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A Partnership in Treating Childhood Asthma
required at this time; however, in the event of an asthmatic episode, emergency or quick relief treatment can be attained through the use of a short-acting bronchodilator (Gallagher, 2002). However, the parents should know that the existence of only one symptom of greater severity is enough to warrant classifying asthma as more severe. Nevertheless, there are multiple opportunities for error in symptom perception and management. A study in Nursing Research concluded that families lack accuracy in symptom identification and asthma symptomology. The child and/or family may not be accurate in assessing the physical parameters of the symptom, they may attend to the wrong symptom, or they may wait too long to intervene. In fact, a majority of the families being studied correctly identified wheezing as an asthma symptom, but seemed to ignore coughing (1999).
A case control study of children with asthma, ages zero to 14, revealed that a written asthma management plan was associated with reduced risk of hospitalization and ED visits (Gallagher, 2002). Management plans, which are based on asthma severity assessment, provide information regarding both routine and emergency asthma care, including how to evaluate an emergency situation and respond appropriately to it.
Provide the parents with a CPR/First Aid course schedule and encourage them to take the class together so that they may learn how to administer proper care in the event that their child stops breathing. Instruct the parents and child that the use of a peak flow meter will enable them to identify the need for medical intervention when physical early warning signs are missed. The nurse will instruct the child and parents to keep a diary of peak flows for 7 days (every morning and at bedtime). If the beta-antagonist is needed, measure peak flow before and after using and document. Determine the child’s personal best peak flow by marking the line. Based on the child’s personal best peak flow (100%), the nurse will show the parents how to calculate zones: Green – 80-100% of personal best, Yellow – 50-80% of personal best, and Red – Below 50%. If the peak flow is in green, no intervention is needed. If the peak flow is in yellow, a Beta2-Antagonsit inhaler is used and the parent will call the primary provider if there is a negative response. If the peak flow is red, the parents will take their child to the emergency room if there is a negative response to initial therapy or if peak flow is < 50% of baseline (Lippincott, 1999). The nurse should stress that unrelieved symptoms of asthma may lead to status asthmaticus, and that early intervention will almost always lessen the likelihood of unforeseen complications.
The nurse will use the following guidelines in order to instruct both parents and child on signs and symptoms associated with the four categories of asthma severity classifications, and techniques used for emergency treatment. In mild persistent asthma, daytime symptoms occur three to six times a week, nighttime symptoms three to four nights per month, or both. Daily medications include [next page]