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Health Assessment
AsthmaUnderstanding Asthma
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Introduction-Identification
Chronic Lung Disease that constricts airwaysand causes breathing difficulties
Pravakar. 2011. Asthma symptoms. A1Health Source. Retrieved from http://www.a1healthnews.net/2011/07/asthma-symptoms/
Pravakar. 2011. Asthmasymptoms. A1HealthSource. Retrievedfrom http://www.a1healthnews.net/2011/07/asthma-symptoms/
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Introduction-Definition
What is Asthma?
Asthma is a chronic lung disease that inflames and narrows
the airways (NHLBI, 2011).
Asthma may cause:
Wheezing
Shortness of Breath
Trouble sleeping Coughing at night or early morning
NHLBI. (2011). Asthma. U.S. Department of Health & Human Services. Retr ieved from http://w ww.nhlbi.nih.g ov/health/d ci/Diseases/Asthma/Ast hma_What Is.html
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Introduction-Incidence or Prevalence
Source: Environmental Protection Agency: CDC National Center for Health Statistics
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Introduction-Incidence or Prevalence
Source: Environmental Protection Agency: CDC National Center for Health Statistics
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Introduction-Incidence or Prevalence
Source: Environmental Protection Agency: CDC National Center for Health Statistics
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Summary-Signs and Symptoms
Symptoms Frequent coughing that worsens during high activity
Recurrent wheezing
Shortness of breath
Chest tightness
Difficulty breathing
Chest tightness
Symptoms that worsen at night or early in the morning
Symptoms that are triggered by cold air, exercise and/ allergens
Mayo Clinic. (2011). Asthma: steps in testing and diagnosis. Retrieved fromhttp://www.mayoclinic.com/print/asthma/AS00003/METHOD=print
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Summary of Relevant Evidence-EstablishedRisk Factors
Established Risk Factors
1. Genetics
Bodys genetic make-up todevelop the antibody called
immunoglobulin E (IgE).
2. Allergies
Grass
Pollen
Molds
Dust & Dust Mites
Animal dander
Vitamin D Deficiency
Foods
Air pollution
Tobacco smoke
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Summary of Relevant Evidence-
Suspected Risk Factors
Medical conditions
Respiratory infection in
childhood
Low birth weight
Gastrointestinal Reflux disease(GERD)
Obesity (also increases Vitamin
D deficiency) Congestive Heart Failure (CHF)
Pulmonary Embolism
Use of acetaminophen
Exposure to Potential
Allergens Second hand tobacco smoke
Pets
Mold
Dust &Dust Mites
Occupational Irritants such aschemicals used in Farming, beauty salons,
manufacturing plants, fuel exhaust
High levels of Air pollution
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Summary of Relevant Evidence-CurrentViewpoints about Disease Management
The primary goal of asthma management is to control asthma,
preventing asthma-related morbidity and mortality. Poorcontrol of asthma increases the risks of troublesome
symptoms and hospitalization, and reduces patient quality oflife (Oh,Y. & Koh., 2011).
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Summary of Relevant Evidence-Current
Viewpoints about Disease Management
Environmental Control
Avoid exposure to:
Viral infections
Environmental pollutants
Tobacco smoke
Irritant gases/chemicals
Pollens
Dust & Dust Mites
Animal dander
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Summary of Relevant Evidence-Current
Viewpoints about Disease Management
Medications
1. Relievers-used for acute asthma symptoms
A. Fast Acting beta2-Agonist (also known as short acting beta2-
Agonist)
Salbutamol
Terbutaline
B. Long Acting beta2-Agonist
Formoterol
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Summary of Relevant Evidence-Current
Viewpoints about Disease Management
Medications cont.
Controllers- used to control chronic uncontrolled asthma
1. Inhaled corticosteroid (ICS)
2. Leukotriene Receptor antagonists (LTRAs)
montelukast
zafirlukast
3. Long Acting beta2-Agonist
fluticasone/salmeterol combination
budesonid/formoterol combination
4. Anti-immunoglobulin E
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Summary of Relevant Evidence-Current
Viewpoints about Disease Management
Management goals:
Maintain control of symptoms
Maintain normal activity levels
Prevent asthma exacerbations
Prevent asthma mortality
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Summary of Relevant Evidence-Current
Literature on Nursing Interventions
Nursing Interventions Educate patient and family about:
Asthma and asthma triggers Recognizing symptoms
What to do upon onset of symptoms
Use of peak flow meter
Medications
Benefits
Actions
side affects
proper use of regimen dose, time, and techniques
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Summary of Relevant Evidence-Current
Literature on Nursing Interventions
Nursing Interventions cont Develop a plan of Action to manage/control
asthma Avoidance of viral infections
Avoid environmental pollutants
Educate on the removal of environmental asthmatriggers
Behavior modifications to decrease stress
What to do upon asthma attack
Department of Public Health. ( 2010). Asthma action plan. State of Connecticut. Retrieved from http://ww w.ct.gov/dp h/cwp/view .asp?a=3137 &q=397020
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Health AssessmentStrategies-Expected
abnormal findings
Upper Respiratory tract: Increasednasal secretions, mucosal swelling
Chest Sounds: Wheezes (continuoushigh pitched hissing sound) uponexpiration and sometimes inspiration.
Barreled chest from hyper expandingthe thorax
Use of accessory muscles
Shoulders are hunched
Source: NHLBI.
http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_What Is.html
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Health Assessment Strategies-Assessment Techniques
Gathering information:
1. Patient History:
History of allergies
Recent and past viral infections
Hospitalizations
Symptoms of dyspnea, wheezing, cough, chest tightness, anxiety
2. Physical exam:
Increased respiration rate
Shortness of breath while at rest and can hardly speak
Use of accessory muscles
Increased anteroposterior thoracic diameter
Pallor or cyanotic color
Confusion
Percussion may reveal a hyper resonance sound
Auscultation: high pitched inspiratory and/or expiratory wheezes, prolongedexpiratory phase, rapid heart rate, limited to no breath sounds
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Screening Guidelines
Screening done on individuals are performed on a patient
history, history of asthmatic symptoms, Doctor diagnosis ofasthma, lung function test, allergy tests, patient education,
and regular follow-up visits.
Due to the incomplete understanding of asthma and the lackof tests to identify if a person symptomatic and non
symptomatic will develop asthma, it is not possible at this
time to screen whole populations for this disease (Boss, L., etal., 2003).
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Screening Guidelines-Implementation ofGuidelines into Nursing Practice
Since nurses are in constant contact with asthma patients, they arein an ideal situation to promote, establish and maintain asthmacontrol, with the main focus of asthma management. EPR-3
organizes asthma care around four components:1. Assessment and monitoring measures
2. Education for a partnership in asthma care
3. Control of environmental factors and comorbid conditions thataffect asthma
4. Drug therapy
NHLBI. (2007). Expert panel report 3: guidelines for the diagnosis and management of asthma. U.S. Department of Health and Human Services. R etrieved from
http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf
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Prevention Strategies-Non-drugMeasures to Reduce Incidence
Reduce exposure to triggers that cause exacerbations
Wash bedding weekly
Keep living quarters dust free
If allergic to animals, do not have them or at least wipe themdaily with a wet washcloth or disposable wipes
Avoid exposure to tobacco smoke
Quit smoking
Limit exposure to environmental pollutions Limit exposure to pollens
Eliminate molds
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Prevention Strategies-Measures to Dealwith High-Risk Patients
Patients who have frequent and severe asthma symptoms andevidence of airflow limitation are at greatest risk. Therefore, any acuteexacerbation of asthma may be a potentially fatal attack (O'Hollaren,M., & Hartert,T.,2003). It is crucial to obtain and maintain control of
the asthma and ensure the patient adheres to the individualized actionplan.
Nurses can help manage high risk patients by: Educate the patient about asthma and treatment
Devising an individualized Asthma Action Plan
Reduce allergen exposure
Regular follow up visits by clinician at least monthly
Periodic consults with a pulmonologist or allergist
Combination therapy with rescue and controller medications
Adherence to Asthma Action Plan
O'Hollaren ,M., & Hartert, T. (2003). Managing patients with high-risk asthma. Patient Care for the Nurse Practitioner, Retrieved from EBSCOhost.
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Conclusion-Importance of this Disease
Cost to society Measured as a cost to society, the bill for asthma is staggering.
In 1990 asthmas cost to society was $6.2 billion. Currently it is
$11 billion, a figure that could rise to $18 billion by 2020. Bythen, asthma treatment will absorb $2 billion in Medicaid andMedicare dollars alone, double what we spend today.
We are already facing a national crisis in our inability tounderstand and stem the rise in asthma prevalence. Weestimate that by 2020, 29 million Americans could have asthma
and costs due to asthma could rise to $18 billion per year. Direct and indirect costs are estimated to be more than $11
billion per year.
Pew Environmental Health Commission. (2000). Attack asthma: why America needs a public health defense system to battle environmental threats. Retrievedfromhttp://healthyamericans.org/reports/files/asthma.pdf
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Conclusion-Morbidity and Mortality
According to research, deaths due to asthma are expected to continue to rise, due to lackof knowledge in the disease.
Today, asthma causes more than 5,000 deaths per year. Unless the rates and severity ofthe disease are slowed, the annual number of asthma-related deaths could double by2020, taking a tremendous personal toll on families across our nation (Moorman, J.,2007). Asthma related deaths may be preventable and could decrease the mortality rate.
Due to the rapid rise in asthmatic cases, this disease is now viewed as an epidemic; onethat is hitting hardest at the way of the very young, minorities, and the poor.
Current asthma prevalence was higher in children (8.5%) than in adults (6.7%) and higherin females (8.1%) than in males (6.2%). Male children (9.6%) had higher prevalence thanfemale children (7.4%), but male adults (4.9%) had lower prevalence than female adults(8.4%). The difference in prevalence between blacks and whites was greater for children
(12.5% versus 7.7%) than for adults (7.6% versus 6.7%). In general, Hispanics (5.4%) hadlower current asthma prevalence than non-Hispanics (7.4%); however, Hispanics of PuertoRican ancestry (14.5%) had higher prevalence than Hispanics ofMexican ancestry (3.9%).Asthma prevalence rates were higher in the Northeast (8.1%) than in the other threeregions and higher in the Midwest (7.5%) than in the South (6.7%) or West (6.8%). Asthmawas more prevalent among persons with family income below the federal povertythreshold (10.3%) than among persons with family income at or above the federal povertythreshold (6.4% to 7.9%) (Moorman, J., 2007)
Moorman, J., et al. (2007). National Surveillance for asthma united states 1980-2004. CDC.gov. Retrieved fromhttp://www.cdc.gov/mmwr/preview/mmwrhtml/ss5608a1.htm#tab2
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Conclusion-Financial Implications
The federal government invests quite a bit of money on asthma researchand medications but relatively little in the direct efforts to prevent asthma.
Asthma treatments and research costs an estimated $11 billion annually.
Medicare and Medicaid expenditures for asthma treatment exceeded $1
billion.
Analysis shows that more than $125 million is spent on asthma relatedresearch.
Less than $1 million was spent on tracking Asthma cases and about $13
million is spent on direct prevention research.
Pew Environmental Health Commission. ( 2000). Attack asthma: why America needs a public health defense system to battle environmental threats. Retrieved
fromhttp://healthyamericans.org/reports/files/asthma.pdf
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Conclusion-Financial Implications
Source: Pew Environmental Health Commission. 2000.
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Conclusion-Need for Evidence inManaging and Preventing Disease
The HHS asthma plan is contained in two documents. The first, HealthyPeople 2010, focuses on treating asthma not preventing it or stopping its rateof growth. The second, Action Against Asthma, lists prevention and tracking asgoals and shows that HHS is heeding the wake-up call to address asthma.Unfortunately, overall the federal government is failing to commit the
resources necessary to slow or stop the rise in asthma prevalence rates. Thefederal government should be launching prevention efforts that have thepotential to directly and quickly stop new cases of asthma from developing.Analyzing the more than $125 million HHS research budget for 1999, the PewEnvironmental Health Commission found that less than 1% went to asthmatracking a core public health activity. Less than 9% was spent on preventionand less than 17% was dedicated to the study of asthma etiologyresearch intothe factors that cause asthma. Much of the remainder, more than 70%, went to
asthma treatment and biomedical research to identify basic cellular processesand mechanisms (Pew Environmental Health Commission, 200).
There is much research and evidence that discuss the importance of preventionand management to decrease the rise in asthma cases. In doing so, the annualasthma related costs drop as well.
Pew Environmental Health Commission. (2000). Attack asthma: why America needs a public health defense system to battle environmentalthreats. Retrieved fromhttp://healthyamericans.org/reports/files/asthma.pdf
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Conclusion-Implications for Nursing
Nurses should be well educated in the subject
Gather data and perform thorough assessment
Educate patient on the disease, triggers, medication use and techniques, and importance of continuingtreatment
Help patient to eliminate or reduce triggers and environmental allergens
Development of individualized Asthma Action Plan
Adherence to plan and follow up appointments
Be familiar with the real costs of asthma care to patients in the community including costs of asthma medicines
Be aware of community resources to help meet the financial needs of asthma patients These may include drugprograms for people with low income, social services, State and local health departments, and voluntaryorganizations.
Be familiar with the coverage of asthma care that various health insurance policies and government-sponsoredprograms provide before a treatment plan is worked out with the patient.
Nurses: partners in asthma care. (1995). United States Department of Health and Human Services Public Health Service. Retrieved from EBSCOhost.
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Reference
Moorman, J., et al. (2007). National Surveillance for asthma united states 1980-2004. CDC.gov. Retrieved fromhttp://www.cdc.gov/mmwr/preview/mmwrhtml/ss5608a1.htm#tab2
UMMC. (2011).Asthma in adults-risk factors. UMM.edu. Retrieved fromhttp://www.umm.edu/patiented/articles/what_causes_asthma_000004_3.htm
University of Virginia School ofMedicine. (2011). Asthma attacks. Pediatrics Webmaster. Retrieved fromhttp://www.medicine.virginia.edu/clinical/departments/pediatrics/clinical-services/tutorials/asthma/attacks
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