Asthma And Stepwise Management NURS 6521

Asthma And Stepwise Management NURS 6521

A Sample Answer For the Assignment: ASTHMA AND STEPWISE MANAGEMENT NURS 6521

Introduction

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.

Treatment Options

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.

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Long-term control drugs

•There are several stated models of treatment of asthma. However, the major ones include bronchodilators and anti-inflammatory drugs. Bronchodilators include: beta 2 selective agonists, muscarinic antagonists, xanthine derivatives, leukotriene receptor blockers and anticholinergics. Anti- inflammatory drugs include: corticosteroids and mast cell stabilizers.

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•These Long-term control drugs : Long acting beta-2 agonists (LABA), Methylxanthines, Inhaled corticosteroids, Leukotriene receptor antagonists and Cromolyn.

1.  Long- acting beta-2 agonists (LABA) mode of action is by activating the pre-junctional β2-adrenoceptors and reduce acetylcholine release thereby prevent any   functional competition by acetylcholine .

•They include drugs such as: Salmeterol, formoterol and olodaterol

•The therapeutic effects include: improving lung function, increase number of  asthma symptom free days, reduce the asthma symptoms and reduce number of asthma attacks.

•However they include contraindications and adverse effects whereby in a drug such as salmeterol caution should be taken in use by African Americans and for (LABA) should be used with an oral glucocorticoid to minimize various risks and shouldn’t be used alone for prophylaxis as it can lead to increased risk of severe asthma attacks and asthma related deaths.

2.   Methylxanthines mode of action is through non-competitive inhibition of the phosphodiesterase enzyme, methylxanthines cause an intracellular increase in levels   of cyclic adenosine monophosphate and cyclic guanosine monophosphate.

•Here the most common drug used is theophylline.

•The therapeutic effects involve it preventing and treating wheezing, shortness of breath, and chest tightness caused by asthma.

•However it also has contraindications and adverse effects whereby caution should be taken in patients with heart disease, seizure disorders and liver dysfunction and its adverse effects involve toxicity, severe dysrhythmias and even death

Inhaled corticosteroids mode of action is by suppressing inflammation through decreasing inflammatory mediators, decreasing activity of inflammatory   cells and decreasing edema of airway mucosa.

•The inhaled corticosteroids include drugs such as budesonide, fluticasone propionate, ciclesonide and beclomethasone.

•The therapeutic effects involve reducing inflammation, reducing production of mucus, improve response to bronchodilators and reduce potential of dyspnea.

•However there are contraindications and adverse effects involved such as caution should be observed  in patients tested positive with candida albicans and its adverse effects involve it could lead to candidiasis development and decreased growth.

4.   Leukotriene receptor antagonists mode of action is by preventing leukotriene release from mast cells and eosinophils or by blocking the specific   leukotriene receptors on bronchial tissues it also reduces the influx of eosinophils, thus limiting inflammatory damage in the airway.

•The main drugs prescribed here are montelukast and zafirlukast.

•The therapeutic effects involve it prevents bronchoconstriction, mucus secretion and edema thus having open airways.

•However there are contraindications and adverse effects involved such as it shouldn’t be used in patients with a hypersensitivity to it or with hepatic impairment and its adverse effects involve it could lead to fever, headache, cough, sore throat and risk of upper respiratory infections.

Short-term control drugs

•These involves drugs such as: Short acting beta-2 agonists (SABA), Anticholinergics and Oral  corticosteroids.

1.   Short acting beta-2 agonists mode of action is through activates the beta-2 receptor, and this helps relax the bronchial tubes within   five minutes.

•Drugs involved her include albuterol, levalbuterol, isoproterenol and terbutaline sulphate.

•The therapeutic effects include: relieving of symptoms of asthma attack such as dyspnea, wheezing and coughing.

•Contraindications and adverse effects are also involved in these drugs such as caution should be taken in patients with heart disease, diabetes and hypertension then on the adverse effects there are usually no adverse effects as long as patient is compliant with the practitioner’s instruction though one may experience mild effects such as headaches, trembling and nervousness.

2. Anticholinergics mode of action is through activates the beta-2 receptor, and this helps relax the bronchial tubes within five minutes.

•Drugs involved her include alcidinium and ipratropium bromide.

•The therapeutic effects include: reducing inflammation, decrease mucus production in the airways and prevent bronchospasms.

•Contraindications and adverse effects are also involved in these drugs such as caution should be taken in patients with heart disease, hypertension and myasthenia the adverse effects include dry mouth, constipation, urinary retention, bowel obstruction, dilated pupils, blurred vision, increased heart rate, and decreased sweating.

•These involves drugs such as: Short acting beta-2 agonists (SABA), Anticholinergics and Oral  corticosteroids.

3. Oral Corticosteroids mode of action is through binding to intracellular receptors which then act to modulate gene transcription in target tissues .

•Drugs involved her include: prednisone, prednisolone, methylprednisolone and dexamethasone.

•The therapeutic effects include: reduce inflammation and swelling in the airways they also relieve asthma related symptoms, such as body pain, swelling, and stiffness.Contraindications and adverse effects are also involved in these drugs such as caution should be taken in patients with

Stepwise-approach to asthma treatment and management

•It involves six steps whereby in the first step a short acting beta-2 agonists (SABA) is used when necessary such as albuterol.

•In the second step when the asthma is persistent a low dose inhaled corticosteroid is used or alternatively a methylxanthine such as theophylline is used.

•In the third step preferably a low dose inhaled corticosteroid is used together with a long acting beta- 2 agonist or alternatively a low dose inhaled corticosteroid and either theophylline or leukotriene receptor antagonists .

•In the fourth step preferably a medium dose inhaled corticosteroid and a long acting beta-2 agonist or alternatively medium dose inhaled corticosteroid with theophylline.

•In the fifth step a high dose inhaled corticosteroid is used together with a long acting beta- 2 agonist is preferred and omalizumab can be considered for patients with allergies.

•In the sixth step a high dose inhaled corticosteroid  with a long acting beta- 2 agonist and an oral corticosteroid is preferred  and the same omalizumab should be considered for patients with allergies.

•The drugs used change depending on the category asthma condition they are in whether it is intermittent, mild persistent, moderate persistent or severe.

Stepwise management use in controlling the disease

•The six steps involved are used to benefit the patient in the phase of the patient’s asthma whether it is intermittent, mild persistent, moderate persistent or severe.

•One is able to step up or step down in the steps involved if relief is found and vice-versa and throughout one should have a short acting beta-2 agonist. The effectiveness of it should be assesses by the heard breath sounds.

•If relief is not heard one steps up. The stepwise approach helps to not the category of the condition of the patient and the effectivity of the medication. If the medication is not working it helps the practitioner determine what the next course of treatment is as it is indicated in the steps depending on the ,medication listed on that step.

•Then in the case of relief the drugs the patient to use as they are stepping down.

•It also aids healthcare providers in identifying alternatives that can be used if the preferred one can’t be used such as a low dose inhaled corticosteroid and either theophylline or leukotriene receptor antagonists in the third step.

•It also aids the patient in knowing the level of symptoms and which category they are in whether it is intermittent, mild persistent, moderate persistent or severe.

•The patient is also able self- examine themselves and identify if symptoms are worsening to prevent from reaching that stage and use the medication in the step they  are situated in such as if they are still in intermittent asthma they use medication as directed in the first step and don’t let it get to persistent asthma that requires another regimen that is daily medication. Having exercise induced bronchospasm is an indicator for inadequate asthma control.

•The patient benefits also by gaining relevant information on how to use the various drugs, the potential side effects and their management together with other significant health education such as chronic use of high dose inhaled corticosteroids could lead to osteoporosis.

Advanced practice nurses offer treatment for respiratory disorders.

Asthma is one of such disorders.

Asthma adversely affects a patient’s airways.

The condition requires a consistent management.

Patients experience mucus production, inflammation and bronchospasm.

This presentation explores step-wise management.

The advanced practice nurses have the expertise to offer patient care services to patient having various conditions such as respiratory conditions or disorders. Among the disorders is asthma with is a respiratory that impacts both adults and children. Asthma can present in varied magnitude with some being mild while others can be life-threatening, as such, the nurses have to distinguish the type for better care services. Asthma adversely impacts the patient’s airways hence requires a consistent management

from the care team. The kind of management strategy employed in most cases depends on the age, symptoms and severity (Leas et al., 2018). Therefore, this presentation explores the step-wise approach of asthma management.

qThe long-term treatment strategies inhibit asthma attacks.

qChronic symptoms are also controlled through the strategy.

qThey include:

üTheophylline

üLong-acting beta agonists

üLeukotriene modifiers

üInhaled corticosteroids

üCombining corticosteroids and long-acting beta agonist.

As earlier indicated, the management strategy applied for patients experiencing asthma depends on the patient’s age, and the severity of the symptoms. The implication is that a clinician goes for either short-term/quick relief or long-term treatment strategies. When the long term option is chosen, then various options exists such as theophylline which relieves the patient by relaxing the muscles which cause the airways to narrow. The long-acting beta agonists like salmeterol operate as bronchodilators and function in a patient’s body for up to twelve hours. The Leukotriene modifiers like Accolate deals with swelling and smoothing the airway muscles. In addition, the corticosteroids follows an action that blocks the reaction to allergen and lowers the hyper responsiveness of the airways (Bleecker et al., 2020).

Apart from the long-term management options, the other option is recue or quick relief medication which are short term options. In most cases, patient use them for short term relief whenever they experience asthma attacks. Various categories of medications used as short term options also follow different mechanisms of action. The intravenous and oral corticosteroids like prednisone treat the airways inflammation which comes with severe asthma (Bleecker et al., 2020).

When medications are administered to patients, the medications can have either positive or negative impacts. The medications used in asthma treatment and management are no exception. It is also worth noting that these impacts may vary from one patient to another. These medications offer relief to patients experiencing asthma attacks. However, these medications can also have various negative impacts. Some of the negatives effects include rapid heart beats and cases of headache (Mahemuti et al., 2018). A patient using these medications may experience through fungal infection as wells sore mouth and throat which may lead to further patient’s pain.

qThe step-wise approach uses six steps.

qFirst step-administration of short-acting beta agonist (SABA)

qSecond step- offering low doses of SABA with corticosteroids.

qThird step –a combination of a low dose of ICS and the long acting  beta agonists.

qFourth step-  administration of the medium does of LABA-ICS.

qStep 5: SABA+LAMA, LABA+ ICS(Daily medium to high dose)

Step 6: administration of the high dose of steroids+SABA+LABA

The stepwise approach of asthma has been detailed by the National Asthma education and Prevention program (Cloutier et al.,2020). The management starting point depends on the severity of the symptoms as displayed by the patient. There are a total of six steps to follow with the first step having the lowest treatment dosage involving the use of short-acting beta agonists only. Step two entails the low doses of SABA and ICS give per day (Bernstein& Mansfield, 2019).

The third step also entails offering medications of low doses, but in this case LABA and ICS in combination on a daily basis. The fourth step entails a medium dose of a combination of LABA and ICS. The fifth step involves a high dose of SABA-LAMA-LABA-ICS. Finally the six step entails high dosage of the same.

. The anticholinergic agents are also used as short term options and act to immediately and quickly relax the airways. In addition, the short-acting beta agonists are inhaled as quick relief bronchodilators. They help a patient to be relived within a few minutes of using the medications. Some of them include albuterol and levalbuterol

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.

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.

Understanding the dynamics of an illness and its severity is crucial to effective treatment and management. Current statistics depict asthma as a genuine global health concern since it affects approximately 235 million people worldwide (Beasley et al., 2021). To offer an appropriate intervention, healthcare practitioners should understand asthma’s manifestations and how patients experience and cope with it.

Asthma usually results in sporadic or persistent respiratory symptoms characterized by cough, shortness of breath, and other signs (Papi et al., 2020). When designing and implementing the care plan, healthcare professionals should prioritize anti-inflammatory treatment due to asthma’s capacity to limit airflow. The patient should be actively involved in developing the action plan to promote patient-centeredness and medication adherence.