College of Nursing

NCM 53 – Pediatric Rotation

RESOURCE UNIT ON
Care of a 1-Year-Old with Asthma

Prepared and Submitted on:

September 14, 2022
Time Allotment: 30 minutes

Topic: Care of a 1-Year-Old with Asthma

Topic Description: Childhood asthma is not a different disease from asthma in adults, but children face unique challenges. In this topic, we will learn about asthma occurring in young patients,
how to recognize, analyze, and manage it as student nurses.

Central Objective: At the end of this lecture, the learners will gain comprehensive knowledge, skills, and attitude on the care of the 1-year-old patient with asthma.

Time
Learning Assessmen
Learning Outcomes Allotmen Content
Strategies t
t
At the end of this 3 minutes I. The 1-Year-Old Child Face-to- Knowledge
discussion, the learners • Growth and Development at 1 Year face will be
will be able to: - Toddlerhood (1-2 years) discussion assessed
o During the second year, toddlers are moving around more, and are aware of themselves and their with the through a
• Define surroundings. Their desire to explore new objects and people also is increasing. They begin to use of 10-item
childhood show greater independence, defiant behavior; recognize themselves in pictures or a mirror; and PowerPoint review
asthma. imitate the behavior of others, especially adults and older children. Toddlers also should be able presentatio quiz after
• Recognize to recognize the names of familiar people and objects, form simple phrases and sentences, and n and/or the
signs and follow simple instructions and directions. handouts discussion.
symptoms of • Developmental and Moral Theories
asthma in - Anal Stage of Sigmund Freud’s Theory of Psychosexual Development
children. o Between ages 1-3, the region around the anus become highly sensitive to the stimulation of
• Identify the “holding on” and “letting go”.
contributing o Freud believed that the primary focus of the libido was on controlling bladder and bowel
factors and movements.
pathophysiolog o The major conflict at this stage is toilet training — the child has to learn to control his or her
y of asthma. bodily needs.
• Discuss the o Developing this control leads to a sense of accomplishment and independence.
applicable o Toilet training is child’s first encounter with authority.
treatments or - Trust vs Mistrust Stage of Erik Erikson’s Theory of Psychosocial Development
methods of o In the first year after birth, babies depend completely on adults for basic needs such as food,
therapy. comfort, and warmth. If these needs are met, the babies become attached and develop a sense of
security. Otherwise, they may develop a mistrustful, insecure attitude.
• Apply the o Caregivers who are inconsistent, emotionally unavailable, or rejecting contribute to feelings of
nursing process mistrust in the children under their care. Failure to develop trust will result in fear and a belief
in providing that the world is inconsistent and unpredictable.
care for - Sensorimotor Period of Jean Piaget’s Theory of Cognitive Development
patients o At birth until roughly two years, children learn by using their senses and moving around. By the
experiencing end of the sensorimotor period, children become capable of Symbolic Thought, which means
asthma. they can represent objects in terms of mental symbols. More important, children achieve object
• Provide permanence in this stage. Object Permanence is the ability to recognize that an object can exist
nursing care even when it’s no longer perceived or in one’s sight.
according to
the child’s 2 minutes II. Overview on Childhood Asthma
growth and • Definition of Childhood Asthma
development. - Asthma is a common chronic inflammatory disorder in children characterized by bronchial constriction,
• Discuss hyperresponsive airways, and airway inflammation.
possible play - Childhood asthma isn't a different disease from asthma in adults, but children face unique challenges.
therapy • Classifications of Asthma Severity in Children
techniques 1. Intermittent – symptoms 2 or less days a week
applicable to 2. Mild Persistent – symptoms more than 2 days a week but not daily
the patient. 3. Moderate Persistent – daily symptoms
4. Severe Persistent – symptoms throughout the day
• Symptoms / Clinical Manifestations
1. Breathing difficulty (shortness of breath)
2. Productive cough
3. Frequent cough
4. Expiratory wheezing
5. Chest congestion or tightness
6. Fatigue (may be due to poor sleep)
• Common Complications
1. Pneumothorax – collapsed lung
2. (Susceptibility to) pneumonia – due to previous lung damage or weakness in lung tissue
3. Acute exacerbation requiring hospitalization, intubation, mechanical ventilation
4. Death – On average, 11 people in the US die from asthma every day. (Goff, 2022)

5 minutes III. Etiology and Pathophysiology

• Multiple factors cause asthma, including environmental exposures, viral illnesses, allergens, and genetic
disposition among others. Potential genes or regions of chromosomes are also found to be associated with
asthma, like those associated with increased immune and inflammatory response and airway remodeling.
Environmental exposures that contribute to asthma include smoking, indoor air contaminants (e.g.
animal/insect feces), and outdoor air pollutants. Recurrent respiratory viral infections and protective factors
such as large family size, later birth order, childcare attendance, and exposure to infections may also
contribute to the child’s immune system to develop along a nonallergic pathway. Persistent inflammation
causes the lungs to overreact in response to triggers such as:
- Exercise
- Infectious agents
- Allergens (e.g. pollen, dust)
- Fragrances
- Food additives
- Pollutants
- Weather changes
- Emotions
- Stress
These triggers initiate the inflammatory response of the airways. Involved in this process are several
inflammatory cells including mast cells, macrophages, eosinophils, neutrophils, T and B lymphocytes, and
epithelial cells of the airways. As the inflammatory process begins, mast cells which are found beneath the
basement membrane of the bronchial wall degranulate and release multiple inflammatory mediators. IgE
antibodies are linked to mast cells, and the allergen cross-links the IgE. Mediators released include histamine,
tryptase, leukotrienes, and prostaglandins. These inflammatory mediators affect the blood vessels, causing
vasodilation and increase of capillary permeability (which leads to runny nose), the nerve cells, causing
itching, the smooth muscle cells, causing bronchial spasms and airway narrowing, and goblet cells, causing
mucus production. The entire airway inflammation process ultimately leads to bronchoconstriction, airway
hyperresponsiveness (or increased sensitivity to an inhaled constrictor), and edema of the airways. This initial
phase is referred to as the early-phase response. It occurs within 30-60 minutes after exposure. In the late-
phase response, where symptoms can recur 4-6 hours after the early response, the patient’s symptoms may
return or worsen. This occurs in about 50% of people with asthma. In this phase, more inflammatory cells are
activated. Inflammation and bronchoconstriction may go on for 24 hours or more. Corticosteroids are
effective in treating inflammation at this phase. Chronic inflammation may cause structural changes in the
bronchial wall, referred to as remodeling, meaning loss of lung function that is not fully reversible. These
structural changes may also include airway edema, mucus hypersecretion, the formation of mucus plugs.
 • Pathophysiology illustrated:

2 minutes IV. Diagnosis

• Diagnostic tests
1. Detailed Medical History – family history of allergy, asthma, eczema, dermatitis; identify symptoms
consistent with asthma and pattern of symptoms that occur or worsen in presence of specific triggers
2. Focused Physical Examination – special attention on the upper respiratory tract, chest, skin
3. Laboratory Procedures
 a. Spirometry – recommended test to diagnose asthma; done by breathing into a spirometer, a device
that records the amount of air you breathe in and the speed of your breath
b. Peak flow meter (monitoring tool) – not a diagnostic tool; handheld device that measures how well
air moves out of your lungs
c. Blood tests, allergy testing, x-rays – done for infants/children under 3 years old
• Expected Findings
1. In spirometry, a low FEV1 (how much air you can forcefully exhale in 1 second) is a sign of an
obstructed airway which could indicate asthma. If this increases after taking a bronchodilator, the
obstruction is reversible, confirming the diagnosis.
2. In peak flow monitoring, a lower reading could indicate onset of asthma.

*Note: Spirometry and peak flow are indicated for children at least 4 years of age.

5 minutes V. Nursing Management of Childhood Asthma

• Assessment and Diagnosis
1. Physiologic Assessment
- Assess ABCs (airway, breathing, circulation), quality of breathing, oxygen saturation, RR and
PR. Assess for wheezing, cough, stridor, retractions on the chest.
2. Psychosocial Assessment
- Assess child’s anxiety r/t the asthma episode or hospitalization, the parents’ response and
concerns.
3. Examples of nursing diagnoses
- Ineffective airway clearance (r/t airway compromise, copious mucous secretions, coughing)
- Impaired gas exchange (r/t airway obstruction)
- Fluid volume deficit (r/t inability to drink adequate fluid when in respiratory distress)
- Anxiety/Fear (child and parents; r/t difficulty breathing)
- Ineffective health management (r/t lack of understanding about the need for daily management of
a chronic disease)
• Planning and Implementation
1. Maintain airway patency – provide oxygen with nasal cannula or face mask; position the child in semi-
Fowler position to promote and ease respiratory effort
2. Meet fluid needs – encourage increased fluid intake to thin and break mucous plugs in the airways; PO
or through IV infusion; monitor intake and output to detect overhydration or dehydration
3. Promote rest and stress reduction – tiredness could result from prolonged labor breathing; put the child
in a quiet, stress-free environment
 4. Support family participation – encourage – not expect – the parents to assist with the child’s treatment
and to take breaks; provide frequent updates about the child’s condition
5. Discharge Planning and Home Care Teaching – increase the family’s knowledge about the disease,
medication therapy, and the need for follow-up care
• Evaluation
1. Expected outcomes include
- Child recognizes early asthma symptoms and promptly uses appropriate medications and
techniques before the condition progresses.
- Child learns to identify and avoid asthma triggers.
- Child and family implement the prescribed daily action/treatment plan.
- Child responds to oxygen, fluids, and medication therapy.

5 minutes VI. Medical Management and Treatment of Childhood Asthma

• Pharmacological Therapy
1. Nebulization Therapy
- Done with a device that delivers high doses of medicine quickly and easily by changing liquid
medicine into a fine mist. The mist is then breathed in through a face mask or mouthpiece.
- Salbutamol - a reliever medicine which opens up the airways and calms down the inflammation,
is usually the first treatment given
- Ipratropium bromide - may be added if your symptoms don’t improve with salbutamol alone
2. Long-term Control Medications
- Inhaled corticosteroids – most commonly used in children under 5; ex. budesonide, fluticasone,
and beclomethasone
- Leukotriene modifiers – can be added to inhaled corticosteroids; chewable tablet or granular;
ex. montelukast (Singulair)
- Long-acting beta antagonist – inhaled; add-on treatment to corticosteroids; ex. salmeterol
- Cromolyn – inhaled; add-on treatment
- Oral corticosteroids – only used when asthma management cannot be controlled with other
treatments
3. Short-acting Medications – short-acting bronchodilators; provide immediate relief
- Albuterol (ProAir HFA, Ventolin HFA)
- Levalbuterol (Xopenex HFA)
• Non-pharmacological Therapy
1. Play Therapy
- Although everyone can benefit from play therapy methods, babies and young toddlers have a
limited experience when it comes to play therapy.
 - In play therapy for the 1-year-old child, a nondirective approach is more efficient. Techniques
such as the use of puppets, stuffed animals, masks, dolls, and action figures can be used to
encourage the child to express their experiences and feelings regarding their condition and
treatment.
- Provide a safe environment where the child feels comfortable and there are few limitations and
distractions.
2. Relaxation and breathing techniques – to help maintain calm, controlled breathing; ex. pursed-lip
breathing
3. Prevention – limiting exposure to triggers, regular check-ups, encouragement to stay active, maintaining
a healthy weight

3 minutes VII. Presentation of Infographic

5 minutes VIII. Open Forum

 REFERENCES

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