Care Management of Asthma on a Pediatric Patient
Introduction
Asthma is a chronic condition that affects the bronchial tree, portrayed by partially or completely reversible obstruction of the airway. Asthma can be managed through particular treatment and the condition can improve. Airway hyper-responsiveness is characterized as the narrowing of the airway as a reaction to different types of stimuli, for example, diseases, allergens, and nonspecific triggers. Asthma is an issue that affects both adults and children. An asthma attack is when symptoms of asthma turn out to be more severe than normal. Asthma is treated with two types of medical prescriptions. A quick-relief medicine that is used to control the side effects of asthma and long-term control medicines that are prescribed to prevent the symptoms of the disease. Severe asthma attacks are dangerous and require medical intervention in an emergency room. The symptoms shown by my patient with asthma history included chest wheezing, and retracting that begun 1 hour before he was brought to the pediatric emergency room.
Primary Health Care Need
Decrease in the chances of an asthma attack can be accomplished by preventing repetitive stimuli that trigger the symptoms of asthma. This reduces the requirement for emergency room visits and hospitalizations (In Mattu et al., 2017). As indicated in the case study, Morris loves fast food that is provided by his foster mother. Consumption of fast food at least three times weekly is connected with increasing the danger of extreme asthma in teenagers by 39% and 27% in children lower than 12 years. In addition, fast foods raise chances of contracting conditions such as extreme skin inflammation (eczema) and serious rhinoconjunctivitis (Robbins, 2010). Contrary, consumption of organic produce such as fruits at least three times each week is linked to an 11% decrease in the prevalence of extreme asthma in teenagers and a 14% reduction in young children (Robbins, 2010).
The statistics above propose that fast food intake might contribute the increase of asthma prevalence, rhinoconjunctivitis, and skin inflammation in young people and kids, while organic product consumption demonstrates a positive and protective relationship with the three conditions (Shenoi, Pereira, Li, & Giardino, 2013). Therefore, Morris should change his diet from the consumption of fast foods and increase the intake of organic food such as fruits and vegetables.
When the patient’s condition is characterized and treatment has been started, consistent evaluation is vital for illness control (Shenoi et al., 2013). Asthma control is characterized as “how much the symptoms of asthma are limited by restorative medication. Since the Moris is young, the parent should take the responsibility of assessing if the objectives of treatment are met. Asthma can be characterized as greatly or poorly controlled. Therefore, monitoring and evaluation by the foster mother is a primary need of care that can help the patient’s condition to improve.
Lack of adherence to the treatment prescribed for asthma has been connected to excessive visits to healthcare centers to seek emergency care and mortality. Non-adherence to drugs also affects aspiratory function leading to increased cost of health care. Patients end up living low-quality lives (Robbins, 2010). Adherence to asthma drug centers on ICS (inhaled corticosteroid) treatment commonly known as the inhaler. It is the most broadly utilized and is suggested by the Expert Panel Report aside from mellow asthma. Therefore, Morris and his parent should be educated about the importance of medication adherence.
Secondary Health Care Needs
Young people above 10 years ought to be involved when creating an action plan for the management of asthma (Robbins, 2010). In addition, they should be trained on how to follow it. Morris falls into this category. Therefore, the foster mother should make certain that Morris follows the action plan for it to work. It is also important for the parent to take Morris for medical checkups or visits to lung and allergy specialists. A doctor will play a significant role in ensuring that the foster mother and the patient comprehend the action plan for the management of asthma (Robbins, 2010).
The foster mother should converse with Morris about asthma and how to control it. In addition, she should protect the patient from passive smoke from cigarettes, whether at home or in public places. In addition, the parent should keep Morris from coming into contact with basic asthma triggers, for example, dust, pollen, chemical fumes and strong odors, dust mites, mold, or pet dander (Robbins, 2010). In addition, the parent should ensure that Morris gets his asthma prescription, and show him how to utilize medicinal gadgets appropriately, for example, peak flow meters with the aim of succeeding in the management of the disease.
Adolescents may require some additional attention, as they tend to view the condition as a barrier to their freedom. Encouragement, Support and consolation will enable Morris to implement and stick to the action plan. It is essential to enable Morris to recall that asthma will not destroy his life. The parent should also consider allowing him to visit doctors on his own and encourage him to be independent in care management (Shenoi et al., 2013).
It is also imperative for Morris to be dynamic and take part in regular play and activities that other kids his age do. An arrangement that enables Morris to take part in games and exercise is perfect. Extra help might be achieved by acquainting the child with different children who suffer from the same condition.
The direct expenses can be a challenge to the patient’s family. They incorporate asthma management costs such as visits to admissions in the hospital. On the off chance that Mossis is admitted for several days more than once, it can be very demanding financially to the parent. Second, medical prescriptions can be very costly since they include a wide range of drugs and medical gadgets such as the inhaler (Shenoi et al., 2013). An additional cost is also incurred when Morris needs outpatient visits, including every resources involved, for example, specialists, attendants, paramedics, and psychologists (Robbins, 2010). Correlative examinations or medications such as imaging, laboratory tests, lung framework tests, and pulmonary restoration are expensive. However, even though management of the disease is expensive, the foster mother should ensure that everything possible including providing healthy food to avoid fast food is done to help Morris.
The Patient’s Health Beliefs and How These Impact on the Patient’s Health Behaviors
Patients’ beliefs and perceptions of the infection and treatment play a vital role in the management of the disease. Patients have various convictions and states of mind concerning their malady and treatment, which are essentially impacted by their own, social, and financial condition. There is little data accessible in regards to the impact of patient convictions and practices on adherence in patients with asthma. Yet, the issue of patient beliefs is frequently neglected (Robbins, 2010). Patients’ perceptions of the illness can encourage or discourage adherence to treatment. Patients’ choices to pursue prescribed treatment are affected to a substantial degree by their convictions and states of mind concerning the infection and treatment (In Mattu et al., 2017). For example, patients regularly do not stick to the care plan for long-term treatment because of a misguided conviction that it is not important to take their drugs when the symptoms become suppressed. Also, a patient can have worries of becoming dependent on the drugs or ending up suffering from unfavorable impacts related to long-term treatment. Most patients regularly adhere to their recommended drugs only when they believe that their medicine gives more advantage than side effects (Shenoi et al., 2013).
Understanding Morris’ beliefs of the illness and treatment can expand the odds of accomplishing better treatment results. Normal counselling with healthcare experts give chances to upgraded correspondence for support and patient training, which can prompt enhanced adherence. Moreover, endeavors to distinguish hindrances to adherence to medication can upgrade patients’ comprehension of their ailment and treatment (Robbins, 2010). Furthermore, understanding Morris’ beliefs can play a positive role in enhancing asthma control and better clinical results.
Patient’s Health History and Interview Data
The reason for gathering information about health history is to illustrate how the patient thinks of himself and how the medical attendant takes care of them. Abstract information or data the patient enlightens the medical attendant concerning them can be a benchmark for the medical caregiver’s knowledge. Target information can be gotten by palpation, percussion, auscultation, and assessment. Target information can likewise be laboratory test results, radiology examination, and critical signs (Robbins, 2010).
While evaluating the respiratory framework for Morris, the underlying appraisal ought to be to approach the Morris in a calm manner. Talking to Morris to assemble data ought to revolve around his wellbeing history, respiratory issues, current medications, home and school environment, and whether there is a family member who smokes. The following are inquiries from Morris that give his respiratory wellbeing history:
| Interview Questions | Patient’s Response |
| Are you experiencing any difficulty breathing? | Yes |
| When breathing, do you experience any chest pain? Assuming this is the case, how is the agony, when does it happen, and what alleviates it? | Sharp pains when taking deep breaths |
| Do you find yourself coughing? | Tries unblocking the airway through coughing |
| Please describe the cough, When does it happen, do you produce any sputum or mucus? | Occasionally discharges sputum. |
| When a cough happens, what does the sputum/ mucus resemble? (Ordinary sputum is thin, clear to white in shading, and dull and scentless. Yellow-green shaded sputum may demonstrate a bacterial contamination and rust-hued sputum is normal for pneumonia (Robbins, 2010).) | Occasionally discharges a white and clear sputum. |
| Do you ever experience shortness of breath? Assuming this is the case, does your shortness of breath happen when you are resting or when doing activities? | Yes, mostly triggered by allergens |
| Do you have any issues breathing during evening time? Provided that this is true, do you utilize a pillowcase to enable you to get in a situation to inhale easier? | Yes, does not use pillows |
| What are your allergies? In the event that you do, how does your hypersensitivity influence your normal breathing? | Known allergens: smoke, exhaust, pet fur, dust, and cold temperatures and perfumes |
| Do you smoke now or have you at any point tried smoking? Is there anyone around you that smokes? In the event that you do, how long did you smoke and what number of packs of cigarettes did you smoke every day? | Does not smoke. |
| What sort of work do you do/did you do? In your work are/would you say you were presented to substances, for example, asbestos, synthetic compounds, or tobacco smoke? | A student in a proper environment. |
| Do you have an individual or family ancestry of asthma, emphysema, tuberculosis, cystic fibrosis, bronchitis, lung malignancy, or some other lung sickness? | Family lineage has history of asthma. |
At the point when a medical caregiver is taking this information, he or she should first inspect the patient. The medical caretaker should check the number of respirations, the profundity and exertion the patient is putting while breathing (Robbins, 2010). The medical caregiver ought to likewise examine the produced cough. Palpation should be possible to recognize lesions, tenderness, or masses. In addition, percussion is performed to recognize the contrast between fluid and air. Auscultation ought to be done to tune in for abnormalities that may result from things, for example, additional fluid (Robbins, 2010).
The Health Belief Model.
This is a model that endeavors to clarify and foresee wellbeing behaviors. It incorporates the patient’s psychology. This is accomplished by concentrating on the attitudes and convictions of people (Corcoran, 2007). I intend to use this model since learning Morris’ beliefs are essential in treating his condition. Also, the patient’s behavior is a contributing facture to a successful health results in the future.
(Corcoran, 2007).
Nursing Care Plan
| Diagnoses
| Goals/ Expected Outcomes
| Intervention |
Patient a history of Asthma | 1. The patient breathes with a rattling whistling sound coming from the chest, because of obstacle noticeable in the air passage. He can exhibit profound coughing to help with clearing the air passage tract. The patient’s airway is patent and free of liquid discharges. This is proven by clear lung sounds, and capacity to clear the airway after medications and lessons on how to take deep breaths (Robbins, 2010). 2. The patient indicated that he is allergic to allergens like animal fur, smoke, dust, and strong perfumes and these stimuli are aggravations or variables that can trigger wheezing and chest pain. He was advised to avoid these allergens (Robbins, 2010). | 1. Manage the airway by freeing if through suction, respiratory rate and then observing retraction of the chest wall. 2. Assess the coming from the lungs and screen the delivery of oxygen. 3. Evaluate the color, texture, and quantity of the sputum. 4. Train the patient how to take deep breaths 5. 5. Instruct the patient on the distinctive stimuli that can trigger that can result to asthma attacks |
| 2. Inconsistent patterns of breathing and exhaustion because extra effort is put for breathing. | 1. Presence of a whistling and rattling sound when breathing; is free of dyspnoea and cyanosis (Robbins, 2010). | 1. Screen the recurrence, depth and rhythm of the patient’s breathing. 2. Encourage deep breathing and/ or coughing when necessary (Robbins, 2010). 3. Position the patient’s chest in a comfortable position. 4. Discourage the patient from contemplating tension and instruct him how to inhale and exhale adequately. 5. Console the patient and support him when dyspnoea happens. |
| Willingness to do daily activities | 1. The patient will exhibit ability in saving energy when breathing and when doing day by day activities (Robbins, 2010). 2. The patient will have no shortness of breath, exhaustion, or weakness. 3. The patient will demonstrate a quantifiable increment in willingness to daily activities (Robbins, 2010). 4. Patient will stick to proper diet and avoid fast foods. | 1. Management of energy by finding out the reasons for weariness, checking respiratory by assessing dyspnoea, breath, and paleness (Robbins, 2010). 2. Screen reaction of breathing when doing activities; evaluate irregular patterns of breathing, heartbeat, and blood pressure. 3. Assess patient’s reaction to normal activities. 4. Help the patient to pick activities that are favorable to his condition. 5. 5. Clarify the significance of rest in the treatment plan and the need for balancing rest and activities. |
Evaluation Plan
| Goals/ the Expected Outcomes | Evaluation |
| 1. The airway of the patient is free of discharges (Robbins, 2010). It is also patent, as confirmed by clear lung sounds, and capacity to successfully breathe normally after medications and breathing lessons. | Assess the airway physically and note if there is any blockage. On the off chance that the child requires suction, re-assess the airway once more and examine if there are any abnormal sounds from the lungs. Note any breathing sounds, for example, wheezing as this could demonstrate an impediment. Screen the chest respiratory and retraction rate. Survey and assess changes in crucial symptoms and temperature routinely. Hypertension and tachycardia might be identified with strain while breathing (Robbins, 2010). The patient may also contract fever if secretions such as sputum are not released. Note any signs of sputum; evaluate the texture, quantity, scent, and consistency. This may be due to infection such as bronchitis. An indication of disease is stained sputum that is not clear or white; a scent might be available. |
| Survey the coughs for viability and profitability – take note of the procedure and the technique that the patient is using to cough. The patient ought to sit in an upright position to enable a full stretch of the thorax. Think about conceivable foundations for the insufficient coughs: respiratory muscle weariness, thick discharges extreme bronchospasm, and others. |
| Solicit the patient to give precedents from allergens that can aggravate and cause blockage to the airway. On the off chance that the patient cannot express the variables, the medical attendant should instruct and give proper information. |
Conclusion
Asthma is a chronic condition that affects the bronchial tree, portrayed by partially or completely reversible obstruction of the airway. Decreasing the chances of an asthma attack can be accomplished by preventing repetitive stimuli that trigger the symptoms of asthma. In addition, when the patient’s condition is characterized and treatment has been started, consistent evaluation is vital for illness control. Lastly, understanding Morris’ beliefs of the illness and treatment can expand the odds of accomplishing better treatment results.
References
Corcoran, N. (2007). Communicating health: Strategies for health promotion. Los Angeles, CA: SAGE.
In Mattu, A., In Chanmugam, A. S., In Swadron, S. P., In Woolridge, D., In Winters, M. E., In Marcucci, L., & Ovid Technologies, Inc. (2017). Avoiding common errors in the emergency department. Philadelphia: Wolters Kluwer.
Robbins, L. (2010). How to deal with asthma. New York, NY: PowerKids Press.
Shenoi, R., Pereira, F., Li, J., & Giardino, A. P. (2013). The Complete Resource on Pediatric Office Emergency Preparedness. New York, NY: Springer.