Assignment: Asthma and Stepwise Management ppt Essay

Long-term asthma management

ICS – anti-inflammatory, blocks late reaction to allergen, reduce airway sensitivity.
Inhibit cytokine production, adhesion protein activation, inflammatory cell migration and activation at cellular level.
Reverse beta2-receptor down-regulation. Inhibit microvascular leakage.
Side effects- oropharyngeal candidiasis, delayed growth in children (Heffle, et al., 2018).
Oral corticosteroids- works the same as inhaled corticosteroids.
Short-term use- reversible abnormalities in sugar metabolism, mood changes, hypertension, rare aseptic necrosis of femur.
Long-term use- systemic effects

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Inhaled and oral corticosteroids have the same mechanism of action. They are both anti-inflammatory medications which act by inhibiting cytokine production, activation of adhesion protein, inflammatory cell migration and activation at the cellular level. They also reverse beta2-receptor down-regulation and inhibit microvascular leakage. Oral corticosteroids may cause short-term and long term side effects. The long-term effects are systemic and may include growth suppression, dermal thinning, hypertension, muscle weakness, and impaired immune function. Assignment: Asthma and Stepwise Management ppt Essay

Long-term Treatment
LABAs- work slowly and lasts longer than SABAs (Boulet, et al., 2019).
Cause bronchodilation by relaxing bronchial smooth muscle, increases cyclic AMP producing functional antagonism of bronchoconstriction (Lenney, et al., 2018).
LABAS can increase heart rate, tremors, hypokalaemia.
A reduced Broncho protective effect may occur 1 week after chronic therapy (Ramsahai, et al., 2018).
Leukotriene modifiers – LTRAs and 5-lipoxygenase inhibitor. Block synthesis of all leukotrienes at the cellular level.
May elevate liver enzymes, thus monitoring is recommended (Zahran, et al., 2017).
LRTAs +ICSs – used as adjunctive therapy for >12 years .
Immunomodulators – adjunctive therapy for >12 years.

The long-term medications for asthma control are taken on daily basis to achieve and maintain control of persistent asthma. Leukotriene receptor antagonists (LTRAs) is for patients aged more than one while 5-lipoxygenase pathway inhibitors are used for more than 12 years. Long-acting beta-agonists such as salmeterol and formoterol act as bronchodilators for at least 12 hours after a single-dose. LABAS cannot be used as monotherapy due to short duration of acting.

Short-Term management – Assignment: Asthma and Stepwise Management ppt Essay

Quick-relieve inhalers – fast acting bronchodilators e.g albuterol.
Provide short-term relieve of symptoms –rescue inhalers
Act by opening inflamed airways and relieving asthma symptoms.
Short-acting Beta-agonists- most common quick relieve drugs for asthma attacks.
Oral steroids – for frequent attacks, not quick-relief medications.

Asthma quick-relief drugs are used for fast control of asthma attacks. Also called rescue drugs. They can be used before exercise to dilate and relax muscles of the airways. Short-acting Beta-agonists are the most common quick relievers for asthma attacks. They include albuterol, levalbuterol, metaproterenol, and terutaline. Oral steroids can also be administered although not for quick relieve. They are given 7 to 14 days during symptom flare-ups.

Quick-relievers –Assignment: Asthma and Stepwise Management ppt Essay

Short-acting beta-agonists act as bronchodilators – relax airway muscles within 5 minutes.
Increase airflow and make breathing easier.
Relieve symptoms within 3-6 hours.
Pharmacologically predictable dose-related and potency related adverse effects.
Cause tachycardia and tremors.
The potential for arrhythmia increases with comorbidity and hypoxemia (Lenney, et al., 2018).
Non-pharmacologic predictable side effects – non-specific and specific stimuli.
Increased airway inflammation. Assignment: Asthma and Stepwise Management ppt Essay

SABAs are bronchodilators which relax the airway muscles within 5 minutes and relieve asthma symptoms within 3 to 6 hours. Research shows pharmacologically predictable dose-related and potency related adverse effects of SABAs including tachycardia, tremors, and effects on potassium and glucose levels. However, the effects resolve with increased exposure to the medications. Also, there is potential for arrhythmia in comorbidity and hypoxemia. Non-pharmacologically predictable effects include nonspecific and specific stimuli including allergen and exercise, and increased airway inflammation.

Importance of Step-wise management – Assignment: Asthma and Stepwise Management ppt Essay

Prevent recurrent asthma exacerbations.
Prevent progressive loss of lung function.
Provide optimal pharmacotherapy with minimal or no adverse effects.
Reduce ED visits and hospitalization (Bernstein & Mansfield, 2019).
Providers and patients gain and maintain control of asthma.
Providers use the approach to complement decision making in meeting patient needs.
Alternative treatment in unresponsive cases available.
Effective control and management of asthma for both patients and providers.

The step-wise approach to asthma management helps patients and providers to gain and maintain asthma control. It helps prevent recurrent asthma exacerbation , improve lung function, and improve the quality of life. The approach does not replace decision-making in asthma management but is used by providers as an alternative in decision-making regarding meeting patient’s individual needs. Alternative treatment are used in unresponsive cases . Alternatives therapies can be discontinued and the preferred treatment used before stepping up. The step-wise approach helps providers and patients control and manage asthma effectively.

Step-wise management of ASTHMA

Step 1: ICS- formoterol+ SABA
Step 2: Low –dose ICS- formoterol or daily low-dose ICS + SABA
Step 3: Low-dose ICS long-acting agonist +SABA
Step 4: Medium dose ICS-LABA +SABA
Step 5: Higher dose ICS-LABA or refer to a pulmonologists.

References

Boulet, L. P., Reddel, H. K., Bateman, E., Pedersen, S., FitzGerald, J. M., & O’Byrne, P. M. (2019). The global initiative for asthma (GINA): 25 years later. European Respiratory Journal, 54(2).
Bernstein, J. A., & Mansfield, L. (2019). Step-up and step-down treatments for optimal asthma control in children and adolescents. Journal of Asthma, 56(7), 758-770.
Heffler, E., Madeira, L. N. G., Ferrando, M., Puggioni, F., Racca, F., Malvezzi, L., … &Canonica, G. W. (2018). Inhaled corticosteroids safety and adverse effects in patients with asthma. The Journal of Allergy and Clinical Immunology: In Practice, 6(3), 776-781.
Lenney, W., Bush, A., Fitzgerald, D. A., Fletcher, M., Ostrem, A., Pedersen, S., … & Zar, H. J. (2018). Improving the global diagnosis and management of asthma in children. Thorax, 73(7), 662-669.
Ramsahai, J. M., Hansbro, P. M., & Wark, P. A. (2019). Mechanisms and management of asthma exacerbations. American journal of respiratory and critical care medicine, 199(4), 423-432.
Zahran, H. S., Bailey, C. M., Qin, X., & Johnson, C. (2017). Long-term control medication use and asthma control status among children and adults with asthma. Journal of asthma, 54(10), 1065-10.

Assignment: Asthma and Stepwise Management

Asthma is a respiratory disorder that affects children and adults. Advanced practice nurses often provide treatment to patients with these disorders. Sometimes patients require immediate treatment, making it essential that you recognize and distinguish minor asthma symptoms from serious, life-threatening ones. Since symptoms and attacks are often induced by a trigger, advanced practice nurses must also help patients identify their triggers and recommend appropriate management options. Like many other disorders, there are various approaches to treating and managing care for asthmatic patients depending on individual patient factors. Assignment: Asthma and Stepwise Management ppt Essay

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One method that supports the clinical decision making of drug therapy plans for asthmatic patients is the stepwise approach, which you explore in this Assignment.

To Prepare

Reflect on drugs used to treat asthmatic patients, including long-term control and quick relief treatment options for patients. Think about the impact these drugs might have on patients, including adults and children.
Consider how you might apply the stepwise approach to address the health needs of a patient in your practice.
Reflect on how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.

By Day 7 of Week 3

Create a 5- to 6-slide PowerPoint presentation that can be used in a staff development meeting on presenting different approaches for implementing the stepwise approach for asthma treatment. Be sure to address the following:

Describe long-term control and quick relief treatment options for the asthma patient from your practice as well as the impact these drugs might have on your patient.
Explain the stepwise approach to asthma treatment and management for your patient.
Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Assignment: Asthma and Stepwise Management ppt Essay. Be specific.

Submission and Grading Information

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Click on the Submit button to complete your submission. Assignment: Asthma and Stepwise Management ppt Essay
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NURS_6521_Week3_Assignment_Rubric

	Excellent	Good	Fair	Poor
Describe the long-term control and quick relief treatment options for the asthma patient from your practice, as well as the impact these drugs might have on your patient.	27 (27%) – 30 (30%) The presentation clearly and accurately describes in detail the long-term control and quick relief treatment options for the asthma patient from their practice. The presentation clearly and accurately describes in detail the impact these drugs might have on their patient.	24 (24%) – 26 (26%) The presentation accurately describes the long-term control and quick relief options for the asthma patient from their practice. The presentation accurately describes the impact these drugs might have on their patient. Assignment: Asthma and Stepwise Management ppt Essay	21 (21%) – 23 (23%) The presentation inaccurately or vaguely describes the long-term control and quick relief options for the asthma patient from their practice. The presentation inaccurately or vaguely describes the impact these drugs might have on their patient.	0 (0%) – 20 (20%) The presentation inaccurately and vaguely describes the long-term and quick relief options for the asthma patient from their practice, or is missing. The presentation inaccurately and vaguely describes the impact these drugs might have on their patient, or is missing.
Explain the stepwise approach to asthma treatment and management for your patient.	27 (27%) – 30 (30%) The presentation clearly and accurately explains in detail the stepwise approach to asthma treatment and management for their patient.	24 (24%) – 26 (26%) The presentation accurately explains the stepwise approach to asthma treatment and management for their patient. Assignment: Asthma and Stepwise Management ppt Essay	21 (21%) – 23 (23%) The presentation inaccurately or vaguely explains the stepwise approach to asthma treatment and management for their patient.	0 (0%) – 20 (20%) The presentation inaccurately and vaguely explains the stepwise approach to asthma treatment and management for their patient.
Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.	27 (27%) – 30 (30%) The presentation clearly and accurately explains in detail how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. The presentation provides accurate and detailed examples to support the explanation provided.	24 (24%) – 26 (26%) The presentation accurately explains how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. The presentation provides accurate examples to support the explanation provided.	21 (21%) – 23 (23%) The presentation inaccurately or vaguely explains how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. The presentation provides inaccurate or vague examples to support the explanation provided.	0 (0%) – 20 (20%) The presentation inaccurately and vaguely explains how stepwise management assists health care providers and patients in gaining and maintaining control of the disease, or is missing. The presentation provides inaccurate and vague examples to support the explanation provided, or is missing.
Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.	5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity.	4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.	3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.	0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. Assignment: Asthma and Stepwise Management ppt Essay
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation	5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors	4 (4%) – 4 (4%) Contains a few (1–2) grammar, spelling, and punctuation errors Assignment: Asthma and Stepwise Management ppt Essay	3.5 (3.5%) – 3.5 (3.5%) Contains several (3–4) grammar, spelling, and punctuation errors	0 (0%) – 3 (3%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding

Assignment: Asthma and Stepwise Management ppt Essay