According to the Australian Institute of Health and Welfare the frequency of asthma among Australian children is one of the highest in the world. A national survey conducted in 2008 found that 20. 8% of people aged 0 to 15 years old were diagnosed with asthma, whilst 11. 3% were found to show current signs and symptoms of asthma amongst this age group. To gain a greater understanding of this problem this essay will critically evaluate a case study where Steven, a 15 year old Indigenous Australian male, has been presented to hospital with shortness of breath.
When conducting a health history check on Steven it was found that he has been diagnosed with having asthma and that he has been smoking for the past two years. In addition to this, Steven has told the nurse that he has not been compliant with his asthma medication and healthcare plan. To achieve a better healthcare outcome for Steven, this essay will discuss the pathophysiology of asthma and critically evaluate the nurse’s role in relation to Steven’s nursing care plan.
By discussing these topics in detail, it hoped that health care professionals will gain a greater understanding on how to treat adolescents who present with asthma in a hospital or healthcare setting. Asthma is a chronic inflammatory disorder which affects the lower airways by obstructing airflow through the lungs. This obstruction of the airways is the result of bronchospasm, mucous plugging, smooth muscle hypertrophy, inflammation and oedema of the airways. Symptoms associated with asthma include coughing, chest tightness, wheezing, and breathlessness which causes the person to increase their respiratory drive.
This increased effort to breathe can lead to hypoxia and hypercarbia due to gas trapping in the lungs. This can potentially lead to haemodynamic instability and respiratory arrest if not treated properly. Asthma triggers vary from person-to-person, however the most common causes of asthma are allergens, respiratory tract infections, air pollutants, smoking, cold air, and physical activity. To treat and relieve asthma related symptoms two key concepts must be noted; relieving bronchospasm with bronchodilators and reducing inflammation with steroid administration.
It is important to note that early administration of steroids is important due to it taking several hours to take effect. To understand Steven’s psychosocial development we will look at Erikson’s Theory. Erikson’s theory looked at stages of development by explaining how society, culture and conflict, influences a person’s thought process. According to Erikson, he believed that a person’s development is shaped by how well they resolved crisis that were social in nature.
Erikson’s theory suggested a lifespan model which outlines the personality and thought processing ability a person has at certain stages of their life. Due to Steven being 15 years old, according to Erikson’s theory his psychosocial stage is identity vs. role confusion. This stage starts at 12 to 18 years of age. It is believed that this is the most important stage in someone’s life as the person starts to understand where they fit in within society. In addition to this, this is when children start to become more independent as they begin to enter into adulthood.
During this stage of life, Erikson explains that people start to show more risky and rebellious behaviour. As seen in the case study, Steven has been smoking for the past two years, thereby proving Erikson’s theory. Steven is currently trying to fit in within his social structure, either with family or peers. Due to this reason, Steven is most likely influenced and enabled by his fellow family members or friends. As part of Steven’s healthcare plan, the nurse should talk to his family members and highlight the benefits of not smoking, especially around people who have asthma.
Smoking is known to trigger asthmatic symptoms which can lead to; more frequent attacks, lessen effect of asthmatic medication, and worsen the control the person has to relieve or stop symptoms. In addition to this, smoking can also lead to further inflammation and loss of lung function, thereby making it harder to reverse symptoms. Steven and his family should also be advised that adolescents in his age group are more prone to having severe reactions to smoke due to having narrower airways compared to adults.
Due to this reason, children who are exposed to smoking are more likely to develop chest infections which can increase the likelihood of experiencing an asthma attacks. It should also be advised that second hand smoke can also cause asthmatic attacks and has been known to have worse affects then actually smoking. The nurse should talk to Steven and his family to try and persuade them to stop smoking together. By getting his family to cease the habit they will also experience the health benefits of quitting. In addition to this, they can also help each other when trying to cease the habit.
It is crucially important that nurses implement high-quality care that is appropriate to the child or adolescent age group. To successfully do this the nurse should take into consideration the individual’s unique social, emotional, and environmental needs so they can better tailor a healthcare plan that is appropriate to the patient. In addition to this, it is crucially important that the nurse communicates the health advice in a way that is age appropriate. This communication should be positive and nurturing so they feel comfortable communicating their health related problems to the healthcare professional.
By implementing such measures, this will allow the patient to get a better understanding of their health related problems as they will be more willing to communicate their concerns to the nurse involved. When developing an appropriate care plan for Steven’s age group, the nurse should consider certain aspects to ensure the patient will more likely follow the advice given to them. As explained previously, Erikson states that people who are aged 12 to 18 years are more self-directed and independent in their own lives.
Due to this reason, the nurse should talk directly to Steven in an adult manner when advising him on his health care needs. When providing health related information to Steven, the nurse should also ensure that adequate explanation of his health and health care plan is provided. This will allow Steven to be better informed about his health problems. In addition to this, to encourage Steven’s independence the nurse should allow him to be involved in all decisions relating to his health. This will allow Steven to feel more independent when making decisions about his own health, thereby providing greater autonomy and independence.
By providing this information in this manner, it is hoped that Steven will be more likely to take control of his own health and wellbeing. In order to achieve a good family centred care plan the nurse must ensure that a collaborative approach between the patient and family is implemented. To encourage this family centred approach, the healthcare professional should involve all parties by ensuring that everyone involved participates in the informed decision making process. It is important that the healthcare professional provides the patient and family with unbiased information that is easily understood so that informed decisions can be made.
In addition this, the healthcare professional should show the dignity and respect each person deserves by listening and honouring the family needs and choices, no matter their cultural beliefs, values, and background. By implementing such measures the family will feel more supported in making informed decisions about the patient’s health and wellbeing. Due to this reason, the nurse should involve Steven’s family as much as possible, however, due to Steven’s age it is important to give him the independence and autonomy he deserves so he can take control of his own health and wellbeing.
A concerning feature about this case study is that Steven has not been adherent to his medication plan. By not adhering to his medication plan Steven is more prone to experiencing more frequent asthma attacks in the future. Due to this reason, a healthcare professional needs to explain to Steven and his family the implications of not taking his medication. To make things more clear the healthcare professional should also explain what each medication does and how it prevents asthma attacks. In addition to this, the nurse should also find out why Steven does not like taking his medication.
This is crucial information to find out as the healthcare professional involved could think of strategies so he feels more comfortable taking the medication. According to a study conducted in 2010, motivational interviewing had great success in patient adherence to medication. The study focused on 10 to 15 year olds and used motivational methods such as weighing up the pros and cons of taking medication, built upon motivation to create change, and discussed cooperative decision making and problem solving strategies.
After providing this motivational interviewing it was found that care givers reported 100% adherence to taking asthma medication. By highlighting this vital information and implementing motivational interviewing, it is hoped that Steven and his family will take note of the importance of taking his medication so he can limit the chances of experiencing another asthma attack in the future. It is hoped that this case study has provided healthcare professionals with a better understanding on how to manage an adolescent patient who presents with asthmatic symptoms in a hospital or healthcare setting.
By providing the patient with good family centred care which allows the adolescent to make informed decisions autonomously, it is hoped that Steven will adhere to his treatment plan more effectively. It is important that healthcare professionals show the dignity and respect the patient and involved family members deserve throughout the process to enable better healthcare standards. By implementing such measures it is hoped that better healthcare outcomes will be achieved for Steven and other members of this age group.
