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Question:
Discuss about the Asthma in Teens.
Asthma is known as a chronic disease, which encompasses inflammation of the airways. It results in obstruction of the airflow. The inflammation of the airways can be the result of interaction various cellular elements, cytokins and cells (Halbert et al, 2009). Cytokins is responsible for causing inflammation as the immune process of saving the cell from the infection. Airway inflammation can result into wheezing, breathlessness, cough and tightness in chest. The inflammation of the airway is also known as the hyperreactivity of the airway or bronchial hyperresponsiveness (BHR). This is the natural procedure of the airways that results in their narrowing in response to different irritants, stimuli and environmental allergens.
Physiologically, it has been documented that bronchial hyperresponsiveness is the result of the decreased airflow (Towns & Van Asperen, 2009). The airway obstruction can also be triggered by exercise, cold, air, smoking cigarette, viral infection in upper respiratory tract and other allergies. Thus, the leading physiological occurrence, which leads to symptoms of asthma, is airway narrowing. The changes in the structure and functions of the airway occur in the form of bronchospasm, mucosal edema, epithelial cell sloughing, mucus gland hypersecretion and cilia cell disruption (Towns & Van Asperen, 2009). Due to the airway obstruction the expiratory rate decreases and results in hyperinflation.
The provocation of Bronchial with the allergen induces the early phase of immunoglobulin E (IgE). Under the microscopic view, asthma is characterized by presence of increased “eosinophils, neutrophils, lymphocytes, and plasma cells in the bronchial tissues, bronchial secretions, and mucus” (Mitchell et al, 2012). On the initial stage leukocytes are engaged from the bloodstream towards the airway by activated CD4 T-lymphocytes. Activated T-lymphocytes is considered to be responsible for eosinophils, which is also a the inflammatory mediators. It also involves lymphocytes and mast cell. “The subclass 2 helper T-lymphocytes subset of activated T-lymphocytes produces interleukin (IL)-4, IL-5, and IL-13. IL-4 in conjunction with IL-13 signals the switch from IgM to IgE antibodies” (Towns & Van Asperen, 2009). The cross linkage of the two IgE molecules is responsible for the degranlation of mast cells. It further releases leukotrienes and histamine and other mediators, which causes inflammation of airway. The activation of eosinophils is done by IL-5, thus by the activation process of eosinophils and mast cells, cytokines are generated that result in inflammation (Towns & Van Asperen, 2009). The remodeling of the airway are resulted by the repeated incidents of inflammation in the lungs and injured pulmonary tissues, which is further followed by the repair. In some of the cases the genetic factors are also found responsible for asthma. The study has stated the association of dis-functioning of lungs and bronchial responsiveness since the neonatal period, which leads to occurrence of asthma in the early childhood (Halbert et al, 2009).
Asthma is a chronic disease, which is mainly found in children from minority group. Medical conditions and chronic illness in children and adolescents can lead to various kinds of stress and emotional problems. The assignment is based on the case study of 15 years old Steven. He had been diagnosed with Asthma, since he was two years old. Through different developmental stages, children develop new skills and coping skills (Haley, 2016). The developmental stage can be identified by the age of children, as they display stages according to their age. According to the age of Steven he is in adolescence age, where he will learn to develop coping skills for his illness (Compas et al, 2012). Adolescence is the transition period for child to adulthood. Children became more independent at this stage and start to think about their future. This is the period, when children are more influenced with their peers (Compas et al, 2012).
The children from minority groups are often exposed to unhealthy living environment (smoking, alcoholism, substance abuse) (Mitchell et al, 2012). They are more likely to develop anxiety and stress due to chronic illness that can disturb their effective self-management treatment in the adolescent. The role of nurse is very important in this relevance. Asthma can result into depression and high risk behavior in children. It is the duty of nurse to identify the factors responsible for posing risk associated with the condition of the child (Sadof & Kaslovsky, 2011). While assessing adolescents with asthma, it is important to consider significant mental health co-morbidities (Guo et al, 2010). With the poor control over the disease and increases severity of asthma, Psychiatric co-morbidities also increase. With the increased severity of the disease, children may also develop post traumatic disorder. The risk of asthma is increased by smoking tobacco. According to the case study, Steven has two years history of smoking, which have deteriorated his condition and increased the severity of disease (Guo et al, 2010).
Nurse should understand that while teaching an adolescent patient of asthma about the self-management techniques, the developmental issues must be addressed, such as confidence, building self-image, and developing problem solving skills and increasing personal responsibilities. Adolescents also display vulnerability and denial (Sadof & Kaslovsky, 2011). They may think that medication is not important, as in the case of Steven. The influence of peers increase and children do not want to show that they are suffering from any disease. Children are often concerned that they will not be accepted by peers (Seid, 2008). For this peer stress related coping strategies can be helpful. This involves justifying the importance of the management of asthma regardless of any support from the peers, explaining the process of self management in asthma with peers, explaining the importance of self management to the trusted peers, or hiding the problem of asthma to ignore unsupportive peers (Sadof & Kaslovsky, 2011). Thus proper action plan must be developed in collaboration with parents. The role of parents is very important in supporting the self-treatment efforts of adolescent.
Family centered care is the new philosophy for the nurses in Pediatric care. The main focus of the Family Centered Care (FCC) is that every clinician should understand the importance of family, while treating children. Children a affected by their environment and by the people they are in relation with. Including the families in the process of care is very essential for offering high quality care to children (Arango, 2011). The constant support of families, help in improving the health outcomes in children. Adopting the framework of FCC by the pediatric nurses is meant to accept the responsibility of care for children. This includes supporting physical health of individual and promoting their healthy psychological and emotional development in relation to the family (Fonseca, 2010).
There are many issues related to chronic illness of asthma in minority groups and involvement of families. As Steven belongs to an indigenous family from a rural area of Australia, he is the highest risk. Often such families have their own priorities, due to which keeping the track of regular medication becomes difficult for the family (Arango, 2011). These conditions influence the asthma outcomes in poor populations. Such people often fear that daily medication can also reduce the effectiveness of medication, and smoking can be a great barrier in medication. Families might also face difficulty in understanding and negotiating that how much responsibility should adolescent take for the self-management the disease. Some of the other barriers could be knowledge gap, misconception about the disease, and low care expectations. Thus, it is the duty of the nurse in Family Centered Care setting to respect and collaborate with families. It is also essential to develop care giving and decision making relationship among parents and nurse. Thus, main focus of FCC is on support and collaboration. Parents must be actively involved in the treatment and interventions (Harrison, 2010). This will help them to develop closer relationship with their child and also improve health outcomes. Nurse must built a care plan based on the family strengths and support learning of the child about his participation in self-management. The nurse must use the developmental and individual approach and must encourage family to family and peer support. Nurse will also support the youth during their transition period towards adulthood.
For the quality healthcare delivery it is important to have the knowledge of adolescent development. Comprehensive understanding of the legal and ethical issues related to adolescent population is also important during the hospitalization of adolescent. Puberty is the period of rapid psychological, physical and cognitive changes (Findlay et al, 2008). The cognitive development in this stage allow the adolescents to have right of decision making. Such teen also develop mature coping skills and independence. The period of hospitalization can be very challenging for teen as well as for family. They lose the sense of independence and freedom, which they experience in all the other areas of life. They may have the feeling of losing control, and thus, they may feel depressed, helpless, powerless and over-dependent.
Due to the loss of control, they may behave in a different manner. The ethical dilemma could also arise for nurses, where parents may ask to withhold information from teen and teen may ask to withhold information from parents. Thus, it is very important for the nurse to respect the competence of the teen and safe guard their information till the time it does not challenge patient’s safety (Findlay et al, 2008). The support of nurse in the family centered care can help the patient to feel comfortable in hospital and considering the particular needs of teens during hospitalization.
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