Edition 1, Volume 4
Table of Contents Editors’ Note ..........................................................................................................x Doctor Who? Asthma ...........................................................................................1 In The Spotlight ....................................................................................................6 From the Nurse’s Station ....................................................................................9 Get the Facts..........................................................................................................12 Loving an Asthmatic Child ....................................................................................14 Kids Say the Darndest Things ............................................................................18
©All rights belong to those students who worked hard to produce this final product. This magazine is not subject for individual sale. Any form of duplicates will result in an F for this course. Enjoy your reading, peace and love!
Editors’ Note
When I sat down to write this month’s column, I was a little stumped as to what I was going to write. There are many BIG health topics that concerned parents want to have addressed (yes, I read your letters!), so many that I know it to be impossible for me to tackle each one, but I promise you that my colleagues and I will, as always, keep you informed to the best of our ability. No longer will you have to depend on Google to find the answers to those burning questions concerning your child’s health; just flip the page. This month’s focus is asthma. Asthma affects people across the spectrum, cases ranging from mild to severe, but even though it’s so common, there is still much to be learned in regards to signs and symptoms, home care, and medications, some of our many objectives in this issue. Never will I claim to be some health professional (wink wink), but I do know how to present the facts to my readers and keep them informed. Peace and love. -Carissa Manley, Editor
I have been working with this company for about 3 years now and each new magazine that is published is an accomplishment. Our purpose is to educate those around the world and to answer those burning questions that some people or families may be afraid to ask their healthcare provider at an appointment. We are not a replacement for a doctor so everyone should still see a doctor regularly; instead, we are more of a support group to help you understand the disease processes that are present today, how to manage them, and give you experiences of others who have those same disease processes as encouragement to keep going. The letters we receive from our readers are overwhelming and we definitely try our best to respond and include your ideas for the next magazine. Please continue to send in your letters and we will continue to provide you with the magazines that continue to bring you the knowledge to make better health decisions. -Andrelisae Robinson, Editor
Doctor Who? Asthma Background Asthma is one of the most prevalent chronic diseases of childhood and adolescence. Asthma exacerbation can lead to missed days of school, decrease involvement in physical activity and sports, increase time and money spent on medications, as well as, clinic and emergency department (ED) visits, hospitalizations, and even sometimes death. Asthma can occur at any point across the life continuum and currently affects about 30 million Americans and 300 million people worldwide. Pathophysiology Asthma is a chronic inflammatory disorder of the airways in which many cells play a role. Asthmatic episodes are associated with airflow limitation or obstruction that is reversible either spontaneously or with treatment. The inflammation also causes an increase in bronchial hyperresponsivesness to a variety of stimuli. There is general agreement that inflammation contributes to heightened airway reactivity in asthma. Multiple mechanisms contribute to airway inflammation, involving a number of different pathways. It appears that asthma results from complex interactions among inflammatory cells, mediators, and the cells and tissues present in the airways.
The mechanisms responsible for the obstructive symptoms in asthma include (1) inflammatory response to stimuli; (2) airway edema and accumulation and secretion of mucus; and (3) spasm of the smooth muscle of the bronchi and bronchioles, which decreases the caliber of the bronchioles. Clinical Manifestations Symptoms)
(Signs
and
The classic manifestations of asthma are dyspnea, wheezing, and coughing. However, children may experience symptoms that range from acute episodes of shortness of breath, wheezing, and cough followed by a quiet period to a relatively continuous pattern of chronic symptoms that fluctuate in severity. Older children may complain of chest tightness and an intermittent generalized chest pain. An attack may develop gradually or appear abruptly and may be preceded by a URI. Symptoms are often worse at night. An asthmatic episode usually begins with children feeling uncomfortable or irritable and increasingly restless. The may also complain of having a headache, feeling tired, or feeling tightness in the chest. Respiratory symptoms include a hacking, paroxysmal, irritating, and nonproductive cough caused by bronchial edema. Accumulated secretions stimulate the cough. As the secretions become more profuse, the cough becomes rattling and productive of frothy, clear, gelatinous sputum.
A common symptom of asthma is coughing in the absence of respiratory tract infection, especially at night. This may disrupt sleep, leading to excessive fatigue during the day and poor school performance. Wheezing may be mild or discernible only on auscultation at the end of expiration, or severe enough to be audible. Younger children have a tendency to assume the tripod sitting position, whereas older children have a tendency to sit upright with shoulders hunched over, hands on the bed or chair, and arms braced to facilitate the use of accessory muscles of respiration. The child speaks with short, panting, broken phrases. Infants and small children are restless, irritable, and unable to be comforted. Infants may display supraclavicular, intercostal, suprasternal, subcostal, and sternal retractions.
sensitive, they place the child at risk for an asthmatic episode and should be done under close observation in a qualified laboratory or clinic. Skin testing is useful in identifying specific allergens. It is recommended that all patients with year-round asthma symptoms be tested with skin tests or laboratory blood analysis to determine sensitization to perennial allergens. Associated Lab Tests In addition to these tests, other important tests include laboratory tests (complete blood count with differential) and chest radiographs. The complete blood count may show a slight elevation in the white blood cell count during acute asthma. Management
The diagnosis is determined primarily on the basis of clinical manifestations, history, physical examination, and to a lesser extent laboratory tests. Generally, chronic cough in the absence of infection or diffuse wheezing during the expiratory phase of respiration is sufficient to establish a diagnosis.
Management of asthma requires a mastering of several tasks including identifying symptoms of an impending attack, identifying and avoiding triggers, proper and consistent peak flow technique, and correct usage of maintenance and rescue medications. Effective patient and family education is an important component in the mastery of these self-care skills.
Pulmonary function tests provide an objective method of evaluating the presence and degree of lung disease and the response to therapy. Bronchoprovocation testing helps to identify inhaled allergens. Exposure to methacholine, histamine, or cold or dry air may be performed to assess airway responsiveness or reactivity. Exercise challenges may be used to identify children with exerciseinduced bronchospasm. Although these tests are highly specific and
Asthma can greatly affect a child’s daily activities. Physical activity and sports are vital for children because they have a long term impact on children’s social and psychological development as well as on their physical health. Asthma symptoms of coughing and wheezing are especially prevalent at night which can lead to disruptions in sleep. Decreased sleep and school absences can ultimately lead to poor school performance. There are many psychological
Diagnostic Tools/Procedures
consequences of asthma as well. Children report anxiety and fear of sudden attacks and dying, peer rejection, and negative side effects from asthma medications particularly corticosteroids. In addition, asthma is known to cause sibling rivalry and family discord related to treatment demands and financial consequences. Besides prescribing medications, all behaviors related to the treatment and control of asthma symptoms require patient involvement. Patients must be able to assess and respond to their own asthma symptoms. Essentially, there cannot be asthma disease management without the provision of education for asthma self-management. Asthma self-management education is a fundamental part of caring for children with asthma. -Carissa Manley
5 Steps for Self-Management 1. Form a partnerships with your doctor. a. Show you how to use a peak flow meter to monitor your asthma and tell you when you should use it b. Make sure you know when and how to use an inhaler correctly c. Review your asthma triggers and suggest ways to avoid them 2. Learn your symptoms 3. Learn your asthma triggers and how to avoid them a. Allergens b. Irritants c. Exercise d. Respiratory infections e. GERD f. Emotions g. Medications 4. Know your medications and how to take them. a. The medicines b. Delivery device and proper technique 5. Monitor your asthma and respond to warning signs.
With Jaylen Lester
Q: Hello Jaylen. How are you today? FUN FACTS ABOUT JAYLEN Birthday: March 15, 2005
Jaylen: Hello. I’m excited to be here today! I love this magazine and glad I get to be in it this month!
Favorite Sport: Karate Favorite Food: Pizza!!! Siblings: James, 16 years old Jada, 7 years old Favorite color: Black and Red Pets: Sparks, dog
Q: Well, I’m glad to hear that you’re excited and that you love our magazine. Why don’t you tell us about yourself? Jaylen: My name is Jaylen Lester. I’m 10 years old. I go to Stewart Elementary School and I’m in the 5th grade. Q: You sound like a smart, fun boy. Do you like school? Jaylen: Yes, I love school. I was on honor roll last year and my grandma gave me $20. At recess, I play with my friends
and we run and play. My best friend is Leon and he likes to play football. Sometimes I play with him and sometimes I don’t. Q: That’s excellent! Congratulations and keep up the good work. You said sometimes you play with Leon and sometimes you don’t. Why don’t you play with him all the time? Jaylen: Sometimes I can’t keep up with my asthma and I have to sit down to catch my breath. Q: How does that make you feel when you have to sit out to catch your breath? Jaylen: It makes me sad sometimes because I feel like my friends don’t understand and they don’t like to wait for me to catch my breath. They just tell me to ‘come on’ and sometimes I do but other times I know I can’t keep going because I can’t breathe. [Click here to add a caption]
Q: Have you told them how you feel and about asthma?
Jaylen: Yeah. I told them how I feel but sometimes I think they forget because they don’t have it. I don’t want to remind them because then they may start treating me like I’m different and I don’t like that. Q: Well that’s understandable to feel that way. What other challenges do you face with your asthma? Jaylen: Just trying to keep up with my friends at recess and sometimes I’m afraid of passing out like I did before from my asthma. It was scary and I don’t want that to happen again. Q: What happened? Jaylen: I was at karate practice with my friends and I couldn’t breathe and nothing was helping. I passed out and they had to rush me to the hospital. I rode in the ambulance with my mom. It was really scary. Q: That is scary. It looks like you’re doing much better and taking good care of yourself. What do you do when you can’t breathe or feel really tired now? Jaylen: I sit down and catch my breath. Sometimes I don’t want to because I want to keep playing with my friends but I don’t want to pass out again so I sit down or go play something else. Q: What about when you’re playing with your brother and sister? Jaylen: We always have fun and they always ask if I’m okay. If I say no, then they’ll sit with me until I’m ready to play again. Q: Well Jaylen I’m glad to hear that you’re doing better and you’re taking care of yourself. Your siblings are very caring to stop and check on you and that’s great. Thank you for talking with us today. Jaylen: Thank you.
-JAYLEN, AGE 10
FROM THE NURSE’S STATION
Mrs. Gina Nicole Thompson, RN, BSN Every patient wants to know what a nurse thinks or their true perspective on how they care for their child. Luckily, we were able to catch up with Mrs. Gina Nicole Thompson, RN, BSN to answer our questions, Q: Hello Mrs. Thompson. How are you today? A: Hello. I’m fine. Thank you for asking me to do this interview with you. I’m much honored. Q: No problem. Thank you for taking time out of your schedule to speak with us. So from a nurse’s perspective, how do you begin to treat a child who has recently been diagnosed with asthma? A: Well, based on the medical diagnosis, we [nurses] make nursing diagnoses that pertain to the patient’s condition. A nursing diagnosis is a clinical judgment about individual, family, or community experiences/responses to actual or potential health problems/life processes. Nursing diagnoses are developed based on data obtained during the nursing assessment. Q: So for a child that has a diagnosis of asthma, what type of nursing diagnoses would be made? A: Each case is different, but two possible nursing diagnoses for asthma would be Ineffective Breathing Pattern related to bronchospasms and Ineffective Airway Clearance related to inflammation and mucus production. Q: So how does the care aspect come from these nursing diagnoses? A: From the nursing diagnoses, we [nurses] develop interventions. Interventions are basically the actions that nurses take in order to address or fix the actual or potential problems identified. Q: Continuing with those two nursing diagnoses, what interventions would you use? A: For Ineffective Breathing Pattern, I would administer medications as prescribed, assess the patient’s vital signs, position patient in semi-fowler, deliver oxygen as needed, and identify triggers of bronchospasm.
The interventions for Ineffective Airway Clearance are cough and deep breath, encourage fluid intake, administer medications to facilitate breathing, allow patient to find a position of comfort, and deliver oxygen via mask if needed. Q: Are these interventions generalized or based off age? A: For the pediatric population, developmental stage. For example, a 10 year old would be dealing with Industry vs. Inferiority. In this stage, the child is trying to cope with new things and new surroundings. Asthma could possibly hinder the child because they may not be able to do some of the things that their peers can. When playing sports, they may need to take breaks or sit down and catch their breath and keep their inhaler on them at all times. Q: Well, thank you for taking the time to sit and talk with us in order for us to educate parents about asthma. A: Thank you. I appreciate whenever I can stop and educate anyone about something healthcare related.
There’s no such thing as a stupid question when it comes to asthma.
LOVING AN ASTHMATIC CHILD EXCLUSIVE INTERVIEW WITH JAYLEN’S MOTHER, TERESEA
Living with a child that has asthma
about your experience when you
can
found out Jaylen had asthma?
be
stressful.
From
giving
medications, to avoiding triggers of an
A: Well, at first we didn’t know what
asthmatic attack, and to making sure
was wrong with Jaylen. It started as a
you are always prepared for the worst,
normal Saturday with us taking him to
the mind and body can get drained.
karate class at the local recreation
Many parents are afraid when they
center in our neighborhood. He was
learn their child has been diagnosed
playing with his friends and then all of
hooked him up to this oxygen machine
with asthma and they turn to health
a sudden he said he couldn’t breathe
and they told me that he was going to
professionals for answers to their
and fell to the floor. It was terrifying
be receiving 2 liters of oxygen by a
questions. For this edition, we had the
to see my child struggling to breathe,
nasal cannula. It was hard to see him
sit
and I felt helpless
hooked up to the machine in the
with
because I didn’t
hospital but once he started breathing better, I was relieved.
chance
to
down Teresea
Lester
know what to do.
whose son, Jaylen
We called 911 and
Lester,
rushed him to the
Q: It’s hard to believe that Jaylen
emergency room.
went through that when you look at
with
struggles having
asthma
and
him now. He seems healthy, active,
remaining active.
Q:
In this interview
sound terrifying
having any breathing problems.
we ask Teresea
to witness. What
A: Yeah, now Jaylen is back to his
about her and her
happened next?
normal self. He does have to keep an
families
A: While in the
inhaler on him at all times but as long
experience living
emergency room,
as he takes it easy, he’ll be fine.
with asthma.
the
That
nurses
doctors
does
and does not show any signs of
and were
Q: What would you say is the
Q: Hello Mrs. Lester. You’re son
asking all types of questions and all I
hardest part about having a young
Jaylen has had asthma for about 2
could say was ‘I don’t know’. This
child diagnosed with asthma?
years now, correct?
had never happened before. Jaylen
A: The hardest part is telling Jaylen to
A: Yes, my son Jaylen was diagnosed
was always an active child, running
slow down and having that fear that he
when he was 8 years old. He is now
around with his friends. That’s when
will have another episode like before,
10 years old.
the nurse’s asked if he had asthma. I
but possibly worse. Being that he is
told
were
so young, it’s hard for him to
Q: Many parents say that they had
convinced that Jaylen had asthma.
remember that he has to be a little
a sense of fear run through their
Jaylen was crying out for me and I did
more careful than his peers. He can
body when they were told their
my best to try to comfort him but
still have fun, just be more cautious.
child has asthma. Can you tell us
nothing worked. Finally the nurses
them ‘No’,
but they
EXCLUSIVE INTERVIEW WITH JAYLEN’S MOTHER, TERESEA
Other than that, the nurses were very
with and handle my child’s asthma.
A: Jaylen currently takes albuterol,
helpful in helping me to understand
These things helped me understand
which comes as a nebulizer that he
what asthma is, how to administer the
how I was feeling and reassured me
takes every 4 hours and when he needs
medication, and what the medication
that these feelings were normal. Now,
it to help him breathe and he takes
does.
I am more confident in my abilities to
cromolyn sodium, which is 2 puffs 4
help my son manage his condition.
times a day.
Q: You said the nurses helped you
There’s always that fear of an asthma
Q: Well, your words have not only
cope with your son being diagnosed
attack,
been encouraging but helpful for
with asthma. Can you go into more
knowledgeable
other
detail about how they helped you?
now about how
now know how to cope
Did they suggest groups?
to handle that
and handle their child
A: They didn’t suggest any groups but
situation.
The
having a diagnosis of
they teach me coping methods that
nurses also told
asthma. Thank you for
helped a lot. I learned that at first I’d
me
always
taking the time to talk
go through a series of emotions, such
keep a list of the
to us and help other
as
self-doubt,
medications that Jaylen takes for his
parents out there.
powerlessness, and denial, regarding
asthma. I always keep a copy in the
A: You’re welcome. Thank you for
the diagnosis of Jaylen. Then when I
house on the refrigerator and a copy in
the
accepted the reality of the situation,
my purse at all times.
experience.
I’d work to gain control and things
Q: If you don’t mind me asking,
will go back to normal. The last phase,
what medications does Jaylen take
one that took the most work, involved
to manage his asthma?
guilt,
anxiety,
me developing coping skills to deal
to
but
I
am
much
more
opportunity
parents.
to
share
They
my
-Andrelisae R.
“Being woken up by my son’s precious laughter would be the absolute best way to be woken up if it didn’t actually wake me up.”—@DadandBuried
“Experience the feeling of getting kids ready for school by shouting words like TEETH and SHOES into an abyss whilst crying into a cup of tea.”—@Pandamoanimum
“90% of parenting is just walking around yelling “WHERE ARE YOUR SHOES? WE’RE ALREADY LATE! FIND YOUR SHOES!”—@LurkAtHomeMom
“I set my alarm so I know when I have 10 minutes to leave and my son poops his diaper to let me know I’m running 5 minutes late.”—@AmateurIdiot
“Things my 2-year-old won’t throw a temper tantrum about: 1) 2)
“It’s when you see yourself in your children that you really start to worry for their future.”— @OneFunnyMummy
“I don’t know the answer” I say to my kid as I stare into the electronic device that can potentially connect me to all the world’s info.”— @Playing_Dad
“How do you restore your kids to the factory settings?”— @TheMichaelRock
“My tween and her erratic behavior and frequent mood swings remind me of someone… Oh right. Her as a toddler.”— @really10months
“Kids are like that big mirror in the hotel bathroom pointing out the zits you were hoping no one would notice.”—@thatkristen
“FIND THAT SMELL—the game where no one wins.”— @NoDomesticDiva
3) --@ThatsParenting
“Don’t hate the toddler, hate the tantrum.”— @Tw1tter_K1tten
“For some people, suffering means living with a life-long debilitating disease. For my 8 y.o. it means eating last night’s leftovers apparently.”— @KateWhineHall
Kid’s Say the Darndest Things
Kids may say the darndest things, but parents tweet about them in the funniest ways. Here’s some to brighten your day.
WORD BANK: COUGH, ANXIETY, AIRWAYS, RETRACTION, TALKING, CYANOSIS, EXERCISE, FORWARD
Word Search Puzzle Find the following words: Jaylen, mother, breathe, asthma, inhaler, puffs, dog, family, karate, cough
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