An African American girl aged 8 years, was diagnosed with asthma, which in the recent past has been controlled using a rescue inhaler. She is being admitted to the emergency department after the escalation of the disease to an acute exacerbation, and she is receiving oxygen per nasal at 2 L. The prescribed medication for her is DuoNeb treatments every 4 hours and methylprednisolone sodium 10 mg IV every 12 hours. Additionally, there is an order to start giving her an IV of D51/2 NS at 100mL/hour. If her condition improves or she recovers after these treatments within 24 hours, the girl will be weaned off oxygen and discharged home. Where another prescription of rescue inhaler and prednisolone orally for 5 days will be administered while making follow-up with a pulmonologist in one week. However are scared about the treatment procedures, and should be taught clearly about the etiology of asthma, its symptoms, triggers, the use of a peak flow meter, and a spacer dose inhaler.
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On observation, the patient was looking restless when provoked and she was aggravated. The airways were swollen, with contracting muscles. She had difficulty in breathing and speaking, wheezing sound when breathing, and at times breathing very fast. The child’s mother explained that the disease has been recurring in the recent past occasionally. Further, tests revealed anxiety and depression in the child, and she looked emotionally and physically drained.
The interview with the mother portrayed a family that is deeply rooted in religious beliefs, they have faith in miraculous spiritual healing. Their child who is in the fourth developmental milestone seems to be much inclined to these beliefs but is beginning to explore more interactions in social life beyond her parents. The child is in the process of discovering new things, and understanding competencies. Thus, she needs encouragement to build her confidence in her abilities (Chery, 2021). At this stage, the child thinks logically, and organized, on issues; she understands that her views might not be the same as other people’s (Chery, 2020). However, chances are that she can also be rigid if things are not explained well to her.
The patient has ineffective breathing patterns; and the airway clearance is poor due to bronchospasms, increased pulmonary secretions, or ineffective cough. The girl has also developed anxiety which could be due to Change in the environment or change in health status. She showed signs of fatigue which could be as a result of either Increased work of breathing, hypoxia, or respiratory distress. There was an indication of interrupted family processes necessitated by the child’s sickness and emergent hospitalization. Lastly, the family seemed to be in need of information about preventive measures and behavior changes.
Firstly, the nurse will assess the child’s vital signs like increased BP, RP, and HR which occur during hypoxia and when it is severe BP, and HR drops leading to respiratory failure. Then check her respiratory rate, depth, and rhythm to see what could be the cause of anxiety; assess breath sounds and adventitious sounds such as wheezes and stridor, since wheezing happens due to bronchospasm, and reduced wheezing and irregular breath sounds suggests that respiratory failure is about to occur. Monitor oxygen saturation, peaked expiratory flow rates and forced expiratory volume (Belleza, 2021). Normal oxygen levels (95-100%), and the severity of exacerbation are measured through peak expiratory flow rate generated by a forced maneuver with inflated lungs.
Explain to the family members that asthma is a very sensitive disease that is easily triggered by exposure to cold things, tobacco smoke, dry air, vigorous exercises, upper respiratory infections, and allergens like pollen grain, mold, and dust. Persuade the through kind and simple reasoning not to expose the child to these triggers while at home. Through counselling, let them see the importance of keeping the child safe from the triggers. Practically, demonstrate slowly, to the child and the family procedure on how to use the peak flow meter and a spacer dose inhaler, to help them while at home.
Create a period of rest between activities, to reduce fatigue which is normally high when ineffective breathing patterns increases, and so it increases metabolic rate and oxygen requirements. The patient should have her head placed on an elevated bed, to allow maximum lung expansion which assists in breathing. Conduct psychological therapies on both the patient and family so as to influence them to positively change their behaviors and beliefs, help reduce the disease symptoms (Belleza, 2021). Having identified that the child’s family believes in spiritual healing and that it affected the patient medication patterns before, educate them by reinforcing that healing indeed comes from God. Incorporate praying sessions, each and every time before the patient is attended to either at home or in the hospital. Perform cognitive therapy to the family members to help repair their thoughts, perceptions, helplessness state, and wrong fear they have developed about asthma which may trigger the disease.
as little as 3 hours
Further, symbolic plays graphic arts which includes drawing, coloring, or working with clay in the child is the ideal activity. It requires buying artificial clay from the shops, which the child can use to mold different shapes, like cars, houses, all sorts of electronics, and even animals’. Symbolic play is excellent in helping children learn to express themselves and explore nature, technology, and the world in general through different experiences, ideas, and emotions which build their confidence in their abilities.
Ensure she is receiving oxygen per nasal at 2 L for the next 24 hours until her normal oxygen levels (95-100%) are back. Make sure together with the mother to administer to the patient DuoNeb treatments every 4 hours and methylprednisolone sodium 10 mg IV every 12 hours. Explain to the family and the girl that an additional drug called IV of D51/2 NS at 100mL will be given to her after every one hour. At every interval of drugs administration, allow the family members or their church leader whom they may invite to pray before the procedure is executed. For the next 24 hours monitor the patient’s progress and if her condition stabilizes, wean off oxygen and recommend discharge to home.
Discharge the patient after 24 hours, and together with colleagues ensure to follow them at home to confirm if they are following procedures on how to manage asthma. While at home the child must always carry the inhaler just in case of an attack, let the parents take the active role as caregivers, and administer the drugs to the child. Review continuously to confirm if the child has maintained an optimal breathing pattern.
Chery, K. (2021). Erikson’s Stages of Psychosocial Development. Web.
Cherry, K. (2020). The 4 Stages of Cognitive Development. Web.
Belleza, R. N. M. (2021). Asthma Nursing Care Management. Web.