Poor self-management can harm your asthma patient
Poor self-management can harm your asthma patient
An asthma patient was told frequently by ED nurses at St. Vincent's HealthCare in Jacksonville, FL, that his condition was cold-induced.
"His job was in a warehouse that was a freezer for food items. He made frequent visits due to his work environment, until he finally realized he had to make a career change," says Diane Fox, RN, BSN, CEN, clinical resource coordinator for the ED.
If you assumed that your long-time asthma patient doesn't need specific instructions about self-management of their condition, you might be wrong. In fact, low-income, minority patients often use alternative therapies instead of medications, which can result in acute exacerbations necessitating an ED visit, according to a new study.1
When researchers interviewed 25 urban, low-income asthma patients, they found that only one had received asthma self-management training. Only 10 used short-acting beta2-agonists, and none used a peak flow meter or an asthma action plan. In fact, most (52%) chose to initially treat acute asthma with complementary and alternative medicine, due to a belief that this approach was safer than traditional medication.
Even adults with a long-standing history of asthma likely don't correctly assess or manage their condition at home, warns Maureen George, PhD, RN, the study's lead author and an assistant professor at the University of Pennsylvania School of Nursing in Philadelphia. "Specifically, they may not have a peak flow meter, asthma action plan, or knowledge of how to perform repetitive albuterol dosing," says George. "This can mean delays in conventional medical care, underuse of albuterol in acute asthma, and poor differentiation of milder vs. more severe asthma symptoms."
At St. Vincent's, ED nurses review detailed, printed instructions with every asthma patient. The instructions include what asthma is, what to do, what not to do, when to return if symptoms increase, and follow-up care. Nurses make sure that when an inhaler is prescribed, the patient knows how to use it. "We call the respiratory therapists and have them teach the patient the correct method of use," says Fox.
Reference
- George M, Campbell J, Rand C. Self-management of acute asthma among low-income urban adults. J Asthma 2009; 46:618-624.
Tell asthma patients this to avoid tragedy Diane Fox, RN, BSN, CEN, clinical resource coordinator for the ED at St. Vincent's HealthCare, Jacksonville, FL, often sees asthma patients who overuse their inhalers. "We used to see patients using over-the-counter inhalers. That is not common anymore, but they do have a tendency to overuse prescribed inhalers when having an attack," says Fox. Fox also sees patients with asthma is triggered by pet dander who refuse to give up their pets, and children whose asthma is triggered by cigarette smoke whose parents refuse to quit. "The patients that are at risk for poor management are the ones that do not continue with follow-up care," says Fox. "This is due to many reasons — the main one being no health insurance and lack of funds. These patients tend to use the ED for their primary care." However, even patients who are financially secure and educated mighty not adhere to good self-management practices. Fox recalls a man in his 30s who was brought to the ED by ambulance after failing to receive any relief from his inhaler all night. "His wife finally convinced him to call rescue. When he arrived, he was cyanotic and was in bronchospasm. We were unable to intubate, and he died shortly after arrival despite all our efforts," says Fox. "This patient was a college-educated professional who was under the care of a primary physician for his asthma." For every asthma patient, ED nurses emphasize the importance of obtaining follow-up care with a primary care physician. If the patient is financially unable to do this, a referral is made to a clinic. "Make the patient realize that this is not going to go away, and that they do need to be followed," says Fox. "Emphasize that the patient should not wait until they are in status asthmaticus or severe distress before seeking treatment." |
Avoid dangerous side effects of epinephrine Giving epinephrine to adult asthma patient can increase the heart rate and cause an elevated blood pressure, warns Diane Fox, RN, BSN, CEN, clinical resource coordinator for the ED at St. Vincent's HealthCare in Jacksonville, FL. "Since most asthma patients are usually already tachycardic and can be hypertensive, this is a problem," she says. Instead, on occasion, ED nurses might have to give racemic epinephrine to adults, which previously was administered only to pediatric patients. Racemic epinephrine in a nebulizer can cause tachycardia, but not as severely as the injectible, says Fox. It is most likely to be given if albuterol and atrovent nebulizer treatments are ineffective and the patient already has received a steroid and magnesium. "Racemic epinephrine is used mainly for children with stridor or croup for the constricting properties, but it can be used for the lower airway edema and act as a dialator on smooth muscle," she explains. |
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