Reply to my peers

Peer 1

What are the appropriate pharmacological therapies to be prescribed for Johnathan?

Corticosteroids are appropriate for the patient (Ramsahai & Wark, 2018). He is reported to be using albuterol, which has not been effective in relieve of the symptoms. Albuterol is usually used as a quick reliever especially when the patient is experiencing asthma attacks. A long acting medication is required to help relieve the symptoms. Dexamethasone 10mg is recommended as the appropriate corticosteroid which will help relieve the symptoms, improve his breathing, and reduce the asthma severity (Ramsahai & Wark, 2018). Albuterol will still be continued to be used as a quick reliever in case of future asthma attacks.

What information is necessary to provide to Johnathan and his mother regarding asthma exacerbation?

Jonathan and his mother would be educated o detection of worsening symptoms of asthma. Once asthma symptoms are observed to be worsening, they should seek immediate medical attention (Ramsahai et al., 2019). They would also be educated on importance of having the quick relieve inhaler at all times for emergency response in case of asthma attacks. They are also educated on asthma triggers that lead to exacerbation (Gautier & Charpin, 2017). Common asthma triggers include smoke, pollen, dust, chemical irritants, and breathing cold air. Therefore, the patient should avoid these triggers whenever possible to avid exacerbations.

What is an appropriate clinical assessment tool to be use with Johnathan?

The Childhood Asthma Control Test is appropriate in asthma assessment for children below 11 years. The tool contains 7 questions of which 4 are completed by the child and 3 are completed by the parent of responsible caregiver (Somashekar & Ramakrishnan, 2017). The results help to determine asthma severity as well as provide the healthcare provider with information regarding how well the patient is able to control asthma.

What are the classification of asthma?

Asthma is classified into four categories which are mild intermittent, mild persistent, moderate persistent, and severe persistent asthma. Mild intermittent asthma is characterized by asthma symptoms occurring less than 2 times in a week (Ramsahai et al., 2019). Mild persistent asthma is characterized by symptoms occurring 3-6 times in a one week. Moderate persistent asthma symptoms occur every day while severe persistent asthma is characterized by symptoms occurring continuously and persistent.

How would you as the NP address his mother's concern regarding providing an inhaler at school?

It is normal for the mother to be worried about her son’s condition while at school. She is assured that use of inhalers in school is allowed. She should however inform the school nurse of her son’s condition so that constant monitoring is done while at school. She should discuss the son’s condition with the administration and the school nurse, including the use of inhaler and other prescribed medication while at school (Isik & Isik, 2019). The communication is important as it will help the patient be assured of safety at school.

What is an appropriate plan of care for Johnathan?

The plan of care for Jonathan include prescription of asthma medication. Dexamethasone is prescribed for the patient to help relieve his persistent asthma symptoms (Ramsahai & Wark, 2018). The medication is taken 10mg orally BID. Albuterol inhaler is also continued to be used as a quick reliever when experiencing asthma attacks. The patient is advised to take the medication as prescribed for improved health outcomes. Patient education is also provided on prevention of asthma exacerbation including avoidance of asthma triggers such as pollen, dust, smoke, and cold air (Gautier & Charpin, 2017). Physical exercise and healthy diet is also recommended to help in effective asthma management.

References

Gautier, C., & Charpin, D. (2017). Environmental triggers and avoidance in the management of asthma. Journal of Asthma and Allergy, Volume10, 47-56. https://doi.org/10.2147/jaa.s121276

Isik, E., & Isik, I. S. (2019). Asthma care coordination in schools by school nurses: An integrative literature review. Public Health Nursing. https://doi.org/10.1111/phn.12610

Ramsahai, J. M., & Wark, P. A. (2018). Appropriate use of oral corticosteroids for severe asthma. Medical Journal of Australia, 209(S2). https://doi.org/10.5694/mja18.00134

Ramsahai, J. M., Hansbro, P. M., & Wark, P. A. (2019). Mechanisms and management of asthma exacerbations. American Journal of Respiratory and Critical Care Medicine, 199(4), 423-432. https://doi.org/10.1164/rccm.201810-1931ci

Somashekar, A. R., & Ramakrishnan, K. G. (2017). Evaluation of asthma control in children using childhood—asthma control test (C-ACT) and asthma therapy assessment questionnaire (ATAQ). Indian Pediatrics, 54(9), 746-748. https://doi.org/10.1007/s13312-017-1167-2

Peer 2

What are the appropriate pharmacological therapies to be prescribed for Johnathan?

· Initial treatment for Johnathan in this situation would include an inhaled short-acting beta2-agonist (SABA) of MDI as needed for his symptoms (Miller, 2020). This is usually adequate treatment for symptoms that result from triggers such as allergens, or in his case, a viral respiratory illness. If this alone does not reduce his symptoms, a temporary increase in anti-inflammatory therapy may be needed to treat the exacerbation (Miller, 2020). Oral prednisone 40 to 60mg/d as a single or divided dose for 3 to 10 days is the recommendation for Johnathan (Miller, 2020). If this is successful, no other treatment is indicated. If it is not, a higher step of therapy is needed.

· What information is necessary to provide to Johnathan and his mother regarding asthma exacerbation?

· Home management and recognition of asthma exacerbation is crucial. Patients and parents dealing with asthma should be able to recognize early symptoms of decreasing lung function and adjust medications accordingly (Miller, 2020). First, always begin with two treatments of 2 to 6 MDI puffs of SABA twenty minutes a part. If symptoms do not improve, education on when to call their provider or 911 should be provided. Common asthma education includes triggers, early symptoms and symptom log, medications, and correct inhaler technique.

· What is an appropriate clinical assessment tool to be use with Johnathan?

· The most commonly used, appropriate tool for Johnathan’s care would be the Childhood Asthma Control Test (C-ACT). This tool is used to assess children ages 4 to 11 years. It consists of 4 picture items and 3 verbal items, that are answered by both parents and children (Dinakar & Chipps, 2017). According to this, children tend to assess their asthma control much lower than their parents.

· What are the classification of asthma?

· According to the GINA, asthma severity is determined by the level of treatment needed to control symptoms (Miller, 2020). There are three classifications in defining the severity of asthma. Mild asthma is defined as symptoms that can be controlled with step one or two medications. Those medications would include short-acting reliever medications alone or with low-dosed inhaled corticosteroids (Miller, 2020). Moderate asthma requires step three medications such as inhaled corticosteroids with long-acting bronchodilators (Miller, 2020). Lastly, severe asthma occurs when symptoms require step four or five treatment including high-dose inhaled corticosteroids. In some severe cases, even these medications do not improve symptoms (Miller, 2020).

· How would you as the NP address his mother's concern regarding providing an inhaler at school?

· As the NP caring for Johnathan, I would inform the mother of the importance of an inhaler at school. GINA recommends sharing a written asthma action plan with the child’s school (Miller, 2020). Johnathan should be instructed on the correct use of his inhaler and be involved in his asthma treatment plan. Many schools do not allow student to self-administer medications; however, some type of agreement should be reached among the provider, school, and parent (Miller, 2020). This could mean storing the inhaler with the school nurse until needed.

· What is an appropriate plan of care for Johnathan?

· Based on the severity of Johnathan’s exacerbation, he should be seen again in 2 to 6 weeks to evaluate his level of control achieved. Low- dose inhaled corticosteroids will be prescribed as the controller medication (Miller, 2020). If he begins to need his inhaler more than 2 times a week, he will need to be moved up a step. After the initial follow up, Johnathan will require regular follow up appointments every 2-3 months to monitor his response to the medications (Miller, 2020). The goals for his care include preventing exacerbations and reduced lung growth, while providing optimal pharmacologic methods for management.

 

 

 

References

Dinakar, C. & Chipps, B. (Jan. 2017). Clinical tools to assess asthma control in children. Official Journal of the American Academy of Pediatrics.  DOI: 10.1542/peds.2016-3438

Miller, B. (2020). Asthma and chronic obstructive pulmonary disease. In T. M. Woo, & M. V. Robinson (Eds.), Pharmacotherapeutics for advanced practice nurse practitioners (5th ed., pp. 937- 966). F. A. Davis.