Assignment: Asthma and Stepwise Management Essay

Assignment: Asthma and Stepwise Management Essay

. Patients with these disorders are frequently treated by advanced practice nurses. Because some patients require immediate treatment, you must be able to recognize and distinguish minor asthma symptoms from serious, life-threatening symptoms. Because symptoms and attacks are frequently triggered, advanced practice nurses must assist patients in identifying their triggers and recommending appropriate management options. As with many other disorders, there are different approaches to treating and managing asthmatic patients based on individual patient factors. The stepwise approach, which you investigate in this Assignment, is one method that supports clinical decision-making of drug therapy plans for asthmatic patients.

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https://class.waldenu.edu/webapps/discussionboard/do/message?action=list_messages&course_id=_16936824_1&nav=discussion_board_entry&conf_id=_4227190_1&forum_id=_9792784_1&message_id=_124344213_1

To prepare:

• Consider 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.
• Review Chapter 25 of the Arcangelo and Peterson text. Reflect on using the stepwise approach to asthma treatment and management.
• Consider how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.

To complete:

Write a 2- to 3- page paper that addresses the following:

• Describe long-term control and quick relief treatment options for asthma patients, as well as the impact these drugs might have on patients.
• Explain the stepwise approach to
• Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Important information for writing discussion questions and participation Welcome to class
• I’m your course’s instructor; hello everyone and welcome to the class. It will take a lot of effort, planning, and attention to complete this week-long course. To help you complete all of the assignments needed for the course, please refer to the syllabus for the class. To help you understand what is expected of you in this course, I have also attached the classroom policies to this announcement. Please carefully read this material, and if you have any questions, let me know. If you need to get in touch with me, you can email me at any time or use Halo’s “message” icon. You should receive a response from me within 24 hours because I frequently check my inbox. Send a follow-up text to if you need to reach me immediately and haven’t heard from me after 24 hours.You should not put off finishing your projects till the very last minute, in my opinion. Planning ahead is necessary for your tasks in weeks 4 and 5, as you’ll need to present a lesson plan and conduct an interview with a community health provider. I suggest that you review the prerequisites for these tasks at the start of the semester and make appropriate plans. I’ve provided a YouTube link that provides a detailed explanation of each of the class tasks. You must watch this 32-minute video since the assignments for weeks three through five depend on your ability to adhere to the guidelines exactly. A zero could result if these assignments aren’t finished as instructed. Please arrange a one-on-one meeting with me to discuss your project topic after watching the video by the second week of class. To schedule a 15-minute session, use this link. Call me at the time of your appointment if you would, please. Please be aware that I won’t be calling you.Please note that I DO NOT accept any assignments sent to me by email. Contact the technical department and let me know if you are experiencing any difficulties uploading assignments. Please let me know if there are any problems that would make it difficult for you to submit your assignments by the due date in order to discuss the possibility of an extension. Keep in mind that working overtime or full-time is not an acceptable defense for submitting assignments late. For each day your assignment is late, you lose 5% of your points. Only authorized expansions are covered by this. Assignments turned in late won’t be accepted.Please get in touch with the relevant department to request accommodations if you believe you might require them for whatever reason.
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The Expert Panel believes that regular follow-up contact is critical (Evidence B). Contact should be made at 1- to 6-month intervals, depending on the level of control; consider 3-month intervals if a step down in therapy is expected (Evidence D). Clinicians must determine whether asthma control has been maintained and whether therapy should be increased or decreased. Clinicians must also monitor and review the patient’s written asthma action plan, medications, and self-management behaviors (e.g., inhaler and peak flow monitoring techniques, actions to control aggravating factors) (See “Component 2: Education for a Partnership in Asthma Care,” figures 3-11 and 3-15.).

The Expert Panel recommends that, once asthma is well controlled and the control is achieved and maintained for at least 3 months, a reduction in pharmacologic therapy—a step down—can be considered. This will be helpful to identify the minimum therapy for

maintaining good control of asthma (Evidence D). Reduction in therapy should be gradual and closely monitored, because asthma can deteriorate at a highly variable rate and intensity. The patient should be instructed to contact the clinician if and when asthma worsens. Guidelines for the rate of reduction and intervals for evaluation have not been validated, and clinical judgment of the individual patient’s response to therapy is important. The opinion of the Expert Panel is that the dose of ICS may be reduced about 25–50 percent every 3 months to the lowest dose possible that is required to maintain control (Hawkins et al. 2003; Lemanske et al. 2001). Patients may relapse when the ICS is completely discontinued (Lemanske et al. 2001; Waalkens et al. 1993).

The Expert Panel recommends that, if asthma control is not achieved and maintained at any step of care (See figure 4-7.), several actions may be considered:

▪ Patient adherence and technique in using medications correctly should be assessed (Evidence B). See “Component 2: Education for a Partnership in Asthma Care” for discussion on assessing adherence. Key questions to consider asking patients include:
— Which medicines are you currently taking? How often?
— Please show me how you take the medicine.
— How many times a week do you miss taking the medication?
— What problems have you had taking the medicine (cost, time, lack of perceived need)?
— What concerns do you have about your asthma medicines?
▪ A temporary increase in anti-inflammatory therapy may be indicated to reestablish asthma control (Evidence D). A deterioration of asthma may be characterized by gradual reduction in PEF (approximately 20 percent), by failure of SABA bronchodilators to produce a sustained response, by a reduced tolerance to activities or exercise, and by the development of increasing symptoms or nocturnal awakenings from asthma. To regain control of asthma, a short course of oral prednisone (See figure 4-8a.) is often effective. If asthma symptoms do not recur and pulmonary functions remain normal, no additional therapy is necessary. However, if the prednisone burst does not control symptoms, is effective only for a short period of time (e.g., less than 1–2 weeks), or is repeated frequently, the patient should be managed according to the next higher step of care.
▪ Other factors that diminish control may have to be identified and addressed (Evidence C). These factors include the presence of a coexisting condition (e.g., rhinitis/sinusitis, gastroesophageal reflux, obesity), a new or increased exposure to allergens or irritants, patient or family barriers to adequate self-management behaviors, or psychosocial problems. In some cases, alternative diagnoses, such as VCD, should be considered.
▪ A step up to the next higher step of care may be necessary (Evidence A).
▪ Consultation with an asthma specialist may be indicated (See “Component 1: Measures of Asthma Assessment and Monitoring.”) (Evidence D). The Expert Panel recommends referral to an asthma specialist for consultation or comanagement if: there are difficulties achieving or maintaining control of asthma; immunotherapy or omalizumab is being considered; the patient requires step 4 care or higher; or the patient has had an exacerbation requiring a hospitalization. (See “Component 1: Measures of Asthma Assessment and Monitoring.”). Referral may be considered if a patient requires step 3 care