Persona 1
Mrs. Gladys Kravitz Age 50 School Teacher Charlotte, North Carolina
Occupation: Kindergarten teacher, 28 years Marital Status: Married Family: Two adult children, one grandchild Household: Lives with husband Hometown: Charlotte, NC Education: BA & MA, Early Elementary Ed (UNC-Charlotte) Hobbies: Sewing, knitting, cooking Computer Use: Intermediate to advanced user Mrs. Kravitz is aware of basic asthmatic care, but in the past has been able to send a student in distress to the school nurse. Due to spending cuts, Mrs. Kravitz is now challenged with learning how to use an Asthma Action Plan and how to administer asthma related medications. She has no previous experience with metered dose inhalers or nebulizers.
Persona 2
Mrs. Claire Huxtable Age 63 Retired Social Worker Pelham, North Carolina
Occupation: Retired Social Worker (42 years) Marital Status: Married Family: One adult child, one grandchild Household: Lives with husband Hometown: Atlanta, GA Education: BS, Social Work (Spelman College) Hobbies: Gardening, French cooking Computer Use: Intermediate user She is mildly asthmatic and is familiar with metered dose inhalers. She has seen the patient receiving treatment with a nebulizer, administered by his mother or father, but has never given a treatment herself. Mrs. Huxtable will need to be able to decipher the patients Asthma Action Plan and be able to administer his medications as needed. She has previous experience with metered dose inhalers and no experience with nebulizers.
Occupation: Branch Manager, USA Bank Marital Status: Married Family: Three children Household: Lives with husband and children Hometown: Greenwood, MS Education: BS, Accounting (U of MS); MBA (Wharton School of Business) Hobbies: Reading, singing Computer Use: Advanced user
No one in the Woods household is asthmatic. Mrs. Woods is not familiar with Asthma Action Plans and only has a rudimentary understanding of how to administer asthma related medications via metered dose inhalers and nebulizers.
True/False When an asthma patient is in the RED Zone, the patient requires urgent medical attention. Asthma is a chronic disease of the lungs. Asthma attacks often accompany a cold or respiratory virus. This Asthma Action Plan is for the patient Curtis Canty. Tobacco smoke is an allergen that can trigger an asthma attack. Blue lips and fingernails are not a red flag symptom of asthma. Asthma Action Plans are one size fits all. When a patient is in the YELLOW Zone, they may demonstrate asthma symptoms that do not respond to medication.
What are the five (5) items that should be included in an Asthma Action Plan? 1. 2. 3. 4. 5.
What is Asthma?
Asthma is a chronic disease that affects the lungs, making it difficult to breathe. Symptoms of asthma include: Wheezing (a whistle in the breath) Coughing Tightness in the chest Fast breathing
During an asthma attack, the lining of the bronchial tubes in the lungs become inflamed. The lungs may secrete a sticky liquid called mucus along with inflammation, can restrict air flow.
that,
http://www.mckinley.illinois.edu/handouts/asthma/asthma.html
URGENT. The patient requires urgent and immediate attention. In addition to YELOW Zone symptoms, it is very difficult for the patient to breathe, medication does not improve symptoms
MODERATE. The patient may demonstrate mild to moderate signs of asthma. There may be coughing, wheezing, tightness in the chest but the symptoms respond to treatment.
NORMAL. The patient has no signs of asthma. Breathing is good. There are no symptoms such as wheezing, coughing or tightness in the chest. To fully comprehend how to proceed when the patient displays symptoms, please review the following sections of the Asthma Action Plan. Signs of an Asthma Attack Asthma Triggers Medications Medical Devices o Metered Dose Inhaler (MDI) o Nebulizer
Once you have identified the patients status, please proceed to the corresponding section (Red, Green, Yellow) of the action plan to correspond to the patients Zone.
Doing Great!
Symptom Free: No cough No wheeze Sleeps through the night Regular activities
Administer as usual: Fluticasone One spray per nostril 1x/day Budesonide One vial by nebulizer 1x/day Childrens Loratidine One teaspoon by mouth 1x/day
Caution!
Moderate Symptoms: Cough Wheezing Short of breath Unable to do usual activities Loss of appetite Give quick relief medicine Albuterol Aerosol By MDI and spacer Two sprays as needed Administer Albuterol Sulfate Inhalation Solution By nebulizer One vial every four hours as needed 1. Call parents (caregivers) 2. If no improvement within 10 to 20 minutes, repeat treatment 3. If no improvement go to RED ZONE
DANGER!
Symptoms: Trouble walking or talking Vomiting (no apparent reason) Fast breathing Exaggerated rise & fall of chest Incoherent QUICK RELIEF MEDICATION NOT WORKING Administer Albuterol Sulfate Inhalation Solution By nebulizer Two vials every 20 min. as needed Next Steps 1. Call parents (caregivers) 2. If unable to reach parents call doctor 3. Parents call doctor right away 4. Call 911 if patient does not improve within five to ten minutes or becomes worse
Before an attack, Joshua may demonstrate these symptoms. He may have all or some of these signs. A dry, hacking cough that does not seem to be relieved by anything. It may be worse at night or when lying down. A whistling sound when breathing. It may be worse when exhaling. There may also be a rattling or crunchy sound in his chest. May include shortness of breath, gasping for air, breathing very fast or slow at an abnormal pace. His abdomen may appear very depressed due to gasping for air. He may complain of a pain in his chest area or that it feels as though there is a heavy weight on his chest. Feeling very tired or weak. He may be very listless, quiet and spend time lying down. (Joshua is a very active child anything else is unusual.) Short-tempered and cranky for no apparent reason. Incoherent and unaware of his surroundings he may not recognize people that he knows quite well or may not be able to answer simple questions such as his name and birthdate. Sudden, violent vomiting without warning or indication. A temperature of 102 degrees or higher. Attacks often accompany a cold or respiratory virus (sneezing, runny nose, congestion, etc.).
Danger Signs
Please seek medical attention right away (emergency room or call 911) if these red flag symptoms appear: Trouble walking and talking because of difficulty breathing Hunching over, unable to stand or sit up straight Blue lips or fingernails Very slow, shallow breathing
Nebulizer with Mask Used to administer Albuterol Solution 1. 2. 3. 4. 5. 6. 7. Pour the solution in the nebulizer cup Attach the cup to the mask mouthpiece Use the tubing to connect the air compressor and the nebulizer cup Have patient sit where s/he is most comfortable Gently place the mask on the patients face tighten the elastic straps as needed Switch the compressor on Check to ensure the device is functioning properly (you should see a mist coming through the tube and out of the mouthpiece) 8. Once nebulizer cup is empty, switch off the compressor and remove the mask
Step-by-Step
Metered Dose Inhaler (MDI) with Spacer Used to administer Albuterol Aerosol
1.
2.
Remove the cap from (a) inhaler, and from (b) spacer, if it has one
3.
4.
5.
Bring the spacer to mouth, put the mouthpiece between teeth and close lips around it
6.
7.
Very slowly, take in a full breath A whistle sound means the breath is blowing too fast Slowly breathe in as much air as possible
8.
9.
Breathe out
Repeat
10.
Wait 60 seconds (one minute) Repeat steps four through nine for second puff
Nebulizer with Mask Used to administer Albuterol Solution Nebulizer Solution Nebulizer Cup Mask
Tubing
Nebulizer
3. Use the tubing to connect the air compressor and the nebulizer cup
5. Gently place the mask on the patients face tighten the elastic straps as needed
7. Check to ensure the devise is functioning properly (you should see a mist coming through the tube and out of the mouthpiece)
8. Once nebulizer cup is empty, switch off the compressor and remove the mask
Resources McKinley Health Center University of Illinois http://www.mckinley.illinois.edu/handouts/asthma/asthma.html (Fight Asthma Milwaukee) FAM Allies Coalition Childrens Hospital of Wisconsin http://www.famallies.org/education_medications.asp National Institutes of Health www.nih.gov/