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Assessing asthma control An evidence-based approach to improve skills and outcomes Abstract: The goal of asthma therapy is to achieve and maintain...

Hi, Im looking to get a paper done formy nursing class.  these are the aprroved articles and outline.  please, the outline must be followed and articles used and correctely cited.  thanks.

40 The Nurse Practitioner • Vol. 38, No. 6 sthma is a common chronic disorder of the airways that is complex and characterized by variable and recurring symptoms, airfl ow obstruction, bron- chial hyperresponsiveness, and underlying infl ammation. 1 According to the CDC and the National Center for Health Statistics Report on Asthma Prevalence, Healthcare Use and Mortality from 2005 to 2009, asthma prevalence is in 8.2% of the U.S. population (24.6 million people). 2 The CDC re- cently reported that asthma prevalence in children increased from 8.7% in 2001 to 9.6% in 2009. 3 Prevalence is greater among females, children, non-Hispanic Black and Puerto Rican ethnicities, and those below poverty level. 2 Asthma exacerbations are costly; 35% to 50% of medi- cal costs for asthma are due to acute exacerbations. 2 Loss of asthma control results in signifi cant productivity loss and high indirect costs. In 2007, there were 1.7 million asthma- related ED visits reported along with 456,000 hospital- izations due to asthma. In 2008, 10.5 million school days were missed due to asthma along with 14.2 million work days. 2 Impairment of quality of life is a signifi cant and an By Christy Yates, MSN, FNP-BC, NP-C, AE-C A Abstract: The goal of asthma therapy is to achieve and maintain good asthma control. By utilizing evidence-based guidelines recommended by the National Asthma Education Prevention Program Expert Panel-3 Report, nurse practitioners can improve assessment of asthma control, and ultimately improve asthma outcomes. Assessing asthma control An evidence-based approach to improve skills and outcomes Key words: asthma control, asthma exacerbations, classifi cation of asthma control, heterogeneity and variability of asthma, multiple measurements of control Illustration by istockphoto/Marcello Bortolino Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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Assessing asthma control: An evidence-based approach to improve skills and outcomes The Nurse Practitioner • June 2013 41 often overlooked outcome of uncontrolled asthma. 4 A prior history of an asthma exacerbation has been consistently found to be the most important predictor for a future ex- acerbation. 5,6 In addition, asthma exacerbations have been associated with a greater reduction in lung function. 7 In most instances, achieving and maintaining good asthma control is a realistic and achievable goal. Asthma exacerbations can be prevented, symptoms can be mini- mized, and lung function can be maximized. By utilizing measurements of control recommended in evidence-based guidelines for the diagnosis and management of asthma, healthcare providers can improve assessment of asthma control, and ultimately, improve asthma outcomes. National Asthma Education Prevention Program Expert Panel-3 update The National Heart, Lung, and Blood Institute coordinates the National Asthma Education and Prevention Program (NAEPP). Initial NAEPP guidelines for the assessment and management of asthma were released in 1991, and the most recent update, Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma , was released in 2007. 1 The latest update recognized the heterogeneity/ variability of asthma and introduced an asthma severity and control classifi cation system that refl ects the dynamic nature of asthma. A stepwise approach to asthma management was devel- oped to guide healthcare providers in their decision-making process. On initial diagnosis of asthma, the appropriate step therapy is determined by the assessment of asthma severity. On follow-up visits, appropriate step therapy is determined by the assessment of asthma control. Routine and accurate assessment of asthma control emphasized in the EPR-3 update represents a paradigm shift with regard to long-term treatment of asthma. One of the desired outcomes of this change was to dispel the myth that a particular severity level correlates with a certain level of control. For instance, mild asthma does not automatically mean asthma will stay mild and be well controlled. Severe asthma exacerbations may occur at any level of asthma severity. Since no single outcome measure is suffi cient to measure control, the EPR-3 recommends using multiple measure- ments of control, including report of symptoms, quality- of-life measures, validated asthma control questionnaires, lung function, biomarkers, and historical data regarding asthma control. 1 Classifi cation of asthma control Asthma control is classifi ed in the EPR-3 update as well controlled, not well controlled, and poorly controlled in ages 0 through 4 years old, 5 through 11 years old, and 12 years and older. Both asthma severity and asthma control are de- scribed in terms of two distinct domains: impairment and risk. Impairment is defi ned as the frequency and intensity of symptoms and functional limitations that a person is expe- riencing or has recently experienced. Risk is the likelihood of an asthma exacerbation or progressive loss of lung function. Well-controlled asthma is achieved when both impairment and risk domains are minimized, and the goals of therapy are met. Periodic visits and ongoing monitoring are required to determine if asthma control and goals have been achieved. 1 (See Classifi cation of asthma control [0 through 4 years of age, 5 through 11 years of age, and 12 years of age and older]. ) According to the EPR-3 guidelines, asthma is consid- ered well controlled if symptoms (daytime and nighttime) rarely occur, use of the short-acting beta 2 -agonist (SABA) is rare (except to prevent exercise-induced bronchospasm [EIB]), the patient can participate in all normal activities without asthma symptoms, and there is minimal risk of an asthma exacerbation. “Rare” daytime symptoms and use of SABA means 2 days/week or less. Nighttime symptoms vary somewhat depending on the age group. Normal lung func- tion and a score corresponding to well-controlled asthma on a validated asthma control questionnaire are two other indicators of well-controlled asthma. Normal lung function is an FEV 1 (forced expiratory volume in the fi rst second of exhalation after full inspiration) or a peak expiratory fl ow (PEF) greater than 80% of predicted or personal best. 1 (See Criteria for well-controlled asthma. ) Asthma is classifi ed as not well controlled when symp- toms occur several times per week, and more frequent use of quick relief medication is needed. PEF ranges from 60% to 80% of predicted or personal best, and nighttime symptoms occur more frequently. Very poorly-controlled asthma is characterized by daily symptoms and daily use of quick relief medication. PEF is less than 60% of predicted or personal best. The goals of asthma, as defi ned above, are not achieved when asthma is not well controlled. It is the healthcare provider’s responsibility to assess the level of reduced control in both impairment and risk domains to determine the appropriate step therapy needed. 1 The criteria for well-controlled, not well-controlled, and very poorly-controlled asthma are noted in Classification of asthma control . Though the classifi cation system and cor- responding step therapies may appear overwhelming, there are more similarities than differences among the various age groups. The frequency of visits needed to monitor asthma control requires clinical judgment. The EPR-3 guidelines suggest scheduling visits every 2 to 6 weeks for patients just starting treatment or who require a step-up in therapy to achieve or regain control. Patients who are currently well Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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Outline for Asthma Disease Paper Thesis Statement: Asthma is a chronic airway disorder resulting from increased bronchospasms, production of mucus. It is a condition whereby the airways become narrowed and excessive mucus production. This becomes an impediment to breathing and triggers coughing, wheezing and shortness of breath. There is no cure for the disease; doctors only treat to manage the disease. Many patients react differently to the same disease, and have different risk factors associated with it. Introduction: Pathophysiology of asthma, statistics on asthma, the writer’s view of the disease, and its relevance to the nursing profession as a whole. Nursing concepts pertaining to asthma is as follows: Ineffective airway clearance: Assessment: Objective and Subjective data, Risk factors,(modifiable & Non modifiable) Diagnosis: Pulmonary function test, Peak flow monitoring Planning: Pt. will deep breathe, productive cough, proper usage of medications Intervention: Nurse will elevate the head of pt. bed, to deep breath, use of spacer. Evaluation: Pt. condition at the end of process, (continue or discontinue) Risk for activity intolerance: Assessment: Objective and Subjective data, Risk factors,(modifiable & Non modifiable) Diagnosis: Adl’s, Planning: Pt. will perform Adl’s without exhaustion, Attend PT. sessions successfully. Intervention: Nurse and PT. therapist will space out activities and provide rest periods. Evaluation: Pt. condition at the end of process, (continue or discontinue) Anxiety: Assessment: Objective and Subjective data, Risk factors,(modifiable & Non modifiable) Diagnosis: Planning: Patient will be able to identify conditions that cause his /her anxiety. Intervention: Nurse will help patient identify the causes of anxiety in their situation. Evaluation: Pt. condition at the end of process, (continue or discontinue) Patient teaching: Proper usage of rescue inhalers such as Beta 2 agonist as soon as disease symptoms begin to show up, ways to protect one’s self from triggers of the disease, pursed lip breathing, Use of spacers etc. Conclusion / Prognosis:
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Works Cited Centers for Disease Control and Prevention. (2016). National Center for Health Statistics . Retrieved from Clancy, J. & Blake, D. (2013). Pathophysiology and pharmacological management of asthma froma nature-nurture perspective. Primary Health Care , 34-41. Lippincott. (2016, May 6). Lippincott Advisor for Education . Retrieved from Diseases and Conditions: Asthma: bid=4&did=461671 Mary C. O’Laughlen & Karen Rance. (2012). Update on asthma management in primary care. The Nurse Practitioner , 32-40. Yates, C. (2013). Assessing asthma control. An evidence-based approach to. The Nurse Practitioner , 40-47.
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34 September 2013 | Volume 23 | Number 7 PRIMARY HEALTH CARE Continuing professional development Aims and intended learning outcomes The aim of this article is to enable readers to review their understanding of the nature and aetiology of asthma, sufficient to support their work with pharmacological treatments of the condition and to answer potential questions from patients or other clinicians. After reading the article and completing the time out activities you should be able to: ± Briefly summarise what happens physiologically when an asthma attack is triggered. ± Review with patients their perceptions of what causes asthma and what helps to manage the problem. ± Share with patients a clearer rationale of why particular drugs are therapeutic. ± Assist patients to re-evaluate what is involved in managing their condition (sustaining homeodynamism). Introduction An estimated 5.2 million people in the UK have asthma, making its prevalence one of the highest of any country in the world; on average asthma affects people in one of five UK households and is responsible for one hospital admission every 7.5 minutes (Asthma UK 2011). The National Institute for Health and Care Excellence (NICE) (2008) reported 1,266 asthma-related deaths in 2004. Now do time out 1 The World Health Organization (WHO) (2012) defined asthma in terms of its symptoms as ‘a disease characterised by recurrent attacks of breathlessness and wheezing which vary in severity and frequency from person to person’. The British Thoracic Society 1 Description of asthma Time out The reflective activities associated with this article centre on an asthma care case that you are familiar with and which may have posed some difficulties, either in terms of treatment or of helping patients to understand what is happening. Jot down a paragraph outlining the patient’s circumstances as you remember them and what seemed challenging. Pay attention to how the patient defined his or her asthma and note the treatment prescribed. Abstract The maintenance of health depends on nature (associated with genes) and nurture (associated with lifestyle and living conditions) interactions at an intracellular chemical level. Asthma is a common, chronic lung disease affecting more than five million people in the UK, but there is uncertainty about the development of this disease. This article will discuss the pathophysiology of asthma as a cellular or chemical homeodynamic imbalance of inflammation and bronchial hyperactivity. Understanding of such imbalance supports the pharmacological rationale of treatment. The article will explore what has been discovered to date through human genomic research, introduce some of the theories associated with the development of asthma from a nature-nurture perspective and highlight potential developments in the diagnosis and management of the condition. Pathophysiology and pharmacological management of asthma from a nature-nurture perspective PHC725 Clancy J, Blake D (2013) Pathophysiology and pharmacological management of asthma from a nature-nurture perspective Date of submission: November 21 2012. Date of acceptance: March 27 2013. Correspondence [email protected] John Clancy is senior lecturer in physiology applied to health care, school of nursing sciences, University of East Anglia, Norwich Deborah Blake is a nurse practitioner at Holt Medical Practice, Norfolk Keywords Asthma, environmental triggers, allergens, Human Genome Project, beta-2 adrenergic receptors, beta-2 agonist bronchodilators, hygiene hypothesis This article has been subject to double-blind review and checked using antiplagiarism software. For related articles visit our online archive and search using the keywords Conflict of interest None declared Author guidelines PHC SEPT 2013 34-41 cpd.indd 34 28/08/2013 11:26
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35 PRIMARY±HEALTH±CARE± ± ± September 2013 | Volume 23 | Number 7 and Scottish Intercollegiate Guidelines Network (BTS) guidelines (2012) suggested that ‘central to all definitions is the presence of symptoms (more than one of wheeze, breathlessness, chest tightness and cough) and of variable airflow obstruction’. However, these definitions may be considered somewhat dated. Historically, it was thought that the basic defect in asthma was an abnormality of airway smooth muscle contractility, resulting in the symptoms described above. The authors now realise that, regardless of the disease severity, an underlying chronic inflammation of the airways is present in patients. It is something of a paradox that in the two credible definitions associated with the disease given here the term ‘inflammation’ is not present. A more up-to-date definition is provided by NICE (2008): ‘Asthma is a chronic disorder of the airways, which is predominantly caused by the inflammatory response and bronchoconstriction brought about by various environmental stimuli, such as: environmental temperature, smoke, allergens, respiratory infections, exercise, mould, animal fur, pollen and house dust mites.’ Alongside insight into the inflammatory nature of asthma, consideration needs to be given to the nature of cellular change in the respiratory system (the homeodynamics). Theories that have been used to explain asthma, such as the hygiene hypothesis, outlined below, need to be reconsidered as part of a rationale for treatment. Now do time out 2 Homeodynamic responses to allergens Most physiologists find the terms ‘health/homeostasis’ and ‘illness/homeostasis’ imbalances interchangeable in that they operate at a cellular level; cells are regarded as the ‘basic unit of life’ and are responsible for maintaining stability of body fluids (Clancy and McVicar 2009). However, the appropriateness of the term ‘homeostasis’ had been challenged by Clancy and McVicar (2011a) because ‘homeodynamism’ appears to offer a richer understanding of individual subjectivity regarding clinically defined ‘normal’ values associated with human health. Receptors detect a homeodynamic chemical disturbance, and relay this information to the homeodynamic control centre(s) (Figure 1). It is here that the severity of the deviation, for example how far is it above or below the homeodynamic range, is assessed. The control centre or centres then stimulate appropriate responses – usually a negative feedback – via effectors to correct the disturbance and normalise the chemical parameter. Since illnesses are homeodynamic imbalances of either an excess or deficiency of a chemical product of metabolism, it follows that an imbalance is a failure of receptor and/or homeodynamic control centre and/or effector functioning (Clancy and McVicar 2011a, 2011b). Knowledge of this process is fundamental for the primary healthcare practitioner when caring for patients with asthma. A clear understanding is needed of normal functioning of the airways and the immunological response to allergens to explain the pathophysiology of asthma and secondary homeodynamic imbalances that may accompany this disease. Pathophysiology of asthma and drug interaction The respiratory airways: ± Supply optimal oxygen levels for cellular respiration to provide energy in the form of adenosine triphosphate (ATP) – a chemical that drives chemical reactions (metabolism) of the body and heat to thermoregulate body fluids to optimise enzymatic function. 2 Description of asthma Time out Revisit your case study and determine how the patient has described his or her asthma. Has ‘inflammation of the airways’ been used in the explanation, or does the patient instead talk about bronchial spasm? Understanding a patient’s perception of illness is essential to building more effective discussions of treatment . Figure 1 Principles of homeodynamic control a1-4: Homeodynamism – values fluctuating within the homeodynamic range, reflecting individual variation within the population. (b) Homeodynamic disturbance – value parameters moves outside the homeodynamic range. (c) Homeodynamic mechanisms – receptors, homeodynamic controls, genes, effectors, enzymes, pH, adenosine triphosphate restore homeodynamism, usually by negative feedback mechanisms. (d) Homeodynamism re-established. Homeodynamic graph Re: respiratory function. Arbitrary units could be labelled bronchial activity so labels (a 1-4 ) indicate healthy and normal bronchial activity demonstrating individual variation within the population. (b) Indicates temporary increases and/or decreases in bronchial activity due to life-events or environmental triggers. (c) Indicates the natural homeodynamic responses of the body to correct the disturbance. (d) Indicates that normal bronchial activity has been re-established. (Clancy and McVicar 2009) Figure reproduced with the kind permission of the publishers a 1 a 2 a 3 a 4 Arbitary units 100 per cent Time Mean Norm (homeostatic range) 95 per cent b c c d b PHC SEPT 2013 34-41 cpd.indd 35 28/08/2013 11:26
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32 The Nurse Practitioner • Vol. 37, No. 11 oninfectious diseases have surpassed infectious diseases as the dominant adversary in healthcare. Currently, asthma prevalence stands at histori- cally high levels and puts a considerable burden on health- care resources in the United States. 1 The CDC estimates that 25 million Americans are currently living with asthma. 2 In 2007, the National Asthma Education and Prevention Program (NAEPP), coordinated by the National Heart, Lung, and Blood Institute of the National Institutes of Health, published the Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma . These guidelines provide an evidence-based methodology for treating asthma with an emphasis on disease control. The goal of the guide- lines is to prevent chronic and troublesome symptoms, require infrequent use of an inhaled, short-acting broncho- dilator, maintain normal pulmonary function, maintain normal activity levels, and meet patients’ and families’ expectations for asthma care. Nurse practitioners (NPs) have the opportunity to im- prove asthma outcomes and quality of life for patients. NPs are widely employed in primary care to manage asthma; research has demonstrated that NPs improve patient out- comes and provide equivalent care to that of physicians. 4 To best equip NPs for the role of asthma care provider, the NAEPP recommendations have been systematically re- viewed using the common SOAP (subjective data, objec- tive data, assessment, plan) format. 3 Using a SOAP format during the primary care visit is a simple, easy, and compre- hensive technique to organize symptoms, observations, assessments, and treatment plans for patients with asthma. Asthma: A single disease? Asthma is a complex, chronic, infl ammatory lung disease characterized by variable and recurring symptoms of airfl ow obstruction, bronchial hyperresponsiveness, and infl amma- tion. 3 The interaction of these features determines the clin- ical manifestations and severity of the disease as well as the patient’s response to treatment. 3 Underlying infl ammation causes recurrent episodes of coughing, wheezing, shortness of breath, and chest tightness in susceptible patients. These episodes are generally associated with widespread but vari- able airfl ow obstruction, which is often reversible either spontaneously or with treatment. 3 There has been a longstanding debate whether asthma is a single disease with a variable, clinical presentation or several diseases that present with variable airfl ow obstruc- tion as a common feature. 5 In 2006, it was proposed that the different phenotypes expressed by patients with asthma are partially dependent on different disease processes in each person. 6 It is also suggested that asthma comprises distinct, heterogeneous, infl ammatory disorders that are character- ized by patients presenting with different phenotypes with distinct genetic components, environmental causes, and immunopathologic signatures. 7 Additional phenotypes will By Mary C. O’Laughlen, PhD, RN, FNP-BC, and Karen Rance, DNP, RN, CPNP, AE-C N Update on asthma management in primary care Abstract: Asthma, a chronic infl ammatory lung disease, is one of the most common and costly diseases in the United States, affecting people of all ages and all ethnic groups. While there is no cure for asthma, optimal disease control and quality of life are possible with proper management and treatment. Illustration by Evans Brian/Getty Images © Key words: airway infl ammation and hyperresponsiveness, asthma management, chronic infl ammatory lung disease Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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Running Head: ASTHMA AND THE NURSING PROCESS 1 Asthma and the Nursing Process Name
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