NM706 Exam 4 Mods 7/8 questions with
correct answers
Intermittent- Persistent Mild-
Persistent Moderate-
Persistent Severe- Answer ✔✔ Classification of asthma severity
sx -/= 2 days/week, nocturnal awakenings -/= 2x month, use of SABA -/= 2 days/week, doesn't interfere w/ normal activity, lung function normal b/w exacerbations, FEV1 + 80% predicted and FEV1/FVC normal Answer ✔✔ Define Classification of asthma severity
Intermittent-
sx +2 days/week but not daily, nocturnal awakenings 3-4x month, use of SABA +/= 2 days/week but not + 1x day minor interference w/ normal activity, FEV1 +/= 80% predicted and FEV1/FVC normal Answer ✔✔ Define Classification of asthma severity
Persistent Mild-
sx daily, nocturnal awakenings + 1x week but no nightly , use of SABA daily Some limitation w/ normal activity, FEV1 60- 80% predicted and FEV1/FVC - 5% Answer ✔✔ Define Classification of asthma severity
Persistent Moderate-
sx throughout day, nocturnal awakenings often 7x week , use of SABA several times daily Extremely limited w/ normal activity, FEV1 - 60% predicted and FEV1/FVC - greater than 5% Answer ✔✔ Define Classification of asthma severity
Persistent Severe-
Even early asthma stages may be dangerous. The woman has a smaller functional residual capacity and + pulmonary shunting, rendering the woman more susceptible to hypoxia and hypoxemia. *But risks mainly + at mod and greater levels*
*Pre-e*
Increased morbidity & mortality GDM Answer✔✔ Asthma
Maternal implications
SAB *PTL/PTB*
*FGR* Placental abruption
Placenta previa PROM Answer✔✔ Asthma
Fetal implications
⅓ unchanged, ⅓ worsen, ⅓ improve, no way to predict Answer ✔✔ How does pregnancy affect asthma severity? Answer✔✔ Differential diagnosis
GI system for GERD sx Answer ✔✔ What other system do you need to review when reviewing asthma?
Subjective include IZ, meds, sx, triggers, social hx (smoking), pets, etc. Subjective doesn't always correlate w/ objective. Any s/sx (coughing, wheezing, tight chest, does inhaler improve sx?) Sx include labored breathing, tachycardia, pulsus paradoxus, prolonged expiration and use of accessory muscles. Rhales/wheezes. Note general appearance. Mucus membranes. Potentially fatal attack includes central cyanosis and altered consciousness. ABG best objective assessment of maternal oxygenation, ventilation and acid base status. Not recommended as routine. Pulmonary function testing should be routine. Measure FEV1 or peak expiratory flow volume. Answer ✔✔ Assessment of Asthma
Collaborate or refer for ANY level of persistent asthma. Answer ✔✔ Asthma
Management B-2 agonists and ICS have no none perinatal s/e. Oral steroids possible teratogenic or adverse fetal effects. Several reports show a slightly higher risk for varied abnormalities such as cleft lip/palate and autism spectrum disorders. Known risks to uncontrolled asthma. For mild asthma SABAs are enough, but for persistent asthma ICS usually bumped
up to q 3-4 hrs to - need for additional SABAs. Keep rescue inhaler at bedside during intrapartum stay. Continue ICS during intrapartum stay. Avoid nubain during acute asthma attack. Labetalol and hemabate are not first line meds for asthmatics. If pt also allergic to ASA no indocin. Also, remember that if pt was on 2 weeks + of oral steroids in the 4 weeks prior to intrapartum period pt needs to be on IV corticosteroids during labor, so consult MD. Answer✔✔ Asthma Medications and safety
Review tx every 1-6 months and a gradual stepwise reduction in tx may be possible (but we don't do this for pregnant women). If sx not controlled consider step up after assessing pt med technique, adherence, and environmental control. Mild Intermittent- SABA
Mild Persistent- SABA & low dose ICS
Moderate Persistent- SABA, Low dose ICS & LABA
Severe Persistent- SABA, High dose ICS, LABA
Very Severe Persistent- SABA, High dose ICS, LABA, OCS (oral corticosteroid) Answer✔✔ Asthma
Stepwise therapy
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