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A Partnership in Treating Childhood Asthma
learn more about asthma and appropriate self-management Some topics to cover include: Eating a well balanced diet, taking sufficient rest periods, and gradually increasing activity in order to promote overall good health and increases the resistance to infection; use of an incentive spirometer in order to encourage deep, sustained inspiratory efforts; teach a leaning forward position in order to enhance diaphragmatic excursions and diminishes the use of accessory muscles; teach pursed-lip breathing in order to prolong exhalation, preventing air trapping and air gulping; teach and observe the proper use of a hand-held nebulizer, oxygen therapy, and/or inhaler in order to prevent medication overdose or prevent oxygen dependence. Teach the parents and child that improper use of inhalers has been outlined as an antecedent of asthma. Clients tend to overuse inhalers, leading to their ineffectiveness; and develop an exercise routine in order to increase the child’s stamina. Warn the child that improper exercise may trigger asthma. Instruct the child to avoid exercise in extreme hot or cold weather. Wearing a paper mask may reduce the sensitivity to stimulants. Emphasize the importance of cool-down period. Suggest swimming and exercises indoors to avoid exposure to stimulants (Lippincott, 1999).
During these visits patients and their parents should be instructed in immediate interventions and danger signs. Instruct the client to report the following: change in sputum characteristics or failure of sputum to return to usual color after three days of antibiotic therapy in order to identify an infection or resistance of the infected organism to the prescribed antibiotic; elevated temperature because circulating pathogens stimulate the hypothalamus to elevate body temperature; increase in cough, weakness, or shortness of breath because hypoxia is chronic, and exacerbations must be detected early to prevent complications; and weight gain or swelling in the ankles or feet because these signs may indicate fluid retention secondary to pulmonary arterial hypertension and decreased cardiac output (Lippincott, 1999).
The nurse must also take the time to explain the hazards of an upper respiratory infection (URI), and suggest that the child avoid contact with infected persons, and receive immunization against influenza and bacterial pneumonia. Instruct the parents that children who receive immunotherapy for seasonal allergies may have a lower risk of developing asthma according to a recent study in Nursing. By preventing the immunologic response to allergens, immunotherapy may interrupt the natural progression of allergic disease, which may lead to asthma (2002). The nurse should also strongly recommend that the child take antibiotics as prescribed if sputum becomes yellow or green, and adhere to medication and hydration schedule. In addition, it is thought that URI causes inflammation of the bronchial tree, leading to bronchoconstriction and air trapping (Lippincott, 1999). Adhering to the nursing guidelines and avoiding potential triggers could minimize the chances of the child acquiring an URI.
The following is a list of common triggers, or modifiable risk factors, that tend to precipitate or aggravate asthmatic exacerbations: Outdoor allergens: trees, shrubs, weeds, grasses, molds, pollens, air pollution, and spores; Indoor allergens: dust or dust mites, mold, and cockroach [next page]