Pediatric Asthma A Different Disease

1. Erwin W. Gelfand1 +Author Affiliations 1.

1

Division of Cell Biology, Department of Pediatrics, National Jewish Health,

Denver, Colorado Abstract Asthma currently affects the lives of more than 30 million Americans from infancy to the elderly. In many ways, pediatric asthma differs from adult asthma, including childhood-onset adult asthma. Despite many advances in our understanding of the disease, the natural history of asthma is not well defined, especially in different subsets of patients. For many with allergic asthma the disease has its origins in early childhood, associated with early sensitization to aeroallergens and exposure to repeated viral infections. These early life exposures, coupled with genetically determined susceptibility, have a major impact on the natural history of the disease. A number of risk factors during the critical early stages in the initiation of asthma have been associated with subsequent outcomes. In addition, protective factors linked to early life experiences have also been delineated which may impact the development of atopy and asthma and reduce the prevalence of these diseases. Cumulatively, the data highlight the critical nature of this early period in which immune/inflammatory responses in the lung are initiated and serve to maintain the disease in subsequent years. Source: http://pats.atsjournals.org/content/6/3/278.full

One opportunity for nurses to educate patients and families occurs during acute care visits, and particularly during emergency department visits. These visits can be uses to motivate the child and the family to learn more about asthma and appropriate selfmanagement Some topics to cover include: Eating a well balanced diet, taking sufficient rest periods, and gradually increasing activity in order to promote overall good health and increases the resistance to infection; use of an incentive spirometer in order to encourage deep, sustained inspiratory efforts; teach a leaning forward position in order to enhance diaphragmatic excursions and diminishes the use of accessory muscles; teach pursed-lip breathing in order to prolong exhalation, preventing air trapping and air gulping; teach and observe the proper use of a hand-held nebulizer, oxygen therapy, and/or inhaler in order to prevent medication overdose or prevent oxygen dependence. Teach the parents and child that improper use of inhalers has been outlined as an antecedent of asthma. Clients tend to overuse inhalers, leading to their ineffectiveness; and develop an exercise routine in order to increase the childs stamina. Warn the child that improper exercise may trigger asthma. Instruct the child to avoid exercise in extreme hot or cold weather. Wearing a paper mask may reduce the sensitivity to stimulants. Emphasize the importance of cool-down period. Suggest swimming and exercises indoors to avoid exposure to stimulants (Lippincott, 1999). During these visits patients and their parents should be instructed in immediate interventions and danger signs. Instruct the client to report the following: change in sputum characteristics or failure of sputum to return to usual color after three days of antibiotic therapy in order to identify an infection or resistance of the infected organism to the prescribed antibiotic; elevated temperature because circulating pathogens stimulate the hypothalamus to elevate body temperature; increase in cough, weakness, or shortness of breath because hypoxia is chronic, and exacerbations must be detected early to prevent complications; and weight gain or swelling in the ankles or feet because these signs may indicate fluid retention secondary to pulmonary arterial hypertension and decreased cardiac output (Lippincott, 1999). The nurse must also take the time to explain the hazards of an upper respiratory infection (URI), and suggest that the child avoid contact with infected persons, and receive immunization against influenza and bacterial pneumonia. Instruct the parents that children who receive immunotherapy for seasonal allergies may have a lower risk of developing asthma according to a recent study in Nursing. By preventing the immunologic response to allergens, immunotherapy may interrupt the natural progression of allergic disease, which may lead to asthma. The nurse should also strongly recommend that the child take antibiotics as prescribed if sputum becomes yellow or green, and adhere to medication and hydration schedule. In addition, it is thought that URI causes inflammation of the bronchial tree, leading to bronchoconstriction and air trapping. Adhering to the nursing guidelines and avoiding potential triggers could minimize the chances of the child acquiring an URI.

ETHICO-LEGAL BASIS FOR PRACTICE AND ISSUES/LEGAL CHALLENGES IN THE PEFORMANCE OF DUTY
The professional obligation of the nurses goes hand in hand with their legal responsibilities. Their license to practice is a proof that they are qualified to practice under the law. When nurses assume their profession, they are held responsible and accountable for the quality of performance of their duty. Nurses who are employed in a hospital or any other agency are directly responsible to their immediate supervisors. The nurses of Iloilo Mission Hospital use the Philippine Nursing Act of 2002 as their guide in their nursing practice. It is through this law, that they are able to understand and identify their scope and limitations. This law will also aid them if negligence and malpractice in the area ever occurs. They are also using standards of care when practicing their profession. The standard is a clearly defined, legal expectation to which nurses are held accountable, since nurses are held responsible for their own actions as well as the consequences of such actions. And they are not immune from whatever untoward incidences that may occur. So, the use of standards of care is their one way of assuring themselves that what they are doing is efficient. Nurses are even responsible for the events that they themselves, have not anticipated. That is why the agency provides adequate information to determine if their standards have been met. Also, the agency is using Nursing ethics as the basis for their practice. They use it to make independent decisions when doing their daily duties. Because sometimes, the nurses really find it difficult to resolve ethical issues because they themselves do not have the sensitivity to recognize ethical conflicts that they are facing in the situation. They are using it not only in decision-making but as well as in the performance of their duty.

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Nurses usually receive little or no formal training in ethics and law, and so are unqualified to deal with these issues when they encounter them in the clinical setting (Ramsey, 2000). Ethical and legal issues stemming from such medical issues as organ donation, end-of-life care, euthanasia, physician-assisted suicide, genetic engineering, and managing patient confidentiality in the age of electronic data management are all part of the modern practice of nursing, and there are ethical, legal, and regulatory mandates that require a knowledge of these subjects in healthcare professionals so they can participate in ethical decision-making. Many nurses feel powerless and this often leads to inaction in nurses faced with these decisions, and so they withdraw from the issue and nothing changes. Nurses need to become proactive in ethical and legal issues relating to the care of their patients, and need to spearhead a move to form ethics committees, or to participate in those already in place in their healthcare organizations. This knowledge is vital to nurses, and they need guidance on how to deal with their inadequacies in this area of nursing.