March 20, 2019 0 Comment

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Part A
Executive Summary
Asthma is a chronic inflammatory disorder of the airways that is characterised by recurring attacks of breathlessness and wheezing. According to (Australian Institute of Health and Welfare 2012; Fraser, Waters, Forster ; Brown 2017, pp. 11) it is estimated that about 10% of children aged 0-14 in Australia have been reported to have long-term asthma condition. Over the last decades, there has been an increase in prevalence of asthma both locally and worldwide. An understanding of asthma risk factors is critical in developing effective control measures for management of asthma.

Key Issues/Concerns
The increase in rates of asthma has highlighted the need for an increased focus and understanding on the risk factors associated with the illness. The early focus on asthma risk factors has been on indoor environmental factors and outdoor exposures. The exposures to indoor allergens, moulds, volatile organic compounds, dampness and exposure to environmental tobacco smoke can lead to the development of asthma (Sears 2014). Moreover outdoor air pollution such as traffic and power generation, are some of the major causes of exacerbations of childhood asthma. Outdoor air pollutions accounted for almost 14% of cases of childhood asthma in the European countries.
The parental and infant exposure characteristics such as maternal obesity during pregnancy have been shown to increase risks of childhood asthma. The increasing rates of obesity among pregnant women and smoking during pregnancy have been found to impact on risk of childhood asthma. An abnormally high blood mass index has been found to be a significant risk associated with asthma among the adults and children.
The other asthma risk factors include occupation, exercise, medications and stress. The occupational asthma is associated with the workplace exposures to respiratory irritants. Asthma can be induced by exercises, which become worse if such exercises are done outdoors in place with high amounts of allergens such as ragweed or pollen. Stress related asthma occurs due to maternal prenatal stress. Also, medications have been shown to induce asthma or influence the development of asthma, for example, patients suffering from asthma are sensitive to aspiring, while acetaminophen has been found to influence development of asthma owing to the depletion of glutathione.
In order to avoid the potential of development of asthma or aggravation of existing asthma condition, the following are recommended.

There is need to determination the triggers such as allergens or specific medications in order to avoid contact with them.

Seek for emotional and psychological support for example joining local asthma support groups.
There is need for education to parents and children living with asthma on effective stress management and strategies that can enhance adherence to treatment.

There is need to seek for a coordinated care plan between registered nurse and the children physician for effective management of asthma.
Avoid congested place that is full of pollution or smoke from vehicle emissions or cigarette smoking.

Though asthma is a chronic disorder, it is important to develop an understanding of its risk factors and adopt appropriate prevention and risk factors control measures. The effective management should focus on assessment of symptoms, triggers and choice of appropriate treatment based on the age of the patient and the observed symptoms.

Part B
Case Study 3
In the chosen case study, Joel is clearly a teenager and his asthmatic condition has affected his confidence. The separation of his mother Kate from Joel’s father has also created added financial and support implication. Joel will soon join high school and this can be a huge source of pressure to him as he feels he would want to feel like other students in school. In order to ensure a holistic asthma care plan for Joel, the paper makes several recommendations. First, it is recommended that Joel and his mother join the local support group in order to get advice on how to manage psychological stress that results from his condition. Sears (2014) asserts that living in stressful environment is one of the risk factors that lead to the development of asthma symptoms. Local support groups are instrumental in provision of psychological help and support that will help Joel and his mother overcome stress associated with the condition.
Moreover research conducted by Britto et al. (2014) has found that the adherence to asthma treatment among teenagers is lower than in younger children, yet (Boulet, Vervloet, Magar & Foster 2012) have found that adherence is key in control of asthma. This is evident in the case study, where Joel feels anxious to respond to his peers on questions regarding his condition. The teenager has even asked to be allowed to skip treatment for a short while in order to feel like the rest of his peers. These further highlights the need for the development of relationships between the patient, local support groups and the registered nurse care coordinator can provide effective way of controlling symptoms of asthma associated with stress.
The importance of support groups on management of asthma through effective adherence strategies have been documented well in literature. Mosnaim et al. (2013) found in their study that peer-support, such as mp3 text messages were instrumental in improving treatment adherence. As a result, the development of the patient-local support groups-RN care coordinator relationships is critical in improving the wellbeing of Joel and adherence to his treatment plan.
Secondly, it is recommended that Joel and his mother be involved in his asthma treatment plan through asthma education. The environment under which Joel lives can be considered of great concern to him and can lead to stress and poor treatment adherence. Incorporating asthma education in Joel’s treatment would be important in enhancing adherence to medication. According to (Srof, Taboas ; Velsor-Friedrich 2012) education is important in the promotion of health of teenagers suffering from asthma as well as in reduction of the negative impact of the condition. Teen asthma education programs such as adherence to controller medication, the availability of rescue inhaler and cessation of smoking, can improve greatly the health outcomes of teenagers suffering from asthma.
The New South Wales Ministry of Health have developed policy guidelines for the treatment and management of asthma. Among the strategies proposed in the guidelines is parental education. According to (Ministry of Health, NSW 2012) the admission of a child to a hospital provides an opportunity where asthma education can be provided. In addition, hospital admission offers the opportunity of parental asthma knowledge and that of child where appropriate. The ministry of health asserts that child knowledge, confidence and skills such as inhaler technique should be examined. Education on smoking cessation advice should be provided to the parents or carers and children where appropriate (p. 13). The policy also demands that asthma education should commence immediately in the hospital ward involving the parent, child and medical and nursing staff. Where asthma education has not been provided, the parent/carer and the child must be provided with a referral of a local asthma educator.

Thirdly, there is need to develop a coordinated care program between the school nurse and Joel’s personal doctor for appropriate response and monitoring. Since Joel will be joining high school soon, there is need for an establishment of a coordinated care between the school nurse and Joel’s personal doctor. According to (Rodriguez et al. 2013) asthma is one of the leading causes of absenteeism due to illness and economic costs related to attendance. Moreover, (Kelly et al. 2015) asserts that fragmented care and insufficient education are the leading barriers to asthma control. Having a coordinated care between Joel’s school nurse and his personal doctor will provide an effective way of controlling his asthmatic condition and improving his school attendance.
The NSW Ministry of Health asserts the need for parents to provide the school and childcare with a detailed asthma management plan and the instructions for use in case of an acute asthma attack (Ministry of Health, NSW 2012). As a result the ministry has provided guidelines for management of asthma among school children. The Asthma Action Plan (AAP) provided by the ministry is an individualised for each child, with graduated steps for daily asthma management and management of acute asthma episodes. There are also first aid protocols, which can be followed at the community setting. The protocols are based on the guidelines as set out by the Thoracic Society of Australia and New Zealand.

The other recommendation is that it is important for Joel and his mother to work together with their family doctor and local asthma nurse education in identification of his asthma triggers in order to devise effective prevention measures. Outdoor and indoor allergens such as fungi and moulds have been found to be a significant cause of allergic reactions among asthma patients. According to (Beasley, Semprini & Mitchell 2015) the avoidance of effects of allergens has been investigated as multi-faceted interventions. The author points that avoidance of allergens helps in reduction of risks of asthma in childhood. For example reduced exposure to dust house mite, avoidance of pollen and moulds can great reduce risks of asthma. Therefore, it is important Joel and his mother, together with their family doctor determine specific allergens and design avoidance strategies.
Finally, Joel should avoid places that are congested and polluted from tobacco smoke or smoke that emanates from vehicles or burning of vegetation. According to (Ministry of Health, NSW 2012) tobacco has over 4,000 chemicals that can greatly affect the health of a child. The Environmental Tobacco Smoke (ETS), which the child inhales, can increase attack and severity of asthma among children. Moreover, (Westergaard, Porsbjerg & Backer 2014) point to the detrimental effects that smoking have on asthma. According to the authors, smoking can lead to poor asthma symptom control, decline in lung function and attenuated response to treatment. It is important that Joel avoid smoke or any pollution that results from smoking to avoid aggravating asthma symptoms.
Resources Available for Joel within Western Sydney Local Health District
In order to promote self-management of his condition, there are several resources that Joel and his mother can access within Western Sydney Local Health District. We have the Connecting Care Program which helps in coordination of care and provision of education for the management of chronic illnesses (Western NSW Local Health District, 2018). We also have the Western Sydney Integrated Care Program, which can provide connectivity between primary care providers and the community based services that are close to patient suffering from chronic illnesses such as asthma.
Although resources for self-management of asthma are available in Western Sydney Local Health District, there are barriers that could limit access to the resources by Joel. One of the barriers is the financial ability, which could reduce the number of resources available for Joel. Since Joel’s mother separated with her husband, there will be huge financial burden to her in taking care of the high care demands owing to access to various asthma resources. However, the barrier can be overcome by contacting the local case manager who will take up Kate’s case and assist her in locating for financial assistance.
Australian Institute of Health and Welfare 2012, A Picture of Australia’s Children 2012, Australian Institute of Health and Welfare, Canberra.

Beasley, R., Semprini, A. and Mitchell, E. 2015, Risk Factors for Asthma: Is Prevention Possible?, The Lancet, vol 386, no 9998, pp.1075-1085,.

Boulet, L., Vervloet, D., Magar, Y. and Foster, J. 2012, Adherence, Clinics in Chest Medicine, vol 33, no 3, pp.405-417.

Britto, M., Vockell, A., Munafo, J., Schoettker, P., Wimberg, J., Pruett, R., Yi, M. and Byczkowski, T. 2014, Improving Outcomes for Underserved Adolescents with Asthma, PEDIATRICS, vol 133, no 2, pp.e418-e427.

Fraser, J., Waters, D., Forster, E. and Brown, N. 2017, Paediatric Nursing in Australia, 2nd edn, Cambridge University Press, Port Melbourne.

Kelly, R., Stoll, S., Bryant-Stephens, T., Janevic, M., Lara, M., Ohadike, Y., Persky, V., Ramos-Valencia, G., Uyeda, K. and Malveaux, F. 2015, The Influence of Setting on Care Coordination for Childhood Asthma, Health Promotion Practice, vol 16, no 6, pp.867-877.

Ministry of Health, NSW 2012, Infants and Children – Acute Management of Asthma, Ministry of Health, NSW, Sydney.

Mosnaim, G., Li, H., Martin, M., Richardson, D., Belice, P., Avery, E., Ryan, N., Bender, B. and Powell, L. 2013, The Impact of Peer Support and mp3 Messaging on Adherence to Inhaled Corticosteroids in Minority Adolescents with Asthma: A Randomized, Controlled Trial, The Journal of Allergy and Clinical Immunology: In Practice, vol 1, no 5, pp.485-493.

Rodriguez, E., Rivera, D., Perlroth, D., Becker, E., Wang, N. and Landau, M. 2013, School Nurses’ Role in Asthma Management, School Absenteeism, and Cost Savings: A Demonstration Project, Journal of School Health, vol 83, no 12, pp.842-850.

Sears, M. 2014, Trends in the Prevalence of Asthma, Chest, vol 145, no 2, pp.219-225.

Srof, B., Taboas, P. and Velsor-Friedrich, B. 2012, Adolescent Asthma Education Programs for Teens: Review and Summary, Journal of Paediatric Health Care, vol 26, no 6, pp.418-426.

Westergaard, C., Porsbjerg, C. and Backer, V. 2014, The effect of smoking cessation on airway inflammation in young asthma patients, Clinical & Experimental Allergy, vol 44, no 3, pp.353-361,.

Western NSW Local Health District 2018, WNSWLHD | Chronic Care, viewed 25 April 2018, <>.