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A Partnership in Treating Childhood Asthma
Asthma affects approximately 10.1% of children living in the United States, and continues to be the most common chronic childhood illness (“Strategies,” 2002). Some risk factors that account for this startling percentage of children with asthma include age, heredity, gender, children of young mothers under age twenty, smoking, ethnicity (African American are at greatest risk), previous life threatening attacks, lack of access to medical care, psychological/psychosocial problems, underdiagnosis, and undertreatment (Hockenberry, 2003). The nurse plays a vital part in identifying modifiable and non-modifiable risk factors, and educates both parent and child on effective ways to control unwanted asthmatic attacks through self-care education and participation in asthma management programs.
The responsibility of caring for a child with asthma should be shared equally between the adult caregiver (i.e., parent, relative, or teacher) and child. The overall objective is to avoid or reduce exposure to triggers that tend to precipitate or aggravate asthmatic exacerbations; however, these precautions should not sacrifice the child’s normalcy in development and socialization. At present, nurses are given the opportunity to fully enact their roles in terms of case management; client advocacy in both school and health care systems; education of children, parents, teachers, and support for children and families as they learn to master the complexities of managing a chronic illness (Horner, 1999). For the child, there are six themes that need special attention upon initial diagnosis: worries, asthma knowledge, school issues, medications, parental support, and the desire to be normal (Ming & McConnell, 2002). The ability of the nurse to address initial and ongoing parental concerns, as well as those of the child, will foster an effective nurse, parent, and child partnership in managing childhood asthma.
Assessment
A school age girl (7 years-old) is brought in to the emergency department (ED) with the following symptoms: Wheezing and dry cough; prolonged expiration, restlessness, fatigue, and tachypnea. Her chest x-ray reveals hyperinflation of the airways, and a pulmonary function test reveals reduced peak expiratory flow rates (PEFR). Upon completing a physical assessment the nurse notes skin as cyanotic, and a use of accessory muscles for respiration but no signs of an abnormal chest configuration. Nurses assist with diagnostic tests, pulmonary function tests, and skin testing, as well as a general health assessment. Nurses also obtain assessments of how asthma impacts the child’s everyday activities and self-concept (Hogan & White, 2003). The pre-diagnosis phase of a child’s asthma is a time of fear, and it is both desirable and necessary for the nurse to create a good nurse/parent partnership. A good partnership involves, among other things, understanding a family’s situation, knowledge about the disease and its treatment, and open communication between parent and nurse (Englund et al., 2001).
The nurse continues with the assessment by asking the parents if there is a family history of asthma or respiratory dysfunction. The nurse also asks if either of them smokes and if they have any family pets. Upon completing a family and social history the nurse learns that both parents smoke, they live with two dogs, and [next page]