1. TH2-type cytokine response predominance
2. General atopy
Nonspecific hyper-irritability of TB tree
1. TH2-type cytokine response predominance
2. General atopy
As documented by MEngr, Zhao& Winders (2017, pp.86), effective application of the National Asthma Council Australia 2015 and execution of the NSW Chest Pain Pathway will depend on a number of factors. It is important to increase the competencies of the attending physicians, nurses, and paramedics offering healthcare to asthmatic patients towards the breathing and chest pain management. It is also important to educate the concerned, including the family members, of the signs and symptoms of an asthma attack to improve diagnosis and management of this condition (“National Asthma Council Australia 2015 ”). Such awareness will help patients and family members to recognize the symptoms and seek medical treatment, early, since awareness has been proven to be the best control measure for any disease. The education will also entail first aid skills that are essential in preventing complications of asthma attack and its complications associated to breathing and chest pain management. Appropriate training will also equip the nurses and the asthmatic experts with skills to diagnose asthmatic conditions, control of chest pain even at primary assessment stage, with a clear knowledge of the appropriate treatment. Such training will also provide the medical facilities with a strategic approach to curb asthma (Woods et al., 2012, pp. 465-472).
Equipping the health centers with appropriate facilities is equally as important as administering the right treatment to asthmatic and chest pain patients. Such facilities can include the use of “e-health technologies to deliver information and services to those in rural areas “where access is problematic” (“National Asthma Strategy”). The facilities should also provide a wide range of medications to cover various forms of asthmas (Masoli et al., 2004, pp. 469-478). Any medical facilities who do not use an existing Chest Pain Pathway must implement the standard NSW Chest Pain Pathway together with the facilities which merge with this policy.
Finally, asthma and chest pain is a health threat that requires a professional approach. Acute nursing care is the savior of human beings from breathing complications and chest pain associated to asthma as a consequence of proper diagnosis and correct medication. However, this requires a professional and strategic approach, based more on control (in the case of asthma attack-breathing complications) and proper diagnosis and treatment in the case of chest pain. A step by step medical approach should, therefore, be followed to ensure that the cause and scope of the two complications is determined. Public awareness is equally as essential in ensuring diagnosis and treatment of asthma at early stages before it results to breathing and chest pain complications. Acute nursing care for asthma attacks can also be addressed from two perspectives: breathing and pain management. A strategic implementation of National Asthma Council Australia 2015 and execution of the NSW Chest Pain Pathway stands out as the best practices to curb these complications. However, the two concepts can be made effective by competent health personnel equipped with modern skills and facilities. As asthma and chest pain remains a health concern affecting over 26 million people across America, it is a social responsibility to improve the strategies to fight asthma and chest pain as a way of achieving a healthy nation.
The organ of the heart is the main function within the cardiovascular system. When the heart developed the coronary heart disease (ischaemic heart disease) due to health issues formed by lifestyles such as unhealthy diet, lack of exercise, being overweight and smoking the disease. When the heart is diseased functions of the cardiovascular system becomes effected due to to unavailability to provide towards its functions of circulating blood through the body giving necessary cells supplies of oxygen and blood. Heart disease is a disease which causes a build-up of plaque builds from fats called atheroma within coronary arteries (atherosclerosis) which effects the functions of the cardiovascular system. This causes a limitation of providing blood circulation which can cause a blood clot due to the build-up within the coronary arteries which can cause the arteries to narrow and become damaged from the build-up of plaque from heart disease which increases individuals heightened levels of cholesterol, high blood pressure as well as causing Triglycerides a type of fat within blood which functions towards energy resources as well as developing Peripheral arterial disease. Coronary heart disease can cause reduced blood flow within the cardiovascular system as the circulatory system is limited the weakness of the capacity for pumping blood within the chambers of the heart muscle reducing blood supply within the entire body which can cause a coronary heart failure caused by the effects of blockage of arteries due to heart disease which can cause permanent damage towards the heart within a long-term condition causing strain towards cardiovascular system functions.
The negative effect of atherosclerosis increases the heart to experience a heart attack (Myocardial Infarction) as build-up of plaque are common within larger main arteries closer towards the heart the effects of high blood pressure is easily assessable to flow regularly within the hearts functions. This can cause the tearing of plaque within the arteries which can result in bleeding as this can forms blood to become clotted the heart then produces itself blood via smaller arterial branches that break off the main arteries this can cause a blocking of blood supply leading to heart muscle death. This reduces the ability of the heart to function. Another effect of the coronary heart disease towards the functioning of the cardiovascular system can case strokes. Due to clots forming and traveling within the main bloodstream which are then reached through a vessel and travelled to Early branches off the arteries include smaller arteries that lead up to the brain which are in constant need towards retrieving blood supplies. If clotting of arterial clots travels up these passages into the brain lodging of blood can occur as arteries branch and causing narrowing this can cause blood flow to be prevented to portions of the brain which causes cells to die due to insufficient retrievals of oxygen and blood as well as a stroke from blood supply being cut. The after effects of stokes can cause individuals to loss of movement or speech or sensation as well as fatality.
A stroke is a condition caused by a shortage of blood supply within the brain resulting in the essential nutritional needs of blood and oxygen being obtained causing brain cells to become damaged or to die the damaging or deaths of cells can have impact towards within certain areas of the brain of neurons within the nervous system can be effected resulting in individuals having permanent damages towards issues such as loss of ability to communicate. There are Haemorrhagic stroke which cause by the result of blood vessels rupturing or breaking which causes blood to become spilled into its surrounded tissues caused by aneurysm or arteriovenous malformation. There is also Ischemic stroke and Transient ischemic attack. An ischemic stroke is cause by blood clots which are flowing within the brain caused by atherosclerosis, which is a build-up of fatty deposits on the inner lining of a blood vessel from heart diseases which causes blood to become blocked within the brain. A transient ischemic attack is a mini stroke or a warning also caused by blood flow circulation prevention but only last for short periods of time.
The nervous system provides towards the main functioning of the organ if the brain which controls major functions towards all the human body by the prevention of blood flow the brain in unable to provided towards it functions due to blood pressure. Stroke can cause individuals to be disabled or cause death towards individuals dur to the depriving of blood and damaging of cells which can cause individuals to have Behaviour changes, Speech difficulties, Numbness or pain or paralysis and memory loss caused by the damaging factors towards the nervous system because of stokes destroying neurons within the nervous system which are unable to be replaced causing permanent abilities to become lost as well as brain damage. The right side of the brain caused by brain damage from the effect of a stroke effect difficulties towards communication this causes individuals to experience attention and decreased perception as well as processing information (visual and verbal) and decreased cognitive thinking, poor judgment, short attention span as well as short term memory loss. While the left side of the brain damaged through an effect of stroke can cause paralysis as well as Aphasia is a disorder that results from damage to portions of the brain that are responsible for language which usually is appeared to be slurred speech from the right sided face and/or mouth weakness known as dysarthria.
Asthma is a chronic condition which causes issues towards the unavailability towards breathing. The condition of hypersensitive causes inflammation and narrowing of the airways system within the respiratory system the air ways from the result of asthma causes periods of wheezing during breathing as well as tightness and the shortness of breath as well as coughing. The respiratory system provides towards the main functioning towards the lungs within individuals who have asthma the airways of the bronchioles that carry air in and out of the lungs are restricted sue to inflammation and the narrowing of the airway path which also causes production of excessive mucous this causes the tightness experienced causing breathing difficulties. An individual who suffers from asthma can experience an asthma attack caused by triggers of irritants towards the air way of the respiratory system such as allergies, chemicals, dust, smoking an asthma attack is an occurrence of worsening of symptoms causing difficulties of further breathing the lining of the airway system is thickened due to swelling of exceeded inflaming and produces of mucous the tightening of muscles around the airway system the causes a bronchospasm which constricts muscles within the walls of the bronchioles which causes the difficulties towards breathing.
During an asthma attack the developed mucous within the airways cause a limiting of air access towards the airway and the lungs the effect of this cause individuals to feel a choking sensation as well as the sputum and mucus causes restrictions to constrict airways which increase asthma attacks severity. Due to the over reactions of stimuli of irritants of allergens causing the lining of the air way to build up of fluids which cause more constrictions to the airways. When over exposure towards stimulants called stimuli from allergens as well as being developed by viral infections which can promote an asthma attack. An Asthma occurs within two stages the first stages consists of mucous surrounding the airways causing mass cells to be released as the second stages begin to proceed by large quantity of cells are released and inflammation which builds up in the airways which constrict the surrounding muscles which cause fluids to develop within the lining of the bronchiole as well as further worsening of inflammation which can cause chronic and cause irreparable damage to the airways.
Damage towards the lungs from asthma can be developed by A pneumothorax from asthmas symptoms. A pneumothorax is when the lungs collapse due to a tear in the lungs causing air to escape into the chest cavity this causes of a collapse lung can be due to an abnormal collection of air resources within the lungs and chest walls within asthma stimulants of allergens can be of impact. A collapsed lung can cause impairments towards breathing and ventilation due to the effects of impacts of asthma towards the respiratory system which can cause the lungs difficulties within exchanging air within the airways and circulating oxygen within the body towards cells and tissue which can cells functions to become strained.
Asthma is a common long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm.
If you frequently experience shortness of breath or you hear a whistling or wheezy sound in your chest when you breathe, you may have asthma. This results in asthma symptoms, including coughing, wheezing, shortness of breath, and chest tightness. If it is severe, asthma can result in decreased activity and inability to talk. Asthma symptoms affect an estimated 26 million Americans — 19 million adults and 7 million children — and are one of the leading causes of absences from work and school.
Triggers for asthma
A trigger is something that sets off or starts asthma symptoms. Everyone’s asthma is different, and everyone has different triggers. For most people with asthma, triggers are only a problem when their asthma is not well-controlled with medicine.
How Do Triggers Make Asthma Worse?
In people with asthma, the airways are always inflamed and very sensitive, so they react to a variety of external factors, or “triggers.” Coming into contact with these triggers is what causes the symptoms of asthma the airways tighten and become more inflamed, mucus blocks the airways and results in a worsening of asthma symptoms. An asthma attack can begin immediately after exposure to a trigger or several days or even weeks later.
Different Triggers for asthma
Can I avoid triggers?
It is not always possible to avoid your triggers however reducing exposure to your asthma or allergy triggers may make your symptoms easier to manage. Trying to avoid triggers isn’t likely to make much difference to your asthma, but can often place limits on your lifestyle. The first step is to know what your triggers are so you focus your efforts in the right area. Your doctor will be able to help you work this out and give you some helpful advice and tips on how to avoid your triggers.
The best practice for acute nursing care for an asthma attack that entails breathing and chest pain management is explained by National Asthma Council Australia 2015 and Chest Pain Evaluation (NSW Chest Pain Pathway) respectively. Australia is the world’s leader in addressing asthmatic conditions and gives the best approach to nursing care for an asthma attack. The National Asthma Council Australia 2015 is a policy that revolves on asthma attack treatment procedures. The first process is to assess the severity of the illness. This can be done through noting deviation in vital signs such as body temperature, blood pressure and respiratory rates among others. This goes hand in hand with administering bronchodilator treatment (Reddel et al. 2015 pp.25).
Oxygen therapy is administered through oxygen saturation in a case the patients’ blood saturation has gone below 92%. The completion of the physical assessment against the vital signs is superseded by administration of corticosteroids. This should be done not later than four hours of admission to the health facility. Reassessment continues until the patient recovers. This follows laboratory assessments that will ascertain the severity and need for other treatments. The patient should be admitted to the hospital or intensive care unit in case the laboratory tests indicate necessity for additional treatments. After the respiratory difficulties are resolved, the patient should be observed for at least one hour before been discharged. Arrangements of post-acute care such as clinic visits and monthly checkups should be arranged before the patient is discharged (Reddel et al. 2015 pp.25).
The best practices of chest pain management are discussed in NSW Chest Pain Pathway (Boufous & Kelleher 2003 pp.2). This policy requires all the healthcare centers to embrace the NSW Chest Pain Pathway in their emergency department when handling chest pains. According to Boufous & Kelleher (2003 pp.2), for the management of chest pain, triage category 2 should be assigned first to determine the severity of the illness and inform the patients whose care is not urgent on their waiting time. This can be achieved through Electrocardiography and recording of ECGs. Troponin levels and vital signs are documented, and aspirin is administered to the patient. According to this provision, further medical support and assessment should be administered by a senior medical officer within 24 hrs. Cardiologist is also assigned to provide advice on further chest pain management if the symptoms persist. Diagnosis of higher risk chest pain attacks such as aortic dissection, pulmonary embolism and pericarditis are addressed through the STEMI management strategy
Asthma is among the life-threatening medical complications that require emergency acute nursing care. Cockcroft (2018, pp. 12-18) categorizes causes of asthma as allergic and non-allergic. Irritants such as dust, smoke, airborne substances, and pollen are allergic causes while non-allergic causes include the flu; cold, dry or windy weather; stress, and illness. According to Cockcroft (2018, pp.17), patients suffering from asthma portray symptoms such as coughing, shortness of breath, wheezing, difficulty in talking, and uncontrolled anxiety or panic. Miller & Lawrence (2018, pp.24-35) posits that asthma is not a continuous illness, but a patient suffering from asthma exhibits severe conditions when exposed to the allergies or situations such as cold weather that can trigger the asthma attack. In such cases, the patients need emergency healthcare or acute nursing care which, in this case, covers two concepts: breathing management and pain management healthcare. For the breathing management and Pain management, the nurses will assess the patient’s condition and evaluate the scope of the asthma attack by use of their health history. Acute nursing care will then be availed upon laboratory tests to ascertain the appropriate medication and post care. The essay will compare the current healthcare system with the best practices and give recommendations for future improvements.
Use non-identifying data to introduce your patient (e.g., 32-year-old female)
Alicia Kingston (pseudonym), 27 years of age was brought to the emergency department by paramedics with a suspected asthma attack. She was dressed in sporting apparel, a clear indication that Alicia was doing her morning jogging when she experienced the attack. Alicia had fallen few meters from her house. She was assisted by passersby who had called the ambulance which rushed her to the hospital where she was admitted to the Emergency Room (ER).
Provide a brief summary of the patient e.g., diagnosis, past medical history, events leading to acute care episode
Alicia past record shows that she was asthmatic. She was diagnosed with asthma in 2001. The cause of her asthma, stated in her EHR was allergy. Her mother stated that the only unusual symptom, in her daughter, was coughing which occurred whenever she was dusting the couches or her father was smoking in the house. Since 2011, Alicia has been using Amoxicillin, especially during winter. She had also been taking Ibuprofen, 200 mg since 2014, with a long record of stomach pains and heavy breathing. On many occasions, she had sought medical attention for chest pains, with records showing a number of pain relief prescriptions such as Tylenol, Aleve and Naprosyn.
Briefly explain why this patient may be considered as ‘complex’. Support your position with evidence from literature
In her second day of admission to the clinic, Alicia began complaining of chest pains. After she had been treated and recovered from the asthma attack and breathing complications, she complained of chest pain, which was not investigated appropriately to diagnose the cause. The difficulties she had in breathing was presumed to be the cause of the chest pains, with the diagnosis giving a blind eye on probable cause of chest pain such as blood pressure or heart attack. No ECG or cardiac enzyme test was done. The patient died from heart attack shortly after been discharged from the hospital.
Identify the two (2) core acute care nursing concepts that you will analyse in relation to the nursing management of your selected patient
Alicia had breathing complications when she was admitted in the emergency care unit. This required the intervention of breathing management. A day after being admitted to the ER, she complained of chest pains. Thus, two acute care nursing concepts relevant to the patient’s admission are the management of her breathing and the management of her pain which fit within the Airway and Breathing index of the A – G algorithm patient assessment framework for acute care nursing.
Analyse the current workplace systems in place for the nursing management of patients in relation to your two concepts
The patient was short of breath and wheezing. The patient was also half-conscious. She kept her arms close to her chest whenever she was breathing or coughing. There were also bluish marks on her hands and on her feet, which indicated a case of cyanosis. The paramedics put the patient in an upright, comfortable position with a cushion on her sides to support her weak body. The female nurses also loosened her apparel and scarf to ease the flow of blood.
Before treatment could be administered, the patient’s condition had to be diagnosed. A physical assessment was first conducted to ascertain the cause of her critical condition. The nose was inspected and, although she had not recently complained of running nose, swellings were detected on the side of her nose and in her nasal passage which was stained with mucus. Vital assessment was done. The body temperature read 35.8, Heart rate: 110 b/m (tachycardia), Respiratory rate;26 b/m (tachypnea), Blood test had to be conducted, indicating a 91% oxygen concentration and blood pressure: 135/85 mmHg. The patient’s respiratory rate was 13 breaths per min. the patient were put in 4-litre oxygen to boost her oxygen saturation from 91%. We administered Ventolin nebulizer to dilate the bronchioles and ease her breathing.
In the second day of admission, the patient started complaining of chest pain. The patient pain was assessed according to PQRST. The chest pain which radiated to the right arm recorded 9 in the 1-10 scale. Based on the recent asthmatic diagnosis, it was assumed that the chest pain was caused by strenuous breathing (Asthma, 2014, pp. 18). The anxiety, rapid breathing, and excessive coughing had strained the chest muscles causing the chest pain. Thus, 2 mg of Morphine was administered to the patient to relieve her pain. The patient relaxed for 30 minutes, after which another pain test was conducted. This indicated that the pain had declined to 5 in the 1-10 scale.
Discuss the strengths and weaknesses of the nursing management provided
There were noticeable strengths as well as weaknesses in the nursing management systems which helped the health status of the patient to improve since the two health concerns – breathing and chest pains – were addressed before the patient left the medical facility. However, an analysis of the healthcare management also depicted weaknesses. In terms of the strengths, the health care nurses succeeded in correctly diagnosing and managing the patient’s breathing problems by conducting an effective primary assessment. Before starting the initial treatment, a physical assessment was done to ascertain the cause of the patient’s unconscious state. Mild assessment; blood test, heart beat and respiratory rate were taken. Much of the affirmation on the cause of her ill health was based on her health history. Thus, the medication was not administered on the basis of laboratory tests, but upon medical records that confirmed that the patient was indeed asthmatic. Additional treatment such as Morphine was administered to mitigate the chest pain, which was assumed to have resulted from the asthma attack.
Among other weaknesses noted in the two acute nursing processes is a lack of proper procedures since the first aid was administered long after the primary assessment. The patient was brought to the medical facility, half conscious. However, the healthcare physicians began the physical assessment while the patient was still in a critical condition. Mild laboratory tests were involved in the diagnosis: imaging tests and a sputum induction test. Additionally, the acute nursing care for the chest pain was entirely treated on the assumption that it was caused by asthma. No other assessment was conducted to ascertain other causes of the chest pain such as a heart attack. Thus, the management response was shallow and the post-acute care was poorly administered. The conclusion can be drawn, therefore, that the hospital either lacks policies, or the health practitioners are not fully cognizant of the guidelines to follow in matters concerning asthma.
Increasing Frequency of Pediatric Asthma Essay Sample
Pediatric asthma refers to asthma in children (Accetta 2006). Over the past decades, pediatric asthma has been rampant worldwide. “In 2002, an estimated 30.8 million people in the United States had asthma diagnosed at some point in their life, including some 8.9 million children. Asthma is estimated to affect as many as 300 million people worldwide. Asthma is the leading cause of hospitalization in children, the most prevalent chronic disease in childhood, and the most common cause of school absenteeism due to chronic disease. It is more common and more severe in African-Americans and in people with a low income living in urban areas” (“Asthma: What We Know” n.d.).
What is asthma?
According to the article reviewed by Owens (2004), “asthma is a chronic condition in which narrowing of the passages from the lungs to the nose and mouth (airways) leads to difficulty breathing. These changes commonly occur in response to changes in the environment, including weather, allergens (such as dog or cat dander, mold, or dust), foods, or respiratory infections (colds).”
Asthma is a chronic inflammatory disorder of medium and small airways (Klinek 1997). Airway inflammation involves numerous cells including antigen presenting cells (such as macrophages), lymphocytes that produce cytokines (T-cells) and IgE molecules (B cells), mast cells that release various mediators when IgE receptors cross-linked by allergens, and eosinophils that can cause epithelial damage via Major Basic Protein.
Based on “Asthma and Children” (2007), “childhood asthma is caused by the child’s genetic predisposition and allergies. The majority of children with asthma have allergies. Even exposure to low-grade allergens (those that do not cause significant allergic reactions) may increase the severity of a child’s asthma. In addition, allergies may play a role in undiagnosed asthma cases.”
Children with asthma may be able to breathe normally most of the time. When they encounter a trigger, however, an attack (exacerbation) can occur (“Pediatric Asthma” 2003). There are a number of triggers in asthma and this may include tobacco smoke, dust, pollen, strenuous physical activity (such as exercise), viral infections (such as the common cold), mold and mildew, animals/pets (hair or dander), insects (cockroaches), chemicals in the air or in food (food additives), mold, changes in weather (frequently cold weather), strong emotions and certain drugs/medications.
Other factors may include viral upper respiratory infections, rhinitis or sinusitis and gastroesophageal reflux disease (GERD) where stomach acids goes up into the esophagus.
As stated in “Asthma and Children” (2007), “approximately 6.2 million children have been diagnosed with asthma according to the American Lung Association. Asthma is one of the most common, serious, chronic diseases among children, accounting for 14 million absences from school each year. Moreover, asthma is the third-ranking cause of childhood hospitalizations under the age of 15.”
In another study, “asthma is affecting approximately one in 20 children” around the world “and the prevalence is increasing” (Maynard 2001).
A whole host of risk factors for the development of asthma have been explained and may include: male gender, atopy, genetic and familial factors (family history of asthma, allergic rhinitis, hives or eczema), respiratory infections, outdoor air pollutants, indoor aeroallergens, smoke, pre-maturity (low birth weight), diet (obesity) and climate. Atopy is the strongest identifiable predisposing factor for the development of asthma (Klinek 1997).
Signs and Symptoms
The most common signs and symptoms of pediatric asthma include coughing, wheezing, shortness of breath (breathlessness), chest tightness and chest congestion. Other signs and symptoms in children are rattly cough and recurrent bronchitis (croup, broncholitis, pneumonia or bronchopneumonia).
Even if wheezing is closely associated to asthma, not all asthmatic children wheeze. Vice versa, not all children who wheeze have asthma. Not all of the above-mentioned signs and symptoms may be present in children with asthma since they may be correlated with other ailments, not only with asthma. The final diagnosis can only be made after pulmonary tests are run by a pediatrician or specialist.
As mentioned in “Asthma and Children” (2007), “although childhood asthma symptoms are the same as adult asthma symptoms, they may not be as noticeable and easy to detect. Wheezing, often a positive indicator of asthma may not be as noticeable in a child with asthma as in an adult. However, most children who have asthma will cough – a common characteristic of asthma, regardless of age. If your child coughs after running or crying, or during the night, consult a physician for a diagnosis. Your child may have “hidden” (undiagnosed) asthma. Other childhood asthma symptoms may include the following:
The so-called “hidden asthma” is said to be undiagnosed asthma with undetected symptoms. These symptoms could be in the form of wheezing or difficulty in breathing (breathlessness), which can only be exposed through testing pulmonary abilities. Therefore, if a child undergoes airway obstruction or any abnormalities in respiratory function, it is advisable that the child be checked by a physician to determine if such symptoms are related to asthma or not.
Classification of Asthma
As determined by the National Institutes of Health (cited in “Asthma and Children” 2007 para. 7), “the following is a guideline used by physicians to help determine the extent of asthma in your child. It is classified as ‘steps,’ because each child may step up or step down to different levels at any time.
The steps are as follows:
Screening and Diagnosis
Pediatric asthma is a very subjective condition. Its severity depends from one child to another. Among the physician’s considerations are the nature and frequency of symptoms together with the testing results to disregard other diseases before finally diagnosing the health problem as asthma. Usually, it is difficult to diagnose asthma among toddlers and infants since some signs and symptoms of asthma at these ages may disappear as they grow up. A more definite diagnosis of asthma can be made as soon as the child reaches after 6 years of age or adolescence.
The physician can use family history of the asthmatic, physical examination, and diagnostic tools such as chest x-ray (CXR) and lung function tests to diagnose asthma in pediatric patients. Pulmonary function tests may include spirometry (measures the amount of air inhaled) and peak flow meters. A spirometer helps to determine whether there is airflow obstruction and whether it is reversible over the short term. On the other hand, the peak flow meter is designed basically for monitoring asthmatic patients by measuring the amount of air that can be expelled from the lungs. A more accurate diagnostic result can be obtained when the doctor uses a combination of history, physical examination and pulmonary function tools (CXR).
For effective treatment of pediatric asthmatic patients, the families and physician should plan together in monitoring signs and symptoms and eradicating triggers of asthma. According to the review by Owens (2004), “there are two basic kinds of medication for the treatment of asthma:
Most asthmatic children live a normal life as long as this disease is properly treated, monitored and managed. Nevertheless, asthma should not be taken for granted because if left untreated, it can be a life-threatening ailment. Therefore, family support together with the physician or allergist should develop a workable plan to fight this respiratory illness which causes impairment to children.
Grave complications of asthma include continuous cough, lack of sleep due to nighttime symptoms, decreased ability to perform exercises and participate in various activities, absence in school, missed work for parents/guardians, frequent emergency room visits and stays in hospital, difficult breathing requiring breathing assistance (ventilator/nebulizer), permanent changes in lung function and even death.
Full prevention of asthma is yet to be discovered. However, the role of the families in the prevention of pediatric asthma cannot be undermined since each member can help in the elimination of triggers inside the home. A common example is avoiding cigarette smoke indoors. As soon as signs and symptoms of asthma in children start to show, immediate consultation to a doctor is advised for implementation of a plan of action for relief.
In general, the following are some tips on how to prevent asthma attacks among children. First, avoid triggers which may activate exacerbation of asthma. Second, encourage the asthmatic child to be active especially in activities which are good for the lungs such as swimming. Next, make a plan which will involve all the people surrounding the child to help in avoiding asthma attacks. And lastly, use a peak flow meter to constantly monitor the extent of lung function to be able to predict a possible asthma attack.
Increase of Frequency of Pediatric Asthma
According to “Asthma: What We Know” (n.d.), “asthma is increasing, especially in young children, both in the number of people affected and in severity. Asthma is increasing in the United States (figure to right) and most developed countries, in many developing countries (e.g., China, India), and indeed, worldwide.”
Number of people in USA with asthma. Data: American Lung Association
“The number of children and the total number of people with asthma in the U.S. has more than doubled since 1980. The number of women in the U.S. with asthma is increasing faster than the number of men with asthma. Comparing children hospitalized for asthma in California in 1993 and 1986, children in 1993 were twice as likely to experience an adverse outcome (such as having a breathing tube inserted into the windpipe, having normal breathing and heart functions stop, and death) compared with children hospitalized there seven years earlier. Experts agree that the increases in asthma are real and not just an increase in reporting due to increased awareness” (“Asthma: What We Know” n.d.).
Many studies have been conducted to derive at a logical explanation as to the increase of frequency of asthma among children lately. It has been proven that genetic and familial factors do affect risk of acquiring asthma. However, “Asthma: What We Know” (n.d.) further explained that “more and more people without a family history of asthma are getting the disease” and “the increase in frequency of asthma has been too fast and too large to be explained by inheritance of genetic susceptibility. Changes in gene frequency occur slowly over many generations, except under highly unusual circumstances that would leave many tell-tale signs.”
Concerned individuals have suggested that environmental factors might be involved in this upsurge of pediatric asthma cases. But “Asthma: What We Know” (n.d.) continued that “there has not been any significant increase in indoor allergen concentrations during the last few decades to account for the doubling of asthma rates during that time. There are no differences in asthma rates in dry, cool regions with low levels of house-dust mites and fungus compared to warm, humid areas where levels are high.” Moreover, “studies have not shown that children with less exposure to these allergens are any less likely to develop asthma” (Asthma: What We Know” n.d.).
Another hypothesis was proposed to explain the increase in asthma cases. This was called the “hygiene hypothesis” which stated that children who grew up “too clean” or hygienic and unexposed to childhood diseases, domestic animals, and bacteria possess an immune system which is hypersensitive and overactive to asthma allergens. Even so, this theory was not accepted because it failed to explain why incidence is higher among African-American children, among children living in urban areas in contrast to those residing in suburban communities, and the rising number of cases in highly-populated developing countries like China and India.
Some possible justifications as to the increase in incidence of pediatric asthma were given by recent researches which encompasses the following:
As an initial conclusion to the preceding assumptions, “asthma is increasing in frequency and severity in all age groups and in most developed countries. In the U.S., it is most common in African-American children living in urban areas. Although genetic factors are involved, environmental factors are almost certainly responsible for the increases” (Asthma: What We Know” n.d.).
According to another study, “In 1994-96, 24 percent of children with asthma had to limit their activities due to their asthma, and the disease caused children to miss 14 million days of school. Studies have shown that outdoor and indoor air pollution causes some respiratory symptoms and increase the frequency or severity of asthma attacks” (cited in “Respiratory Diseases in Children” para. 2).
“Asthma among children is increasing in the United States. Researchers do not understand completely why children develop asthma. The tendency to develop asthma can be inherited, but genetic factors alone are unlikely to explain the significant increases that have occurred in the last 20 years” (cited in “Respiratory Diseases in Children” para. 6). To support this statement, “In the last 20 years, asthma prevalence has doubled, says Derek Johnson, MD, director of pediatric allergy at Temple University, in a news release” (cited in De Noon 2007).
In a recent article by De Noon (2007), Atlanta was named “Asthma Capital” in the United States for 2007 by the Asthma and Allergy Foundation of America (AAFA). “Atlanta earns its “worst” score from the city’s high asthma death rate, high pollen levels, and severe air pollution. The AAFA also cites Atlanta’s “worse-than-average” public smoking laws, although the city does ban smoking in 80% of hotel rooms and in bars and restaurants that allow access to minors (except in private, separately ventilated rooms)” (De Noon 2007).
The 10 worst asthma cities (in the United States), according to the AAFA, are Atlanta (last year: 4th), Philadelphia (last year: 3rd), Raleigh, N.C., Knoxville, Tenn., Harrisburg, Pa., Grand Rapids, Mich., Milwaukee, Wis. (last year: 5th), Greensboro, N.C. (last year: 7th), Scranton, Pa. (last year: 1st) and Little Rock, Ark. (De Noon, 2007).
“Research on environmental factors that exacerbate or may contribute to causing asthma has focused on environmental agents found outdoors and indoors. The Institute of Medicine concluded that exposure to dust mites causes asthma in susceptible children. Cockroaches and tobacco smoke are likely to cause asthma in young children. Other studies have evaluated the role of indoor air pollutants such as nitrogen dioxide, pesticides, plasticizers, and volatile organic pollutants. Some of these pollutants may play a role in asthma. One recent study suggests that chronic exposure to ozone may be associated with the development of asthma in children who exercise outside, and two other studies suggest that chronic exposure to particulate matter may affect lung function and growth” (cited in “Respiratory Diseases in Children” para. 7). Therefore, basing on these studies, environmental aspects along with genetic factors may cause an increase in frequency of asthma attacks in children who already have the disease and may cause the disease among non-asthmatic children.
In conclusion, development of asthma is yet to be determined. It may be the interplay of different factors such as genetic and environmental. Children may have greater mortality and morbidity rates than adults because of their body structure and function which may be weaker. For now, the best thing for adults to do is to work hand in hand with the physician to combat pediatric asthma. Emphasize on the triggers to prevent them and on inflammation to treat it immediately. Parents and guardians must be alert in assessing the child’s condition in order to act the soonest in case of asthma attacks. In critical situations, earlier detection can ensure an instant therapy, thus, the greater possibility of saving the child.
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25, 2009, from http://www.rnweb.com.
The article is introductory yet in-depth resource material for pediatric asthma.
Asthma is the most widespread chronic disease affecting approximately nine million children in the United States alone. In 2002, the dreaded illness caused the deaths of more than 4,261 persons, including 170 children. Irritants such as animal dander, cigarette, dust mites or wood smoke commonly trigger the asthma. It will inflame the airways of the patient and will eventually lead to decrease of oxygenated blood delivered to the body. There are various methods of medicating the illness based on the exacerbation the patient experience. Mild cases can be cured with puffs of albuterol, while mild or severe should be treated with a combination of bronchodilator and on oral steroid. Continuous medication should be partnered with efforts of educating the parents on proper approach and medication about asthma. Drafting an asthma action plan, with the help of the doctor, parent and patient will help lessen the attack of the disease.
Figueiredo, C. A., Alcantara-Neves, N. M., Veiga, R., Amorim L. D., Cattoli, V., Mendonca,
L. R., et al. (2009). Spontaneous Cytokine Production in Children According to Biological Characteristics and Environmental Exposures, Environmental Health Perspectives, 117, 845-849.
The purpose of this study was to investigate the effect of environmental exposures on immune homeostasis of the children, by assessing the production of cytokine by unstimulated peripheral blood leukocytes. Previous studies showed that necessary environmental exposures are most likely to contribute in the development of immunity of human. The children investigated in this study were based in the city of Salvador, Brazil. Their age group belongs to 4-11 years of age and lives below poverty line. The study showed that most of the children assess did not suddenly produce cytokines, and the major cytokines produced were IL-10 and IL-13. IL-13 is an necessary cytokine mediator for allergic asthma and IL-10 limits and terminates inflammatory responses. The study also showed that children with greater IL-10 were those without access to drinking water. Moreover, children who produced greater IL-10 lives where they had never a proper sewage system.
Liu, C. & Feekery, C. (2001). Can Asthma Education Improve Clinical Outcomes? AN
Evaluation Of a Pediatric Asthma Education Program, Journal of Asthma, 38, 269-278.
The researches assessed whether formal asthma educations can lessen the morbidity and severity. Further, they also evaluated whether the learning method is a necessary component in this process. Subjects of the study, all of which never received formal education in asthma, undergone face-to-face, group or home-based education. Prior to this, they answered sets of questionnaires to assess their knowledge of the illness. The researchers discovered that any process of learning will increase parent asthma awareness and instantly lessen their concern and morbidity count on children. However, this positive result will only continue effectively if the learning process will be on the way of interactive and face-to-face setting. Finally, because of the result of the study, the researchers critically assessed the effectivity of mass asthma education campaigns.
Centuries of years ago people died from incurable at that time diseases, however, they were oblivious of the threats which humanity faces today, namely the constant dangers to people’s health caused by the globalization and urban sprawl. With the development of high technologies, people envision a great potential in the modernized cities which have become for them the primary source of income. Not much attention is paid to the environmentally-unfriendly factories and vehicles as they bring speed and profit to their owners. On the other hand, much talk tackles the problems of the polluted planet and health of humans on it, but oftener that talk remains within word frames, and does not reach the action mode.
The range of health issues caused or amplified particularly by the air pollution is increasing gradually nowadays. Those patients who suffer from such diseases as asthma face special challenges as with each inhaling they receive a huge number of irritating bacteria which make their breathing a difficult process restricting their ability to lead a full-value life (Bray, 2005).
The problem of the rapid urbanization is not tied just to the territory of the United States, however, can be found throughout the whole world, especially well-developed and developing countries. Despite the negative side effects of the technological development, new, highly-efficient equipment for treating difficult or even incurable before diseases is also being invented, tested, and applied. The costs for this equipment are very high, but the progress foreshadows that with time medicine will become more affordable and simultaneously more effective (Frumkin et al., 2002).
The controversy in the technological progress polluting our environment and diminishing organic resources and, therefore, adversely influencing humans’ lives since well as helping in order to cure serious illnesses or perhaps alleviate the painful outcomes of others is unquestionable. One action entails an additional, helping as well as destructing typically the health of people (Asthma and Air Pollution, 2005).
Over 20 , 000, 000 Americans suffer from the symptoms of asthma. When the individual has a strike associated with asthma, the airways turn out to be very constricted and enlarged, filling gradually with the mucus. The patient might start gasping or breathing problems because the chest feels very tight hindering the simple catch of breath. Within the worst cases, asthma can cause the fatal outcome. In the United States about 5, 000 individuals succumb to this extreme illness each year (Asthma and Pollution, 2005).
The disease is really a long-term, usually weakening condition that will, unfortunately, has no cure in the modern world yet. Asthma keeps youngsters out of school (in general, up to14 million missed school days each year, as the Centers regarding Disease Control informs) and prevents them performing any physical activity, therefore, leading in order to even more serious issues with health. Employees miss 13 million working days each and every year when because asthma strokes hinder them in order to visit their workplaces. Above two million emergency-room trips are due to typically the asthma fits per yr (Asthma and Air Polluting of the environment, 2005).
Learning the causs of the disease keeps asthma in check. That is comparatively easy to avoid tobacco smoke, dust particles, and cockroach droppings, on the other hand, the triggers from the disease are nowadays reaching a far different scale and are present just in the atmosphere which becomes both a new life savior and a life killer due in order to the pollutants which fill it. As the research shows, in recent years, the air pollution released by cars, power vegetation and factories is a new key cause of episodes of asthma. Moreover, around 159 million Americans – which constitute over half the population in the overall nation – inhabit areas with bad air circumstances (Frumkin et al., 2002).
Scientists estimate of which over 30 percent of asthma that strikes youngsters is caused by typically the environmental issues, costing typically the country $2 billion each year. Furthermore, the same study suggests that this kind of extreme whilst still being growing air flow pollution can contribute to the future development of asthma inside those people who have been previously within a good health. The traffic around the roads is not simply contributing greatly to typically the problems of the garden greenhouse effect around the entire world, responding for above 26 percent of green house gas emissions in the United States but also is considered to be the key trigger of the increase of the testers ill along with asthma (Frumkin et ‘s., 2002).
Except with regard to well-known triggers from the asthma fits, the air of present days contains much more dangerous particles which greatly add up to previously long ago existing problem. Ground level ozone, sulfur dioxide, particulate matter. plus nitrogen oxide cause a lot more complications nowadays than inside past years as their particular percentage up grew significantly (Bray, 2005).
Asthma is a disease regarded as a chronic inflammation of the bronchial tubes that causes swelling and narrowing of the airways, difficulties in breathing. However, this narrowing of the airways can be totally or partially treated with medication. When the bronchial tubes become inflamed, they become highly sensitive to allergens or irritants. These airways usually become twitchy, and they may remain in the state of increased sensitivity. This condition is referred as “bronchial hyper reactivity”. Asthma affects people in different ways considering each individual being uniqueness in the level of reactivity to environmental triggers. This level therefore determines the type and dosage of medication that is prescribed to the individual.
The Scope of Asthma in the General Population and on the Health Care System
Asthma is the most common chronic disease in children affecting one in every 15 children. In North America, 5 percent of all adults suffer from asthma and 9.5 percent of children. In total, there are approximately 1 million people in Canada and 25 million in America who suffer from asthma. New cases of asthma are, however, being diagnosed every day and therefore the number of cases and the annual rate of hospitalization for asthma have increased by 30 percent for the past 20 years. For example, in America in 2009, 1 in every 12 people had asthma compared to 2001 when 1 in every 14 people had asthma. This rate is therefore continuing to grow every year. The greatest numbers of cases among children have been identified among the black children in America that have increased by almost 50 percent between 2001 and 2009. Even considering the advances in treatment, asthma is on the increase that has prompted the doubling of death rates among the young people (Centers for Disease Control and Prevention, 2011).
The Need for a Formal Medical case management Plan
An official case management program for asthma may be the essential to reducing deaths connected to the disease. This particular is because most sufferers do not adhere in order to the medication and this specific leads to deteriorating quality of life which may result in death regarding the patient. Therefore, a plan that will help patients build asthma management expertise is most required instead than just providing fundamental information to patients. Reports have identified some factors that affect adherence to be able to asthma medication being absence social support, poor breathing difficulties knowledge, management skills plus other dynamic issues in the parents, children, and the particular entire family. Therefore, the formal case management program will improve parental oversight in addressing issues such as information and skill of bronchial asthma management as well as improving the patient’ h communication and self-care tasks.
The core components for that asthma case management program include building ability for routine assessment, establishing consistency in patients’ attention through education of healthcare personnel and patient’ h care givers, in addition to a regular reporting method for all outcomes in addition to processes for the care providers. Other contain medication adherence counseling, follow up form for inpatient visits, coordinted care, education and learning on the disease, gadgets, medication and on the particular avoidance of triggers. Nevertheless, there is need for a new dedicated family physician who else will lead the initiative and provide technical assistance. System these elements, the case management program will ensure successful recovery from the disease and reduce mortality rates associated with bronchial asthma (Community Care of North Carolina, 2013).
Potential Benefits to Implementing the Systematic Case Management Program
A systematic case management provides an opportunity for an improvement inside the health outcomes plus cost reduction. Considering typically the elements of a circumstance management program, if that is well implemented, one of the results may be patients’ ability of self-care. Which means that there is reduction in health service utilization among the patients who is able to manage self-care. This specific brings about reduced visits to the health facility, as a result, cutting around the cost regarding those visits. In addition, it indicates that there is decreased cost of paying regarding the doctor’ s consultation fee. When an affected person has the knowledge in addition to skills for managing his or her own situation; this is an economic benefit to the individual and the loved ones. Another benefit of case administration program is that that results in improved quality lifestyle. This quality is improved through improved adherence to be able to medication and self-care. This particular is because this software involves active follow up and ensuring consistency of treatment. This means that typically the patient will be capable to receive high high quality care and continuous monitoring of the progress. Top quality care ensures successful healing and therefore improved high quality of life for your individual (Kathol et al., 2011).
Systematic case management program will also have social benefits to the patient since it involves coordination of care between the physician, the care giver who belongs to the patient’s family and the patient. This helps in improving the social support which acts as a barrier to medication adherence among asthma patients. Social support is also important for the recovery process because it enhances a feeling of belonging for the patient.
Role of Nursing in Coordinating the Case Management Program for Asthma
Nursing role is very important in coordination of case management plans for asthma patients. Nurses should act as a case manager who should assist patients and identify some of the factors that will affect the ability of patient to go through asthma management plan. Some of these factors include social support, economic resources, and lack of knowledge and skills regarding asthma management. Therefore, a nurse will be able to form a multidisciplinary team that will engage other players in addressing the issues identified during patient assessment. The nurse will be able to lead the team in developing clinical pathways and guidelines that will be part of the case management plan (Dinelli & Higgins, 2002). Some of the clinical guidelines will include timing of the intended medication and plan for ongoing monitoring and risk surveillance. These guidelines will also be used in moving the patient to the next recovery level. These guidelines are also provided to the patients to help them in self managemeent of their condition.
One of the reasons as to why the nurses should be involved in formulating the plan of care is the need for coordination with the patient. Patients may well understand the plan of care when they are involved in its writing. The nurse is able to coordinate with the patient in writing the care plan. Another reason as to why the nurse should be the main player is that he or she is able to provide patient education to improve their knowledge and skills. It is important that patients understand the healthcare provider’s recommendations so that they can easily follow them. Therefore, since patient education is the responsibility of the nurse, it is important that he/she be involved in formulation of the plan. Education on asthma also requires that the healthcare provider begin at the patient’s level of understanding when giving advice. This may be possible with the nurse compared to other healthcare providers (Community Care of North Carolina, 2013).
Patient follow up which is also very important in case management of asthma may be possible with the nurse as compared to other healthcare providers. Follow up may involve home visits and meeting family members and care givers. This responsibility may, however, best fit the nurses.
Other Team Members for Case Management Program for Asthma
Other members of the team may include physicians, parents in case of children or a care giver and community health workers. The role of the physician as a member of team will be for consultation by the nurse to discuss the reaction of the patient to the treatments and suggest referrals in case of any adverse reaction. The physician will also act to review the follow up forms and give the recommendations. The parents and the care givers at home are for continuous observation of the patient and for offering social support especially on adherence to medication. Children may sometimes not will to take the drugs and it is important for the parents to assist and encourage them. For the adult patient, a care giver will ensure that they follow the prescriptions and other advice from the healthcare provider. The role of the community health workers acts as the link between healthcare system and the social service system. They help in linking the patients with sources of funds and other resources required to manage their health needs. In case of asthma, they help in dealing with social and environmental issues contributing to the disease in collaboration with the healthcare system (AHRQ, 2011).
Formal case management programs have been found to be effective in managing asthma. This is mostly important due to the economic and social challenges associated with managing the disease. Case management program minimizes the cost and ensures that there is improved outcome of the treatment regime leading to improved quality of life for the patient. It is important to ensure that there is total coordination between various players in case management for a successful outcome. The entire program requires teamwork between the nurses, the physician, the patient and his or her family members and the community health workers.