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Severe bronchial asthma Analysis of Clinical Nursing

Abstract: Objective: To evaluate the method of severe bronchial asthma care for patients with timely treatment and care provided for reference. Methods: 32 patients with severe asthma symptoms observation, care, guidance. Results: good care, the patients were 7 to 21 days to cure or remission, with no deaths, the effect is satisfactory. Conclusion: Patients with severe asthma should strengthen comprehensive care, in particular the need for psychological intervention to improve their quality of life. Bronchial asthma is a by many cells and cellular components involved in chronic inflammatory airway disease, its occurrence and genetics, allergies, infections and certain drug-related factors. Severe asthma attack can not be relieved for 24 hours or more severe asthma who said, is a common critical care, if not rescue, can cause death. In recent years, severe bronchial asthma morbidity and mortality of an uptrend, there is a sudden onset due to its onset, rapidly deteriorating, the timely processing can quickly relieve the characteristics of early intervention can shorten the attack time, to prevent the symptoms of deterioration and death of asthma. Therefore, patients with severe asthma timely,[link widoczny dla zalogowanych], reasonable and effective care is extremely important. Department of Respiratory Medicine of our hospital in April 2004 ~ April 2007 32 patients with severe asthma were treated, nursing now reported as follows. 1 clinical data 1.1 General Information hospital Respiratory Medicine 2004 4 months to April 2007 were treated 32 cases of severe asthma, in which 22 male and female 1l cases; aged 22 to 72 years; the shortest duration of 6 days, the longest 20 days, an average of 12 days; and infection-related 15 patients, 7 patients with allergy-related, and fatigue-related in 4 cases, and stress-related in 4 cases, 2 cases of no obvious incentives; occurred 25 cases of status asthmaticus, mechanical ventilation for 7 cases. 1.2 clinical symptoms of upper respiratory tract symptoms often, when the inflammation spread to the trachea, bronchus can be chest tightness, coughing, accompanied by chest pain, phlegm, became purulent by the clear kind, and sometimes the patient sputum may contain blood. In particular, the anxiety of patients with severe irritability,[link widoczny dla zalogowanych], severe wheezing, orthopnea, sweating, language was a word, respiratory rate 30 to 40 beats / min, lung diffusion loud wheeze, heart rate of 120 ~ 150 times / min , percutaneous oxygen saturation measured at 70 ~ 90%; critically ill patients with lethargy, unable to speak, chest and abdomen showed a contradiction, lungs decreased breath sounds, wheeze could be heard and there was cyanosis, a few hours or more sustainable for a long time, is a serious impact on cardiopulmonary function, harm people's health diseases. 2 care 2.1 understand the cause of severe bronchial asthma, severe bronchial asthma The cause is not yet clear, in addition to hereditary allergies, but also allergic factors and the environment. Allergens include: dust filled, smoke, pollen, drugs, food, animal dander, bacteria, viral infections, industrial dust or gases. Non-allergic factors include: fatigue, chills and a variety of biological infection or environmental pollution. These risk factors through immune, nervous, endocrine mechanisms at all levels, directly or indirectly stimulated bronchial smooth muscle spasm, intimal swelling, increased mucus secretions, causing small airway narrowing, obstruction, in which patients showed episodes of chest tightness, coughing, asthma and respiratory difficulty breathing gas. 2.2 General care First of all, to patients placed in a clean, light, ventilation and good ward, avoid contact with plants, animal dander, dust properties, industrial dust, chemical harmful gases, smoke and other exciting items such as predisposing factors. On the ward and disinfect surfaces, should avoid the use of irritating odor and strong antiseptic solution, the ground can be dragged 1:500 84 disinfectant and then wipe with water and dragged the net, the sick

room temperature should be maintained at 18 ~ 20 ℃, humidity maintained at 50% to 60%. Also, patients should keep the airway open, or semi-sitting or lying position to take seats, expectoration is also an important means to maintain airway patency, and sputum should be given to shoot back, postural drainage and expectoration, critically ill patients given mechanical suction. To carefully observe the patient's condition, observe their vital signs and percutaneous oxygen saturation changes, respiratory changes, fluctuations in vital signs can be detected and timely given the correct treatment is to control the complications of the key. Asthma attack, patients often forced to take seats, should be given appropriate supports, such as moving tables, lifting frames, etc., before guiding patient support arms, shoulders arched, to help to breathe, the lateral position can be closed after attack . 2.3 psychological care of patients with asthma attacks will affect the daily life and study, patients and their families psychological despair is easy to produce, therefore, medical staff and patients and their families should be concerned considerate and help them eliminate fear, and enhance the confidence to overcome the disease so closely with patients and medical staff, looking for allergens and triggers, follow the treatment to control asthma attacks. At the same time, let patients and their families to know asthma can be controlled to ease, with the rapid development of medical standards, but also can be cured. In recent years, with the psychological theory and methods of care and the deepening of China's gradual development of clinical psychology of asthma care and case studies, in particular, is to recognize outstanding individual psychological characteristics of patients in the implementation of the importance of psychological care, such as Lvtian Kun made to understand the psychological state of patients is to do the nursing work premise. We believe that, in order to highlight the personality characteristics of patients, good psychological care should do the following 3 points: ① must pay attention to age, sex,[link widoczny dla zalogowanych], educational level and occupational characteristics; ② must pay attention to different psychological impact on patients condition; ③ is important to note various stages of course the psychological impact on patients. Human services is an overall feeling of the people targeted to provide quality, convenience and comfort, comprehensive, diversified service model,[link widoczny dla zalogowanych], is the modern service industry, a new service concept, it can help meet the psychological needs of patients with asthma in order to achieve health objectives. A large number of proven, for each of the different characteristics of asthma patients to psychological care, to prevent general, formulaic, bronchial asthma is the key to effective psychological care. 2.4 the right amount of care and treatment of adrenal cortical hormone drugs can alleviate the severe asthma attack, but the side effects of multiple doses of long-term use can cause the spread of infection, presence of water and sodium , low potassium and induced upper gastrointestinal bleeding. Aminophylline intravenous injection, if the concentration is too high, too fast, can cause nausea, vomiting, or arrhythmia, decreased blood pressure leading to death. Anticholinergic drugs atropine aerosol isoproterenol used, side effects are dry mouth, difficulty in expectoration, heart rate and so on. To be adrenal class salbutamol, adrenaline and other side effects of drugs leading to tachycardia, arrhythmia. Therefore, when using these types of drugs, should be observed closely monitor drug efficacy, while the adverse reactions, and note that the correct drug compatibility, such as adrenal epinephrine and isoproterenol with the use of cable can cause acute cardiac arrhythmia, but Erythromycin aminophylline combination can cause the latter concentration. We should also guide the patient to take medicine to fully rinse with water immediately to reduce the local reactions and gastrointestinal absorption, systemic administration should pay attention to obesity, diabetes, hypertension, osteoporosis, peptic ulcer disease and other adverse reactions; oral administration should be in after meals to reduce gastrointestinal mucosal irritation. 2.5 care mechanical ventilation to maintain airway patency should first: the timely removal of airway secretion,[link widoczny dla zalogowanych], reasonable suction, action to light, steady, accurate, fast, to avoid injury mucosa, timing stand shoot back, and promote mucus drainage, keeping the airway open. Second, we must strengthen the airway humidification: the equivalent of body temperature and after inhaling the gas humidification, airway conducive to purification, to prevent infection. Respirator should also be closely observed parameters and the suitability of various functions and changes in condition. To observe the patient breathing is synchronized with the breathing machine, when agitated patients with ventilator-resistance, should be given time to find the cause and treatment. The management of the air bag, air bag pressure should be maintained as normal 2.45kPa, inflated or deflated at intervals of 2h 1, each about 10 ~ 20min.
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