ASTHMA APRIL VILLANUEVA, SN

NADIA CABRERA, SN

KRISTA CHAPIN, SN

WHAT IS ASTHMA?• ASTHMA IS DEFINED AS THE SWELLING OF THE AIRWAYS. DURING AN ASTHMA ATTACK, THE MUSCLES THAT SOUND

THE AIRWAY BEGIN TO TIGHTEN AND THE LINING OF THE AIR PASSAGES SWELL. THIS ALLOWS FOR LESS AIR TO PASS THROUGH INTO THE LUNGS. ASTHMA IS OFTEN SEEN IN CHILDREN AND IT IS THE LEADING CAUSE OF MISSED SCHOOL AND HOSPITAL VISITS. AN ALLERGIC REACTION IS A KEY PART OF ASTHMA IN CHILDREN; THEY OFTEN GO HAND IN HAND. USUAL TRIGGERS THAT POTENTIATE ASTHMA SYMPTOMS INCLUDE:

• ANIMALS (HAIR OR DANDER)

• DUST, MOLD, AND POLLEN

• ASPIRIN AND OTHER MEDICINES

• COLD AIR, SUCH AS CHANGES IN WEATHER (MOST OFTEN COLD WEATHER)

• CHEMICALS IN THE AIR OR IN FOOD

• TOBACCO SMOKE

• EXERCISE

• STRONG EMOTIONS

• VIRAL INFECTIONS, SUCH AS THE COMMON COLD

ASSESSING PATIENT STATUS • ABCS!

• AIRWAY, CIRCULATION, BREATHING

• ENSURE THAT CONDITION IS NOT LIFE THREATENING• QUALITY OF BREATHING• HOW IS PATIENT TALKING?

• RETRACTIONS• RESPIRATORY DISTRESS

• LUNG SOUNDS• QUALITY OF BREATH SOUNDS,

WHEEZES• COUGH OR STRIDOR PRESENT?

• COLOR• HEART RATE• PULSE OXIMETER—SPO2• SKIN TURGOR• INTAKE AND OUTPUT• URINE SPECIFIC GRAVITY

HOW OFTEN TO REASSESS/REEVALUATE

• IMMEDIATE ASSESSMENT!• EMERGENCY SITUATION• REASSESS CONDITION AFTER IMPLEMENTING

INTERVENTION • SUPPLEMENTAL O2 VIA NC OR FACE MASK• REPOSITIONING PATIENT TO EASE

RESPIRATORY EFFORT• MEDICATIONS

• EXERCISE-INDUCED ASTHMA• ASSESS PATIENT’S RESPIRATORY EFFORT 5-10

MINUTES AFTER PHYSICAL ACTIVITY• RESOLVES AFTER 20-30 MINUTES• MAY NEED QUICK-RELIEF MEDICATION

• PEAK EXPIRATORY FLOW METER (PEFM)• MEASURE AND RECORD BEST PEFM READING

TWICE A DAY FOR 2-3 WEEKS TO DETERMINE PERSONAL BEST READING• PHYSICIAN WILL USE CHILD’S BEST AVERAGE

READINGS TO GUIDE TREATMENT IN CHILD’S ASTHMA ACTION PLAN

PEFM RATING

APPROPRIATE TEACHING FOR PATIENT/FAMILY • PRINTED EDUCATION MATERIALS AND REFERRAL TO

LOCAL SUPPORT GROUPS FOR ADDITIONAL INFORMATION FOR FAMILY TO HELP WITH MANAGEMENT

• REFER TO FAMILY RESOURCE CENTERS

• EMPHASIZE IMPORTANCE OF DAILY CONTROLLER MEDICATIONS TO KEEP ASTHMA UNDER CONTROL

• WHEN TO SEEK EMERGENCY TREATMENT

– WHEEZE, COUGH, SHORTNESS OF BREATH WORSENS EVEN AFTER TAKING MEDICATION

– DIFFICULTY BREATHING

– TROUBLE WALKING/TALKING

– LIPS/FINGERNAILS ARE BLUE OR GRAY

• CREATE A LOG OF SYMPTOMS TO FIGURE OUT PERSONAL ASTHMA TRIGGERS

• ENGAGE CHILD IN LEARNING ABOUT ASTHMA AND SELF-MANAGEMENT

– ACTIVITY/COLORING BOOK

APPROPRIATE TEACHING FOR PATIENT/FAMILY

• EARLY WARNING SIGNS BEFORE ASTHMA FLARE• DROP IN PEAK FLOW RATE• COUGHING• WHEEZING• CHEST TIGHTNESS• SHORTNESS OF BREATH

• ASSESS THE CHILD’S TECHNIQUE FOR USE OF METERED DOSE INHALER (MDI) AND DRY POWDER (DPI)

• DAILY PEAK EXPIRATORY FLOW (PEF)

• BE AWARE OF SIGNS THAT SIGNIFY ASTHMA NOT BEING CONTROLLED• WAKING UP AT NIGHT WITH AN ATTACK• INCREASED USE OF BRONCHODILATORS• DECREASED ACTIVITY LEVEL• PEAK FLOW READING IN YELLOW OR RED ZONE

• USE OF NEBULIZER• TEACH PARENTS ABOUT DIVERSIONS TO HELP CHILD

COOPERATE DURING TREATMENT

ADDITIONAL DATA TO COLLECT BEFORE NOTIFYING THE PRESCRIBER • LUNG SOUNDS

• INCENTIVE SPIROMETER READING

• DIAGNOSTIC TESTING INCLUDING: CHEST X-RAY, LUNG FUNCTION TESTS, EOSINOPHIL SERUM VALUE, ALLERGY TESTS

• CALL THE PROVIDER WHEN THE CHILD IS EXHIBITING: DYSPNEA, CYANOSIS, SEVERE ANXIETY, TACHYCARDIA, DIAPHORESIS, DECREASED LEVEL OF CONSCIOUSNESS

GIVING REPORT NURSE TO PHYSICIAN • S: PATIENT WAS ADMITTED TO THE

MEDICAL/SURGICAL UNIT OF BAYFRONT MEDICAL CENTER FOR ASTHMA

• B: PATIENT HAS BEEN EXPERIENCING DYSPNEA WHEN PLAYING OUTSIDE WITH THEIR FRIENDS.

• A: AFTER TAKING THIS PATIENT’S VITALS THEY WERE EXPERIENCING TACHYCARDIA, CYANOSIS, ANXIETY AND DIAPHORESIS

• R: CONTINUE TO MONITOR THE PATIENT’S VITALS AND ASK THE DOCTOR TO ORDER AN ALLERGY TEST.

PHYSICIAN’S ORDERS

• HELLO THIS IS DR. CHAPIN CALLING ABOUT PATIENT VILLANUEVA, I WILL LIKE TO READ YOU SOME ORDERS I WANT FOR THIS YOUNG LADY. THEY WILL INCLUDE A REFERRAL TO AN ALLERGIST TO MAKE SURE ALL POSSIBLE TRIGGERS ARE IDENTIFIED. ASIDE FROM AN ALLERGY TEST WE WILL NEED A CHEST X-RAY, EOSINOPHIL COUNT (A TYPE OF WHITE BLOOD CELL), AND A LUNG FUNCTION TESTS (IN ORDER TO MEASURE HOW WELL THE LUNGS TAKE IN AND RELEASE AIR AND HOW WELL THEY MOVE GASES FROM THE ATMOSPHERE INTO THE BODY'S CIRCULATION. A PEAK FLOW METER) AND READING FOR THE PEAK FLOW METER (TO ASSES HOW WELL THE CHILD CAN BLOW AIR OUT OF THE LUNGS. IF POSITIVE FOR ASTHMA THE RESULTS WILL BE LOW.) WE WILL ALSO ASSES HOW WELL CURRENT MEDICATIONS ARE WORKING AND WHETHER WE WILL NEED TO SWITCH THEM.

HIGHEST PRIORITY:

•02 SAT MONITORING,

•FOCUSED LUNG ASSESSMENTS

•LUNG FUNCTION TESTS

APPROPRIATE DOCUMENTATION IN EMERGENT SITUATION• STAT VITAL SIGNS• HEART RATE—TACHYCARDIA• BP—ELEVATED• PULSE OXIMETRY—HYPOXIC• RESPIRATORY RATE—INCREASED• PEFM READING OF LESS THAN 30-50%

OF PREDICTED LEVEL

• GENERAL APPEARANCE• CYANOSIS• DIAPHORESIS• NASAL FLARING• USE OF ACCESSORY MUSCLES• INTERCOSTAL RETRACTIONS• BARREL CHEST (REPEATED ACUTE

EPISODES)• RESTLESSNESS/ANXIETY• ALTERED LEVEL OF CONSCIOUSNESS

• FOCUSED RESPIRATORY ASSESSMENT

– SHORTNESS OF BREATH

– INABILITY TO SAY MORE THAN A WORD OR TWO WITHOUT GASPING FOR BREATH

– RAPID AND LABORED RESPIRATIONS

– PRODUCTIVE COUGH

– EXPIRATORY WHEEZING

– DECREASED AIR MOVEMENT

– CHEST PAIN OR TIGHTNESS

• PAST MEDICAL HISTORY

– PREVIOUS HISTORY OF ACUTE EPISODES

– TRIGGERS

– MEDICATIONS

POTENTIAL PROBLEMS 1. RECURRENT ASTHMA ATTACK

2. LOW OXYGEN SATURATION

3. DECREASED LUNG SOUNDS.

HOSPITALS ARE ALWAYS WELL EQUIPPED FOR POSSIBLE RESPIRATORY FAILURE.

FOLLOWING HOSPITAL PROTOCOL FOR A CODE BLUE AND KNOWING HOW TO

CONTACT RAPID RESPONSE AND WHERE THE CRASH CART IS LOCATED IS

IMPORTANT. OTHER CLINICIANS WHO WOULD NEED TO BE INVOLVED INCLUDE THE ALLERGIST AND A PULMONOLOGIST

LABORATORY FINDINGS FOR PATIENT WHO NEEDS ICU ADMISSION

•HYPOXEMIA

•PACO2 OF > 42 MMHG OR GREATER

•RESPIRATORY ACIDOSIS

•METABOLIC ACIDOSIS

INACTIVATION OF DUST MITES, DUST MITE ALLERGEN, AND MOLD FROM CARPET• OBJECTIVE

• TO EVALUATE AN EFFICIENT CARPET TREATMENT METHOD TO REDUCE ENVIRONMENTAL ASTHMA TRIGGERS AND DECREASE ASTHMA SEVERITY

• METHOD• CONSISTING OF 4 CARPET TREATMENTS:

• VACUUMING• STEAM VAPOR• NEEM OIL• BENZALKONIUM CHLORIDE (ACTIVE INGREDIENT IN LYSOL)

• CONTROL GROUP: NO TREATMENT GIVEN

• RESULTS• VACUUMING: NO SIGNIFICANT DIFFERENCE FROM CONTROL• STEAM VAPOR TREATMENT: SIGNIFICANT DIFFERENCE FROM CONTROL• NEEM OIL: NO SIGNIFICANT DIFFERENCE FROM CONTROL• BENZALKONIUM CHLORIDE TREATMENT: NO SIGNIFICANT DIFFERENCE FROM CONTROL

• CONCLUSION• STEAM VAPOR TREATMENT EFFECTIVELY KILLED DUST MITES, DENATURED DUST MITE ALLERGENS, AND MOLD IS

POTENTIALLY EFFECTIVE IN REDUCING MOLD IN THE LABORATORY ENVIRONMENT; BUT EFFICIENCY NOT YET TESTED IN THE FIELD.

ACETAMINOPHEN AND ASTHMA • TWO HYPOTHESES

• ACETAMINOPHEN INCREASES AIRWAY INFLAMMATION AND ASTHMA SYMPTOMS

• MORE LIKELY TO GET ASTHMA OR ASTHMA SYMPTOMS IF EXPOSED DURING THEIR FIRST YEAR OF LIFE OR IN UTERO

• CLINICAL STUDIES • OVER 200,00 CHILDREN AGE SIX TO SEVEN YEARS OLD CHILDREN SUFFER FROM ASTHMA.

PATIENTS WHO TAKE ACETAMINOPHEN HAVE A 1.6 FOLD HIGHER CHANCE OF DEVELOPING ASTHMA

• OVER 320,000 CHILDREN AGE 13 TO 14 HAVE A 3.23 HIGHER FOLD CHANCE OF DEVELOPING ASTHMA, AND 30% OF THESE CHILDREN REPORTED TAKING ACETAMINOPHEN.

• THE PREVALENCE OF ASTHMA HAS INCREASED DRAMATICALLY FROM 1980-2003. THIS PERCENTAGE HAS RAISED FROM 3.5% TO 5.8%

• PREVALENCE OF ASTHMA IS EXPECTED TO INCREASE 30-40%

REFERENCES

• BALL, J., BINDLER, R., & COWEN, K. (2012). PRINCIPLES OF PEDIATRIC NURSING: CARING FOR CHILDREN. UPPER SADDLE RIVER, NEW JERSEY: PEARSON EDUCATION, INC.

• MCBRIDE, J. (2011). THE ASSOCIATION OF ACETAMINOPHEN AND ASTHMA PREVALENCE IN SOCIETY. PEDIATRICS OFFICIAL JOURNAL OF THE ACADEMY OF PEDIATRICS, 4(6), 270-276.

• ONG, K.H., LEWIS, R.D., DIXIT, A., MACDONALD, M., YANG, M., & QIAN Z., (2014). INACTIVATION OF DUST MITES, DUST MITE ALLERGEN, AND MOLD FROM CARPET. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE. RETRIEVED ON JANUARY 29, 2014 FROM HTTP://WWW.TANDFONLINE.COM/DOI/PDF/10.1080/15459624.2014.880787.