Health Assessment Project

8/4/2019 Health Assessment Project

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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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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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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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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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Management goals:

Maintain control of symptoms

Maintain normal activity levels

Prevent asthma exacerbations

Prevent asthma mortality


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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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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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