Transcript Asthma management in children and the role of the nurse

ASTHMA MANAGEMENT IN
CHILDREN AND THE ROLE OF
THE NURSE SPECIALIST
Amanda Jones
Paediatric Respiratory Nurse Specialist
Childrens Community Team
ALL ABOUT ASTHMA
5.2m people in UK receive treatment for asthma
 Most Common childhood disease in UK
 1 in 10 children have asthma
 Equates to 1.4 million
 Most children develop asthma before 8yrs old
 Over half before the age of 3yrs
 80,000 admissions to hospital each year
 34,000 were children
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An estimated 75% of these are avoidable
ALL ABOUT ASTHMA
Approx 3,000 attendances to Urgent Care in
Bolton for children
 Approx 350 children required admission
 1,300 deaths from asthma each year in UK
 29 children each year in UK

90% of deaths are preventable
HOW DO WE MANAGE ASTHMA IN
CHILDREN
www.brit-thoracic.org.uk/asthma-guideline
British Thoracic Society Guidelines
Scottish Intercollegiate GuidelinesNetwork
NICE Guidelines
THE ROLE OF THE NURSE SPECIALIST
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Autonomous practitioners who are accountable
for a caseload of children providing highly
specialist nursing skills, knowledge and expertise
for children and their families in the
management of asthma across all stages of the
illness
Involved in the development of clinical services
and act as a specialist resource in collaboration
with partnership agencies, locally, regionally and
nationally
SUPPORTING THE CHILD & FAMILY
Successful asthma management can only be
achieved by the child/family & health
professional working together in partnership to
achieve optimum control
Experience and Knowledge of a full Assessment,
implementing treatment and reviewing the child
is important, but the key to success is educating
the family on an ongoing basis
EDUCATING THE CHILD/FAMILY
What is Asthma
 Trigger Avoidance
 Understanding of Medications
 Importance of compliance
 Correct Inhaler Technique
 What to do during an URTI
 What to do in an emergency
 Self Management Plan
 Management in nursery, school, etc
 Who to contact
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INHALER TECHNIQUE IS IT IMPORTANT ?
To gain control of symptoms
 To improve deposition of medication
 Ensure patient receives correct dose of treatment
 Encourage compliance of treatment
 To adminster reliever during an acute episode
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INHALER TECHNIQUE
Every consultation is an opportunity to check
inhaler technique
 Families often receive conflicting advice from
various settings
 Families can pick up bad habits over a period of
time
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INHALER DEVICES USED AT HOME
SPACERS
INHALER DEVICES IN SCHOOL
INHALERS IN SCHOOL
SELF MANAGEMENT PLANS EVIDENCE
Personalised plans have been shown to improve
health outcomes, esp for those in secondary care
and those who have had a recent exacerbation
 Reduction in unscheduled GP visits
 Reduction in hospital admissions
 Reduction in days off work and school
 Reduction in nocturnal symptoms
 Improves compliance
 Reduction in deaths
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SMP IN PRACTICE
Every asthma consultation is an opportunity to
review, reinforce and extend knowledge and
skills
A consultation for an URTI is an opportunity to
rehearse with the family their self management
in the event of their asthma deteriorating
An acute consultation offers the opportunity to
determine what action the patient has already
taken and what ongoing support is required
Education is an ongoing process, is every ones role
and is not a single event
COLD VIRUSES
Biggest trigger esp for under 5’s
 Advice to commence regular reliever at first signs
(2-4 puffs) four times a day
 If no improvement after 24-48 hrs, can increase
reliever to 4-6 puffs, but must seek review, prob
require a course of oral steroids
 Under 2yrs- 10mgs, 2-5yrs- 20mgs, over 5yrs 3040mgs for 3 /5 days
 In Emergency can have 10 puffs but must seek
urgent review ASAP – contact 999
 Advise to have Flu vaccine every year if taking
inhaled steroids
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HOW CAN WE ACHIEVE THIS IN BOLTON
Consistent advice esp during acute symptoms
and URTI
 Support from Childrens Respiratory Nurses to
provide education etc
 Provision of Childrens Community Nurses to
support children at home with acute symptoms
 Use of Guidelines to ensure correct
treatment/devices
 Bolton respiratory Pathway
 Leaflets- After your wheezy episode and After
your asthma attack
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AND TO FINISH
Always Remember
Inhaler technique is just like driving, you pick up
bad habits over time…….would you pass your
test again?
Asthma Management without education & written
action plans is like flat pack furniture without
instructions!