Report for Fundamentals of Nursing Essay

Bronchoconstriction : Prominent feature observed in asthma is narrowing of the airways and this narrowing leads to the interference with airflow. In cases of acute exacerbations of asthma, exposure to the different stimuli like allergens or irritants leads to the contraction of bronchial smooth muscle. Allergens induce bronchoconstriction by the release of immunoglobulin E (IgE) dependent mediators. IgE crosslink with the receptors on the mast cells and degranulation of the mast cells occurs. This degranulation of mast cells results in the release of different mediators like histamine, tryptase, leukotrienes, and prostaglandins. These mediators act on the airway smooth muscle and contract it.  There is also non-IgE dependent bronchoconstriction. Aspirin is the prominent example of the non-IgE dependent bronchoconstriction. Other physical factors like exercise and cold air are also responsible for the acute bronchoconstriction. Stress is also responsible for the contraction of the airways. Possible reason behind bronchoconstriction of these factors is increased release of pro-inflammatory cytokines.  Report for Fundamentals of Nursing Essay.

Airway edema : With the progression of the disease there is more obstruction to the airflow from the airways. This is mainly due to the edema, mucus hypersecretion, and development of thickened mucus plugs. There are also structural changes like hypertrophy and hyperplasia of the airway smooth muscle.

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Airway hyperresponsiveness: Airway hyperresponsiveness is an increased bronchoconstrictor response to stimuli like methacholine. Inflammation, impaired neuroregulation and structural changes like hypertrophy and hyperplasia are mainly responsible airway hyperresponsiveness. Degree of airway hyperresponsiveness correlates with contractile response of methacholine challenge and severity of asthma.

Airway remodeling : Airway remodeling comprises of permanent structural changes of airways, increased airflow obstruction, airway responsiveness and this leads to the progressive loss lung function. Patients with airway remodeling are less responsive to the current therapy for asthma. These permanent changes include sub-basement membrane thickening, subepithelial fibrosis, hypertrophy and hyperplasia of airway smooth muscle, blood vessel proliferation and dilation, mucous gland hyperplasia and mucus hypersecretion (Craft et al., 2013).

Growth and developmental theories

Nurse should make realize Steven that, he should achieve all his developmental goals irrespective of the asthma. In the age group of Steven, which is adolescents, it is difficult for the Steven to understand the seriousness of the asthma, its management and its long term implication on the development of Stevens. An adolescent is the most dynamic phase of the life in which both physical and psychological changes occurs at very rapid rate. Nurse should make understand Steven that, his physical and psychological improvement would be stopped due to asthma. Nurse should try making Steven’s life normal like other adolescents, should try to make him eligible for peer approval and try to evade his feelings of invincibility. Adolescents always try to make their own identity and nurse should keep this thing in mind while providing nursing intervention to Stevens. Nurse should remind him to take all the measures to get out of asthma to make identity of him as a healthy person. An adolescent thinking is always based on the scientific and deductive aspects. Report for Fundamentals of Nursing Essay. Nurse should utilize this characteristic of Steven and showcase him few of the evidences of asthma control and its positive impact on the further development of him. This type of display to the Steven, help nurse to make him understand importance of treatment in a convenient way (Berman et al., 2014).

While giving nursing care to Steven, nurse should consider that adolescents of Steven age are more inclined towards friends and social influences as compared to the family members. Hence nurse should incorporate friends and other members in the Stevens society for his care. This type incorporation of members other than family might improve his interest in the asthma care and management. For this nurse should assess the relation of Stevens with his peers and plan the strategy accordingly. Also, nurse should motivate Steven and his family members to get asthma control as early as possible by following all the instructions for care and management of asthma. Nurse should make Steven and his family members realize that controlling asthma at the earliest is helpful for Steven by regaining normal life and joining his peers for adolescent activities. This motivation to control asthma would definitely improve upon the compliance of asthma care and management. Also nurse should teach Stevens, to neglect peers who used to tease him about his diseased condition. This would help in building moral boost in Stevens and he would focus more positively towards activities of asthma care and management (Crisp & Taylor, 2012).

Family centered care

Nurse should listen to concern of Steven’s family about the asthma care and management. Understand about their knowledge about asthma and correct if any misconception is there. This is very important because family members of Steven and nurse might not have same understanding of the care of asthma and family members can direct their care about Steven in another direction. After getting the family’s knowledge about care, nurse should teach them required skills like use of equipment and giving medications. Nurse should teach Steven and his family members about the usage of peak flow meter. This peak flow meter assist in understanding changes occurring in the respiratory system before the sever attack of asthma is evident. Nurse should also teach Steven and family members about the threshold readings on the flow meter and its relative medication timings. Thus administering medication before the asthma attack, help in preventing the actual severe asthma attack. In addition nurse should educate them about the assessment of the medication effect using the flow meter. This monitoring of the medication effect also help family members to decide upon whether to take care of Steven at home or should take him to the hospital for further management of asthma attack. Incorporation of continuous monitoring of the condition of Steven and medication management helps in minimizing the number of asthma attacks. This learning of usage of equipment and proper dosage schedule, help to control asthma attacks in Steven.Report for Fundamentals of Nursing Essay.  In initial few days nurse should provide consultation to family members through phone about the control of asthma attacks because family members need to get confidence in managing asthma independently as this is an entirely new task for them (Hudson et al., 2015; Janamian et al., 2014).

Nurse should also advise them about the future visit and when to seek emergency visit to the hospital. This is necessary because parents should be capable to judge the severity of asthma in Steven and instead of managing it on their own they should consult to the expert.  By doing all these exercises of educating family members, there would be more confidence in family members about the care and management of Steven’s asthma. Most importantly, nurse should advise family members of Steven to stop him from smoking cigarettes because cigarette smoking would exaggerate existing condition of the asthma in Steven and it would be very difficult to manage in the future once asthma become severe (Mitchell et al., 2016; Hayes et al., 2016).

III. The effects of hospitalization on the child and family

Long term illness like asthma and hospitalization have numerous negative impacts on child like cognitive, social, motor and emotional development. There are hormonal and psychological dependent emotional alterations in the children due to hospitalization. Severe disease and hospitalization of child due to this disease make childs’ identity as diseased instead of normal child. This lead to the social isolation of the child and consequently to the depression and sometimes rebellion nature in the children. Childhood is progressive and both child and parents always plan for immediate future of child. However, due to hospitalization this plan gets badly affected because decision making for both parents and children gets affected. Also, there can be negative impact on the social and educational development of the children due to frequent absence in the school. Due to disease there can be bodily changes in the children like reduced weight and not looking like normal children. This can impact self image and self esteem of the children. Due disease most of children become completely dependent on parents for most of their activities and this can affect their confidence level. In such scenario nurses should assist children and family by giving appropriate education and consequences of the disease (Fraser et al., 2014). Report for Fundamentals of Nursing Essay.

Nurse should encourage children to express their view on disease, so that they can feel relaxed about the disease. Nurse should suggest implementing different trainings for the improvement of cognitive, emotional and social well being of the hospitalized children. Nurse should suggest children to spend more time with good peers so that can feel relaxed and social interaction can be improved. Nurse should take precaution that privacy of hospitalized child should be maintained so that it would not affect its identity. Nurse should also suggest controlling negative behavior of the children. Hospitalization of the children increase the stress level in the family members particularly parents. Hospitalization of the children has social, emotional, financial impact on the family of the children. Family members feel socially isolated and emotionally disturbed due to hospitalization of the children. Financially also they get affected as they have to spend money on hospital charges and moreover at least one family member should be with the children in the hospital at the expense of job and loss of salary. Report for Fundamentals of Nursing Essay. In such scenario, nurse should have good communication with the family members and boost their confidence and advise them to boost the confidence of the hospitalized child also (Hill et al., 2011; Franck et al., 2015).

References:

Berman, A., Snyder, S. J., Kozier, B., & Erb, G. L. (2014) Kozier & Erb’s Fundamentals of Nursing Australian Edition. Pearson Austrlia.

Craft, J., Gordon, C., Tiziani, A. P., & Huether, S. E. (2013). Understanding Pathophysiology – ANZ adaptation. Elsevier.

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Crisp, J. & Taylor, C. (2012). Potter & Perry’s Fundamentals of Nursing. Elsevier.

Franck, L.S., Ferguson, D., Fryda, S., & Rubin, N. (2015). The Child and Family Hospital Experience: Is It Influenced by Family Accommodation? Medical Care Research and Review, 72(4), 419-37. doi: 10.1177/1077558715579667.

Fraser, J., Waters, D., Forster, E., Brown, N. (2014). Paediatric Nursing in Australia: Principles for practice. Cambridge University Press.

Hayes, P., Lynch, A., & Stiffe, J. (2016). Moving into the ‘patient-centred medical home’: reforming Australian general practice. Education for Primary Care, 30, 1-3.

Hill, M.K., Pawsey, M., Cutler, A., Holt, J.L., &  and Goldfeld, S.R. (2011). Consensus standards for the care of children and adolescents in Australian health services. Medical Journal of Australia, 194(2), 78-82. Report for Fundamentals of Nursing Essay.

Hudson, P.L., Girgis, A., Mitchell, G.K., Philip, J., Parker, D., et al., (2015). Benefits and resource implications of family meetings for hospitalized palliative care patients: research protocol. BMC Palliative Care, 14(73). doi: 10.1186/s12904-015-0071-6.

Janamian, T., Jackson, C.L., Glasson, N., & Nicholson, C. (2014). A systematic review of the challenges to implementation of the patient-centred medical home: lessons for Australia. Medical Journal of Australia, 201(3), S69-73.

Mitchell, M., Coombs, M., & Wetzig, K. (2016). The provision of family-centred intensive care bereavement support in Australia and New Zealand: Results of a cross sectional explorative descriptive survey. Australian Critical Care, pii: S1036-7314(16)30072-8. doi: 10.1016/j.aucc.2016.07.005. Report for Fundamentals of Nursing Essay.