肌的收缩;增强气道纤毛清除功能和抗炎作用。
  aminophylline氨茶碱 sustained-relea theophylline缓释茶碱(controller)
3 Anticholinergics降低迷走神经的张力,解除支气管痉挛
  溴化异丙托品( ipratropium bromide )噻托溴铵(tiotropium bromide)
4 Glucocorticosteroids
controlling airway inflammation
decreasing airway hyperresponsiveness
  systemic glucocorticosteroids:甲基强的松龙methylprednisolone、地塞米松dexamethasone、氢化可的松hydrocortisone、泼尼松prednisone、强的松prednisone.
  inhaled gulcocorticosteroids(ICS):倍氯米松(beclomethasone.BDP)、布地奈德budesonide、氟替卡松fluticasone.
5 Sodium Cromoglycate
6Leukotriene Modifier
  扎鲁司特(zafirlukast安可来)、孟鲁司特(montelukast顺尔宁)
treatment of Asthma exacerbation
The aims of treatment are to relieve airflow obstruction and hypoxemia as quickly as possible, and to plan the prevention of future relaps. Early intervention may lesn the verity and duration of an exacerbation. The primary therapies for exacerbations include, depending on verity, repetitive or continuous administration of an inhaled short-Acting β2 -Agonists, early introduction of systemic glucocorticosteroids to patients with moderate to vere asthma exacerbations , and oxygen supplementation.
treatment of asthma paracmasis
Depending on the patients’ current level of asthma control and current treatment , each patients is assigned to one of five “treatment steps”. For example, if asthma is not controlled on the current treatment regimen, treatment should be stepped up until control is achieved. If control has been maintained for at least three months, treatment can be stepped down. At each treatment step ,reliever medication should be provided for quick relief of symptoms as needed. At step 2 to 5, patients also require one or more regular controller medications, which keep symptoms and attacks from starting.
9 Nursing diagnosis
impaired gas exchange 
related to incread airway resistance, airway inflammation, and airway spasm
ineffective airway clearance 
related to bronchospasm, ineffective cough, excessive mucus production, tenacious cretions, and fatigue
knowledge deficit
chairrelated to knowledge deficits of MDIs
10 nursing implemention
reduce exposure to risk factors
avoid food allergies, lay off alcohol and somking
provide comfortable position, such as orthopnea
敷衍了事是什么意思monitoring conditions, especially at night or in the early morning
keeping airway clear, and oxygen is given by mask or nasal prongs
teach clients effective coughing techniques
teach client to breathe deeply through the no and exhale 2-3 times through purd lips
decrea the clients’ anxiety and panic
teach clients the correct administration of medications, especially how to u inhaler devices and monitoring the side effects.
Medicine care
glucocorticosteroids
Oral candidiasis ,hoarness, irritated throat and dry cough are local adver effects caud by inhalation of corticosteroids. The problems can be reduced or prevented by mouth washing; take oral medicine after meals to reduce stimulation of gastrointestinal. It should never be abruptly discontinued but tapered gradually over time to prevent adrenal insufficient.
画一幅做家务的画β2  agonists
short-acting inhaledβ2  agonist should be ud only on an as-needed basis at the lowest do and frequency required, not for long-term, regular, single, and large-do u
control the drip rate while using salbutamol, and monitor adver systemic effects, such as tremor and tachycardia.文爱文字
methylxanthines
the main problem with theophylline is the relatively high incidence of side effects, which include gastrointestinal symptoms, cardiac arrhythmias, low blood pressure, and even death.
Side effects can be reduced by careful do lection and monitoring the rum concentration of theophylline.
pay attention to concentration and speed while iv.drip ,>10min
theophylline administration requires monitoring of its rum concentrations for safe and effective u.
liver dia, congestive heart failure, and certain drugs including cimetidine, some quinolones, and some macrolides increa the risk of toxicity.
11 Heath education
knowledge of dia
Identify and reduce exposure to risk factors
remove animals from the home, or at least from the sleeping area.
stay away from tobacco smoke. patients and parents should not smoke.
avoid drugs, foods, and additives, if they are known to cau symptoms.
keep the bed simple, wash sheets and blankets often in very hot water. put them in the sun to dry.
clo windows and doors and remain indoors when pollen and mold counts are highest.
take asthma medicine before doing some activities
lf-monitoring 
be alert for ugh, chest tightness, wheeze, wake up at night…
act fast if an asthma attack starts.
get emergency help from a doctor if you donot get better.
drug management
psycho-social guidance

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标签:气道   平滑肌   哮喘   急性
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