Feb 23, 2024 ASTHMA AND STEPWISE MANAGEMENT NURS 6512
ASTHMA AND STEPWISE MANAGEMENT NURS 6512
A Sample Answer For the Assignment: ASTHMA AND STEPWISE MANAGEMENT NURS 6512
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.
Assistance to Health Care Givers
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).
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.
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.
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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.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.
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.
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.
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.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.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).
•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.
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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.
Submission and Grading Information
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NURS_6521_Week3_Assignment_Rubric
CriteriaRatingsPtsThis criterion is linked to a Learning OutcomeDescribe the 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.30 to >26.7 ptsExcellentThe presentation clearly and accurately describes in detail the long-term control and quick relief treatment options for the asthma patient from their practice. … The presentation clearly and accurately describes in detail the impact these drugs might have on their patient.26.7 to >23.7 ptsGoodThe presentation accurately describes the long-term control and quick relief options for the asthma patient from their practice. … The presentation accurately describes the impact these drugs might have on their patient.23.7 to >20.7 ptsFairThe presentation inaccurately or vaguely describes the long-term control and quick relief options for the asthma patient from their practice. … The presentation inaccurately or vaguely describes the impact these drugs might have on their patient.20.7 to >0 ptsPoorThe presentation inaccurately and vaguely describes the long-term and quick relief options for the asthma patient from their practice, or is missing. … The presentation inaccurately and vaguely describes the impact these drugs might have on their patient, or is missing.30 ptsThis criterion is linked to a Learning OutcomeExplain the stepwise approach to asthma treatment and management for your patient.30 to >26.7 ptsExcellentThe presentation clearly and accurately explains in detail the stepwise approach to asthma treatment and management for their patient.26.7 to >23.7 ptsGoodThe presentation accurately explains the stepwise approach to asthma treatment and management for their patient.23.7 to >20.7 ptsFairThe presentation inaccurately or vaguely explains the stepwise approach to asthma treatment and management for their patient.20.7 to >0 ptsPoorThe presentation inaccurately and vaguely explains the stepwise approach to asthma treatment and management for their patient.30 ptsThis criterion is linked to a Learning OutcomeExplain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.30 to >26.7 ptsExcellentThe presentation clearly and accurately explains in detail how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. … The presentation provides accurate and detailed examples to support the explanation provided.26.7 to >23.7 ptsGoodThe presentation accurately explains how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. … The presentation provides accurate examples to support the explanation provided.23.7 to >20.7 ptsFairThe presentation inaccurately or vaguely explains how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. … The presentation provides inaccurate or vague examples to support the explanation provided.20.7 to >0 ptsPoorThe presentation inaccurately and vaguely explains how stepwise management assists health care providers and patients in gaining and maintaining control of the disease, or is missing. … The presentation provides inaccurate and vague examples to support the explanation provided, or is missing.30 ptsThis criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.5 to >4.45 ptsExcellentParagraphs and sentences follow writing standards for flow, continuity, and clarity.4.45 to >3.95 ptsGoodParagraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.3.95 to >3.45 ptsFairParagraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.3.45 to >0 ptsPoorParagraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.5 ptsThis criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation5 to >4.
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