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The Disease

Asthma, which occurs in adult and pediatric patients, is a chronic inflammatory

disorder of the airways characterized by an obstruction of airflow. Among children

and adolescents aged 5-17 years, asthma accounts for a loss of 10 million school

days annually and costs caretakers $726.1 million per year because of work absence.

(Netina, 2009).

Asthma is a chronic inflammatory disorder of the airways characterized by recurring

symptoms, airway obstruction, and bronchial hyperresponsivness. In children that

are susceptible, inflammation causes recurrent episodes of wheezing,

breathlessness, chest tightness, and a cough, especially at night or early in the

mornings. Airway obstruction causes increased resistance to airflow and decreased

expiratory flow rates. These changes lead to a decreased ability to expel air and may

result in hyperinflation. The resulting over distention helps maintain airway

patency, thereby improving expiratory flow; however, it also alters pulmonary

mechanics and increases the work of breathing. (Netina, 2009).

There are four categories of asthma based on their symptom indicators and

the disease severity. These categories are intermittent, mild persistent, moderate

persistent, and severe persistent. Symptoms increase in frequency or intensity until

the last category of severe persistent asthma. (Netina, 2009).


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Signs and Symptoms

 Wheezing: A musical, high-pitched whistling sound produced by airflow

turbulence is one of the most common symptoms of asthma. The wheezing is

usually during exhalation.

 Cough: Usually, the cough is nonproductive and nonparoxysmal; coughing

may be present with wheezing.

 Cough at night or with exercise: Coughing may be the only symptom of

asthma, especially in cases of exercise-induced or nocturnal asthma; children

with nocturnal asthma tend to cough after midnight, during the early hours

of morning.

 Shortness of breath

 Chest tightness: A history of tightness or pain in the chest may be present

with or without other symptoms of asthma, especially in exercise-induced or

nocturnal asthma.

Therapeutic management

The overall goals of asthma management are to maintain normal activity levels,

maintain pulmonary function, prevent chronic symptoms and recurrent problems,

provide accurate drug therapy with minimum to no adverse effects, and assist the

child in living as normal and happy a life as possible. (Bhattacharjee, 2014)


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Pharmalogical Treatment

Pharmacologic asthma management includes the use of agents for control and

agents for relief. Control agents include the following: (Bhattacharjee, 2014).

 Inhaled corticosteroids

 Inhaled cromolyn or nedocromil

 Long-acting bronchodilators

 Theophylline

 Anti-immunoglobulin E (IgE) antibodies (omalizumab)

Nursing Care

The goal of nursing care in a child having an asthma attack is to make sure there

is adequate oxygen intake. To do this, the nurse does the following as ordered by the

physician:

 Administer corticosteroids such as prednisone to reduce inflammation in the

airways.

 Administer low flow humidified oxygen to prevent hypoxemia.

 Administer inhaled rapid acting bronchodilators like albuterol to open up the

child's airways.

 Administer intravenous fluids to prevent dehydration and liquefy secretions

in the airways.
 Prepare for mechanical ventilation if the child cannot breathe on their own.

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Long term care of the asthmatic child involves taking certain medications on

a regular basis even when no symptoms are present. In this case, the nurse has to

ensure that long term asthma medications like inhaled corticosteroids, long acting

bronchodilators, cromolyn and theophylline are administered as prescribed by the

physician. Other nursing interventions include: (Bhattacharjee, 2014).

 removing any potential allergen or trigger from the child's environment like

flowers or perfumes

 maintaining a quite calm environment to reduce anxiety and promote normal

respiratory rate

 monitoring the child for side effects of administered medications

 monitoring the child's arterial blood gases as an indication of improvement

or deterioration

Patient Education

Discharge planning for an asthmatic plan involves providing the child and his

parents with information that will help prevent asthmatic episodes and teaching

them skills required to administer asthmatic medications properly. These skills and

information are as follows: (Bhattacharjee, 2014).


1. The need to identify and eliminate any actual or potential allergen, substance

or condition that could precipitate an asthma attack.

2. The need to permit no smoking around the child.

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3. The need to report frequent use of rapid acting bronchodilators. The need to

take long term medication as prescribed even when there are no asthma

attacks.

4. How to use an inhaler and a spacer.

5. How to use a peak flow meter and the significance of the readings.

6. Assisting the family to create an asthma management and emergency plan.

7. When to contact a healthcare provider or seek emergency services.

References
Bhattacharjee R, Choi BH, Gozal D, Mokhlesi B. Association of adenotonsillectomy
with asthma outcomes in children: a longitudinal database analysis. PLoS Med. 2014
Nov. 11.

Lippincott Manual Of Nursing Practice, Sandra M. Nettina. Lippincott Williams &


Wilkins, 2009.
National Health Interview Survey, National Center for Health Statistics. CDC.
Available at http://www.cdc.gov/nchs/products/pubs/pubd/hestats/ashtma03-
05/asthma03-05.htm.