Refer the parents for genetic counseling, particularly if they plan to have more children. Encourage adolescents and young adults in the family to receive genetic counseling and testing as well. Referrals and support groups and contact with others with the disease can be helpful.
African American Culture:-Grandmothers play an important role in care of children-Children are expected to demonstrate respectfulness, conformity to rules, obedience, and good behavior-Extended family is very important-Religious healing (laying on hands)-Talisimans (amulets or lucky charms)-Herbal remedies/oils-Use of healers: o“old women” healersoVoodoo healersoShamansoSpiritualist oRoot doctors Muslim Culture
Asthma (Pg. 540-552)Asthma is a common chronic disorder in children characterized by bronchial constriction,hyperresponsive airways and airway inflammation. 1.Etiology and Pathophysiology: Asthma is a chronic inflammatory disease caused by multiple factors (environmental exposures, viral illnesses, allergens and a genetic predisposition) that occur at a crucial time in the immune system’s development. More than 100 genes are associated with thesusceptibility and pathology of asthma. Risk Factors for asthma include passive smoke exposure, indoor air contaminates (for example pet dander, cockroach feces) outdoor air pollutants, recurrent respiratory viral infections, and allergic disease (atopic eczema, food allergies). Protective Factorsinclude a large family size, later birth order, childcare attendance, dog in the family, and living on a farm. These factors increase exposure to infections early in life, enabling the child’s immune system to develop along a nonallergic pathway. Inflammation causes the normal protective mechanisms of the lungs (mucous formations, mucosal swelling and airway muscle contractions) to overreact in response to a trigger (an inflammatory or noninflammatory stimulus that initiates an asthma episodes) Triggers include exercise, infectious agents, allergens, fragrances, food additives, pollutants, weather changes, emotions and stress. Inflammatory mechanisms enhance air way responsiveness and trigger stimulate bronchospasm (smooth muscle contractions). The trigger may activate IgE and sensitized mast cells, leading to the release of inflammatory mediators (histamines, prostaglandins, and leukotrienes). The inflammatory mediators release pro-inflammatory cytokines, causing chronic airway inflammation, which may be associated with permanent airway damage. The resulting decreased airway elasticity and lung function are not prevented or fully reversed by treatment. The reactive airway response exists before the Tigger initiates the physiologic sequence that results in an acute asthma episode. Airway narrowing results from bronchial constriction, airway swelling, and mucus production. Mucus clogs small airways, trapping air below the plugs. Decreased perfusion of the alveolar capillaries results from hypoxic vasoconstriction and increased pressure due to hyperinflammation of the alveoli.