Asthma: Management and Complications (Pediatric Nursing)

00:01 How do we manage asthma? Well, every patient with asthma should have an asthma action plan.

00:06 The goal of asthma self-management is to achieve better health through controlling and preventing the asthma attacks.

00:13 An asthma action plan is a written plan that is created with the child's health care provider to help control their asthma.

00:20 The goal is to reduce and prevent flare-ups and decrease emergency department visits.

00:26 Here's an example of an asthma action plan.

00:30 The patients kind of perform their peak expiratory flows and then calculate which percentage of their expected they have achieved.

00:37 If the peak flow result is > 80% of their predicted or expected amount, then they're in the safe zone.

00:43 They're in the green zone, and they're going to persist with their normal baseline regimen.

00:48 If the peak flow result is between 50% and 79% of their predicted amount, the patient is in the yellow zone.

00:55 This is the caution zone.

00:56 They're going to initiate their interventions in the yellow section, which may be to increase their inhaled bronchodilator and continue to adhere to their routine asthma care.

01:06 Now, if the patient's result is <50% of their predicted and expected amount, then the patient is in the danger zone or the red zone.

01:14 And they're supposed to attempt to aggressively resolve their exacerbation with their medications.

01:19 And if there's no improvement in about 15 minutes, they need to call 911 or get to a hospital.

01:26 To achieve good asthma control, the patient is going to need to use a stepwise approach.

01:30 They should be able to step up their treatment if needed, and if they're well controlled, they may be able to step down the treatment.

01:37 Before stepping up, you would want to review the adherence to medication, review the patient's inhaler technique, ask about their environmental controls, and also assess for co-morbid conditions.

01:49 If an alternative treatment option was used in a step, discontinue that and use the preferred treatment for that step.

01:56 So, in step 1, with intermittent asthma, the patient's only going to need access to a short-acting beta-2 agonist, that they can use PRN, or as needed.

02:05 This patient needs rare asthma medication less than 2 times per week.

02:11 Next, we go to step 2, and this is a patient who may have more persistent asthma and may need daily medications.

02:17 These patients will have access to step 1, which is their short-acting beta agonist that they can use as needed, and they will be put on a low-dose inhaled corticosteroid or ICS.

02:28 The next step would be the patient requiring a higher dose of the steroid inhalation and this would be a medium-dose inhaled corticosteroid.

02:36 Now, patients in step 3, remember, also have access to their short-acting bronchodilator in step 1.

02:42 Step 4 is a patient who needs a medium-dose inhaled corticosteroid, and then they also need access to a long-acting beta agonist.

02:51 This is sort of a long-acting albuterol substitute.

02:55 In step 5, the patient's steroid dose is going to go up even higher to a high-dose inhaled corticosteroid with, again, a long-acting bronchodilator.

03:04 Remember, these patients can still use their as needed short-acting bronchodilator in step 1.

03:09 In step 6, these patients have a high-dose inhaled corticosteroid, a long-acting beta agonist, and these patients may also need a burst of oral corticosteroids, like prednisone.

03:21 The patient should be able to move up and down on this continuum with the help of their health care provider.

03:26 If the patient's not well controlled on one step, they may need to go to the higher step.

03:30 And once they've tolerated that pretty well, sometimes for a few weeks, you can attempt to step the patient down and see how they tolerate these.

03:38 The clinician also needs to decide if the patient has intermittent or persistent asthma.

03:43 You can also determine if the patient's tolerating their current step, if they need to move up or down on the management plan.

03:48 This includes the assessment of the patient's symptoms.

03:51 How are they doing? How many times at night are they waking to cough? And what's their interference with normal activity? In persistent asthma, you're going to ask about their short-acting beta agonist use, you're going to compare their lung function scores, and you're also going to consider the exacerbations requiring oral steroids.

04:13 Now, don't get your asthma blinders on.

04:15 A patient can develop other infections along with their asthma exacerbation.

04:20 Patients sometimes will develop a secondary pneumonia and that pneumonia is going to require treatment in addition to their asthma exacerbation.

04:28 A pneumothorax, or a collapsed part of the lung, can also develop.

04:32 A patient can go into respiratory failure as the levels of oxygen in the blood become dangerously low, and the levels of carbon dioxide become too high.

04:41 Now, status asthmaticus.

04:43 This is a severe, unrelenting asthma attack that is not responding to treatment.

04:49 This is a life-threatening emergency.

04:52 Increase patient asthma education on recognition in worsening signs, and understanding how to use their management plan can be very useful in preventing status asthmaticus.

05:03 There are some chronic complications associated with asthma: fatigue, under performance, or absence from school.

05:11 And this can be that something is triggering the child, they're coughing too much, they're not sleeping at night, and they have to miss school.

05:18 The inability to exercise leading to weight gain because, remember, some patients have exercise-induced asthma.

05:26 And the patient may develop permanent problems with their lungs, such as COPD.

05:32 The patient may also have repeated hospital visits and this may include visits to the emergency department or stays overnight, and this can be costly.