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Asthma



             inflammation (Busse et.al. 1993). There is emerging evidence that stress can play a .
             role in precipitating asthma exacerbations. The mechanisms involved have yet to be .
             established and may include enhanced generation of proinflammatory cytokines .
             (Friedman et. Al. 1994). Airway wall edema, even without smooth muscle .
             contraction of bronchoconstriction, limits airflow in asthma. Increased microvascular .
             permeability and leakage caused by released mediators also contribute to mucosal .
             thickening and swelling of the airway. As a consequence, swelling of the airway wall .
             causes the airway to become more rigid and interferes with airflow. Chronic mucus .
             plug formation. In severe intractable asthma, airflow limitation is often persistent. In .
             part this change may arise as a consequence of mucus secretion and the formation of .
             inspissated mucus plugs. In some patients with asthma, airflow limitation may be.
             only partially reversible. The etiology of this component is not as well studied as .
             other features of asthma but may relate to structural changes in the airway matrix that.
             may accompany longstanding and severe airway inflammation. There is evidence that .
             a histological feature of asthma in some patients is an alteration in the amount and.
             composition of the extracellular matrix in the airway wall. (Djukanovic et. El 1990; .
             Laitinen and Laitinen 1994). .
             Nursing goals for Lisa Lambos would be to maintain a good effective airway and.
             relieve bronchoconstriction, while allowing mucus plug expulsion. This could be .
             accomplished by assisting Lisa to sit in an optimal position, perform coughing and .
             breathing manoeuvres. Lisa needs to be instructed to use a pillow or hand splints .
             when coughing, to use abdominal muscles for more forceful cough, the use of an .
             incentive spirometer and the importance of ambulation and frequent position changes .
             directed coughing techniques help mobilise secretions from smaller airways to .


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