Asthma and COPD Q 49

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Which of the following assessment findings would help confirm a diagnosis of asthma in a client suspected of having the disorder?

  

     A. Circumoral cyanosis

     B. Increased forced expiratory volume

     C. Inspiratory and expiratory wheezing

     D. Normal breath sounds

    

    

Correct Answer: C. Inspiratory and expiratory wheezing

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Inspiratory and expiratory wheezes are typical findings in asthma. Patients will show some respiratory distress, often sitting forward to splint open their airways. On auscultation, a bilateral, expiratory wheeze will be heard. In life-threatening asthma, the chest may be silent, as air cannot enter or leave the lungs, and there may be signs of systemic hypoxia.

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Option A: Circumoral cyanosis may be present in extreme cases of respiratory distress. In many cases, circumoral cyanosis is considered a type of acrocyanosis. Acrocyanosis happens when small blood vessels shrink in response to cold. In older children, circumoral cyanosis often appears when they go outside in cold weather or get out of a warm bath. This type of cyanosis should go away once they warm up. If it doesn’t, seek emergency medical treatment. Circumoral cyanosis that doesn’t go away with heat could be a sign of a serious lung or heart problem, such as cyanotic congenital heart disease.

Option B: The nurse would expect the client to have a decreased forced expiratory volume because asthma is an obstructive pulmonary disease. Peak expiratory flow measurement is common today and allows one to document response to therapy. A limitation of this test is that it is effort-dependent. Spirometry should be done before treatment to determine the severity of the disorder. A reduced ratio of FEV1 to FVC is indicative of airway obstruction, which is reversible with treatment.

Option D: Breath sounds will be “tight” sounding or markedly decreased; they won’t be normal. Asthma is a condition mediated by inflammation. The resulting physiologic response in the airways is bronchoconstriction and airway edema. This response is triggered by an irritant, allergen, or infection. As air moves through these narrowed airways, the primary lung sound is high-pitched wheeze.

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