Extant nursing scholarship demonstrates that asthma remains the most common chronic childhood disease and one of the leading causes of childhood morbidity, school absenteeism, parent lost work days, emergency department visits, and hospitalizations not only in the United States but also globally (McCarty & Rogers, 2012; Toole, 2013). However, it has been documented that many of these adverse outcomes could be prevented with maximum long-term care and proper support during attack (Choi & Chung, 2010). In light of this, the current paper details a discharge plan for a 6-year old asthma patient, focusing on patient education, use of the metered dose inhaler, and when the patient should use the nebulizer.
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Owing to the young age of the patient, it is important to involve parents in patient education regarding the treatment of asthma exacerbations upon discharge from hospital as this has been shown to improve adherence (Hussain-Rizvi et al., 2009). Overall, patient education should revolve around the following dimensions:
- Educating the patient (and parents) on the identification of triggers that may cause or contribute to attacks, as well as the possible causes of such triggers (e.g., diet, medications, emotional stress and environment), with the view to assisting the patient take steps to reduce or eliminate exposure to such triggers (Toole, 2013).
- Educating the patient (and parents) on the use of various instruments (e.g., the peak flow meter) to access his condition, and also educating them on the scenarios that may call for the utilization of bronchodilators, anti-inflammatory agents or antibiotics, as such information will assist the patient to take proactive steps aimed at preventing a major attack (McCarty & Rogers, 2012).
- Educating the patient (and parents) on the proactive strategies that they may use when confronted with an environmental irritant, with the view to imparting knowledge that could assist the patient to implement an assertive, nonaggressive approach for dealing with potentially hazardous environmental situations (Choi & Chung, 2010).
- Educating the patient on the methods to be employed during a coughing episode and for acute shortness of breath, with the view to assisting him to minimize forceful exhalation that may ultimately lead to enhanced airway obstruction (Toole, 2013).
- Educating the patient on how to practice relaxation and stress reduction exercises aimed at reducing the frequency of attacks, and on assessing the symptoms of an impending attack to know the opportune time to seek for medical attention (Hussain-Rizvi et al., 2009).
Use of the Metered Dose Inhaler
- The patient (and parents) should be educated on the use of a metered dose inhaler with a spacer (MDIS) to deliver asthma medications, the importance of complying with the prescribed regimen, and the potential adverse reactions asthma medications can trigger, such as nervousness and tremor from bronchodilators and moon face, loss of muscle tissue, and a propensity to bruise from corticosteroids (Toole, 2013).
- Although the paradigm of asthma education should embrace an approach that enhances self-management (McCarty & Rogers, 2012), the parents of the young patient should be educated on the importance of adhering to albuterol use with metered dose inhaler during the recommended two weeks upon discharge from hospital (Hussain-Rizvi et al., 2009).
Use of the Nebulizer
- The patient may use a breathing machine, often called a nebulizer, when he is exposed to environmental stimuli that could occasion the breathing passages to become distended and inflamed, or when he is exposed to other disease-related factors that may lead to wheezing, shortness of breath, and difficulty breathing (Hussain-Rizvi et al., 2009).
- Consequently, it is recommended that the patient use a nebulizer when he is taking asthma medicines, such as inhaled corticosteroids to reduce breathing passage inflammation, bronchodilators to address asthma symptoms, and non-steroid anti-inflammatory medications to minimize inflammation in the airways (Tzeng et al., 2010).
Choi, J.Y., & Chung, H.I.C. (2010). Effect of an individualized education program on asthma control, inhaler use skill, asthma knowledge and health-related quality of life among poorly compliant Korean adult patients with asthma. Journal of Clinical Nursing, 20(1/2), 119-126.
Hussain-Rizvi, A., Kunkov, S., & Crain, E.F. (2009). Does parental involvement in pediatric emergency department asthma treatment affect home management? Journal of Asthma, 46(8), 792-795.
McCarty, K., & Rogers, J. (2012). Inpatient asthma education program. Pediatric Nursing, 38(5), 257-263.
Toole, K.P. (2013). Helping children gain asthma control: Bundled school-based interventions. Pediatric Nursing, 39(3), 115-124.
Tzeng, L.F., Chiang, L.C., Hsueh, K.C., Ma, W.F., & Fu, L.S. (2010). A preliminary study to evaluate a patient-centered asthma education program on parental control of home environment and asthma signs and symptoms in children with moderate-to-severe asthma. Journal of Clinical Nursing, 19(9/10), 1424-1433.
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