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User Document #3 Personas

Persona 1
Mrs. Gladys Kravitz Age 50 School Teacher Charlotte, North Carolina

Occupation: Kindergarten teacher, 28 years Marital Status: Married Family: Two adult children, one grandchild Household: Lives with husband Hometown: Charlotte, NC Education: BA & MA, Early Elementary Ed (UNC-Charlotte) Hobbies: Sewing, knitting, cooking Computer Use: Intermediate to advanced user Mrs. Kravitz is aware of basic asthmatic care, but in the past has been able to send a student in distress to the school nurse. Due to spending cuts, Mrs. Kravitz is now challenged with learning how to use an Asthma Action Plan and how to administer asthma related medications. She has no previous experience with metered dose inhalers or nebulizers.

Persona 2
Mrs. Claire Huxtable Age 63 Retired Social Worker Pelham, North Carolina

Occupation: Retired Social Worker (42 years) Marital Status: Married Family: One adult child, one grandchild Household: Lives with husband Hometown: Atlanta, GA Education: BS, Social Work (Spelman College) Hobbies: Gardening, French cooking Computer Use: Intermediate user She is mildly asthmatic and is familiar with metered dose inhalers. She has seen the patient receiving treatment with a nebulizer, administered by his mother or father, but has never given a treatment herself. Mrs. Huxtable will need to be able to decipher the patients Asthma Action Plan and be able to administer his medications as needed. She has previous experience with metered dose inhalers and no experience with nebulizers.

User Document #3 Personas


Persona 3
Mrs. Willona Woods Age 43 Bank Manager Charlotte, North Carolina

Occupation: Branch Manager, USA Bank Marital Status: Married Family: Three children Household: Lives with husband and children Hometown: Greenwood, MS Education: BS, Accounting (U of MS); MBA (Wharton School of Business) Hobbies: Reading, singing Computer Use: Advanced user

No one in the Woods household is asthmatic. Mrs. Woods is not familiar with Asthma Action Plans and only has a rudimentary understanding of how to administer asthma related medications via metered dose inhalers and nebulizers.

Photographs Persona 1 - http://www.udel.edu/chem/beebe/class2003SACscholars.htm Persona 2 - http://www.blackisonline.com/wp-content/uploads/grandmother-300x199.jpg Persona 3 - http://bossip.files.wordpress.com/2012/12/black-woman-smiling.jpg?w=446&h=350

Asthma Action Plan User Test


Numerical Order There are eight steps in administering the Albuterol Solution by nebulizer. Please number the following steps in order from one to eight. ___ Attach the cup to the mask mouthpiece ___ Check to ensure the device is functioning properly (you should see a mist coming through the tube and out of the mouthpiece) ___ Gently place the mask on the patients face tighten the elastic straps as needed ___ Have patient sit where s/he is most comfortable ___ Once nebulizer cup is empty, switch off the compressor and remove the mask ___ Pour the solution in the nebulizer cup ___ Switch the compressor on ___ Use the tubing to connect the air compressor and the nebulizer cup

True/False When an asthma patient is in the RED Zone, the patient requires urgent medical attention. Asthma is a chronic disease of the lungs. Asthma attacks often accompany a cold or respiratory virus. This Asthma Action Plan is for the patient Curtis Canty. Tobacco smoke is an allergen that can trigger an asthma attack. Blue lips and fingernails are not a red flag symptom of asthma. Asthma Action Plans are one size fits all. When a patient is in the YELLOW Zone, they may demonstrate asthma symptoms that do not respond to medication.

True True True True True True True True

False False False False False False False False

What are the five (5) items that should be included in an Asthma Action Plan? 1. 2. 3. 4. 5.

Asthma Action Plan


A tutorial
Tiffini W. Canty Document #3 Revision ENGL 5181

What is Asthma?
Asthma is a chronic disease that affects the lungs, making it difficult to breathe. Symptoms of asthma include: Wheezing (a whistle in the breath) Coughing Tightness in the chest Fast breathing

During an asthma attack, the lining of the bronchial tubes in the lungs become inflamed. The lungs may secrete a sticky liquid called mucus along with inflammation, can restrict air flow.

that,
http://www.mckinley.illinois.edu/handouts/asthma/asthma.html

What is an Asthma Action Plan?


An Asthma Action Plan is also sometimes called an Asthma Emergency Guide. Each Plan/Guide is a step-by-step list that is tailored to meet the needs of a specific asthma patient. The plan provides information on the signs that the patient may be having an asthma attack. The plan also outlines the steps to be taken, depending upon the severity of the situation. Asthma Action Plans are usually created with the patients physician and should be shared with anyone who may need to take care of the patient in the event of an asthma episode. This may include any caregiver such as a teacher, coach, or sitter. It is important that everyone is aware of the plan and how to use it. A well written Asthma Action Plan should include: A list of the patients known asthma triggers What to do in the event of an episode A list of medications and instructions for administering the medication(s) When to seek help i.e. when to contact parents, physician or emergency services Emergency contact information.

How to Use this Asthma Action Plan


Asthma Zones
Many Asthma Action Plans are formatted to compare the patients condition with a traffic signal. Using the colors green, yellow, and red, one can evaluate the patient and determine the most appropriate steps to take. Green is normal and symptom free. Yellow involves mild to moderate symptoms but responds to medication. Red is an asthma emergency that requires immediate attention. The patients goal is to remain in the GREEN Zone at all times. Movement to the YELLOW or RED Zones requires attention.

URGENT. The patient requires urgent and immediate attention. In addition to YELOW Zone symptoms, it is very difficult for the patient to breathe, medication does not improve symptoms

MODERATE. The patient may demonstrate mild to moderate signs of asthma. There may be coughing, wheezing, tightness in the chest but the symptoms respond to treatment.

NORMAL. The patient has no signs of asthma. Breathing is good. There are no symptoms such as wheezing, coughing or tightness in the chest. To fully comprehend how to proceed when the patient displays symptoms, please review the following sections of the Asthma Action Plan. Signs of an Asthma Attack Asthma Triggers Medications Medical Devices o Metered Dose Inhaler (MDI) o Nebulizer

Once you have identified the patients status, please proceed to the corresponding section (Red, Green, Yellow) of the action plan to correspond to the patients Zone.

Asthma Action Plan

Doing Great!
Symptom Free: No cough No wheeze Sleeps through the night Regular activities

Administer as usual: Fluticasone One spray per nostril 1x/day Budesonide One vial by nebulizer 1x/day Childrens Loratidine One teaspoon by mouth 1x/day

Asthma Action Plan

Caution!
Moderate Symptoms: Cough Wheezing Short of breath Unable to do usual activities Loss of appetite Give quick relief medicine Albuterol Aerosol By MDI and spacer Two sprays as needed Administer Albuterol Sulfate Inhalation Solution By nebulizer One vial every four hours as needed 1. Call parents (caregivers) 2. If no improvement within 10 to 20 minutes, repeat treatment 3. If no improvement go to RED ZONE

Asthma Action Plan

DANGER!
Symptoms: Trouble walking or talking Vomiting (no apparent reason) Fast breathing Exaggerated rise & fall of chest Incoherent QUICK RELIEF MEDICATION NOT WORKING Administer Albuterol Sulfate Inhalation Solution By nebulizer Two vials every 20 min. as needed Next Steps 1. Call parents (caregivers) 2. If unable to reach parents call doctor 3. Parents call doctor right away 4. Call 911 if patient does not improve within five to ten minutes or becomes worse

Asthma Action Plan


Action Plan Date April 2, 2013 (v.04-29-2013) Patient Joshua Hanks Patient DOB Mother Tiffini Huxtable Hanks Mobile Phone Mobile Phone Office Phone Father Curtis Hanks Physician Marcus Welby, MD Anderson Pediatrics January 2, 2008 (704) 339-8433 (704) 995-1903 (704) 385-1000

Signs of an Asthma Attack


Coughing Wheezing Breathing Problems Tightness in Chest Fatigue Irritable Confused Vomiting Fever

Before an attack, Joshua may demonstrate these symptoms. He may have all or some of these signs. A dry, hacking cough that does not seem to be relieved by anything. It may be worse at night or when lying down. A whistling sound when breathing. It may be worse when exhaling. There may also be a rattling or crunchy sound in his chest. May include shortness of breath, gasping for air, breathing very fast or slow at an abnormal pace. His abdomen may appear very depressed due to gasping for air. He may complain of a pain in his chest area or that it feels as though there is a heavy weight on his chest. Feeling very tired or weak. He may be very listless, quiet and spend time lying down. (Joshua is a very active child anything else is unusual.) Short-tempered and cranky for no apparent reason. Incoherent and unaware of his surroundings he may not recognize people that he knows quite well or may not be able to answer simple questions such as his name and birthdate. Sudden, violent vomiting without warning or indication. A temperature of 102 degrees or higher. Attacks often accompany a cold or respiratory virus (sneezing, runny nose, congestion, etc.).

Danger Signs

Please seek medical attention right away (emergency room or call 911) if these red flag symptoms appear: Trouble walking and talking because of difficulty breathing Hunching over, unable to stand or sit up straight Blue lips or fingernails Very slow, shallow breathing

Asthma Action Plan Joshuas Asthma Triggers


An asthma attack may be brought on by a trigger an environmental element that irritates the lungs. These triggers should be avoided and minimized as possible. Allergens Animal Dander (flakes of skin or dried saliva from animals with fur or feathers) Dust Mites (tiny bugs that are found everywhere in fabric covered items such as mattresses, pillows, upholstery, clothes, and stuffed toys) Cockroaches (dried droppings and remains of cockroaches) Indoor Mold Pollen and Outdoor Mold (especially during allergy season when pollen and mold spore counts are very high) Irritants Tobacco Smoke (avoid second hand smoke at all times) Other Smoke, Strong Odors, Sprays (smoke from fires fueled by accelerants, perfume, powder, hair spray, paint) Other Vacuum Cleaning (avoid the dust that is stirred up by vacuuming, use dust mask if necessary, always use filtered vacuum cleaner bags) Food Allergies (sulfites in certain foods may cause asthma symptoms) Cold Air (cold air and wind can irritate bronchial tubes)

Asthma Action Plan Medications


Medication Brand Name Amount Frequency Administer Medication Brand Name Amount Frequency Administer *Note Medication Brand Name Amount Frequency Administer Medication Brand Name Amount Frequency Administer Medication Brand Name Amount Frequency Administer Albuterol Sulfate Inhalation Solution 0.83% One (1) vial Every four (4) hours by Nebulizer As needed Albuterol Aerosol Ventolin HFA Two (2) puffs Every four (4) hours As needed for cough or wheezing Two (2) puffs 15 minutes prior to exercise Fluticasone Flonase One (1) spray per nostril Once daily Upon waking Budesonide Pulmicort One (1) vial Once daily Bedtime Childrens Loratidine Claritin One (1) teaspoon Once daily Upon waking

Asthma Action Plan Medical Devices


Metered Dose Inhaler (MDI) with Spacer Used to administer Albuterol Aerosol 1. 2. 3. 4. 5. 6. 7. Shake the inhaler well before use (3-4 shakes) Remove the cap from (a) inhaler, and from (b) spacer, if it has one Put the inhaler into the spacer Breathe out, away from the spacer Bring the spacer to mouth, put the mouthpiece between teeth and close lips around it Press the top of inhaler once Very slowly, take in a full breath. A whistle sound means the breath is blowing too fast. Slowly breathe in. 8. Hold breath for about ten seconds, then breathe out. 9. Repeat steps four through eight for second puff.

Nebulizer with Mask Used to administer Albuterol Solution 1. 2. 3. 4. 5. 6. 7. Pour the solution in the nebulizer cup Attach the cup to the mask mouthpiece Use the tubing to connect the air compressor and the nebulizer cup Have patient sit where s/he is most comfortable Gently place the mask on the patients face tighten the elastic straps as needed Switch the compressor on Check to ensure the device is functioning properly (you should see a mist coming through the tube and out of the mouthpiece) 8. Once nebulizer cup is empty, switch off the compressor and remove the mask

Step-by-Step
Metered Dose Inhaler (MDI) with Spacer Used to administer Albuterol Aerosol

1.

Shake the inhaler well before use (3-4 shakes)

2.

Remove the cap from (a) inhaler, and from (b) spacer, if it has one

3.

Put the inhaler into the spacer

4.

Breathe out, away from the spacer

5.

Bring the spacer to mouth, put the mouthpiece between teeth and close lips around it

6.

Press the top of inhaler once

7.

Very slowly, take in a full breath A whistle sound means the breath is blowing too fast Slowly breathe in as much air as possible

8.

Hold breath for about ten seconds

9.

Breathe out

Repeat

10.

Wait 60 seconds (one minute) Repeat steps four through nine for second puff

Nebulizer with Mask Used to administer Albuterol Solution Nebulizer Solution Nebulizer Cup Mask

Tubing

Nebulizer

Appearance will vary by manufacturer

1. Pour the solution in the nebulizer cup

2. Attach the cup to the mask mouthpiece

3. Use the tubing to connect the air compressor and the nebulizer cup

4. Have patient sit where s/he is most comfortable

5. Gently place the mask on the patients face tighten the elastic straps as needed

6. Switch the compressor on Refer to manufacturer's instructions to locate on/off switch

7. Check to ensure the devise is functioning properly (you should see a mist coming through the tube and out of the mouthpiece)

8. Once nebulizer cup is empty, switch off the compressor and remove the mask

Resources McKinley Health Center University of Illinois http://www.mckinley.illinois.edu/handouts/asthma/asthma.html (Fight Asthma Milwaukee) FAM Allies Coalition Childrens Hospital of Wisconsin http://www.famallies.org/education_medications.asp National Institutes of Health www.nih.gov/