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NURS 3122 Final: Clinical Therapy- Asthma

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NURS 3122
Robert Catena

Clinical Therapy - Clinical therapy includes medications, hydration, education, and support of parents and child. Pharmacologic therapies are matched to the severity of asthma for long-term control and for management of acute episodes. The goal is to maintain asthma control long term using the least amount of medication, thus reducing the risk for adverse effects. Exercise-induced asthma - Children should be encouraged to participate in physical activities and exercise. - Children with exercise-induced asthma have a history of coughing, breathlessness, chest pain, or wheezing that occurs during and after exercise. - A spirometry or PEFM reading of a 15% decrease in peak flow with exertion is usually noted. - Pretreatment with short-acting beta2-agonists immediately before exercise often prevents exercise-induced asthma and provides relief for up to 3 hours. Acute asthma episodes - Most children with acute exacerbations respond to aggressive management in the emergency department, including continuous albuterol by nebulizer, oral systemic corticosteroids, and inhaled ipratropium. - Chest physiotherapy is not beneficial and it causes unnecessary stress to the child. Children who do not respond or who are already being managed at home on corticosteroids have a greater chance of hospital admission. Severe asthma exacerbations - Some children with severe (potentially life-threatening) asthma exacerbations need aggressive and immediate intervention in the intensive care unit, such as those who had an emergency department or private physician visit in the prior 24 hours. - These children may progress to respiratory failure and die. The child is placed on a cardiorespiratory monitor and pulse oximeter. - Intravenous magnesium sulfate may be used in addition to other medications used for the acute exacerbation. - Heliox (70% helium, 30% oxygen) may be used to drive the nebulizer. Some children will need mechanical ventilation or CPAP. Maintain Airway Patency - If the child is exhibiting breathing difficulty, give supplemental oxygen by nasal cannula or face mask. Humidified oxygen should be used to prevent drying and thickening of mucous secretions. The child should be placed in a sitting (semi-Fowler) or upright position to promote and ease respiratory effort. Medication Used to treat Asthma NURSING MANAGEMENT ACTION/INDICATION QUICK-RELIEF MEDICATION ■Use this rescue medication Relaxes smooth muscle in Short-Acting Beta2-Agonists before inhaled steroid, wait airway leading to rapid (SABA)Albuterol 1–2 minutes between puffs, bronchodilation (within 5–10 Levalbuterol wait 15 minutes to give minutes) and mucus clearing Pirbuterol:Metered dose inhaled steroid. Child should Drug of choice for acute inhaler (MDI) or nebulizer hold breath 10 seconds after therapy and for prevention of inspiring. Then rinse mouth exercise-induced and avoid swallowing bronchospasm medication. Use a spacer. ■Differences in potency exist, but all products are comparable on a per puff basis. ■S
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