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A Partnership in Treating Childhood Asthma
cockroach antigen; Irritants: tobacco smoke, wood smoke, odors, and sprays; exposure to occupational chemicals; exercise; cold air; changes in weather or temperature; Environmental change: moving to new home, starting new school, etc.; colds and infections; Animals: cats, dogs, rodents, and horses; Medications: aspirin, Nonsteroidal anti-inflammatory drugs (NSAIDS), antibiotics, and beta-blockers; Strong emotions: fear, anger, laughing, and crying; Conditions: gastroesophageal reflux, and tracheoesophageal fistula; Food additives: sulfite preservatives; Foods: nuts, and milk/dairy products; and Endocrine factors: menses, pregnancy, and thyroid disease.
Parental smoking and the child’s two family dogs are modifiable risk factors that appear on the list of common triggers. Not smoking near their child or to quite smoking is within the parent’s ability to make changes in the home environment. This course of action is likely to provide better asthma management and prevent more serious asthmatic episodes (McCarthy et al., 2002). However, careful consideration must be taken when removing family pets from the home, because the psychological anguish of the child may outweigh the benefit of decreasing the frequency of asthmatic episodes.
It is important that nurses discover the beliefs, misconceptions, and expectations of the families they serve. This can be done by using simple, open-ended questions and by approaching the family in a non-judgmental manner. Each belief and misconception should be acknowledged, and then gently refuted by factual information. General questions such as, “What do you know about asthma?” “What are some of your concerns about having asthma?” “What problems are you having taking your medicine?” can serve as the beginning of these teaching sessions. In this way, the patient or parent can be helped to understand the disease and its appropriate treatment. It is also important for the nurse to keep a detailed record of these teaching sessions so he or she can refer to what was said and what was taught when future visits occur (“Strategies”, 2002).
During the first visit the nurse should ask what the patient/family expects the asthma treatment to achieve, for this question can uncover many misconceptions. Parents often believe that children with asthma should not go outside or participate in sports; many also believe that their child will eventually “outgrow” asthma. In addition, the child and family should be taught the nature and cause of the asthma, the two primary treatment methods (preventers and relievers) and how they work, when to seek medical help, and proper inhaler use. Also during the visit a self-management plan should be codeveloped and agreed upon. It is essential to be concrete and specific with all instructions, telling the patient exactly when and how to take her medication (“Strategies”, 2002).
In 1995 the NHLBI developed a classification of asthma based on the following four categories: mild intermittent, mild persistent, moderate persistent and severe persistent. Understanding the level of treatment associated with each classification of asthma will enable the nurse to implement the appropriate plan of care. The seven-year-old child has been diagnosed with the lowest classification of asthma, mild intermittent asthma, and should be told that daily medications are not required [next page]