AST HMA BE ST PRACT I CE S F OR SCHOOL NURSE S Sc ho o l - PowerPoint PPT Presentation

AST HMA BE ST PRACT I CE S F OR SCHOOL NURSE S Sc ho o l Nurse s No ve m b e r 2015 1

BACK GROUND AND CURRE NT ST AT S Ge ne ra l de finitio ns a nd e xpla na tio ns 2

I nc ide nc e o f Asthma ◦ Ce nte rs fo r Dise a se Co ntro l (CDC) - ◦ 1 in 12 a dults ha ve a sthma ◦ 65% o f the se pe o ple ha ve pe rsiste nt a sthma ◦ 35% o f the se pe o ple ha ve inte rmitte nt a sthma ◦ 1 in 11 c hildre n ha ve a sthma ◦ 60% o f the se c hildre n ha ve pe rsiste nt a sthma ◦ 40% o f the se c hildre n ha ve inte rmitte nt a sthma ◦ K a nsa s ra nks in the to p 8 sta te s in the US fo r hig he st numb e r o f c hildre n with pe rsiste nt a sthma ◦ 9 pe rso ns die da ily fro m a sthma ◦ I n 2009 – 3,388 pe rso ns die d fro m a sthma ◦ NHL BI – a sthma is the mo st c o mmo n c hro nic dise a se o f c hildho o d, a ffe c ting 6 millio n c hildre n 3

Asthma Sta ts ◦ I n 2013 – numb e r o f misse d sc ho o l da ys re po rte d re la te d to a sthma – 13.8 millio n ◦ 20 – 25% o f pe rso ns with a sthma o ve ruse the ir “q uic k re lie f me dic a tio ns” a nsa s) * (K ◦ Only 40% o f pe rso ns with a sthma use d “lo ng te rm c o ntro l” me dic a tio ns a nsa s) * (K ◦ 40% o f c hildre n a nd 47% o f a dults ha ve unc o ntro lle d a sthma (K a nsa s) * ◦ 22% o f pe rso ns with a sthma smo ke [16% witho ut a sthma smo ke ] (K a nsa s) * ◦ 30% o f c hildre n a nd 33% o f a dults with a sthma a re o b e se (K a nsa s) * ◦ 97% o f c hildre n a nd 85% o f a dults with a sthma ha d insura nc e c o ve ra g e a nsa s) * (K * Na tio na l Ce nte r fo r He a lth Sta tistic s, Divisio n o f He a lth Inte rvie w Sta tistic s (2012) 4

Wha t is Asthma ? ◦ Chro nic , o b struc tive , infla mma to ry diso rde r due to hype r-re spo nsive ne ss o f a irwa y, a irwa y e de ma , a irwa y na rro wing , a nd muc us pro duc tio n. ◦ Chro nic infla mma to ry diso rde r o f the a irwa ys tha t re sults in inte rmitte nt a nd re ve rsib le a irflo w o b struc tio n o f the b ro nc hio le s. 5

I nfla mma tio n Airwa y Airwa y Hype r-re spo nsive ne ss Ob struc tio n Clinic a l Sympto ms 6

Asthma T ria d ◦ Bro nc ho c o nstric tio n ◦ Airwa y hype r-re spo nsive ne ss ◦ Airwa y e de ma (muc us a nd e de ma ) ◦ Re mo de ling 7

Re po nse s ◦ I mme dia te re spo nse ◦ Mast cells activate IgE → release of mediators (histamines, leukotrienes, and prostaglandins)→ bronchospasms shortly after exposure. Resolves in 1 -2 ho urs. ◦ De la ye d re spo nse ◦ Che mic a l me dia to rs a ttra c t immune syste m c e lls (e o sino phils, b a so phils, a nd neutrophils) → infiltrate and cause release of additional inflammatory material → damage to smooth muscle cells causing further edema and muc us o b struc tio n o f sma ll a irwa ys. 8

Re spo nse s ◦ Bro nc ho c o nstric tio n ◦ Several hours in length → can reoccur ◦ Airwa y hype r-re spo nsive ne ss ◦ Ca n la st fo r we e ks o r mo nths ◦ Blood flow to obstructed alveoli and open alveoli → ventilation -pe rfusio n mismatch → decreased pO 2 → hypoxia 9

Ca use s o f Asthma ◦ I nte rpla y o f a ho st o f fa c to rs ◦ I nna te immunity ◦ Ge ne tic s ◦ E nviro nme nta l fa c to rs ◦ Airb o rne a lle rg e ns ◦ Vira l re spira to ry infe c tio ns ◦ T o b a c c o smo ke ◦ Air po llutio n ◦ Die t 10

Sympto ms o f Child Asthma ◦ Childre n typic a lly ha ve mo re c o ug hing VS whe e zing ◦ Childre n o fte n pre se nt with nig ht va ria nt a sthma ◦ Ve ry yo ung c hildre n ma y ha ve he a d b o b b ing with b re a thing ◦ Spiro me try in c hildre n o lde r tha n 5-6 ye a rs ma y b e use d fo r dia g no sis ◦ Childre n ma y re po rt sympto ms b ut mo st like ly sympto ms a re o b se rve d a nd he a rd 11

E XPE RT PANE L RE PORT 3 (E PR3) Na tio na l He a rt L ung a nd Blo o d I nstitute Na tio na l Asthma E duc a tio n a nd Pre ve ntio n Pro g ra m 12

Ma na g ing Asthma L o ng te rm ◦ Go a ls: ◦ I mpro ve the q ua lity o f life ◦ Pre ve nt tro ub ling a nd c hro nic sympto ms ◦ Re q uire infre q ue nt use o f SABA (< 2 time s pe r we e k) ◦ Ma inta in ne a r no rma l pulmo na ry func tio n ◦ Ma inta in no rma l a c tivity le ve ls ◦ Me e t pa tie nt a nd fa mily e xpe c ta tio ns o f sa tisfa c tio n with a sthma c a re ◦ Pre ve nt re c urre nt e xa c e rb a tio ns o f a sthma to minimize misse d sc ho o l da ys, E D visits, a nd ho spita liza tio ns ◦ Pre ve nt lo ss o f lung func tio n; fo r c hildre n – pre ve nt re duc e d lung g ro wth ◦ Pro vide o ptima l pha rma c o the ra py with minima l o r no r a dve rse e ffe c ts o f the ra py 13

4 Co mpo ne nts o f Ca re 1. Asse ssme nt a nd mo nito ring 2. E duc a tio n fo r a pa rtne rship in c a re 3. Co ntro l o f e nviro nme nta l fa c to rs a nd c o mo rb id c o nditio ns tha t a ffe c t a sthma 4. Me dic a tio ns 14

Co mpo ne nt 1: Asse ssing a nd Mo nito ring Asthma Se ve rity a nd Asthma Co ntro l ◦ Se ve r ity : inte nsity o f the dise a se pro c e ss ◦ Contr ol : de g re e o f c o ntro l ◦ Re sponsive ne ss : e a se o f c o ntro l a c hie ve d ◦ Impair me nt : fre q ue nc y a nd inte nsity o f sympto ms ◦ Risk : like liho o d o f e xa c e rb a tio n, pro g re ssive de c line , a dve rse e ffe c ts o f me dic a tio ns. F o r c hildre n – risk o f re duc e d lung g ro wth 15

Asthma Cla ssific a tio ns Inte r mitte nt Mild Pe r siste nt Mode r ate Pe r siste nt Se ve r e Pe r siste nt F re q ue nc y o f 2x/ we e k >2x/ we e k b ut Da ily T hro ug ho ut the sympto ms no t da ily da y Nig httime 0-4 yrs: 0 0-4 ye a rs o ld: 1- 0-4 yrs o ld: 0-4 yrs o ld: a wa ke ning s Olde r: 2x/ mo nth 3-4x/ mo nth >1x/ we e k 1x o r Olde r: Olde r: > 1x/ we e k b ut Olde r: o fte n, le ss/ mo nth 3-4x/ mo nth no t nig htly 7x/ we e k Ac tivity No Mino r limita tio n So me limita tio n E xtre me ly limite d limita tio ns SABA use < 2 d/ we e k 2 d/ we e k o nly Da ily Se ve ra l x/ da y E xa c e rb a tio ns No ne – 0-4 yrs: >2x/ yr o r 0-4 yrs: no > 2x/ yr fo r a ll a g e s Re q uiring o ra l 1x/ ye a r 4 whe e zing impro ve me nt with risk fa c to rs syste mic e piso de s/ yr Olde r: >2x/ yr with risk a nd c ha ng e s to c o rtic o ste ro ids la sting 1 da y fa c to rs a nd c ha ng e s F E V 1 with risk fa c to rs to F E V 1 Olde r: >2x/ yr 16

Co mpo ne nt 2: E duc a tio n o f a Pa rtne rship in Ca re ◦ Ope n c o mmunic a tio ns ◦ Addre ssing c o nc e rns ◦ De ve lo ping tre a tme nt g o a ls to g e the r ◦ E nc o ura g ing se lf-mo nito ring a nd se lf-ma na g e me nt ◦ Asthma a c tio n pla n ◦ T a lking a b o ut a sthma sympto ms a nd pla n a t e ve ry o ppo rtunity ◦ (PHCP – se le c ting me dic a tio ns tre a tme nts g o a ls to g e the r) 17

Asthma Ac tio n Pla ns  Written Care Guidelines are very important…  Define what to do when… daily & acute  Define when to be concerned  Define when to seek help Obtaining a plan is important for o the school nurse Fax form to office for PHCP to o complete and return Use of standardized AAPlan form o 18

Pe a k F lo w Me a sure me nts ◦ Pe rso na l Be st (PB) ◦ Gre e n 80-100% o f PB ◦ Ye llo w 50-70% o f PB ◦ Re d >50% 19

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Co mpo ne nt 3: Co ntro l o f E nviro nme nta l F a c to rs a nd Co mo rb id Co nditio ns tha t Affe c t Asthma ◦ I de ntify a lle rg e n a nd po lluta nts o r irrita nt e xpo sure s ◦ Skin te sting ◦ HE PA filte rs ◦ I de ntify a nd tre a t c o mo rb id c o nditio ns ◦ GE RD ◦ Ob e sity ◦ Ob struc tive sle e p a pne a ◦ Alle rg ie s a nd sinusitis ◦ Stre ss 22

T rig g e rs in the sc ho o l… ◦ Cle a ning supplie s ◦ Smo king a re a s ◦ Cla ssro o m pe ts ◦ F o o ds a t pa rtie s ◦ F ra g ra nc e s ◦ Building re mo de ling , pa inting , ne w c o nstruc tio n, rug s ◦ Bus a nd pa re nt dro p-o ff ho lding a re a s ◦ We a the r - b us sto ps, re c e ss, tra ve l b e twe e n b uilding s 23

Co mpo ne nt 4: Me dic a tio ns ◦ Co rtic o ste ro ids ◦ Ma st c e ll sta b ilize rs ◦ I mmuno mo dula to rs ◦ L e uko trie ne mo difie rs ◦ L o ng a c ting b e ta 2 a g o nists (L ABA) ◦ Sho rt a c ting b e ta 2 a g o nists (SABA) ◦ Me thylxa nthine s ◦ Antic ho line rg ic s 24

T re a tme nt b y Ste ps ◦ Appro pria te tre a tme nt o f a sthma is no t b y c la ssific a tio n ◦ T re a tme nt is b y ste ps – pro g re ssing fro m ste p 1 fo r inte rmitte nt a sthma to ste ps 2-5 fo r pe rsiste nt a sthma ◦ T re a tme nt thro ug h ste ps 2-5 is fluid a nd mo ve s in e ithe r dire c tio n b a se d o n c o ntro l a sse ssme nt o f the c hild ◦ Re q uire s re g ula r visits a nd c ha ng e s in a sthma a c tio n pla ns 25