CAE C-Management

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Author:
samatwell
ID:
96666
Filename:
CAE C-Management
Updated:
2011-08-09 23:59:35
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asthma educator
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Description:
Asthma Educator Prep cards
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  1. The primary goal of asthma management
    to achieve and maintain control
  2. Long term benefits of asthma control
    • 1. Improve quality of life by maintaining the pt's lung function and activity level as normal as possible
    • 2. Reduce the risk of exacerbations, hospitializations, loss of lung function, or impared development
  3. Two people responsible for achieving control
    Professional and patient
  4. Define Severity
    The intrinsic intensity of the disease
  5. Define Control
    The degree to which manifistations are minimized and goals of therapy are met
  6. Define Responsiveness
    The ease by which control is achieved
  7. Define Impairment
    The frequency and intensity of symptoms and funcitonal limitations the patient is experiencing or recently experienced (present)
  8. Define Risk
    The likelihood of exacerbations, decline in lung function, imparement of development or adverse effects of medication (future)
  9. Early vs Late Phase Reactions
    • Early: within 1 hour of exposure to allergen, use SABA and antihistamines
    • Late: 3 to eight hours after exposure, often more severe, use corticosteroids
  10. Phases and parts of management
    • Phase I: Initial Control
    • (Classification and Initial Therapy)

    • Phase II: Maintaining Control
    • (Patient Monitoring and Therapy Adjustment)
  11. Classification Requirements
    Age and SALSA
  12. Goal of Initial Therapy
    To quickly achieve control
  13. Patient Monitioring Requirements
    • SALSA
    • Peak Flow
    • Follow-up visits
    • Questionaires
  14. Peak Flow
    • Primary assessment tool
    • Early detection of deteriorating airflow
    • Most helpful for moderate to severe asthma
  15. Obtaining Personal Best Peak Flow
    • Record PF every morning and afternoon for 2-3 weeks
    • Record PF after SABA and DO
    • Highest is Personal Best
    • Repeat occasionally to note changes in Personal Best
  16. Typical PF values
    • 10 L/sec
    • 600 L/min
  17. Green Zone
    • 80-100% of Personal Best
    • Good control
    • Children <6: No cough, wheeze, chest tightness, SOB day or night, normal activities
  18. Yellow Zone
    • 50-79% Personal Best
    • Worsening Asthma
    • Children <6: has cough, wheeze, chest tightness, SOB, waking at night with symptoms, most activities
  19. Red Zone
    • <50% of Personal Best
    • Medical attention is needed
    • Children <6: very SOB, SABA has no effect, cannot do usual activities, symptoms same / worse after time in yellow zone
  20. Peak Flow Frequecy
    • 1. Every morning before meds
    • 2. During symptoms
    • 3. After meds during attack
    • 4. During clinical visit
  21. Cleaining Peak Flow Meter
    • Dust and dirt, germs and mucuous affect readings
    • Wash once a week normally
    • Wash after every use if a virus
    • Remove mouthpiece
    • Wash both in warm soapy water
    • Rinse and air dry
  22. Follow up medical visit frequency
    every 6 months
  23. Three QOL Questionaires
    • ATAQ: <1 is good
    • ACQ: <1 is good
    • ACT: >20 is good
  24. Therapy Adjustment: Well Controlled
    • 1. Maintain at current step
    • 2. FU every 1 to 6 months
    • 3. Consider step down if well controlled 3 months
  25. Therapy Adjustment: Not Well Controlled
    • 1. Step up one step
    • 2. Re-eval 2 to 6 weeks
    • 3. If side effects, consider alt treatment options
    • 4. FU every 1 to 6 months
    • 5. Consider step down if well controlled 3 months
  26. Therapy Adjustment: Poorly Controlled
    • 1. Step up 1 to 2 steps
    • 2. Re-eval in 2 weeks
    • 3. Consider short course oral systemic steroids
    • 4. If side effects, consider alt treatment options
    • 5. FU every 1 to 6 months
    • 6. Consider step down if well controlled 3 months
  27. What if no improvement in 0-4 years old after stepping up their therapy?
    Consider alternative diagnosis
  28. Before stepping up therapy, evaluate:
    • MDI/DPI technique
    • Adherence to medication regime
    • Environmental control
    • Co-morbities
  29. How to reduce oral steroids
    25% every 2 to 3 months until lowest dose to maintain control is reached.
  30. Poor Control
    • > 1 SABA canister per month
    • Awakened at night with symptoms
    • Have urgent care visit
  31. School allergens and irritants
    • Chemicals, pollens, mold spores
    • Animal dander
    • Mold in vents, odors from printers, fumes from AC/heat
  32. School considerations
    • Do other children have same symptoms?
    • Improve away from bldg?
    • Appear after pesticides, painting or construction?
  33. Smoking Control
    • Number one source of indoor pollution
    • Not permitted in house
  34. Air Filtration System Control
    • Use HEPA filters (3 microns)
    • Use ULPA (0.12 microns)
    • Vacuums and air purifiers should use these
  35. Most important area of home to have trigger free from allergens and irritants
    Bedroom
  36. Animal Dander Control
    • No pets best, keep outside 2nd best
    • If must have indoors, not in bedroom
    • Bathe once per week
    • After playing, wash hands before touching pt/bedroom
    • Have someone else clean hamster/mice cage
    • Exterminate cockroaches
    • Control mice with block access or low-toxic pesticide
  37. Dust and Dust Mite Control
    • Plastic zippered covers for matress and pillows
    • Wash linen in water >130 or detergent and bleach
    • Use synthetic materials for bedding
    • Remove carpet
    • Keep humidity between 30 to 50%
    • Avoid upholstered furniture
    • Vacuum one per week
    • Use mask when dusting
    • Use AC instead of windows
    • Avoid stuffed animals (freeze once per wk for 6 hrs)
  38. Pollen Control
    • Use no windows, but AC
    • Clean / replace AC filters regularly
    • Know triggers and avoid outdoor activities then
    • Bathe before bedtime
    • Don't dry clothes outdoors
  39. Mold Control
    • Keep humidity <50%
    • Clean mold from refrigerator and inside house
    • Don't dry clothes outside
    • Avoid live or dried plants inside house
    • Have someone else mow and garden
  40. Food Allergy Control
    • Avoid food completely
    • Carry EpiPen
  41. Treatment for Food Allergy
    • Epinephrine
    • Antihistamines
    • Hydrocortisone
    • O2
    • Orpharyngeal Airway
    • IV fluids
    • Ambulance called, keep at leat 12 hours
    • (attacks happen up to 8 hours later)
  42. Aspirin or NSAID Control
    • Avoid
    • Use Acetaminophen instead
  43. Occupation Trigger Control
    • Common causes are:
    • Lates
    • Gases, chemicals, fumes
    • Tobacco smoke, perfume
    • Temp and humidity
    • Formaldehyde and volitile organic compounds
    • Platinum, chromium and nickel sulfate
  44. EIB Control
    • Use SABA 15 to 30 minutes before
    • Use midway if needed
    • Use LABA 30 minutes before
    • Use Cromolyn Sodium or Nedocromil 15 to 30 min
    • Use inhaled corticosteroids to control
    • Use leukotriene modifiers regularly
    • Wear mask or scarf in cold weather

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