Sample Answer for NURS 6521 Asthma and Stepwise Management 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.
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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.
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: NURS 6521 Asthma and Stepwise Management
Title: NURS 6521 Asthma and Stepwise Management
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: NURS 6521 Asthma and Stepwise Management
Title: NURS 6521 Asthma and Stepwise Management
Introduction
Asthma is a serious condition characterized by narrowed airways that may swell and produce excess mucus. To some patients, asthma could be an ordinary nuisance while some patients may struggle with executing daily activities. Since asthma has no cure, health care professionals should adequately understand the interventions necessary to control it according to symptoms and severity level. As a result, this presentation will describe long-term control and quick-relief options for a patient with asthma. The other crucial area for practitioners is the stepwise approach to asthma management, which entails the stepping up and down of medication doses according to the patient’s condition (Meghdadpour & Lugogo, 2018). The last part describes how the stepwise management helps healthcare providers and patients to manage asthma.
Long-Term Control Options and their Impacts
Effective asthma management requires health care providers and patients to understand and recognize asthma triggers and track a patient’s breathing. There are various long-term control options for a patient with asthma for different characteristics and control methods. Inhaled corticosteroids are taken for some days before their maximum effect is felt. The other option is leukotriene modifiers for relieving asthma symptoms (Ban et al., 2021). Other categories under the long-term options include combined inhalers and theophylline. Broadly, the role of long-term control medications for asthma is to ensure asthma is adequately controlled and there are no unexpected complications. Effective long-term control of asthma also protects a patient from an asthma attack. Some modifiers may cause hallucinations and aggression.
Quick-Relief Treatment Options and Impacts
Quick-relief options for asthma help to relieve asthma symptoms. It is advisable for the health care provider and the patient to work together in planning the best quick-relief option for a patient. Such a plan includes when to take the quick-relief drug(s) and the quantity that should be taken. Short-acting beta agonists help to ease asthma symptoms rapidly. Anticholinergic agents relax the airways, enabling the patient to breathe (Gosens & Gross, 2018). The third category, the corticosteroids, relieves airway inflammation. Short-acting beta agonists are associated with anxiety, irregular heartbeats, and restlessness. Oral and intravenous corticosteroids may also have severe side effects if used for a long period. Hence, they should be used in moderation.
Stepwise Approach to Asthma Treatment and Management
The stepwise approach for asthma management demonstrates how to match the type of intervention/management with the intensity of the condition. As Bernstein and Mansfield (2019) noted, health care providers step up or step down medications as situations oblige. Indeed, the approach typifies patient-centered care where medication responses (treatment and management) are tailored according to patient needs. Short-acting beta-agonists serve all ages and are primarily for intermittent asthma. As a result, their increased use (more than two days weekly) may signify uncontrolled asthma and the need to step up the treatment. The other steps are for persistent stigma, and it is crucial for the patient to consult a health care provider widely if taking high-dose medication.
How Stepwise Management Assists Health Care Providers and Patients
The stepwise management of asthma has many advantages instrumental in helping health care providers to gain and control of the disease. Through the stepwise approach, health care providers increase treatment intensity in discrete steps to obtain symptom control (Beasley et al., 2021). Such an approach facilitates patient-centered responses and reduces possible exacerbation of risks. As Papi et al. (2020) noted, stepwise management optimizes pharmacotherapy due to a significant reduction in side effects profile. It is also an approach that encourages health care providers and patients working together through communication for appropriate patient monitoring and medication adjustments according to the severity of the condition.
Conclusion
Asthma management can be complicated since the disease is incurable and symptoms change often. As a result, health care providers must know when to administer long-term control medications or quick-relief options. When used effectively, long-term control options keep asthma under control while quick-relief options relieve symptoms through rapid response. The stepwise management approach is highly encouraged in asthma management. Through this approach, health care providers step up and step down medications as situations obligate. It is an effective method for disease management since it allows health care providers to monitor patients and make appropriate adjustments on the amount and frequency of medications.
Quick-Relief Treatment Options and Impacts
Quick-relief options for asthma help to relieve asthma symptoms. It is advisable for the health care provider and the patient to work together in planning the best quick-relief option for a patient. Such a plan includes when to take the quick-relief drug(s) and the quantity that should be taken. Short-acting beta agonists help to ease asthma symptoms rapidly. Anticholinergic agents relax the airways, enabling the patient to breathe (Gosens & Gross, 2018). The third category, the corticosteroids, relieves airway inflammation. Short-acting beta agonists are associated with anxiety, irregular heartbeats, and restlessness. Oral and intravenous corticosteroids may also have severe side effects if used for a long period. Hence, they should be used in moderation.
References
Ban, G. Y., Kim, S. H., & Park, H. S. (2021). Persistent eosinophilic inflammation in adult asthmatics with high serum and urine levels of leukotriene E4. Journal of Asthma and Allergy, 14, 1219-1230. https://doi.org/10.2147/JAA.S325499
Beasley, R., Bruce, P., Hatter, L., Braithwaite, I., Semprini, A., Kearns, C., … & Pavord, I. D. (2021). A proposed revision of the stepwise treatment algorithm in asthma. American Journal of Respiratory and Critical Care Medicine, 204(1), 100-103. https://doi.org/10.1164/rccm.202101-0224LE
Bernstein, J. A., & Mansfield, L. (2019). Step-up and step-down treatments for optimal asthma control in children and adolescents. Journal of Asthma, 56(7), 758-770. https://doi.org/10.1080/02770903.2018.1490752
Gosens, R., & Gross, N. (2018). The mode of action of anticholinergics in asthma. The European Respiratory Journal, 52(4), 1701247. https://doi.org/10.1183/13993003.01247-2017
Meghdadpour, S., & Lugogo, N. L. (2018). Medication regimens for managing stable asthma. Respiratory Care, 63(6), 759-772. https://doi.org/10.4187/respcare.05957
Papi, A., Blasi, F., Canonica, G. W., Morandi, L., Richeldi, L., & Rossi, A. (2020). Treatment strategies for asthma: Reshaping the concept of asthma management. Allergy, Asthma & Clinical Immunology, 16(1), 1-11. https://doi.org/10.1186/s13223-020-00472-8