Asthma: Signs and Health History (Pediatric Nursing)

00:01 Now, your patient with asthma may come in with a chronic cough, or they may just cough after exercise, or they might have a nocturnal cough or a nighttime cough.

00:10 Your patient may describe wheezing and this is the turbulent air flow through their tightened airway.

00:15 Imagine a fireplace, and when the wind is blowing outside and it gets turbulent, you hear a whistling in the fireplace.

00:20 This is the same thing that happens in the airway.

00:23 The patient's going to have increased sputum production.

00:26 They may have chest pain, and they will have difficulty breathing.

00:31 Signs and symptoms associated with an asthma emergency include if your patient's symptoms do not resolve.

00:37 So we give patients about a 15-30 minute window to try their asthma action plan to try to reverse their symptoms, and if it doesn't work, they need to seek medical attention.

00:46 Status asthmaticus can be life-threatening.

00:50 On exam, the clinician will use information obtained in their health history and physical exam to help diagnose and treat a patient with asthma.

00:58 There are a lot of components of information to gather for a complete health-history in regard to asthma.

01:03 These include asking the patient about their symptoms, including their cough, whether or not they're wheezing, do they experience shortness of breath, chest tightness, and are they having a productive cough? The second is the pattern of their symptoms.

01:20 Is this perennial, is this seasonal, or is it both? Is this continual or episodic, or both? And talk about the onset.

01:29 When did these symptoms start? The duration, how long have they lasted? And frequency, how often do they happen? Number of nights per week or number of nights per month.

01:40 Are there any diurnal variations, especially at night and on awakening? The third part of the health history involves precipitating or aggravating factors.

01:50 And this could be the patient saying, you know, "Every time I get a cold, I end up with asthma-type symptoms," and this would be a viral respiratory infection trigger.

01:59 Does your patient have environmental allergen triggers, indoor or outdoor? Sometimes they'll go mow the grass and then come in and say they're wheezing.

02:06 Well, they might have a grass allergy that's triggering their asthma.

02:09 You want to ask about the characteristics of their home, including the age of their home, the location, how do they heat and cool their home, and do they have any carpet? You'll want to ask about pets in the home as these are common triggers.

02:23 You want to ask if there's any smoking in the home, and does this happen after the patient exercises? Sometimes, patients will say after they get emotional or stressed, this will trigger their asthma attack.

02:36 And sometimes, they'll say it's after they take certain medications.

02:40 Perhaps, a change in the weather or an exposure to cold air will also trigger their symptoms.

02:45 Or they might have comorbid conditions.

02:47 Maybe they have GERD, which is gastroesophageal reflux disease or heartburn.

02:51 Or maybe they have chronic sinusitis, and these conditions need to be handled to get their asthma under control.

02:58 The fourth part of the health history is the development of their disease and treatment.

03:02 So, how old were they when this started, and have they been formally diagnosed with asthma? Do they have any history of early life injury to the airways? And those are those viruses we talked about that can cause long-term problems in the airway remodeling.

03:17 How was the progression of their disease? Has it gotten better? Has it gotten worse with time? And how do they manage their current symptoms? If they do have albuterol, or a short-acting beta-2 agonist, you want to ask how often are they needing that medication? And then you also want to ask have they had a need for oral corticosteroids and how often have they needed those? The fifth component is collecting a family history because we know this is familial.

03:44 Is there any family history of asthma or allergic conditions, frequent or chronic sinusitis, rhinitis, which is a runny nose, can be linked with allergies, eczema, or nasal polyps in close relatives.

03:57 All of these conditions are linked with asthma.

04:00 And how about their social history? Does the patient attend daycare? Is their workplace having any triggers, and are there any known school triggers? Then you want to ask about their social and support networks because this is a chronic condition.

04:15 Next, you want to ask about the history of exacerbations.

04:18 Does your patient have a usual prodromal sign or symptom to know that their asthma attack is coming? How about the rapidity of onset? Does this happen fast for a patient? The duration and frequency of their exacerbations.

04:33 And at the severity.

04:34 Does this patient typically manage this at home? Do they need to go into an urgent care setting? Do they need to go to the emergency department? Or have they even been managed in the intensive care unit? And you'll always want to ask about has this patient had any life-threatening exacerbations? This lets you know that their asthma may be fragile.

04:53 Have they been intubated or managed in the intensive care setting with their asthma? The eighth component is the impact of asthma on their patient and family care.

05:03 Do they have episodes of unscheduled care? Are they missing work? Are they missing school? Does this limit their activities, especially their sports, because this is a component of the quality of life? These patients really want to get back to their activities.

05:18 Are they up at night with their cough and managing their asthma symptoms, because this is going to affect their level of rest? And ultimately, what is the effect on their growth and development and behavior, school performance and lifestyle because this is a chronic condition, and it can disrupt the patient's life quite significantly.

05:38 Next, you want to do an assessment of the patient and family's perception of the disease.

05:42 Do they have knowledge of asthma and understand the efficacy of treatment? I see a lot of patients that won't take their chronic asthma medications because on a day by day basis, they're not having many symptoms.

05:54 But when I explained that uncontrolled chronic asthma can actually permanently remodel the airway and make it an irreversible disease, they start taking their treatment.

06:04 The ability of a patient and parent to cope with the disease, the level of family support, and the ability to recognize the severity of an asthma exacerbation.

06:14 The economic resources available.

06:16 So, inhalers are expensive and a lot of patients can't afford them.

06:20 There are vouchers available to be able to get these inhalers for your patients.

06:24 And what are your patients sociocultural beliefs regarding asthma?