Sample Answer for ASTHMA AND STEPWISE MANAGEMENT NURS 6521 Included After Question
Asthma is a respiratory disorder that affects children and adults. Advanced practice nurses often provide treatment to patients with these disorders. Sometimes patients require immediate treatment, making it essential that you recognize and distinguish minor asthma symptoms from serious, life-threatening ones. Since symptoms and attacks are often induced by a trigger, advanced practice nurses must also help patients identify their triggers and recommend appropriate management options. Like many other disorders, there are various approaches to treating and managing care for asthmatic patients depending on individual patient factors.
One method that supports the clinical decision making of drug therapy plans for asthmatic patients is the stepwise approach, which you explore in this Assignment.
RESOURCES
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WEEKLY RESOURCES
To Prepare:
- Reflect on drugs used to treat asthmatic patients, including long-term control and quick relief treatment options for patients. Think about the impact these drugs might have on patients, including adults and children.
- Consider how you might apply the stepwise approach to address the health needs of a patient in your practice.
- Reflect on how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.
BY DAY 7 OF WEEK 3
Create a 5- to 6-slide PowerPoint presentation that can be used in a staff development meeting on presenting different approaches for implementing the stepwise approach for asthma treatment. Be sure to address the following:
- Describe long-term control and quick relief treatment options for the asthma patient from your practice as well as the impact these drugs might have on your patient.
- Explain the stepwise approach to asthma treatment and management for your patient.
- Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.
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A Sample Answer For the Assignment: ASTHMA AND STEPWISE MANAGEMENT NURS 6521
Title: ASTHMA AND STEPWISE MANAGEMENT NURS 6521
Asthma is a chronic, inflammatory disease which affects the airways. It is associated with various symptoms such as wheezing, difficulty in breathing, chest pain, and cyanosis in severe cases. It is very prevalent in America where 22 million people are affected. The situation raises hospitalization levels to more than 497,000 annually (Kirenga et al., 2018). With such a high number, the country is significantly affected both economically and socially. Many children missed school days due to asthma and some caregivers are also forced to leave work to take care of their sick children. As productivity of the country lowers, a lot of money is used in managing the disease (Rothe et al., 2018). However, treatment options have been improved to address the situation.
Both quick-relief and long control medicines are used in treating asthma. Long-term control medicines (also called controller medicines or maintenance medicines). Long-acting beta-adrenergic (LABA) is one of the quick relief medication used. The LABAs help in providing long-term control of symptoms (Kirenga et al., 2018). Inhaled corticosteroids (ICS) are commonly used as anti-inflammatory drugs because they reduce inflammation caused by a vast diversity of inflammatory mediators (Yawn & Han, 2017). Rothe et al. (2018) highlight omalizumab (Xolair) as the most common Immuno-modulators used to prevent the binding of IgE to its receptor and in turn, inhibit IgE-mediated asthma from cascading before it begins.
STEP 1. Step one and two are recommended for all ages. In asthma treatment, inhaled corticosteroids (ICS) are commonly used as anti-inflammatory drugs because they reduce inflammation caused by a vast diversity of inflammatory mediators (Yawn & Han, 2017). STEP 2. Referrals can be considered for ages between 0-4 (White et al., 2018). This treatment is recommended for patients who show no improvement in step one. The intensity of the medications are increased, and other treatment options are introduced to address the problem. According to Yawn & Han (2017), leukotriene receptor antagonists (LTRAs) are introduced as the alternative category of drugs because they help in blocking leukotrienes from binding to the proinflammatory cells in the airways. Most commonly used LTRAs are montelukast, which is effective in allergic asthma.
STEP 3. According to Yawn and Han (2017), this step applies for ages above 12 years. At this stage, either the ICS dose is increased, or a long-acting beta-adrenergic (LABA) is added. The LABAs help in providing long-term control of symptoms (Kirenga et al., 2018). Some of the most commonly used combinations of LABAs and ICS (ICS/LABA) are fluticasone + salmeterol (available as a dry powder inhaler) and formoterol + budesonide (available as an HFA inhaler) (Yawn & Han, 2017). STEP 4. Applies for ages above 12 years. Also, patients who experience recurring severe exacerbations requiring ED visits, oral prednisone, or hospitalizations should be considered for this step. The same applies for patient of ages between 5 and 11.
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STEP 5. Applies for ages above 12 years. For ages between 5-11 years, Rothe et al. (2018) recommends a High-dose inhaled steroid plus
long-acting beta-agonist. Alternative can be a High-dose inhaled steroid plus leukotriene blocker. Rothe et al. (2018) highlight omalizumab (Xolair) as the most common Immuno-modulators used to prevent the binding of IgE to its receptor and in turn, inhibit IgE-mediated asthma from cascading before it begins. STEP 6. Applies for ages above 12 years. For age 5-11 years, a High-dose inhaled steroid plus long-acting beta-agonist are preferred. A combination of High-dose inhaled steroid, either long-acting beta-agonist or leukotriene blocker, oral steroid is preferred for age 0-4.
In 2007, the National Asthma Education and Prevention Program (NAEPP) published its third report, which reinforced the guidelines for the Diagnosis and Management of Asthma. According to Rothe et al. (2018), the Expert Panel recommends that asthma therapy should be aimed at maintaining control of the disease with the least amount of medication which, in turn, minimizes the risks for adverse effects. The stepwise approach increases or decreases the dose administered and also changes them and their frequency till the best medication and with its best amount and frequency of dosage is established. Efforts are focused on suppressing inflammation over the long term and preventing exacerbations (Yokoyama & Yokoyama, 2019).
REFERENCES
uKirenga, B. J., Schwartz, J. I., de Jong, C., van der Molen, T., & Okot-Nwang, M. (2015). Guidance on the diagnosis and management of asthma among adults in resource limited settings. African health sciences, 15(4), 1189-1199.
uRothe, T., Spagnolo, P., Bridevaux, P. O., Clarenbach, C., Eich-Wanger, C., Meyer, F., & Sauty, A. (2018). Diagnosis and management of asthma–the swiss guidelines. Respiration, 95(5), 364-380.
uYawn, B. P., & Han, M. K. (2017, November). Practical considerations for the diagnosis and management of asthma in older adults. In Mayo Clinic Proceedings (Vol. 92, No. 11, pp. 1697-1705). Elsevier.
uWhite, J., Paton, J. Y., Niven, R., & Pinnock, H. (2018). Guidelines for the diagnosis and management of asthma: a look at the key differences between BTS/SIGN and NICE. Thorax, 73(3), 293-297.
A Sample Answer 2 For the Assignment: ASTHMA AND STEPWISE MANAGEMENT NURS 6521
Title: ASTHMA AND STEPWISE MANAGEMENT NURS 6521
Introduction
Asthma is a disease of the airways that is characterized by bronchospasm and airway inflammation. Patients present to the hospital with a wide range of symptoms including difficulty in breathing, chest pain, wheezing, and cyanosis in severe cases. Asthma is associated with significant health impacts. It increases the risk of asthma diseases that is unresponsive to medications and mortality among those affected by it (Bleecker et al., 2018). The economic costs of the disease are enormous. For instance, patients and families have to incur significant costs in seeking the care that meet the needs of the patients. There is also the loss of productivity due to absenteeism from workplace by the patients. The state also suffers from the high cost of care that should be provided to these patients. It is estimated that the cost of providing asthma care in the US has doubled since 2000. Therefore, the treatment outcomes should be optimized by utilizing both pharmacological and non-pharmacological methods to manage asthma.
Treatment Options: Short-term
Beta-2-agonists are a group of drugs that combine with beta-2 adrenergic receptors to bring about relaxation of the bronchial muscles. Example of drugs in this group include salmeterol and albuterol. Generally, this type of drugs are utilized in the treatment of moderate to severe asthma. The drugs are inhaled to exert their immediate effect on the bronchial muscles (Willihnganz et al., 2019). Besides the management of acute asthmatic attack, beta-2-agonists are utilized in preventing anticipated asthmatic attacks in situations such as immediately after engaging in exercise. The onset of action of these drugs is five minutes with maximum bronchodilation being achieved within 15 minutes. The duration of action often ranges between 2 and 4 hours.
Treatment Options: Long-Term
Corticosteroids work by inhibiting the release of inflammatory cells such as cytokines and mast cells in asthma. Examples of drugs in this group include budesonide and beclomethasone. The use of corticosteroids is indicated in the management of mild to moderate persistent asthma. Methylxantines is another group of drugs used in the treatment of asthma. They work by promoting the relaxation of the bronchial smooth muscles by increasing mucociliary clearance and decreasing actions of T-cells and eosinophils. An example of a drug in this group is theophylline. Leukotriene modifiers is a group of drugs that work by inhibiting the actions of the leukotrienes in the inflammatory processes in the airways (Khurana, 2019). These drugs are considered as the second option in the management of mild to moderate persistent asthma. Examples of drugs in this group include montelukast and zafirlukast. Muscarinic antagonists work by blocking muscarinic blockade in the airways. An example of a drug in this group include ipratropium. Monoclonal antibodies work by inhibiting the binding of the IgE to the mast cells. An example of a drug in this group is omalizumab.
Impact of Treatment Options on Patients
As shown earlier, the use of the above treatment options relief the symptoms of the disease by reversing airway inflammation. They also inhibit the release of inflammatory cells that cause the disease. Often, untreated disease state result in the development of asthma that does not respond to treatment (Willihnganz et al., 2019). Therefore, the treatment options prevent the development of this type of asthma since it is associated with poor prognosis. The treatment options also improve the quality of life of the patients affected by asthma. This is achieved through reduction in visits to the hospital, hospitalizations, development and worsening of symptoms, and loss of productivity among the patients affected by the disease.
Step-Wise Management
The approach in stepwise management of asthma consists of six steps. Step one entails the use of inhaled short-acting beta-agonist. Step 2 entails the use of low dose of inhaled corticosteroid. Step three entails the use of low dose inhaled corticosteroid plus short acting beta-2-agonist. Step four entails the use of high dose of inhaled corticosteroid and long-acting inhaled beta-2-agonist (Khurana, 2019). Step six entails the use of high dose of inhaled corticosteroid plus long-acting beta-2-agonist and oral corticosteroid alongside the consideration of omalizumab in patients with allergies. Stepping up of the management of asthma is considered if there is no response to treatment as evidenced by recurrence in the attacks. Step down is considered when asthma has been controlled for at leas three months.
How it Assists Patients and Health Providers
The stepwise approach to treating asthma provides the patient and healthcare provider with a written plan of care. It enables them to come up with realistic goals of care that would aid in the decision making process. The approach also provides observed parameters for evaluating the effectiveness of the treatment plan. The frequency and severity of the attacks will enable the patient and the healthcare provider assess whether a change in the treatment is required or not. There is also individualization of the plan of treatment. The goals of treatment are developed to ensure that the individual health needs of the patients are met. Through this, patients are empowered to embrace the behaviors that minimize the occurrence of the disease. This can be seen in the improvement of the symptoms with the adoption of a given treatment plan (Yokoyama & Yokoyama, 2019).
References
- Bleecker, E. R., Murphy, K. R., Gandhi, H., Gilbert, I., & Chupp, G. (2019). The Natural History of the Burden of Asthma in the United States by Age and Sex. In C44. ASTHMA EPIDEMIOLOGY (pp. A7397-A7397). American Thoracic Society.
- Khurana, S. (2019). Difficult to Treat Asthma: Clinical Essentials. Springer Nature.
- Willihnganz, M., Gurevitz, S. L., Cgp, P., Clayton, B. D., & Rph, B. P. (2019). Study Guide for Clayton’s Basic Pharmacology for Nurses-E-Book. Mosby.
- Yokoyama, A., & Yokoyama, A. (2019). Advances in Asthma. Springer Singapore.
Grading Rubric
| Performance Category | 100% or highest level of performance
100% 16 points |
Very good or high level of performance
88% 14 points |
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56% 9 points
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Failing level
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