Chronic Asthma Disease in Young Teens

Pathophysiology of Asthma

Asthma has become a major problem of concern in many developing nations (Australia NAC, 2014). It is a chronic disease and a pulmonary condition, which causes obstruction and inflammation of the airway. Airway inflammation and obstruction could be the result of various cellular elements. These cellular elements are cells and cytokins. The basic function of cytokins basicly works against the infection. It causes inflammation as the in response to infection from, which it works to save the uninfected tissues (Melen & Pershagen, 2012). The inflammation in the windpipe or the airway can result in breathlessness, wheezing and coughing. As in the case of Steven, shortness of breath is due to hampered flow of air in the airway. Inflammation in the airway is also called as the hyperactivity or bronchial hyperresponsiveness (BHR) (Melen & Pershagen, 2012). This hyperactivity is caused due to narrowing of airway, which acts in this way to respond towards allergens and irritants.

When the airflow decreases, it also results in bronchial hyperresponsiveness. The flow of gases can be reduced due to various reasons, such as smoking, cold weather, over-exercise, any kind of viral infection and allergies. Steven has the two years history of smoking. He was already a patient of asthma, and smoking had caused airway obstruction in his case. Due to these reasons the airways become narrow and start producing mucus in excess. Thus, according to the pathophisiology of asthma, the major reason behind occurrence of asthma is airway obstruction and narrowing of airway pipes (Melen & Pershagen, 2012). It has also been observed that asthma causes structural and functional changes in the airway. These changes are observed in the form of hypoersecretion of the mucus gland, bronchospasm, disruption of cilia, mucosal edema and epithelial cell sloughing. The results of airway obstruction are very severe; they can result into decreases respiration and hyperinflation (Depner et al, 2014).

The major issue with asthma is that it is immunological. There is excessive inflammation in the airway in the case of asthma in young children. Thus inflammation has the major role in Pathophysiology of asthma. The discovery of lymphocytes has helped in understanding the development of asthma. T helper 1 cells and T helper 2 cells (Th1 and Th2), they both have different inflammatory mediator and impacts the functioning of the airway (Depner et al, 2014). The inflammation is caused due to the allergic mechanism of IgE. The inflammation response occurs due to the penetration of the eosinophil. It is also observed that process of inflammation increases in response to infections and parasites (Melen & Pershagen, 2012). The allergens are inhaled through various environmental factors. The ingestion of the allergens is done by antigen-presenting cells (ACPs). These cells sent the allergens to immunity cells such as TH1 and TH2. The allergens are ignored by the immunity cells in patients of asthma, which causes the disease (Depner et al, 2014).

Nursing Approach

Growth and Developmental Theories

According to “Global Initiative for Asthma management and prevention” (GINA), the treatments and management of the asthma are done on the basis of severity of the disease (Crain, 2015). The major goal of the current asthma management practice is to maintain control over asthma over a long term. The avoidance and prevention of the intensified and increasing factors for asthma are of the greatest importance in the pharmacological therapy of the disease. It is also important that patient may understand the importance of medical management of asthma. The management and control over asthma could be a very challenging task in adolescents.

According to the growth and developmental theories of Erik Erikson and Piaget’s cognitive development theories, children in age of 15-16 are in their middle adolescence period. These children separate from their families and try to fit in with their peers (Crain, 2015). Such children also challenge the recommendation of parents towards management of Asthma. It could be true in the case of Steven, as he do not take his medication properly. Young children are at highest influence of their peers and have inductive or deductive reasoning (Sadof & Kaslovsky, 2011).). This is basically the transition period of child towards adulthood. Thus, children try to be more independent and are more influenced by the people other than family members. Asthma can affect children in different ways according to their developmental stage (Martin et al, 2010).

The nurse can play a significant role in helping adolescents in managing asthma. Nurse must have the complete knowledge and understanding of managing the disease in different developmental stages of children. At this stage children are in transitional period from parental management to self management (Martin et al, 2010). The child centered care is not enough for such teens and they require adult centered care. The transitional period of adolescents also pose challenge for the achieving adherence to the treatment. These children are also at the highest risk of dropping their regular medication. Thus denial and vulnerability are also very great risk factors (Dowling, 2014). Steven is not concerned about his medication, as he does not want to take medication in front of peers. This is because he has the fear of peers’ acceptance.

For such conditions, nurses can help the patient to understand the importance of managing the disease (James, Nelson, & Ashwill, 2014). Education based asthma management plan can be introduced. Peers can also be involved in the treatment plan. For this four basic cognitive theories, which can be used are, justification of the treatment, justifying the treatment regardless of unsupportive peers, explaining self management of asthma through peers and  explaining the importance of asthma self management to a trusted friend. Involving parents is also important for developing therapeutic and emotional relationship. The evidence based approach is vital for the developmental needs of adolscents.

Family Centered Care

Family Centered Care is a new approach towards providing quality healthcare and nursing services to the patient and their families. This practice is very significant in the case of adolescents. The main focus of this practice is to involve family in the patient’s disease management. Family is the first and most important support for any individual (Harrison, 2010). Children and adolescents are first affected by their social and family environment. For providing high quality care to the patient, it is important to involve family in the management and control of asthma. Family Centered Care (FCC) encompasses the professional healthcare providers to offer quality care to patients. It is mainly important in the pediatric nurses. Such approach focuses on providing physical as well psychological well-being to the patient through emotional support of family (Harrison, 2010).

Nurses must also understand that motive of FCC is to support patient as well as family emotional and mental support to family enhances the trust of patient’s in care and healthcare setting. The duty of care is the core element of this approach (INSTITUTE, F. P., & FAMILY-CENTERED, C. A. R. E, 2012). The problem of asthma is a major issue for the families from minority groups in Australia. This disease is very severe in Aboriginal and Torres Strait Islander people. The people living in rural areas of the country often lack in proper living and food conditions. The unhealthy habits of smoking, alcoholism and substance abuse is also wide (Mitchell et al, 2012).

The poor families also lack proper education and understanding the importance of disease management. Thus, knowledge gap, misconceptions are among the major barriers of effective treatment of asthma in poor population. Steven also has a big family and lives in the rural part of Australia. The habit of smoking has intensified his problem of asthma (Mitchell et al, 2012). The aim of Family Centered Care is to attain family support, remove the hindrances of adherence, improving quality of life and controlling the disease (Kuo et al, 2012). This approach also acknowledges the importance of working in collaboration with families. This helps the patient to develop close relationship with their parents and improve the outcomes. Family support is believed to reduce the barriers of medication and negative attitude towards medication. Adolescents, who are comforted by their families, feel more secure and asthma control is improved. Thus support and collaboration of family influence the cognitive and social barriers and improves the control over disease (Harrison, 2010).

Effect of Hospitalization over Patient and Family

Hospitalization has a very challenging effect on adolescents and their parents. According to the developmental stage, these children have the sense of independence, and hospitalization seems to be a barrier in their independence. Such teens can also pose many legal and ethical issues for the nurses and other healthcare professionals, while their hospitalization. Due to puberty, there is a rapid development in physical and cognitive growth. Due to the influence of peers, teens may not be comfortable in getting hospitalized and away from their peers. They can refuse to take medication and may also refuse the nursing plan. Such conditions could lead to ethical dilemma for the nurses. However, adolescents have the right to make their own decisions; they require support of their families. By losing their independence and freedom, the children may also develop symptoms of depression, anxiety and hopelessness. It becomes important for the nurses to develop therapeutic relations with patient and maintain the boundaries of service (James, Nelson, & Ashwill, 2014). Every adolescent have their own needs. Thus, it is also important to respect autonomy of the patient and consider him as an individual. With proper support and collaboration of family and professionals, hospitalization barriers can be removed.

References

Australia, N. A. C. (2014). Australian Asthma Handbook. Version. Melbourne: National Asthma

Council. Retrieved From: http://www.asthmahandbook.org.au/management/children.

Crain, W. (2015). Theories of development: Concepts and applications. Psychology Press.

Dowling, M. (2014). Young children’s personal, social and emotional development. Sage.

Depner, M., Fuchs, O., Genuneit, J., Karvonen, A. M., Hyvärinen, A., Kaulek, V., … & Kabesch, (2014). Clinical and epidemiologic phenotypes of childhood asthma. American journal of respiratory and critical care medicine, 189(2), 129-138.

Goodwin, R. D., Robinson, M., Sly, P. D., McKeague, I. W., Susser, E. S., Zubrick, S. R., … & Mattes, E. (2013). Severity and persistence of asthma and mental health: a birth cohort study. Psychological medicine, 43(06), 1313-1322.

Harrison, T. M. (2010). Family-centered pediatric nursing care: State of the science. Journal of Pediatric Nursing, 25(5), 335-343.

Institute, F. P., & FAMILY-CENTERED, C. A. R. E. (2012). Patient-and family-centered care and the pediatrician’s role. Pediatrics, 129(2), 394.

Kuo, D. Z., Houtrow, A. J., Arango, P., Kuhlthau, K. A., Simmons, J. M., & Neff, J. M. (2012).

Family-centered care: current applications and future directions in pediatric health care. Maternal and child health journal, 16(2), 297-305.

James, S. R., Nelson, K., & Ashwill, J. (2014). Nursing care of children: Principles and practice. Elsevier Health Sciences.

Martin, M., Beebe, J., Lopez, L., & Faux, S. (2010). A qualitative exploration of asthma self- management beliefs and practices in Puerto Rican families.Journal of health care for the poor and underserved, 21(2), 464-474.

Melen, E., & Pershagen, G. (2012). Pathophysiology of asthma: lessons from genetic research with particular focus on severe asthma. Journal of internal medicine, 272(2), 108-120.

Mitchell, E. A., Beasley, R., Keil, U., Montefort, S., Odhiambo, J., & ISAAC Phase Three Study Group. (2012). The association between tobacco and the risk of asthma, rhinoconjunctivitis and eczema in children and adolescents: analyses from Phase Three of the ISAAC programme. Thorax, 67(11), 941-949.

Sadof, M., & Kaslovsky, R. (2011). Adolescent asthma: a developmental approach. Current opinion in pediatrics, 23(4), 373-378.

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