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Asthma Basics For Para Professionals Minnesota Department of Health Asthma Program.

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Presentation on theme: "Asthma Basics For Para Professionals Minnesota Department of Health Asthma Program."— Presentation transcript:

1 Asthma Basics For Para Professionals Minnesota Department of Health Asthma Program

2 Presenter Susan Ross RN, AE-C MDH Asthma Program Staff

3 Minnesota Department Of Health Asthma Website:

4 As You View This Program.. Consider how many people you know who have asthma? Consider how many people you know who have asthma? How will you use the information you receive here today? How will you use the information you receive here today? How can you help students prevent their asthma symptoms from appearing? How can you help students prevent their asthma symptoms from appearing? How can you help improve asthma management at your school? How can you help improve asthma management at your school?

5 Asthma: Accounts for 14 million lost school days annually 3 Accounts for 14 million lost school days annually 3 Is the most common chronic disease causing absence from school 2 Is the most common chronic disease causing absence from school 2 Is the leading cause of hospitalizations among children under 15 2 Is the leading cause of hospitalizations among children under in 13 school children have asthma 1 1 in 13 school children have asthma million children under 18 have asthma million children under 18 have asthma 1 1 Asthma Prevalence, Health Care Use, and Mortality, , National Center for Health Statistics, CDC 2 Morbidity and Mortality Report, National Center for Health Statistics (NCHS), U.S. CDC, Surveillance for Asthma - United States, , MMWR Surveillance Summaries, CDC, March 29, 2002

6 Minnesota Children In a 2003 MDH survey of more than 5,000 In a 2003 MDH survey of more than 5,000 7th & 8th graders at 15 junior highs outside the metro area- 7th & 8th graders at 15 junior highs outside the metro area- 1 in 12 reported they currently have asthma 1 in 12 reported they currently have asthma In a 2001 MDH survey of 13,000, 9th - 11th graders in rural MN- In a 2001 MDH survey of 13,000, 9th - 11th graders in rural MN- 1 in 11 reported they currently have asthma 1 in 11 reported they currently have asthma

7 This Means.. In a class of 30 children, you can expect 2 to 3 students WILL have asthma! 2 to 3 students WILL have asthma!

8 The Goal Of Asthma Management Children should live happy, healthy, physically active lives, without asthma symptoms slowing them down Children should live happy, healthy, physically active lives, without asthma symptoms slowing them down

9 Impact Of Asthma On Students School Performance : Poorly controlled asthma has a negative impact on school performance in both academic achievement and physical education Poorly controlled asthma has a negative impact on school performance in both academic achievement and physical education

10 Impact Of Asthma On Students cont... Psychosocial: Psychosocial: Poor self-esteem Poor self-esteem Anxiety about asthma Anxiety about asthma Fear of becoming ill at school Fear of becoming ill at school Anxiety about exercise at school Anxiety about exercise at school Fear of being different Fear of being different

11 What Is Asthma? Asthma is a chronic disease that causes: Asthma is a chronic disease that causes: Tightening of the muscles surrounding the airways (Bronchoconstriction/spasm) Tightening of the muscles surrounding the airways (Bronchoconstriction/spasm) Swelling of the small airways (bronchioles) Swelling of the small airways (bronchioles) Over production of sticky mucus in the airways Over production of sticky mucus in the airways

12 Normal Bronchiole Inflamed Bronchiole with Mucus

13 Common Symptoms Of Asthma Frequent cough, especially at night Frequent cough, especially at night Shortness of breath or rapid breathing Shortness of breath or rapid breathing Chest Tightness Chest Tightness Chest pain Chest pain Wheezing Wheezing Fatigue Fatigue Behavior changes Behavior changes

14 What Causes Asthma? Asthma may be caused by genetic, immune and/or environmental factors, and is often associated with eczema (scaly skin patches) and allergies Asthma may be caused by genetic, immune and/or environmental factors, and is often associated with eczema (scaly skin patches) and allergies Researchers do not understand all of the causes of asthma or its increasing prevalence Researchers do not understand all of the causes of asthma or its increasing prevalence It boils down to We just dont really know for sure It boils down to We just dont really know for sure

15 What Causes Asthma cont.. Of the 17 million asthma sufferers in the US, 10 Million (approx. 60%) have allergic asthma. 3 million of those are children 1 Of the 17 million asthma sufferers in the US, 10 Million (approx. 60%) have allergic asthma. 3 million of those are children 1 Exposure to certain allergens trigger asthma symptoms to begin Exposure to certain allergens trigger asthma symptoms to begin Exposure to certain irritants can also set an asthma episode in motion Exposure to certain irritants can also set an asthma episode in motion 1 National Institute of Environmental Health Sciences

16 Triggers And Irritants Copyright 2004, 3M Pharmaceuticals

17 Common Allergens (Triggers) Seasonal pollens Seasonal pollens Animal dander /saliva/urine Animal dander /saliva/urine Dust mites Dust mites Cockroaches/mice/rat droppings and urine Cockroaches/mice/rat droppings and urine Mold Mold Some medications Some medications Some foods Some foods Strong emotional feelings Strong emotional feelings

18 Common Irritants (Triggers) Exercise Exercise Cold air Cold air Chalk dust Chalk dust Viral/upper respiratory infections Viral/upper respiratory infections Air pollution Air pollution Tobacco smoke or secondhand smoke Tobacco smoke or secondhand smoke Chemical irritants and strong smells Strong emotional feelings Diesel fumes Cleaning supplies

19 Every Child Is Unique! Wheezing and coughing are the most common symptoms -but- Wheezing and coughing are the most common symptoms -but- No two children will have the exact same symptoms or the same trigger No two children will have the exact same symptoms or the same trigger Every child who has a diagnosis of asthma should have access to a rescue inhaler! Every child who has a diagnosis of asthma should have access to a rescue inhaler! Every child who has asthma should have an asthma action plan at school (AAP) Every child who has asthma should have an asthma action plan at school (AAP)

20 Handling Asthma Episodes

21 Whats An Episode? An asthma episode occurs when a child is exposed to a trigger or irritant and their asthma symptoms start to appear An asthma episode occurs when a child is exposed to a trigger or irritant and their asthma symptoms start to appear This can occur suddenly without a lot of warning, or brew for days before the symptoms emerge This can occur suddenly without a lot of warning, or brew for days before the symptoms emerge Episodes are preventable by avoiding exposure to triggers and taking daily controller medications (if prescribed) Episodes are preventable by avoiding exposure to triggers and taking daily controller medications (if prescribed)

22 How Do I Handle An Asthma Episode At School? 1. Remain calm and reassure the child 2. If you know what triggered their episode, move the child away from it 3. Have the child sit up and breathe slowly- in through the nose, out through pursed lips 4. Contact the school nurse for assistance or whomever is responsible for providing medications in the nurses absence

23 Handling An Episode cont.. 5. If you are responsible for medications, check the child's asthma action plan, emergency care plan or medication card for actions 6. Give rescue or reliever medications if ordered and available (some students carry their own asthma inhalers with them) 7. Have the child sip room temperature water/ fluids 8. Contact the parent or guardian as necessary -AND-

24 Do NOT Leave The Child Alone!

25 Call 911 if.. Lips or nail beds are bluish Lips or nail beds are bluish Child has difficulty talking, walking or drinking Child has difficulty talking, walking or drinking Quick relief or rescue meds (albuterol) is ineffective or not available Quick relief or rescue meds (albuterol) is ineffective or not available Neck, throat, or chest muscles are pulling in (retracting) Neck, throat, or chest muscles are pulling in (retracting) Nasal flaring occurs when inhaling Nasal flaring occurs when inhaling Obvious distress Obvious distress Altered level of consciousness/confusion Altered level of consciousness/confusion Rapidly deteriorating condition Rapidly deteriorating condition

26 Exercise Induced Asthma

27 What Is Exercise Induced Asthma (EIA)? Tightening of the muscles around the airways (bronchospasm) Tightening of the muscles around the airways (bronchospasm) Distinct from chronic asthma in that it does NOT cause swelling and mucus production in the airways Distinct from chronic asthma in that it does NOT cause swelling and mucus production in the airways Can be avoided by taking pre-exercise medications and by warming up/cooling down Can be avoided by taking pre-exercise medications and by warming up/cooling down

28 EIA - What Happens? Symptoms include coughing, wheezing, chest tightness and shortness of breath Symptoms include coughing, wheezing, chest tightness and shortness of breath Symptoms may begin during exercise and can be worse 5 to 10 minutes after exercise Symptoms may begin during exercise and can be worse 5 to 10 minutes after exercise EIA can spontaneously resolve 20 to 30 minutes after starting EIA can spontaneously resolve 20 to 30 minutes after starting Can be avoided by doing the following: Can be avoided by doing the following:

29 Preventing Exercise Induced Asthma (EIA) Become familiar with Asthma Action Plans, pre- exercise medication orders and or health care plan Become familiar with Asthma Action Plans, pre- exercise medication orders and or health care plan Student should use reliever (Albuterol) minutes before activity Student should use reliever (Albuterol) minutes before activity Do warm-up/ cool-down exercises before and after activities Do warm-up/ cool-down exercises before and after activities Check outdoor ozone/air quality levels Check outdoor ozone/air quality levels Never encourage a child to tough it out when having asthma symptoms Never encourage a child to tough it out when having asthma symptoms

30 Medications

31 Medication: Determined By Severity Level Classification 1. Mild Intermittent Reliever only prn Reliever only prn 2. Mild Persistent Controller and reliever Controller and reliever 3. Moderate Persistent Controller plus long-acting bronchodilator and reliever 4. Severe Persistent Controller plus long-acting bronchodilator and reliever

32 Two Categories Of Medications Controller Medications Controller Medications Taken every day to prevent swelling in the lungs Taken every day to prevent swelling in the lungs Reliever or Rescue Medications Reliever or Rescue Medications Taken only when needed to relieve symptoms Taken only when needed to relieve symptoms Or to prevent exercise induced asthma from developing (taken before strenuous exercise) Or to prevent exercise induced asthma from developing (taken before strenuous exercise)

33 Controller Medications Keep swelling and mucus from developing in the lungs Keep swelling and mucus from developing in the lungs Must be taken EVERY day even when the child is not having symptoms Must be taken EVERY day even when the child is not having symptoms Inhaled corticosteroids (ICSs) are the most common and effective way to control asthma Inhaled corticosteroids (ICSs) are the most common and effective way to control asthma Help prevent asthma exacerbations from developing! Help prevent asthma exacerbations from developing!

34 Rescue Or Reliever Medications Are taken when asthma symptoms are appearing (asthma episode) Are taken when asthma symptoms are appearing (asthma episode) Are taken minutes before strenuous exercise/activity by children with EIA Are taken minutes before strenuous exercise/activity by children with EIA Do NOT reduce or prevent swelling from developing in the lungs Do NOT reduce or prevent swelling from developing in the lungs May be carried in school by a student only IF approved by the doctor, school nurse and parent! May be carried in school by a student only IF approved by the doctor, school nurse and parent!

35 Picture courtesy of American Lung Association of the Inland Counties CA 2004

36 Typical Spacers/Holding Chambers

37 Spacers Or Holding Chambers Most MDIs (metered dose inhalers) must be used with a spacer or holding chamber Most MDIs (metered dose inhalers) must be used with a spacer or holding chamber This device attaches to the MDI and allows the user to breathe in more medication effectively This device attaches to the MDI and allows the user to breathe in more medication effectively The physician must write an order for it when prescribing your reliever medication The physician must write an order for it when prescribing your reliever medication Dry powder inhalers do NOT require spacers Dry powder inhalers do NOT require spacers

38 How MDI Technology Works

39 How To Use Your Inhaler

40 How To Use: Metered Dose Inhalers w/Spacers 1. Stand up (or sit up straight) 1. Stand up (or sit up straight) 2. Shake the inhaler well to mix up the medicine 2. Shake the inhaler well to mix up the medicine 3. Remove the cap and check the spacer/inhaler for foreign objects 3. Remove the cap and check the spacer/inhaler for foreign objects 4. Insert the inhaler into the spacer 4. Insert the inhaler into the spacer 5. Exhale all your air out fully 5. Exhale all your air out fully 6. Before inhaling, put the mouthpiece of the spacer into your mouth, over your tongue and between your teeth. Close your lips around it while tilting your head and the inhaler back slightly 6. Before inhaling, put the mouthpiece of the spacer into your mouth, over your tongue and between your teeth. Close your lips around it while tilting your head and the inhaler back slightly

41 Using An MDI Cont.. 7. Press down on the inhaler canister and breathe in slowly and deeply through your mouth 8. Hold your breath for 10 seconds, exhale normally 9. If using a reliever, wait 1-2 minutes between puffs 10. Repeat starting with #5 if a 2 nd puff is ordered 11. Rinse your mouth and spit after using a controller inhaler

42 Minnesota Inhaler Law

43 MN Asthma Inhaler Law Summary (2001) Allows MN students to self-carry and administer inhalers Allows MN students to self-carry and administer inhalers In order for a child to carry his/her inhaler at school, authorization and signatures from the following individuals are required: In order for a child to carry his/her inhaler at school, authorization and signatures from the following individuals are required: Childs health care provider Childs health care provider Parent/guardian Parent/guardian Assessment and approval of the school nurse (if present in district) Assessment and approval of the school nurse (if present in district) Be sure to check and follow policies and procedures in local school district Be sure to check and follow policies and procedures in local school district

44 Para Professionals Role Identify students with asthma Identify students with asthma Distribute & collect communication forms Distribute & collect communication forms In the health office the RN may delegate specific tasks such as: In the health office the RN may delegate specific tasks such as: Documenting asthma visits by completing or initiating student asthma records Documenting asthma visits by completing or initiating student asthma records Asking about symptoms & check PFM levels Asking about symptoms & check PFM levels Providing episodic care to students with asthma symptoms including medication administration Providing episodic care to students with asthma symptoms including medication administration Communicating with parents regarding asthma care/episodes Communicating with parents regarding asthma care/episodes

45 Communicate With The NURSE Communicate With The NURSE You are the eyes and ears for the nurse You are the eyes and ears for the nurse Be aware of students with asthma and their typical symptoms Be aware of students with asthma and their typical symptoms Help remind students to pre-medicate before exercise Help remind students to pre-medicate before exercise Always document clearly and neatly what you see, hear and what the student tells you Always document clearly and neatly what you see, hear and what the student tells you Call the nurse with questions or urgent situations Call the nurse with questions or urgent situations If you dont know- ask! If you dont know- ask! Dont be afraid to call 911 in emergencies Dont be afraid to call 911 in emergencies

46 Tools To Help Manage Asthma

47 Peak Flow Meters (PFM)

48 Peak Flow Meters Measures how well the students lungs are doing at that moment Measures how well the students lungs are doing at that moment Associated with the Green-Yellow-Red system of managing asthma symptoms Associated with the Green-Yellow-Red system of managing asthma symptoms Congruent with asthma action plans Congruent with asthma action plans Helps students and families self-manage asthma Helps students and families self-manage asthma

49 How to use a Peak Flow Meter 1. Review the steps 2. Stand up 3. Place indicator at the base of the numbered scale 4. Take a deep breath 5. Place the meter in the mouth and close lips around the mouthpiece 6. Blow out into the meter as hard and fast as possible 7. Write down the achieved number 8. Repeat the process twice more 9. Record the highest of the three numbers achieved

50 Asthma Action Plan (AAP)

51 Asthma Action Plan Zones Green Zone : All Clear/Breathing Good/Go Green Zone : All Clear/Breathing Good/Go –No asthma symptoms and/or –Peak flow % Predicted or Personal best Yellow Zone: Caution/Slow Down Yellow Zone: Caution/Slow Down –Some asthma symptoms and/or –Peak flow 50-80% Predicted or Personal best Red Zone: Medical Alert/Stop Red Zone: Medical Alert/Stop –Severe asthma symptoms and/or –Peak flow < 50% Predicted or Personal best

52 Successful Asthma Management Requires Everyone's Cooperation Teachers Teachers Parents Parents Students Students Medical Providers Medical Providers Coaches Coaches All School Personnel All School Personnel Talk with your school Nurse to find out what YOU can do to help manage asthma in your school


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