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A Partnership in Treating Childhood Asthma
symptoms, maintaining a symptoms diary, medications, use of peak-flow meter, avoidance of exposure to asthmatic triggers and allergens, and community asthma programs; and 2) Risk for situational low self-esteem related to an inability to fully participate in developmentally appropriate physical activities.
The child’s nursing diagnosis in social dimension includes: 1) Altered family processes related to centering family decisions and activities on the needs of the asthmatic child.
Once the child’s problems have been prioritized, the goals for treatment are established. Goals are broad directions to guide the plan of care. A long term/discharge goal indicates the overall end-result of care, although it may not be achieved prior to discharge. Expected client outcomes are the desired results of actions taken and achieve the broader goal and are the measurable steps to achieve the goals of treatment/discharge criteria.
Patient Outcomes
Providers, parents, and children can collaborate to set goals for symptom reduction and increased school attendance and participation in sports. Nursing guidelines for writing expected client outcomes are based on the premise that outcomes should be easily understandable, and if clearly written, should enhance communication and continuity of care. The National Heart, Lung, and Blood Institute (NHLBI) guidelines for patients state that parents should ‘expect nothing less’ that the following: the child has no symptoms or only minor symptoms of asthma; the child sleeps through the night without asthma symptoms; no school days are lost because of the child’s asthma; the child requires no ED visits or hospitalizations because of asthma; the child can participate fully in peer activities; and the child exhibits few or no side effects from asthma medications (Gallagher, 2002).
In addition to NHLBI guidelines, the nurse will ensure that the child is able to successfully self-administer asthma medication prior to discharge, as well as verbalize the reasoning for time and frequency of administration. The child should also be able to correctly use a peak flow meter and incentive spirometer prior to discharge and demonstrate how to properly record results in an Asthma Symptoms School Age Diary. Within the diary, the child will also demonstrate how to accurately record difficulty in breathing or complaints of shortness of breath, fast breathing, impaired speech, wheezing, coughing, complaints of chest pain or a sensation of heaviness or tightness, sleep interruptions (resulting from wheezing or coughing), involuntary drawing in of muscles between ribs, and diminished level of awareness (Gallagher, 2002).
Developing realistic and age appropriate short-term and long-term outcomes are an integral part of the nursing process, and central to the planning and implementation stage of nursing care. In this stage of the nursing process it is helpful for the nurse to keep a record of client teaching, because education covering basic asthma information can take at least three to six 20-minute visits (“Strategies”, 2002).
Planning and Implementation
One opportunity for nurses to educate patients and families occurs during acute care visits, and particularly during emergency department visits. These visits can be uses to motivate the child and the family to learn [next page]