Asthma is a common chronic respiratory disease, which can develop at any stage of life, but most commonly develops in early childhood. According to WHO, Asthma is a disease categorized by persistent attacks of breathing difficulty and wheezing, which differs in severity and frequency from person to person. The number of people with asthma in the world could be as high as three hundred and thirty four million. This figure comes from the comprehensive analysis of the Global Burden of Disease study (GBD), undertaken in 2008-2010. As per WHO, two hundred and thirty-five million people now suffer from asthma globally.Asthma has become the most common chronic disease amongst children and is one of the key reasons of hospitalization among children. Understanding asthma pathophysiology is essential for all medical personnel’s as it helps understand how the condition is diagnosed and treated. Kileen and Skora 2013, explains asthma as a chronic inflammatory disorder that is categorized by three distinct responses: airway hyper-responsiveness and airway remodeling in response to a host of triggers that affect only those who are predisposed to the disease. A normal lung has alveoli where oxygen passes into the bloodstream and small amount of mucous lines the airways while the lung during an asthma attack, mucous secretions rises triggering further narrowing of some of the smaller airway causing in reduction in air to alveoli. A study conducted by (Barners, 1996, p.4) enlightens that the airway vessels and mucous glycoproteins secreted from the surface epithelial cells. Therefore, the airway wall is edematous and infiltrated with inflammatory cells, which are mostly eosinophil and lymphocytes (helps in inflammatory process). Then the airway epithelium sheds a patchy manner and dumps of epithelial cells which are found in the airway lumen. When an individual has asthma, the passages from the nose to the lungs (the airways) are very sensitive and become narrow, causing difficulty in breathing. Asthma symptoms differ from person to person. Some of the signs and symptoms of asthma include frequent episodes of wheezing, chest tightness, cough and shortness of breath. These symptoms are habitually worse at night and early in the morning. In addition cough is one of the indications of asthma. It is a common and often ignored symptom of asthma. The way children react to diagnosis with chronic illness depends on several factors, including child’s development stage. Lifecycle is a series of phases each individual must pass through each stage the way a person grips each of these phases affects the person’s individuality and self-concept. There are child developmental theories which focus on explaining how children change and grow over the course of childhood. Such theories center on various aspects of development counting social, emotional and cognitive growth. Theories help people organize their ideas about raising children. Understand influences on parenting, determine more than one way to interrelate with children and analyze the benefits and consequences of using more than one theory. The three fields of developmental concepts are physical domain, cognitive domain, and social/ emotional domain. Some of the concerns influencing growth and development are genetics, environment, culture, nutrition, health status, family, parental insolences, child-rearing philosophies. Piaget’s cognitive theory is concerned with development of thought process as children think in differently than adults. Erickson’s explains psychosocial development defines growth and change throughout life, focusing on social interactions and conflicts that arise during different stages of development as for Mathew he is not able to socialize due to his illness especially with his friends and other siblings. Sigmund Freud explains whatever the patients go through in mental illness is from their childhood experience. Whatever Mathew is going through now can distract his psychological status in future. The experience of hospitalization exerts a great deal of psychological distress, causing disruption in one’s routine. When a child is scared or in pain, they need a safe and stable environment of their home and support and love of their family in order to be able to cope and feel strengthen and hospitalization makes a child away from home environment. While growing up, children’s greatly reliant on their parents for everyday functioning and well-being, and when they get ill, they require their families care more than ever.A child’s sleeping pattern is disturbed as hospital is not a proper accommodation; environmental change has a great impact on human mind. They lose their personal serenity, sharing room with someone without pleasure. Furthermore, children who live with pain and physical restrictions can be more likely to have problems concerning to their peers. Children born to poverty are more expected to experience a wide series of health problems. Poverty puts additional anxieties on families, which can lead to relationship and financial problems. Reflecting to Mathew’s case, he has asthma which requires frequent admissions and visits to the hospital. His mother is single parent with two other older siblings and resides in a squatter settlement Mathew’s frequent admissions and visits to the hospital would be a traumatic experience for both Mathew and his family. Mathew’s mother and his other siblings may experience anger, sadness, fear, anxiety and depressed mood. Mathew’s mother’s anger and depression can be related to financial issues as she is a single mum and the only source of income is selling doormats, which she is not able to do during hospitalization of Mathew. Mathew receives more attention from the mother, leaving other siblings in worry, jealous, sadness and loneliness.Asthma affects the whole family; they can struggle to stabilize caring for the child with work and other family commitments. The other older siblings have to play other family roles in the absence of their mother. Mathew will be going through social rejection from friends as his physical activities is restricted, this can be extreme and can often challenge the child’s drive to achievement to feeling of unacceptably different from the others, making Mathew sense guilty at the presence of his chronic illness. Social and psychological circumstances can cause long-term stress affecting Mathew’s childhood as well as adulthood. Frequent hospitalization may make Mathew feel removed from his family environment. Mathews illness may impose burden on his mother and other siblings. Overcrowding is a major factor contributing/triggering respiratory problem such as asthma, especially overcrowded place like squatter settlement which has a higher rate of pollution.Family is the main base of support, and is considered the principal social unit. In Mathew’s case, his mother is the primary caregiver leading to emotional overload. At this point of time the nurse should be reassuring and keeping them updated on Mathew’s treatment and progress Mathew can perform physical activities according to his condition &capabilities, give praise for his success.Nurse can also provide positive feedback to reaffirm a parent’s assurance in her parental role. A nurse can always share parent’s problems, by providing encouragement when essential, and take responsibility when needed for e.g. sending home a tired parent to rest and spend time with other children at home. Allow family time (visitation) in hospital, the nurse can give visiting hours for Mathews other older siblings and his friends and plan for some physical activities. Present an environment favorable to the child, reassuring and calm. A nurse should build a trusting relationship with Mathew and his family. In addition, the nurse can seek government financial (social welfare) aid to support Mathew and his family meet the demands imposed on Mathew’s illness. We all see asthma is an incurable disease, but still number of approaches can support in controlling the illness. Life of a patient can be enhanced expressively through proper management asthma. Firstly, nursing management goal is, to maintain an effective breathing airway, the patient’s airway should be patent and free of secretions. This can be done by encouraging deep coughing/breathing, airway management by maintaining the airway through suction. Assist patient to take up position of ease e.g. elevate head of bed, encourage patient to lean on over bed table or sit on the edge of the bed under parent’s supervision. Encourage client to practice pursed-lip breathing for breathing out, pursed lip breathing improves breathing pattern by moving old air out of the lungs and allowing for new air to enter the lungs. Secondly, Family coping potential, the nurse should encourage coping potential for growth related to improve control of asthma with daily therapeutic care. Nurse should listen to the families concerns about asthma management and respond with information to correct any misconception. Educate the parents on danger signs so that they can express greater confidence in averting and managing their child’s asthma. Assess available resources and coping skills of the family, to promote quick recognition of interpersonal problems, mainly within the parent- child relationship. Explain to child/family the potential gains of hypo sensitization therapy where allergies cannot be evaded, as appropriate. To avoid possible asthma exacerbation when allergen induced. Strengthen on actions to avoid infections such as good hand washing, and avoiding crowds, to prevention of infection may minimize asthma exacerbations. Educate the parents on danger signs so that they can express more self-confidence in avoiding and handling their child’s asthma.Thirdly, Deficient / absence of knowledge. This is where nurse get in the way of offering patient and family education as a way of providing care to get the best outcomes for their patients. Nurses can plan counselling sessions for both the patient and his family members. Impart the client and parent ways to avoid asthma triggers e.g. smoke, air pollution and allergens to prevent situations that will exaggerate the condition. Environmental triggers control can lessen the occurrence of asthma attack and progress the client’s quality of life. Teach parents the techniques for using inhaled asthma medications as well as for sustaining the inhaler device. Include physiotherapist in the care. Encourage patients to use an asthma dairy to keep asthma under control and to help reduce the number of exacerbation. Evaluate self-care activities for preventive care and home controlling of an acute attack. Reinforce what to do in an asthma attack (home management and prevention and when to seek out urgent hospitalization); this information assists the client to take control and reduce life-threatening problems. With suitable education, psychological factors such as low self-esteem, isolation and anxiety can also be coped. Assess available resources and coping skills of the family, to encourage early recognition of interpersonal problems, principally within the parent -child relationship. Explain to child/family the potential gains of hypo sensitization therapy where allergies cannot be avoided, as appropriate. To avoid possible asthma exacerbation when allergen induced. Reinforce procedures to avoid infections such as good hand washing, and avoiding crowds, this may lower asthma exacerbations. Educate the parents on danger signs so that they can express greater confidence in avoiding and managing their child’s asthma. Encourage fluid intake as fluids aids in reducing mucosal drying and increases ciliary action to eliminate secretion. Fourthly, Activity Intolerance, nurse should enlighten the importance of rest in the treatment plan and need for balancing activities with rest, this will avoid excessive fatigue. The child and parents should work in partnership with the nurses, family centered care. The nurse should provide nursing energy management defining the cause of patient’s fatigue, to avoid change in respiratory status due to excessive activity. Involve physiotherapist in the care by educating practices which can assist children with difficult asthma comprise breathing pattern retraining, airway clearance, exercise and fitness, relaxation and anxiety management techniques, chronic cough management, postural exercise and self-management. Physiotherapy–led breathing exercise programs can be used together with drug treatments to advance the quality of lifeIn summary, childhood asthma is common issue in Fiji. The prevalence rate of childhood asthma is quite high globally and locally in children these days. Hospital admissions for asthma is an indicator for improvements in the asthma care. It is very important for one to understand the pathophysiology, signs and symptoms, treatment and diagnosis of asthma in order to prevent it. The most major part is the risk factors that generate asthma are genetic and environmental. As nurses, we play a major role in the prevention of asthma by investigating, educating and advocating. The aim of asthma management is to take control of the disease. An asthma attack can be deadly if not managed properly.
Table of Contents