Question

management for child having an asthma

Answer 1

Asthma is a chronic inflammatory disease of the lower airways characterized by recurrent episodes of variable, reversible airflow obstruction and airway hyper responsiveness manifested as recurrent wheeze and cough.

Management

1. Medical management
2. Nursing management

1. Medical management:

a. Education :

Asthma is a chronic condition. So that education has an important role. Make the child and family aware about the chronic nature of the disease, different types of medications, need for long term adherence to medications, warning signs of asthmatic attacks, self management of asthma etc. Provide a written asthma management plan too.

b. Identify and avoid the trigger

Asthma is triggered by some allergen. So we have to identify that allergen and ask the patient and parents to avoid those allergents that triggers asthma.

c. Treatment of comorbidities

Comorbidities such as sinusitis,rhinitis etc. should be treated effectively will helps to reduce the need for medication as well as reducing the severity of asthmatic attacks.

d. Regular assessment and monitoring

Until achieving good control over asthma, regular hospital visits and checkups are essential.

e. Pharmacological management

• Bronchodialators

Bronchodilators are medications that act on beta receptors in the airway and produce bronchodialaton. Eg: salbutamol.

• Inhaled corticosteroids

These are the most effective and potent therapy. It helps to reduce symptoms, improve lung function , reduce the need for prednisolone, reduce the risk for acute exacerbations of asthma and reduce the rate of mortality. Eg. Budesonide, Flunisolide

• Leukotriene receptor antagonists

Leukotriene is responsible for respiratory inflammation, airway edema, bronchospasm and mucus production in children. So leukotriene receptor antagonists helps to relieve symptoms, reduce exacerbations and improve lung function. Eg. Montelukast.

It is recommended to use in children above 12 years .

• Long acting beta 2 adrenergic agonists in combination with inhaled corticosteroids

It has a sudden action. But not recommended for children below 5 years. Eg. Salmeterol, formoterol etc.

• Anti inflammatory drugs

Theophylline act as both bronchodialator and anti inflammatory.

d. Others

- Supplementary oxygen

2. Nursing management

Nursing assessment

• Assess the patient’s respiratory status by monitoring the severity of the symptoms.
• Assess for breath sounds.
• Assess the patient’s peak flow.
• Assess the level of oxygen saturation through the pulse oximeter
• Monitor the patient’s vital signs

Nursing diagnosis:

• Impaired breathing pattern related to response to inhaled allergens as evidenced by cough , nasal flaring and tachypnoea
• Ineffective airway clearance related to increased production of mucus and bronchospasm.
• Impaired gas exchange related to altered delivery of inspired O2.
• Health seeking behavior related to prevention of asthma attacks