Asthma Case Study of Joel: Importance of Proper Management and Healthcare Guidance

The impact of asthma on patients, the importance of proper management and healthcare guidance, and a case study of Joel.

Running head: ASTHMA CASE STUDY OF JOEL
ASTHMA CASE STUDY OF JOEL
Name of the student:
Name of the university:
Author note:

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ASTHMA CASE STUDY OF JOEL
Part A:
Asthma is a chronic condition where the airways of the respiratory system becomes
narrow and thereby swell resulting in the production of excessive mucus. This in turn results in
making breathing difficult in a person. This is seen to trigger coughing, shortness of breath as
well as wheezing. Researchers are of the opinion that asthma cannot be cured but the symptoms
of asthma can be controlled and patients affected with this can lead better quality life. This
assignment will mainly show case study where a teenager named Joel in affected but the chronic
disorder. It will justify that the proper asthma maintenance plan and proper guidance of
healthcare professionals can induce quality life in patients with this disorder.
There are three types of asthma. One may be exercise-induced asthma that may get worse
when air in the environment becomes cold as well as dry. Another type is called the occupational
induced asthma that mainly occurs due to the irritants like that of chemical fumes, dust as well as
gases. The second one is the allergy induced asthma that can be triggered by different airborne
substances such as pollen, mould spores, particles of skin, wastes of cockroach, dried saliva of
pet and many others. A number of risk factors may remain associated with this disorder. Having
a blood relative, having allergic condition, being overweight, being exposed to second hand
smoke and many others increase the chance of asthma attacks.
Studies conducted have shown that about 1 in 9 Australians are seen to suffer from
asthma and this number account to be around 2.5 million. It is more common in males of age 0 to
14 but more common in females above age 15. It has become one of the significant issues of the
nation as only 20% of the patients aged over 15 have written action plan. Only about 41% of
people under 15 are seen to have written action plan. Researchers have repeatedly indicated the

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importance of written action plan and absence of such plan in wide variety of cohorts in
Australia is indeed a concern for the nation. Statistical studies show that about $ 655 million was
spent on asthma treatment in the year 2009 that is about 0.95 of all the direct health spend on
diseases. About 50% was spent on prescription pharmaceuticals, 30% on out of hospital medical
services and 205 on admitted patient costs. There were about 39,500 hospitalisations in 2014-15
where asthma was seen to be the main diagnosis (Asthmaaustralia.org.au, 2018). Children who
are under the age of 15 are more likely to be hospitalised with asthma that counts for about 451
per 100000 populations than those over aged 15 years. They are more likely to report a poor
quality life especially by those who have a poorly controlled asthma symptom. 34% of the
population are seen to report that asthma interferes with daily living and that 21.8% of the people
who are aged between 15 and 25 require time off from work, school or study due to asthma.
Therefore, these are the key issues that the nation is facing from past decade
(Asthmaaustralia.org.au, 2018).
Therefore, it is the duty of the local health government and the other healthcare centres to
make people aware of the triggers that result in exacerbation of symptoms. They need to develop
health promotion programs so that information reaches every household. Development of health
literacy of the patients and their family members are extremely important for making people
aware of the prevention techniques as well as the care plans that help people to overcome such
issues. Healthcare professionals should not only provide proper medications and teach them the
ways to take it, but they should also educate them well so that better quality lives are ensured.
From the above discussion, it is well understood that asthma is a chronic disorder that
requires caring over long period. Having proper knowledge on treatment and maintenance of
symptoms can give patients good quality life.

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Part B:
Asthma and its effect on lives of patients:
People suffering from asthma are seen to lead poor quality lives if not managed well.
Such patients are seen to suffer from frequent episodes of wheezing, coughing, shortness of
breath, chest tightness as well as coughing. This is mainly seen to occur due to narrowing of the
airways that make it difficult for the individuals to breathe. The symptoms of asthma are mainly
seen to vary over time where individuals may remain unaffected for some time or may get
exacerbations in a sudden manner (Butcher et al. 2018). This disorder is seen to affect people
from all ages and has substantial impact on the lives of people as well as on the community.
There are different types of symptoms of asthma. The symptoms may be mild as well as
intermittent symptoms that cause few problems for the patients and their family members. The
symptoms can also be severe as well as persistent and this may include shortness of breath as
well as persistent wheezing. Researchers are still working to learn more about the underlying
pathophysiology of the problem of asthma but certain triggers or factors have been recognised
that result in development of the disorder (Cossette et al. 2015). Researchers are of the opinion
that viral respiratory infections and cold is one of the most common trigger that results in
initiation of the exacerbations of asthma (Yeh et al. 2016). Other triggers that are identified are
heavy exercises and exposure to allergens such as house dust mites, pollens, pets and animals as
well as mould spores. Even environmental irritants such as smoke as well as other pollutants are
also contributors to the occurrence of asthmatic symptoms in individuals affected with the
disorder. Cold dry air is another trigger (Australian Institute of Health and Welfare, 2018).
Besides, dietary triggers like that of food chemicals as well as additives and several other

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medicines like aspirin and NSAIDs are also contributors to asthma development. Occupational
exposure to specific allergens, dust and fumes can also develop asthma.
Using of policies and websites to discuss the optimal care delivery of the patients:
The Australian Asthma Handbook is a guidance policy that has been proposed by them in
the name of the Australian asthma Handbook. They have beautifully divided sections for the
adults as well as children. Since the assignment will be focusing on asthma in children, the
policy guidelines for children need to be discussed. The management and care plan for asthma in
children and adolescents should initiate with the confirmation of the diagnosis. The healthcare
professionals are also instructed to assess the patterns of symptoms of the asthma efficiently.
This should include proper evaluation and monitoring of the frequency of the episodes as well as
the patterns of the symptoms that are observed in between the episodes (Harris et al. 2018). The
professionals should assess the triggers and try to link with the causal factors that are resulting in
the exacerbation of the asthmatic attacks. Following this, the professionals should discuss the
goals of the management with the parents of the child and with the child depending on his age.
Then the professionals should choose an initial treatment that should be based on the age of the
child as well as on the pattern of symptoms. Avery important aspect that the professionals should
be careful about is the reviewing as well as adjusting treatment periodically. This should be
entirely based on the recent asthma control symptom as well as risk factors (Zhang et al. 2017).
The Australian Asthma Handbook had provided a wonderful diagrammatic representation that
professionals can follow for the adjustment of asthma medication in the children (Australian
Asthma Handbook, 2018). Often professionals need to be care about managing the co morbid

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conditions that can affect the asthma. For example, professionals need to be extra cautious in
conditions where children develop allergic rhinitis and similar others.
Another of the very important part that needs to be incorporated in the care plan for all
children affected by asthma is effective patient education resulting in development of health
literacy. The professionals should provide the children as well as parents with information on the
disorder and help them to learn skills by which they can manage asthma. This education plan
would mainly include a written asthmatic plan as well as the detailed information about the ways
to avoid triggers. The professionals also have the duty to teach the patient correctly as well as the
parent about the correct use of medications that would also include the proper utilisation of the
inhales. Effective support and counselling them to adhere with the interventions are also
important and should be ensured by the professionals(Carpenter et al. 2017). The professionals
should also advice patients about the importance to avoid tobacco smoke, physical activity,
healthy eating, healthy weight as well as immunisation.
Discussion of the case study:
Joel is a 13-year-old boy who lives with his elder sister and single mother who tries her
best to provide financial support to the family. Joel’s mother already seems to be quite informed
about the disorder for which she tries her best to ensure that her sin is receiving holistic care.
This had good impacts on Joel as he also follows his mother and takes on proper diets with food
grown in their garden. He also has preferences for healthcare regimes. However, restlessness has
been observed in Joel as he is quite concerned about his health in the high school that he would
be attending. He is anxious that his disorder may make his new friends sideline him or that he
would not be able to participate in different kinds of bonding activities. He is not wanting to take

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his medication and wants it to be stopped. Therefore, the greatest need of Joel at this moment is
to counsel him in ways by which he becomes able to understand the activities that may result
him to suffer from asthma attacks. He needs to realise this and follow a care plan of the
professionals so that he may live better quality life.
Following the suggestions and guidelines provided by the policy, the healthcare
professional who would be attending Joel and his mother would first start by discussion of the
goals of the asthma treatment with the child ‘s parents and then with the child. After the
diagnosis is done, he should develop a plan that should not interfere with the quality of life of the
child. He should also be careful about the die effects of the treatment that he would be proposing
to Joel and his mother. He should try to use the lowest level of medication required to maintain
good asthma control (O’hagan et al. 2014). Stepped approach should be taken by the professional
to adjust the asthma medication in Joel. He should be first advised and prescribed a reliever that
would be non-emergency bronchodilators that would be taken at a regular basis to keep the
symptoms under control and usually on a preventative manner. Moreover, both the mother and
Joel should be properly educated about the triggers that he might face in the new high school and
ways to avoid them. He would be also discussed about the emergency medications that he should
always keep with him in case any emergency occurs.
Discussion of the implementation plan:
Five important aspects should be included in the implementation plan. The first aspect would be
that the professional needs of gain trust of Joel and his mother, thereby collaborate with them to
determine the needs of Joel, and thereby formulate a plan to achieve the outcomes. The better the
trust on the professional, the better will be the degree of adherence and collaboration. The second

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aspect would be teaching Joel about asthma in details so that he can understand the importance
of adherence with medication. The purpose and action of the medication, triggers he should
avoid, proper inhalation technique of medications, peak flow monitoring, and others.
Compliance to therapy is to be assured during implementation of the action plan (Paymon et al.
2018). Regular checkups should be sneered.
Challenges for the implementation plan and ways to overcome it:
Joel is quite concerned that he would not be able to participate in any activities in high
school and therefore he wants to cease or stop his medication for few days. This might affect him
as he may be exposed to asthmatic attacks if not adhered to medication. Therefore, he would be
suggested to use regular preventer treatment according to his patterns or symptoms. Both Joel
and his parent should be counselled and stated that if they take the preventer treatment and
continue taking them every day and for long term, the patient would be safe and can continue
daily activities and different bonding experiences with his friends. In order to overcome any
emergency if it arrives, the professional should also devise an emergency plan (Engelke et al.
2014). Frequent use of reliever medication and increasing the dose of controller medication like
prednisone can be advised. This would help to reduce his anxiety of not being able to be like
regular child and help him to adhere with medications more freely. The policy also supports this
and states that all children and parents should be advised to keep a rapid-acting inhaled
bronchodilator (reliever) inhaler with them at all times.
Healthcare centres he can visit:
The Children’s Hospital at Westmead has a number of services that can align with the
need of Joel and his mother. They perform a wide range of respiratory function test daily from

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Monday to Friday from 8.30am to that of 5 pm (Schn.health.nsw.gov.au, 2018). Their asthma
service works collaboratively in providing asthma care to children. They also provide training
sessions that would be helpful for both Joel and his mother namely the “open airways parent
asthma education”. They have a well-informed website where Joel’s mother can easily make an
appointment within her busy schedules. She can also prefer to contact the Southwestern Sydney
Local Health district who can provide them with information and community program referrals
by which both Joel and his family members would be able to live better quality life
(Swslhd.health.nsw.gov.au, 2018).

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References:
Asthmaaustralia.org.au. 2018. Statistics - An Asthma Australia site. [online] Available at:
https://www.asthmaaustralia.org.au/nsw/about-asthma/what-is-asthma-/statistics [Accessed 29
Apr. 2018].
Australian Asthma Handbook. 2018. Australian Asthma Handbook | Management | Children.
[online] Available at: http://www.asthmahandbook.org.au/management/children [Accessed 29
Apr. 2018].
Australian Institute of Health and Welfare. 2018. Asthma, What is asthma? - Australian Institute
of Health and Welfare. [online] Available at: https://www.aihw.gov.au/reports/asthma-other-
chronic-respiratory-conditions/asthma/contents/what-is-asthma [Accessed 29 Apr. 2018].
Butcher, H.K., Bulechek, G.M., Dochterman, J.M.M. and Wagner, C., 2018. Nursing
Interventions classification (NIC)-E-Book. Elsevier Health Sciences.
Carpenter, D.M., Estrada, R.D., Roberts, C.A., Elio, A., Prendergast, M., Durbin, K., Jones, G.C.
and North, S., 2017. Urban-Rural Differences in School Nurses' Asthma Training Needs and
Access to Asthma Resources. Journal of Pediatric Nursing: Nursing Care of Children and
Families, 36, pp.157-162
Cossette, S., Frasure-Smith, N., Vadeboncoeur, A., McCusker, J. and Guertin, M.C., 2015. The
impact of an emergency department nursing intervention on continuity of care, self-care
capacities and psychological symptoms: Secondary outcomes of a randomized controlled
trial. International journal of nursing studies, 52(3), pp.666-676.

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Engelke, M.K., Swanson, M. and Guttu, M., 2014. Process and outcomes of school nurse case
management for students with asthma. The Journal of School Nursing, 30(3), pp.196-205.
Harris, K.M., Kneale, D., Lasserson, T., McDonald, V., Thomas, J. and Grigg, J., 2018. School-
based self-management educational interventions for asthma in children and adolescents: A
systematic review. Journal of Allergy and Clinical Immunology, 141(2), p.AB207.
Knafl, K.A., Havill, N.L., Leeman, J., Fleming, L., Crandell, J.L. and Sandelowski, M., 2017.
The nature of family engagement in interventions for children with chronic conditions. Western
journal of nursing research, 39(5), pp.690-723.
O'hagan, S., Manias, E., Elder, C., Pill, J., Woodward‐Kron, R., McNamara, T., Webb, G. and
McColl, G., 2014. What counts as effective communication in nursing? Evidence from nurse
educators' and clinicians' feedback on nurse interactions with simulated patients. Journal of
advanced nursing, 70(6), pp.1344-1355.
Parikh, K., Keller, S. and Ralston, S., 2018. Inpatient quality improvement interventions for
asthma: a meta-analysis. Pediatrics, p.e20173334.
Paymon, L.S., Riley, P. and Miller, B., 2018. caregivers' Perception of Asthma Control In
Children. Pediatric Nursing, 44(1), pp.17-37.
Schn.health.nsw.gov.au. 2018. Respiratory services at The Children's Hospital at Westmead |
Sydney Children's Hospitals Network. [online] Available at:
http://www.schn.health.nsw.gov.au/find-a-service/health-medical-services/respiratory-lung/chw
[Accessed 29 Apr. 2018].

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Swslhd.health.nsw.gov.au. 2018. SWSLHD - Patient Information. [online] Available at:
https://www.swslhd.health.nsw.gov.au/healthadvice.html [Accessed 29 Apr. 2018].
Yeh, H.Y., Ma, W.F., Huang, J.L., Hsueh, K.C. and Chiang, L.C., 2016. Evaluating the
effectiveness of a family empowerment program on family function and pulmonary function of
children with asthma: A randomized control trial. International journal of nursing studies, 60,
pp.133-144.
Zhang, J., Wang, J., Han, L., Cao, X. and Shields, L., 2017. Tools to assess risk of bias in
systematic reviews of nursing intervention in China: Global implications of the findings. Nursing
outlook, 65(4), pp.380-391.