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Pediatric Asthma

NURS161
by

Nikki Johnson

on 14 March 2013

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Transcript of Pediatric Asthma

Any ???'s By Nicole Johnson, Debbie Fleming, & Debbie Zalinski Pediatric Asthma What is Asthma? a paroxysmal, often allergic disorder of respiration, characterized by broncho-spasm, wheezing, and difficulty in expiration, often accompanied by coughing and a feeling of constriction in the chest (Hewit, 2012). Asthma: is a syndrome caused by increased responsiveness of the tracheobronchial tree to various stimuli that results in reversible, intermittent constriction of the airway (Figure 25-5). Pathophysiology Asthma is a recurrent and reversible obstruction of the airways in which bronchospasm, mucosal edema, and secretion of mucus contribute to impaired gas exchange (Figure 25-6). ASTHMA
TRIGGERS: House dust
Animal dander
Passive smoking
Wool feathers
Pollen
Mold
Strong odors
Certain foods
Vigorous physical activity
(affected by weather conditions)
Emotional upsets
Children with allergies Diagnostic Testing Eosinophils in blood & sputum
Allergy skin testing & (RAST)
Exercise testing
Pulmonary function tests Nursing Diagnoses Dyspnea, inability to breath related to broncialconstriction
Allergic/sensitivity reactions related to trigger of an asthma attack
Paroxysms of cough related to impaired airway secondary to asthma
Imbalanced nutrition- less than body requirements. (may be related to: dyspnea and sputum production.) Manifestations Coughs
Wheezes
Difficulty breathing
Chin, neck, or chest itches
Air hunger
Orthopnea
Restlessness
Perspiration
Increased pulse and respiration
Rales
Hard chest
Inflammation of nose and sinuses
Abnormal pain
Decreased participation in activities
•Discoloration beneath the eyes (allergic shiners)
•Slight eyelid eczema
•Mouth breathing

Repeated attacks over a long period may lead to emphysema (Leifer, 2011) Chronic asthma: Asthma: is a syndrome caused by increased responsiveness of the tracheobronchial tree to various stimuli that results in reversible, intermittent constriction of the airway (Figure 25-5).

Pathophysiology

Asthma is a recurrent and reversible obstruction of the airways in which bronchospasm, mucosal edema, and secretion of mucus contribute to impaired gas exchange (Figure 25-6). The main goals of asthma therapy are as follows (Figure 25-7): Treatment Shortness of breath accompanied by restricted breath sounds and a rising respiratory rate may indicate imminent respiratory failure and should be reported promptly to the health care provider (Leifer, 2011). Safety Alert!!: Maintain a near-normal pulmonary function
Maintain near normal activity level
Prevent chronic signs and symptoms
Prevent exacerbation that may necessitate hospital treatment
Prevent adverse responses to medications
Promote self-care and monitoring consistent with developmental level NURSING CARE Education is the vital. Medications Bronchodilators
Anti-inflammatory Drugs
& Leukotriene Modifiers Broncodilators Anti-inflammatory Drugs Leukotriene Modifiers The child should always be included and participate in their own care. The necessary general control of the environment is explained to the child and family. Teach the client to implement an action plan: Identify peak flow numbers for your green, yellow, and red zones. Mark zones on the peak flow meter with colored tape or a marker.The medicines that should be taken while in each peak flow zone. The child is taught
How to Pursed lip breath & use biofeedback
To observe for “personal triggers"
To administer their own metered-dose inhalers
It is important of exercise to strengthen vulnerable lungs The child is gradually taught self-care. elf-care Safety Alert!!: Medicated inhalers should be used as prescribed. Overuse can be dangerous (Leifer, 2011). Nursing Tip: Daily monitoring
symptom diary
Treatment plan with active participation of the child
Identification and avoidance of triggers The principles of asthma
treatment include: Status asthmaticus is a medical emergency caused by continued severe respiratory distress that is not responsive to drugs, including epinephrine and aminophylline (Leifer, 2011). Status Asthmaticus Metered Dose Inhaler (How to use) Get ready!
Breathe in slowly
Press down on the inhaler & Keep breathing in slowly
Hold your breath
Clean your inhaler as needed Peak Flow Meter (How to use) Keeping Track (HOW TO USE) Signs of Respiratory Distress THE END Thank you References Test Question #1 Which is a priority nursing diagnosis in a child admitted with acute asthma? A. Risk for infection
B. Imbalanced nutrition
C. Ineffective breathing pattern
D. Disturbed body image C. Ineffective breathing Pattern Test Question #2 The nurse is reinforcing teaching concerning the use of cromolyn sodium inhaler for a 10-year-old with asthma. Which would be an accurate concept to emphasize (Leifer, 2011)? A. You should use the inhaler whenever you have
difficulty in breathing.
B. You should use the inhaler between meals.
C. You should use the inhaler regularly every day
even if you are symptom free
D. You can discontinue using the inhaler when you
are feeling stronger C. You should use the inhaler regularly even if you are symptom free A. Take a full medical history.
B. Give a bronchodilator by nebulizer.
C. Apply a cardiac monitor to the patient.
D. Provide emotional support for the patient A 18-year-old patient comes to the ER with acute asthma. His respiratory rate is 44 breaths/minute, and he appears to be in acute respiratory distress. Which of the following actions should you take first? B.
The patient having an acute asthma attack and needs more oxygen delivered to his lungs.
Nebulized bronchodilators open airways and increase the amount of oxygen delivered.
The patient may not need cardiac monitoring because he’s only 18 years old, unless he has a medical history of cardiac problems. Test Question #4 Which of the following treatment goals is best for the client with status asthmaticus? A. Avoiding intubation
B. Determining the cause of the attack
C. Improving exercise tolerance
D. Reducing secretions A.
Inhaled beta-adrenergic agents, IV corticosteroids, and supplemental oxygen are used to reduce bronchospasm, improve oxygenation, and avoid intubation.
Determining the trigger for the client’s attack and improving exercise tolerance are later goals.
Typically, secretions are not a problem in status asthmaticus. (HOW TO USE) Test Question #3 Charles B. Wang Community Health Center. (2008, September). Breathe easy: Commonly
asked asthma questions for parents. Retrieved from http://www.cbwchc.org/

Center for Disease control and prevention. (2012, April).Asthma action plan: Kids. Retrieved
from http://www.ct.gov/dph/lib/dph/hems/asthma/pdf/aap05_bothpgs.pdf

Hewitt, K. (2012). Proquest. Pediatric Asthma’s Affects on American Kids, 37(28), 1-3.
Retrieved from
http://search.proquest.com.proxy.davenport.edu/docview/963354385/
1371E90971B42EB42B6/2?accountid=40195

Icon Health Publications. (2012). The official patient's sourcebook on asthma: Official patient
guides. (Revised ed., Vol. Illustrated, pp. 260-300). ebook: Icon Health, 2005. Retrieved
from http://books.google.com/books/about/The_Official_Patient_s_
Sourcebook_on_Ast.html?id=BeGEAQAACAAJ

Leifer, G. (2011). Introduction to maternity & pediatric nursing. (6th ed., pp. 595-601). St.
Louis, Missouri: Elsevier Saunders.

Miller, A. (2012, Feb). Pediatric asthma management. Respiratory Care, 57(2), 332-
335. Retrieved June 04, 2012, from Nursing and Allied Health Collection via Gale:
http://find.galegroup.com.proxy.davenport.edu/nrcx/start.do?prodId=NRC http://www.google.com/imgres?q=asthma+triggers&hl=en&biw=1272&bih=680&gbv=2&tbm=isch&tbnid=GZZ-TqGY8_Y0tM:&imgrefurl=http://wvasthma.wordpress.com/2010/03/16/asthma-triggers/&docid=ZDkuMX0C34bpjM&imgurl=http://wvasthma.files.wordpress.com/2010/03/22934.jpg&w=400&h=320&ei=elTOT6-pDaTB2QXUycjGDA&zoom=1&iact=rc&dur=327&sig=112945429557168983232&page=1&tbnh=139&tbnw=174&start=0&ndsp=19&ved=1t:429,r:0,s:0,i:87&tx=119&ty=66 http://www.google.com/imgres?q=pediatric+nurse+with+patient&hl=en&gbv=2&biw=1272&bih=680&tbm=isch&tbnid=sFS5Gpx7S6LflM:&imgrefurl=http://www.apu.edu/nursing/graduate/msnsnscpnp/&docid=2x32I78VCfOa2M&imgurl=http://www.apu.edu/nursing/graduate/msnsnscpnp/images/home_photo.jpg&w=440&h=220&ei=QFXOT_7uK6LE2gXMzfDgDA&zoom=1&iact=hc&vpx=556&vpy=268&dur=251&hovh=129&hovw=257&tx=151&ty=93&sig=112945429557168983232&page=2&tbnh=93&tbnw=185&start=19&ndsp=23&ved=1t:429,r:2,s:19,i:118 http://www.google.com/imgres?q=pediatric+asthma+treatment&num=10&hl=en&gbv=2&biw=1272&bih=680&tbm=isch&tbnid=NYfDriyCeKSjDM:&imgrefurl=http://www.pediatricasthma.org/emergency_departments/washington_dc&docid=NvTuYfpyifaqEM&imgurl=http://www.pediatricasthma.org/files/images/4-4-DC_IMPACT-DrTeach.jpg&w=235&h=196&ei=MlbOT4DyHOnH6AGjqa2dDA&zoom=1&iact=hc&vpx=624&vpy=163&dur=319&hovh=147&hovw=177&tx=77&ty=101&sig=112945429557168983232&sqi=2&page=1&tbnh=147&tbnw=177&start=0&ndsp=17&ved=1t:429,r:8,s:0,i:88 http://www.google.com/imgres?q=pediatric+asthma+treatment&num=10&hl=en&gbv=2&biw=1272&bih=680&tbm=isch&tbnid=NYfDriyCeKSjDM:&imgrefurl=http://www.pediatricasthma.org/emergency_departments/washington_dc&docid=NvTuYfpyifaqEM&imgurl=http://www.pediatricasthma.org/files/images/4-4-DC_IMPACT-DrTeach.jpg&w=235&h=196&ei=MlbOT4DyHOnH6AGjqa2dDA&zoom=1&iact=hc&vpx=624&vpy=163&dur=319&hovh=147&hovw=177&tx=77&ty=101&sig=112945429557168983232&sqi=2&page=1&tbnh=147&tbnw=177&start=0&ndsp=17&ved=1t:429,r:8,s:0,i:88 http://www.google.com/imgres?q=anti-inflammatory+drugs&hl=en&gbv=2&biw=1272&bih=680&tbm=isch&tbnid=Y9xju33T4JqcLM:&imgrefurl=http://www.meloxicamreviews.com/articles/meloxicam-reviews/meloxicam-anti-inflammatory&docid=HbzK_RmUfciyHM&imgurl=http://www.meloxicamreviews.com/images/fotolia_12491625_XS.jpg&w=400&h=300&ei=ElfOT-WZGuGJ2AWW0JHPDA&zoom=1&iact=rc&dur=254&sig=112945429557168983232&page=2&tbnh=150&tbnw=209&start=18&ndsp=21&ved=1t:429,r:1,s:18,i:128&tx=175&ty=17 http://www.google.com/imgres?q=leukotriene+modifiers&hl=en&gbv=2&biw=1272&bih=680&tbm=isch&tbnid=jKqPO_pLcb-JZM:&imgrefurl=http://www.copewithasthma.com/leukotriene-modifiers/&docid=_i6nM6HcS_WyNM&imgurl=http://www.copewithasthma.com/wp-content/uploads/2012/01/Leukotriene-Modifiers-210x300.jpg&w=210&h=300&ei=SFfOT_JVhN7ZBdjmpNgM&zoom=1&iact=rc&dur=238&sig=112945429557168983232&page=1&tbnh=143&tbnw=100&start=0&ndsp=18&ved=1t:429,r:9,s:0,i:104&tx=29&ty=91 http://www.google.com/imgres?q=child+with+oxygen+mask&start=94&num=10&hl=en&gbv=2&biw=1272&bih=680&addh=36&tbm=isch&tbnid=v75Di9ur6W3P8M:&imgrefurl=http://stephyeow.blogspot.com/&docid=aPrJBP-cATxeXM&imgurl=http://3.bp.blogspot.com/_xfA1gD8lcOg/TU4llUNREYI/AAAAAAAAB50/X7OkkFsSWDI/s1600/Oxygen%25252BMask.jpg&w=800&h=800&ei=IFjOT9PdC4nO2AW-5_3VDA&zoom=1&iact=rc&dur=349&sig=112945429557168983232&page=5&tbnh=139&tbnw=139&ndsp=24&ved=1t:429,r:3,s:94,i:11&tx=50&ty=25 http://www.google.com/imgres?q=boy+with+asthma&num=10&hl=en&gbv=2&biw=1272&bih=680&tbm=isch&tbnid=qTi285x0XAfeuM:&imgrefurl=http://news.injuryboard.com/study-boys-more-likely-to-outgrow-childhood-asthma-than-girls.aspx%3Fgoogleid%3D245880&docid=_XR8KF5ViHZWfM&imgurl=http://news.injuryboard.com/uploadedimages/InjuryBoardcom_Content/Blogs/News_Blog/News/iStock_Boy_Asthma.jpg&w=400&h=256&ei=Y1jOT-71MY2J6wH96eS0DA&zoom=1&iact=rc&dur=399&sig=112945429557168983232&sqi=2&page=1&tbnh=145&tbnw=208&start=0&ndsp=17&ved=1t:429,r:14,s:0,i:101&tx=129&ty=93 (Leifer, 2011) (Leifer, 2011) (Liefer, 2011) (Leifer, 2011) (Leifer, 2011) (Leifer, 2011) (Leifer, 2011) (Hewit, 2012) (Icon Health Publications, 2012) (Leifer, 2011) (Leifer, 2011)
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