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Nurse 6500 Power Point Project a Plan to Improve Asthma Care
- 1. Barbara Mc Donagh RN BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 2. OBJECTIVES ASTHMA OVERVIEW ASTHMA STATISTICS PURPOSE OF PEAK FLOW MONITORING SIGNS & SYMPTOMS OF EXACERBATION ASTHMA ACTION PLAN ASTHMA MEDICATIONS BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 3. PURPOSE IMPROVE ASTHMA CARE PROMOTE SELF-MANAGEMENT FOSTER TEAM-BASED PARTNERSHIP EMERGENCY ROOM VISITS FRAGMENTED CARE BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 4. ASTHMA CHRONIC DISEASE AIRWAY INFLAMMATION INTERMITTENT AIRFLOW OBSTRUCTION BRONCHIAL HYPERRESPONSIVENESS BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 5. ASTHMA STATISTICS (CDC,2012) 24 MILLION PEOPLE MOST COMMON CHRONIC DISEASE IN CHILDHOOD 1.9 MILLION EMERGENCY VISITS 475,000 HOSPITALIZATIONS $56 BILLION BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 6. PATIENT POPULATION AFFECTED (CDC, 2012) MORE BOYS THAN GIRLS MORE WOMEN THAN MEN WOMEN ACCOUNT FOR 2/3 OF ALL DEATHS DUE TO ASTHMA AFRICAN AMERICAN & HISPANIC LOWER SOCIO-ECONOMIC BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 7. PATIENT POPULATION AFFECTED (CDC,2012) AFRICAN AMERICAN WOMEN HAVE HIGHEST MORTALITY RATE 3,388 PEOPLE DIED FROM ASTHMA AFRICAN AMERICANS ARE 2-3 TIMES MORE LIKELY TO DIE FROM ASTHMA BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 8. BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 9. ETHIOLOGY & RISK FACTORS FAMILY HISTORY ENVIRONMENTAL ALLERGENS VIRAL EXPOSURE ECZEMA/ ATOPIC DERMATITIS OBESITY BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 10. SIGNS & SYMPTOMS EXACERBATION WHEEZING COUGHING SHORTNESS OF BREATH CHEST TIGHTNESS/PAIN BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 11. ASTHMA TRIGGERS BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 12. ASTHMA EXACERBATION TRIGGERS ALLERGENS/IRRITANTS TOBACCO SMOKE URI’s AIR POLLUTION EXERCISE OCCUPATIONAL HAZARDS SINUSITIS DRUG USE BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 13. ASTHMA CLASSIFICATION (NHLBI,2007) INTERMITTENT 2 DAYS/WEEK 2NIGHTS/MONTH MILD PERSISTENT >2 DAYS/WEEK 3-4NIGHTS/MONTH MODERATE PERSISTENT DAILY/> 1NIGHT/WEEK SEVERE PERSISTENT SEVERAL TIMES/DAY & 7 NIGHTS/WEEK BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 14. GOAL OF ASTHMA CARE CONTROL Symptoms ≤ 2Days/Week Nighttime ≤ 2 x/Month Albuterol Use ≤ 2 Days/Week Peak Flow ≥ 80% Personal Best Perform Daily Activities BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 15. PEAK EXPIRATORY FLOW (PEF) DECREASE IN NUMBER BEFORE WORSENING SYMPTOMS OBJECTIVE DATA ON ASTHMA CONTROL POOR PERCEPTION OF SYMPTOMS DETERMINE EFFECTIVENESS OF ASTHMA MANAGEMENT/TREATMENT PLAN BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 16. Peak Expiratory Flow (PEF) MONITOR PEAK FLOW OVER 2 WEEKS TO DETERMINE ‘PERSONAL BEST’ PERFORM STANDING RECORD HIGHEST OF 3 READINGS NORMAL PEAK FLOW CAN VARY UP TO 20% BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 17. PEAK EXPIRATORY FLOW Personal Best = 300 Green Zone 80%-100% No Symptoms Yellow Zone 51%-79% Symptoms 2-3 days Red Zone < 50% NO IMPROVEMENT = 240 - 300 = 150 – 240 Rescue Inhaler 4-6hrs Start Prednisone Tabs ED if no Improvement <150 Continue Above Worse go to ED/9-1-1 LIFE THREATENINGBARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 18. ASTHMA ACTION PLAN Provider & Patient WRITTEN PLAN THAT ADDRESSES: Daily Inhalers & Medications Avoid Triggers – Molds/Animals What to do When Asthma Symptoms Get Worse / Peak Flow Decreases Increase ICS Start Prednisone Burst Seek Emergency Care BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 19. BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 20. MEDICATIONS RESCUE/RELIEF Albuterol Proventil Ventolin ProAir CONTROLLER Qvar Symbicort Spiriva Serevent Pulmicort Xolair Inj BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 21. CONTROLLER MEDICATIONS QVAR Inhaled Corticosteroid (ICS) SEREVENT DISKUS Long- Acting Beta Bronchodilator SYMBICORT Combination Inhaler SPIRIVA Long-Acting AntiChol Brochodilator BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 22. ASTHMA PATIENT SELF-MANAGEMENT Barriers Cultural/Language/Literacy Rescue V Controller Taking Inhalers as Prescribed Bid Using Aerochamber Peak Flow Monitoring Asthma Action Plan Avoid/Minimize Allergen Triggers BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 23. ASTHMA PATIENT CLINIC VISIT Recent ED Visits Prednisone Use Increased Asthma Symptoms Increased Proventil Use Smoking / Asthma Triggers Influenza & Pneumonia Vaccines BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 24. CARE MANAGEMENT BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 25. REFERRAL TO ASTHMA SPECIALTY AEROALLERGEN SKIN TEST SPIROMETRY ADMINISTER XOLAIR INJECTIONS >2 ED VISITS/YEAR / INTUBATIONS ADDITIONAL TEACHING BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 26. ED VISITS OVER PAST YEAR ANY ADMISSIONS ANY INTUBATIONS PREDNISONE USE BURST/DAILY USE CURRENT SYMPTOMS –COUGHING- DAYTIME OR NIGHTIME/WHEEZING/ SOB/CHEST TIGHTNESS/PAIN MEDICATIONS - CONTROLLER/ RESCUE KNOWS DIFFERENCE USES INHALERS AS PRESCRIBED MONITORS PEAK FLOW KNOWS ASTHMA TRIGGERS USES SPACER BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 27. ADDITIONAL ASTHMA RESOURCES Asthma Action Plans www.nhlbi.nih.gov/health/public/lung/asthma/asthma_ actplan.htm Asthma Care Evidence-Based Guidelines www.nhlbi.nih.gov/guidelines/archives/epr- 2/athmafullrpt_archive.pdf BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 28. ADDITIONAL ASTHMA RESOURCES Peak Flow Monitoring & Self-Management www.lung.org/lung-disease/asthma/taking -control-of- asthma/create-an-asthma-management-plan.html Free Asthma Educational Handouts www.cdc.gov/asthma/faqs.html BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
- 29. REFERENCES CDC. (2012). Asthma's Impact on the Nation. Retrieved from http://www.cdc.gov/asthma/impacts_ nation/default.htm NHLBI. (2007). Guidelines for the Diagnosis and Management of Asthma (EPR-3). Retrieved from https://www.nhlbi.nih.gov/guidelines/ asthma/ BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
Editor's Notes
- WORK IN ASTHMA CLINIC PROVIDE CARE TO PEDS & ADULTS QUESTIONS MAY ASTHMA MONTH INFORMATION ADAPTED FROM THE ASTHMA CARE GUIDELINES
- THIS WILL BE HELPFUL IN COMPLETING YOUR CARE MANAGEMENT FORM ON ASTHMA PATIENT IN MEDICAL HOME NETWORK
- RESULTS IN FRAGMENTED CARE FACILTATE THE PATIENT CENTERED MODEL OF CARE CARE COORDINATION
- INFLAMMATION INCREASED OF SWELLING AIRWAYS AND INCREASED MUCUS PRODUCTION SUPER SENSITIVE TO IRRITANTS/CHEMICALS/ALLERGENS
- DATA GATHERED IN 2009
- OUR PATIENT POPULATION THE PATIENTS WE CARE FOR
- THEREFORE WE NEED TO TEACH AND CONNECT WITH OUR ASTHMA PATIENTS
- PARENT WITH ASTHMA YOU MORE LIKELY TO DEVELOP INCREASE RISK OF ASTHMA DUST MITES & MOLDS VIRAL - RSV RHINOVIRUS IN CHILDHOOD INCREASE RISK OF ASTHMA SMOKE / AIR POLLUTION
- ESPECIALLY NIGHTTIME COUGHING OR EARLY MORNING WAKES PATIENT UP CAN’T SLEEP
- CLEANERS EXPOSED TO CHEMICALS SNORTING HEROIN ASSOCIATED WITH LIFE THREATENING ASTHMA ATTACKS
- CLASSIFICATION DONE UPON INITIAL DX OUR PATIENT POPULATION SICKER FALL INTO THE MODERATE & SEVERE PERSISTENT CATEGORY LIKE OTHER CHRONIC DISEASES THAT COUNTY PATIENTS HAVE
- NOT MISS WORK OR SCHOOL TEACH PATIENTS HOW TO MONITOR THEIR SYMPTOMS & PEAK FLOW
- DURING ASTHMA FLARE UP THE LARGE AIRWAYS SLOWLY BEGIN TO NARROW. DON’T REALIZE HOW SICK THEY ARE MEDS WORK = PEAK FLOW BETTER ASSESS PATIENTS CONTROL
- PEAK FLOWS AVAILABLE FROM MATERIAL MANAGEMENT/ MOUTH PIECES GUIDELINES RECOMMEND PEAK FLOW MONITORING FOR PATIENTS WITH MODERATE/SEVERE PERSISTENT ASTHMA HX SEVERE EXACERBATIONS PEAK FLOW DIARY FORMS AVAILABLE FROM MS HARPER/ FORMS
- OUR PATIENT POPULATION NO IMPROVEMENT GO TO ED
- MEDICATIONS ALLERGY MEDICATIONS/ NASAL SPRAYS/ GERD MEDICATIONS WHEN TO STEP UP TREATMENT /MEDS
- TEACH DIFFERENCE TAKE CONTROLLER WON’T NEED TO USE ALBUTEROL MINIMAL ABSORPTION OF ICS COMPARED TO BEING SICK AND TAKING ORAL PREDNISONE PULMICORT INFANTS & PREGNANT WOMEN
- ICS PREFERRED TREATMENT
- IF OK WITH PATIENT INCLUDE FAMILY IN TEACHING KNOWS HOW TO USE INHALERS EFFECETIVELY
- SMOKING CESSATION THE MORE HEALTHCARE MEMBERS ENCOURAGE PATIENT TO QUIT MORE LIKELY TO QUIT/ HAVE NICOTINE GUM/PATCHES DO THEY KNOW THEIR ASTHMA TRIGGERS ALLERGIES =MOLDS / DUST MITES
- COLLABORATE & COORDINATE CARE REFERRAL TO ASTHMA CLINIC
- Allergies to dust/molds/seasonal Spirometry = Objective Measure to establish Dx of Asthma Xolair = Allergic Asthma Check IgE levels SUBQ BASED ON IGE LEVEL AND MAXED OUT ON INHALERS & MEDS
- GIVE TO STAFF AS TEACHING TOOL/HANDOUT WILL INCLUDE ASTHMA RESOURCES
- These resources are part of your asthma care handout