asthma care plan
DESCRIPTION
Asthma Care plan. Natalie Conrad, Kristen DeGrood, Andrea Faust, Frank Johnson, Lauren Meyers, Kate Poucher, Stephanie Price, Melissa Scherber . Background and issues. Asthma is often undetected and under-treated in low-income high-risk families Standardized system-level approaches available - PowerPoint PPT PresentationTRANSCRIPT
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Natalie Conrad, Kristen DeGrood, Andrea Faust, Frank Johnson, Lauren Meyers, Kate Poucher, Stephanie Price, Melissa Scherber
ASTHMA CARE PLAN
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Asthma is often undetected and under-treated in low-income high-risk families
Standardized system-level approaches available
Screening and surveillance by public health nurses during family home visits
Evidenced-based asthma care plan through Omaha System
BACKGROUND AND ISSUES
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The Omaha System was selected for this asthma care plan because: Used by many health departments in clinical software Enables PHN documentation Can describe evidence based practice Can generate data for evaluation
Problems selected for the asthma care plan: Respiration Sanitation Substance use
OMAHA SYSTEM
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RESPIRATION
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Category
Target Care Description Note
S Continuity of care Adherence to asthma action planS Durable Medical
EquipmentUse of peak flow meter, nebulizer, holding container
S Signs/Symptoms- Physical
Chest tightness, wheezing, cough, shortness of breath, night awakenings
TGC Durable Medical Equipment
Peak flow meter, nebulizer, and holding chamber
TGC Wellness Annual influenza vaccine, handwashingTGC Signs/Symptoms-
PhysicalIndividual triggers: viral infection, allergies, emotions/stress, exercise
TGC Environment Air Quality Index; Pollen countsTGC Anatomy/Physiology Pathophysiology of asthmaTGC Signs/Symptoms-
PhysicalEvidence of Disease/Infections: Signs and symptoms of asthma
TGC Exercises Regular physical activityTGC Medication
Action/Side EffectsPurpose/Benefits: Current asthma management practices including inhaler use, controllers and relievers, side effects
CM Medical/Dental Care Coordination among providers: Primary care, asthma care specialist, allergist, school nurse
CM Other community resources
Financial, housing, transportation, health insurance, educational support, tenants rights
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Adherence to asthma action plan
Provides written guidelines on how to manage asthma including how to take medications properly, identifying allergens and irritants that exacerbate symptoms, and what to do in case of an emergency.
(National Heart, Lung, and Blood Institute, 2007)
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Use of:Peak flow meterNebulizerHolding chamber
Nebulizers, holding chambers, and peak flow meters have been shown to be effective in the treatment of asthma.
(McCormack et al., 2009)
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Chest tightnessWheezingCoughShortness of breathNight awakenings from asthma
Monitoring for signs and symptoms of an asthma exacerbation will ensure prompt treatment of asthma attacks.
(National Heart, Lung, and Blood Institute, 2007)
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Nebulizers, holding chambers, and peak flow meters have been shown to be effective in the treatment of asthma.
(McCormack et al., 2009)
Use of:Peak flow meterNebulizerHolding chamber
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Annual flu shotHandwashing
Viruses increase airway inflammation and worsen asthma symptoms. The flu shot and handwashing reduce the risk of contracting a respiratory virus.
(National Heart, Lung, and Blood Institute, 2007)
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Individual Triggers:Viral infectionAllergies (grass/pollen)Emotions/stressExercise
Knowing an individuals triggers enables them to avoid such irritants and be prepared to manage asthma symptoms if they worsen in presence of a trigger.
(National Heart, Lung, and Blood Institute, 2007)
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Air Quality IndexPollen Counts
Pollen has been linked to seasonal asthma so symptoms may worsen depending on the time of year. When air quality is low, exercise-induced asthma is worsened.
(National Heart, Lung, and Blood Institute, 2007)
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Pathophysiology of asthma
Asthma is a disease that causes inflammation, swelling, and constriction ofairways. It involves partially reversible airway obstruction, over-active mucus glands, and airway thickening from scarring and inflammation. (National Heart, Lung, and Blood Institute, 2007)
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Evidence of Disease/Infection: Signs and symptoms of asthma
Coughing, wheezing, chest tightness and SOB, without evidence of infection.
(National Heart, Lung, and Blood Institute, 2007)
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Regular physical activity
Clinical Guidelines support the use of exercise to reduce the impairment for asthma.
(National Heart, Lung, and Blood Institute, 2007)
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Purpose/Benefits: Current asthma management practices including: Inhaler useControllers and relieversSide effects
Clinical guidelines support the use of medication therapy. The risk of uncontrolled asthma is weighed against the limited risks of side effects.
(National Heart, Lung, and Blood Institute, 2007)
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Coordination Among Providers:Primary careAsthma care specialistsAllergistSchool Nurse
Specific clinical guidelines suggest that collaboration between healthcare providers provides better outcomes in the treatment of asthma.
(National Heart, Lung, and Blood Institute, 2007)
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FinancialHousingTransportationHealth insuranceEducational supportTenants rights
Studies support the use of community based interventions such as schools and public health nurses in asthma education.
(National Heart, Lung, and Blood Institute, 2007)
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SANITATION
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Category
Target Care Description Note
TGC Environment Relationship to disease
S Environment Mold and moisture
S Environment Pests such as rodents, cockroaches
S Environment Feathery and/or furry pets (cat, dog, bird, hamster, other)
S Environment Dust, excess clutter
S Environment Consumer products such as cleaning products personal care products, fragranced products, and ozone air cleaners
S Environment Odors, cooking practice
S Environment Supplemental Heating Sources such as wood burning stove, fireplace, unvented kerosene or gas space heater
TGC Durable Medical Equipment
Products to reduce environmental triggers include bed and pillow encasements, HEPA vacuum cleaner, portable HEPA air cleaner, furnace filters, dehumidifiers
TGC Environment Cleaning and vacuuming (frequency and proper technique)
TGC Environment Integrated pest management, health effects of pesticides
TGC Environment Emphasize environmental triggers in bedroom/sleeping area
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Relationship to disease
Self-management should be tailored to the needs of the individual taking into account cultural beliefs and practices.
(National Heart, Lung, and Blood Institute, 2007)
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Mold and moisture
21% of current asthma in the U.S. is attributed to dampness or mold in homes.
(Sahakian, Park, Cox-Ganser, 2008)
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Pests such as rodents, cockroaches
Studies demonstrate that efforts to maintain pest control help to reduce asthma symptoms. (Sheehan et al., 2010)
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Feathery and/or furry petsCatsDogs BirdsHamstersOthers
Exposure to allergens including pets precipitates worsening of asthma. (National Heart, Lung, and Blood Institute, 2007)
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Dust and excess clutter
Exposure to allergens such as dust and clutter that accumulates dust leads to the worsening of asthma.
(National Heart, Lung, and Blood Institute, 2007)
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Consumer products such as:Cleaning products
Use of cleaning products has been related to new-onset asthma. Personal care productsFragranced productsOzone air cleaners
(National Heart, Lung, and Blood Institute, 2007)
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OdorsCooking practices
Sprays and strong odors, particularly perfumes, can irritate the lungs and trigger asthma symptoms. (National Heart, Lung, and Blood Institute, 2007)
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Supplemental Heating Sources such as:Wood burning stoveFireplaceUnvented kerosene or gas space heater
These supplemental heating sources increase the levels of NO2 inside homes and increase the prevalence and severity of respiratory symptoms.
(National Heart, Lung, and Blood Institute, 2007)
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Products to reduce environmental triggers:
Bed and pillow encasementsHEPA vacuum cleanerPortable HEPA air cleanerFurnace filtersDehumidifiers
Scientists have proven using durable equipment reduces environmental triggers for asthma, provides better air quality, improves the overall quality of life for patients, and decreases the amount of asthma exacerbations.
(McCormack et al., 2009)
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Cleaning and vacuuming (frequency and proper technique)
Conducting proper vacuuming and cleaning techniques reduces exposure to triggers such as pet dander, dust mites, and pollen.
(Wu and Takaro, 2007)
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Integrated Pest ManagementHealth effects of pesticides
Integrated pest management (IPM) reduces the amount of sources of allergens capable of triggering asthma symptoms.
(Kass et al., 2009)
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Emphasize environmental triggers in bedroom or sleeping area
Having limited triggers in the sleeping area allows for better sleep patterns and fewer asthma exacerbations.
(Wu and Takaro, 2007)
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SUBSTANCE USE
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Category
Target Care Description Note
S Substance use cessation Use patternS Environment Environmental tobacco smokeCM Other community resource Telephone
information/reassurance: direct referrals may be make to smoking cessation programs on behalf of clients
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Substance use pattern
Knowing the patterns of use when using a substance can aid in success rate of quitting a substance and reducing overall risk of asthma development and asthma exacerbation.
(Heath et al., 2009)
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Environmental tobacco smoke
Exposure to environmental tobacco smoke increases risk factors for development of asthma as well as causes of asthma exacerbations.
(Gilmour et al., 2007)
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Telephone information/reassurance:Direct referrals may be made to smoking cessation programs on behalf of clients
Follow up phone calls can aid in referrals to other substance cessation programs and increases the likelihood of success when attempting to quit a substance.
(Wadland et al., 2007)
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RESOURCES
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Gilmour, M. , Jaakkola , M. , London, S. , Nel , A. , & Rogers , C . (2006). How exposure toenv ironmental tobacco smoke, outdoor a i r po l lutants , and increased pol len burdens i influences the inc idence of asthma. Envi ronmental Heal th Perspect ives , 114(4) ,627-633. Heath, J . , Young, S. , Bennett , S. , G inn, M. , & Cox, G. (2009) . Ev idence-based smoking
cessat ion intervent ions for pat ients wi th acute respi ratory d isorders . Annual Review Of Nurs ing Research, 27273-296. doi :10 .1891/0739-6686.27.273 Kass, D. , McKelvey, W., Car l ton, E . , Hernandez, M. , Chew, G. , Nagle, S. , & Evans, D. (2009). Effect iveness of an integrated pest management intervent ion in contro l l ing cockroaches, mice, and al lergens in New York C ity publ ic housing . Envi ronmental Heal th Perspect ives , 117 (8) , 1219-1225. doi :10 .1289/ehp.0800149 McCormack, M. , Breysse, P. , Matsui , E . , Hansel , N. , Wi l l iams, D. , Curt in-Brosnan, J . , & Diette, G. (2009) . In-home part ic le concentrat ions and chi ldhood asthma morbidi ty. Envi ronmental Heal th Perspect ives , 117 (2) , 294-298. do i : 10.1289/ehp.11770 National Heart , Lung, and B lood Inst i tute. (2007). Expert Panel Report 3 : Guidel ines for the Diagnos is and Management of Asthma (3rd ed.) . Sahakian, N. M. , Park , J . H. , & Cox- Ganser, J . M. (2008). Dampness and mold in the indoor envi ronment: impl icat ions for asthma. Immunology & Al lergy Cl in ics of North America, 28 (3) , 485-505.
BIBLIOGRAPHY
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Sheehan, W. J . , Rangsithienchai, P. A. , Wood, R. A. , Rivard, D. , Chinratanapisi t , S. ,
Perzanowski , M. S. , Phipatanakul, W. (2010) . Pest and al lergen exposure and abatement in inner-ci ty asthma: A work group report of the American Academy of Al lergy, Asthma & Immunology Indoor Al lergy/Air Pol lut ion Committee. Journal of Al lergy & Cl in ical Immunology, 125 9(31)0, 0507151-578X1. Wadland, W., Holtrop, J . , Weismantel , D. , Pathak, P. , Fadel, H. , & Powell , J .
(2007). Practice-based referrals to a tobacco cessat ion quit l ine: assessing the impact of comparat ive feedback vs general reminders. Annals Of Family Medic ine, 5(2), 135-142. Wu, F. , & Takaro, T. (2007). Childhood asthma and environmental interventions. Environmental Health Perspect ives, 115 (6), 971-975.
BIBLIOGRAPHY
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QUESTIONS?