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A PLAN TO IMPROVE ASTHMA CARE
Barbara Mc Donagh RN WORK IN ASTHMA CLINIC PROVIDE CARE TO PEDS & ADULTS QUESTIONS MAY ASTHMA MONTH INFORMATION ADAPTED FROM THE ASTHMA CARE GUIDELINES BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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OBJECTIVES ASTHMA OVERVIEW ASTHMA STATISTICS
PURPOSE OF PEAK FLOW MONITORING SIGNS & SYMPTOMS OF EXACERBATION ASTHMA ACTION PLAN ASTHMA MEDICATIONS THIS WILL BE HELPFUL IN COMPLETING YOUR CARE MANAGEMENT FORM ON ASTHMA PATIENT IN MEDICAL HOME NETWORK BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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PURPOSE IMPROVE ASTHMA CARE PROMOTE SELF-MANAGEMENT
FOSTER TEAM-BASED PARTNERSHIP EMERGENCY ROOM VISITS FRAGMENTED CARE RESULTS IN FRAGMENTED CARE FACILTATE THE PATIENT CENTERED MODEL OF CARE CARE COORDINATION BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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ASTHMA CHRONIC DISEASE AIRWAY INFLAMMATION
INTERMITTENT AIRFLOW OBSTRUCTION BRONCHIAL HYPERRESPONSIVENESS INFLAMMATION INCREASED OF SWELLING AIRWAYS AND INCREASED MUCUS PRODUCTION SUPER SENSITIVE TO IRRITANTS/CHEMICALS/ALLERGENS BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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ASTHMA STATISTICS (CDC,2012)
24 MILLION PEOPLE MOST COMMON CHRONIC DISEASE IN CHILDHOOD 1.9 MILLION EMERGENCY VISITS 475,000 HOSPITALIZATIONS $56 BILLION DATA GATHERED IN 2009 BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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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 OUR PATIENT POPULATION THE PATIENTS WE CARE FOR BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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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 THEREFORE WE NEED TO TEACH AND CONNECT WITH OUR ASTHMA PATIENTS BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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ETHIOLOGY & RISK FACTORS
FAMILY HISTORY ENVIRONMENTAL ALLERGENS VIRAL EXPOSURE ECZEMA/ ATOPIC DERMATITIS OBESITY 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 BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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SIGNS & SYMPTOMS EXACERBATION
WHEEZING COUGHING SHORTNESS OF BREATH CHEST TIGHTNESS/PAIN ESPECIALLY NIGHTTIME COUGHING OR EARLY MORNING WAKES PATIENT UP CAN’T SLEEP BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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ASTHMA TRIGGERS BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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ASTHMA EXACERBATION TRIGGERS
ALLERGENS/IRRITANTS TOBACCO SMOKE URI’s AIR POLLUTION EXERCISE OCCUPATIONAL HAZARDS SINUSITIS DRUG USE CLEANERS EXPOSED TO CHEMICALS SNORTING HEROIN ASSOCIATED WITH LIFE THREATENING ASTHMA ATTACKS BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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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 CLASSIFICATION DONE UPON INITIAL DX OUR PATIENT POPULATION SICKER FALL INTO THE MODERATE & SEVERE PERSISTENT CATEGORY LIKE OTHER CHRONIC DISEASES THAT COUNTY PATIENTS HAVE BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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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 NOT MISS WORK OR SCHOOL TEACH PATIENTS HOW TO MONITOR THEIR SYMPTOMS & PEAK FLOW BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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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 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 BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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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% 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 BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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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 = = 150 – 240 Rescue Inhaler 4-6hrs Start Prednisone Tabs ED if no Improvement <150 Continue Above Worse go to ED/9-1-1 LIFE THREATENING OUR PATIENT POPULATION NO IMPROVEMENT GO TO ED BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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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 MEDICATIONS ALLERGY MEDICATIONS/ NASAL SPRAYS/ GERD MEDICATIONS WHEN TO STEP UP TREATMENT /MEDS BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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MEDICATIONS RESCUE/RELIEF CONTROLLER Albuterol Qvar Proventil
Symbicort Ventolin Spiriva ProAir Serevent Pulmicort Xolair Inj 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 BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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CONTROLLER MEDICATIONS
QVAR Inhaled Corticosteroid (ICS) SEREVENT DISKUS Long- Acting Beta Bronchodilator SYMBICORT Combination Inhaler SPIRIVA Long-Acting AntiChol Brochodilator ICS PREFERRED TREATMENT BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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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 IF OK WITH PATIENT INCLUDE FAMILY IN TEACHING KNOWS HOW TO USE INHALERS EFFECETIVELY BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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ASTHMA PATIENT CLINIC VISIT
Recent ED Visits Prednisone Use Increased Asthma Symptoms Increased Proventil Use Smoking / Asthma Triggers Influenza & Pneumonia Vaccines 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 BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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CARE MANAGEMENT COLLABORATE & COORDINATE CARE
REFERRAL TO ASTHMA CLINIC BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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REFERRAL TO ASTHMA SPECIALTY
AEROALLERGEN SKIN TEST SPIROMETRY ADMINISTER XOLAIR INJECTIONS >2 ED VISITS/YEAR / INTUBATIONS ADDITIONAL TEACHING 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 BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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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 GIVE TO STAFF AS TEACHING TOOL/HANDOUT WILL INCLUDE ASTHMA RESOURCES BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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ADDITIONAL ASTHMA RESOURCES
Asthma Action Plans Asthma Care Evidence-Based Guidelines BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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ADDITIONAL ASTHMA RESOURCES
Peak Flow Monitoring & Self-Management -control-of-asthma/create-an-asthma-management-plan.html Free Asthma Educational Handouts These resources are part of your asthma care handout BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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REFERENCES CDC. (2012). Asthma's Impact on the Nation. Retrieved from NHLBI. (2007). Guidelines for the Diagnosis and Management of Asthma (EPR-3). Retrieved from BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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