Asthma II: Responding to Asthma Episodes

Transcription

1 Asthma II: Responding to Asthma Episodes California After School Resource Center (C.A.S.R.C.) Administered for the California Department of Education (C.D.E.) Hello! Welcome to the Asthma II: Responding to Asthma Episodes training. This training will take approximately 30 minutes to complete. Let s get started. 1

2 Objectives You will be able to: 1) Recognize asthma symptoms and triggers. 2) Follow an asthma action plan to help a student during an asthma episode or asthma emergency. 3) Describe how to use a quick-relief inhaler. 4) Describe when and how to use a peak flow meter. Let s review the objectives for this training. By the end of this training, you will be able to: 1) Recognize asthma symptoms and triggers. 2) Follow an asthma action plan to help a student during an asthma episode or asthma emergency. 3) Describe how to use a quick-relief inhaler. 4) Describe when and how to use a peak flow meter. 2

3 Before We Begin Please print out handouts as reference materials at this time. We will refer to two documents throughout the course of this module. It may be helpful for you to have these handouts available prior to continuing on to the next slides. These handouts are titled My Asthma Plan and Peak Flow Meters. You may print these handouts now by selecting the links. 3

4 Fictional Scenario This training will include activities that are based on a fictional student. The symptoms, triggers, medication instructions, and asthma action plan included for this student are also fictional. Training content should not be substituted for actual medical instructions for a student for whom you are responsible. As we get started, please note that during this training, you will think through hypothetical scenarios that feature a fictional student. The symptoms, triggers, medication instructions, and asthma action plan included for this student are based on reality, but are fictional. The student-based scenarios were designed to further learning about asthma and should not be substituted for existing or actual medical instructions for students for whom you are responsible. 4

5 What is the Difference Between an Asthma Episode and an Emergency? Episode A flare-up of asthma that is not life threatening and can be controlled with medication and help from adults. vs. Emergency An asthma episode that cannot be controlled, may be life threatening, and needs immediate attention. Let s review the difference between an asthma episode and an asthma emergency. Knowing the difference can help staff determine which actions need to be taken and if help is needed right away. An asthma episode is a flare-up of asthma that is not life threatening and can be controlled with medication and help from adults. An asthma emergency is an asthma episode that cannot be controlled, may be life threatening, and needs immediate medical attention. 5

6 Asthma Symptoms Wheezing Shortness of breath Student-reported tightness in the chest Coughing (persistent or with physical activity) Tiredness at school (often due to waking at night with asthma symptoms) Stomachaches Headaches There are a variety of asthma symptoms, and it is important to remember that each student may experience different symptoms with different levels of intensity. Some of the most common asthma symptoms are: Wheezing Shortness of breath Student-reported tightness in the chest Coughing that is persistent or coughing with physical activity Tiredness at school, which is often due to waking at night with asthma symptoms Stomachaches Headaches 6

7 Meet Peter: What do You Recognize? Jaime brought her pet guinea pig in for show-and-tell. Peter has started coughing and wheezing You realize that Peter has asthma and the guinea pig may have potentially triggered an asthma episode. What are your next steps? Now that you know what asthma symptoms are, let s practice how to recognize and respond to them. Meet Peter, the fictional student we will follow as we move through this training. Jaime, one of Peter s classmates, brought her pet guinea pig in for show-and-tell. After a short time, you observe Peter coughing and wheezing while he is helping Jaime place the guinea pig s cage in a safe spot. You remember that Peter has asthma and that something may have triggered an asthma episode. Peter also mentions that he touched the guinea pig when he was helping Jaime. What are your next steps? 7

8 Peter s Symptoms and Triggers Symptoms: coughing and wheezing Possible trigger: guinea pig hair Let s learn how to help Peter by following an asthma action plan. Peter s main symptoms are coughing and wheezing, and the guinea pig likely triggered his symptoms. Now that we ve recognized the symptoms and triggers, let s learn how to help Peter by following an asthma action plan. 8

9 A Sample Asthma Action Plan Completed by a medical professional and contains: Parent/guardian authorization Emergency contact information Medication instructions Triggers Guidance for monitoring breathing and taking action For this training, we will use an asthma action plan from the Regional Asthma Management and Prevention (RAMP) Initiative. An asthma action plan is completed by a medical professional and contains five main components. These include: parent or guardian authorization, emergency contact information, medication instructions, triggers, and guidance for monitoring breathing and taking action. In the case of Peter, you would refer to this document in order to identify or confirm triggers as well as receive guidance on how to respond to asthma episodes that Peter may experience. If you have not already printed out the handout for your reference, you can access the document titled My Asthma Plan by selecting the handout link. 9

10 Peter s Plan: Triggers You have authorization to follow Peter s asthma action plan. The guinea pig is a possible trigger. Look at Peter s plan. According to the plan, what could we do about the trigger? Let s assume that we have permission to follow Peter s asthma action plan. Earlier in the training, we recognized his asthma symptoms and identified Jaime s guinea pig as a possible trigger. Look at the portion of Peter s plan on the next slide. According to the plan, what could we do about the possible trigger? 10

11 Peter s Plan: Controlling Triggers According to the plan, what could we do about the trigger? According to the plan, what could we do about the trigger? Continue to the next slide when you re ready. 11

12 Peter s Plan: Address the Trigger Ask Peter to move away from the guinea pig. If available, ask Peter to use his inhaler if he uses medication to control asthma episodes. Ask or assist Peter to wash his hands. Use his peak flow meter if he has one available on site to help monitor his air flow. Contact Peter s parent or guardian and your site administrator to alert them to the situation. First, we would ask Peter to move away from the possible trigger, the guinea pig. You may also consider moving Peter into another room to assess his condition while allowing the other students to continue with the activity. Next, determine whether Peter uses medication to control asthma episodes and have him use his inhaler, if available. This may help prevent an asthma episode from worsening into an asthma emergency. If an inhaler is not available, contact your supervisor or administrator for support and contact Peter s parent or guardian immediately for guidance. Next, we would ask or assist Peter to wash his hands to try to remove the pet dander and hair. Continue to monitor Peter s asthma symptoms with a peak flow meter, if available, in case the symptoms worsen. In the next few slides, we will discuss how to use a peak flow meter and follow an asthma action plan to engage in an appropriate response to asthma episodes or emergencies. It is important to keep Peter s parent or guardian and your supervisor informed of the situation, in case they determine other actions would be warranted. Peter s parents may decide to pick him up or they may simply ask to be kept informed through the course of the day. 12

13 Action Plan: Monitor Breathing with a Peak Flow Meter A peak flow meter: Is a useful tool for staff to monitor a student s asthma symptoms. Measures how well a student is breathing. The four main steps to using a peak flow meter are: 1) Set the meter to zero. 2) Take a deep breath in. 3) Blast a breath of air forcefully into mouthpiece. 4) Record reading. Repeat these steps two more times and record the highest reading. Now we have recognized Peter s symptoms and addressed the possible trigger. Let s learn how to monitor a student s breathing, so we can determine the appropriate action steps to assist Peter. A peak flow meter measures how well a student is breathing and is a useful tool for staff to monitor a student s asthma symptoms. Many children with asthma have and know how to use a peak flow meter. The four main steps for using a peak flow meter are: 1) Set the meter to zero. 2) Sit up or stand up straight and take a deep breath. 3) While using your lips to make a seal on the mouthpiece, blast air forcefully out through the mouthpiece. 4) Record the reading. Repeat these steps two more times and record the highest reading to compare to the peak flow zones indicated in the student s asthma action plan, which we will be discussing in the next slide. If you have not already printed out the Peak Flow Meters handout, select the link for more detailed information about using a peak flow meter. 13

14 Action Plan: Understanding Peak Flow Zones A peak flow meter reading measures how well a person is breathing and can help determine the course of action to take during an asthma episode, including how much medication to take and how often. There are three peak flow zones: green (doing well), yellow (getting worse), and red (medical alert). A student in the yellow zone is experiencing some asthma symptoms and may be having an asthma episode, and a student in the red zone may be having an asthma emergency. The peak flow ranges are based on an individual s personal best peak flow reading. Each student will have different ranges for their unique peak flow zones as determined by a medical professional and these ranges will be documented on each student s asthma action plan. A peak flow meter may not always be available at the time of an asthma episode and medication may need to be administered to prevent an escalation to an asthma emergency. Be sure to consult with your supervisor and the student s parents for appropriate steps in these situations, prior to experiencing an episode. 14

15 Action Plan: Medication Instructions Dosage and frequency. Controller medications are used daily to prevent asthma episodes and problems. Quick relief medications are used to reduce symptoms and during an emergency. Instructions for medication are another component of an asthma action plan. This section includes information about medication dosage and frequency. There are two main types of asthma medications. Controller medications are used daily to prevent asthma episodes and problems, and are often administered before school or at bedtime at home. Quick relief medications (such as albuterol or levalbuterol) are used to reduce escalating symptoms throughout the day and night. 15

16 Action Plan: Authorization Parent/guardian authorization needed to follow an asthma action plan. Self-Carry Law (Education Code ) Students can carry and selfadminister their own asthma medication with written doctor and parent/guardian approval. It is important to know that staff need parent or guardian authorization to follow an asthma action plan and take action steps based on the plan. The School Authorization Form is included in the RAMP My Asthma Plan packet. If you have not already printed out the handout, you can access the document titled School Authorization Form by selecting the handout link. This form enables parents or guardians to permit staff to assist children with the asthma medications listed on the authorization form, and follow an asthma action plan, in accordance with state laws and regulations. Another important state law in California to be aware of is the Self-Carry Law (Education Code ), which states students can carry and self-administer their own asthma medications with written doctor and parent or guardian approval. Parents or guardians can give permission for their children to self-administer asthma medications by completing this form. Please be aware that a student in distress might need help finding his or her peak flow meter and inhaler. You may want to find out where the students, who have responsibility for self-carrying, keep their equipment. In addition, students may forget to bring their equipment on any given day. If you are able to work with the students parents or guardians to secure a peak flow meter and an inhaler for storage on-site for each student authorized to do so, make sure all staff can access them during an asthma episode or emergency. All medications stored on site should also be checked periodically for expired medications that need to be returned to parents or guardians for proper disposal and replacement. 16

17 Action Plan: Administer Medication A quick-relief inhaler is a common form of medication for people with asthma. Tips for using an inhaler: 1) Uncap inhaler and shake well. 2) If the inhaler does not have a spacer (a long tube that slows the delivery of medication from inhaler), the inhaler should be held about one to two inches from the mouth. 3) Sit up or stand up straight, exhale completely. 4) Inhale and press down on air canister of the inhaler. 5) Hold breath for a few seconds before releasing to allow the medicine to expand in the lungs. Inhaler with spacer Inhaler without spacer A quick-relief inhaler is a common form of medication. Most students with asthma have and know how to use an inhaler, but they may need assistance in the event of an asthma episode or emergency. Here are some tips for the correct use of an inhaler: 1) Uncap inhaler and shake well. 2) If the inhaler does not have a spacer, which is a long tube that slows the delivery of medication from the inhaler, the inhaler should be held about one to two inches from the mouth. 3) Sit up or stand up straight, inhale and exhale completely once. 4) Inhale and press down on air canister of the inhaler, releasing the medicine. Inhale slowly and deeply to inhale the medication completely. 5) Hold your breath for a few seconds before releasing to allow the medicine to expand in the lungs. If more than one puff is indicated, wait at least one minute before taking the next puff. 17

18 Peter s Plan: Monitor Breathing Peter exhibits asthma symptoms. His peak flow reading is 445. How is Peter doing? Let s use what we just learned about monitoring breathing with a peak flow meter to continue to assist Peter. We have already recognized that Peter exhibits asthma symptoms and had him self administer his medication from his inhaler according to his signed authorization form and asthma action plan as staff are trying to locate his peak flow meter. Let s also imagine that after staff have located Peter s peak flow meter a few minutes later, we have asked him to use his meter to get a current reading. Peter s green zone is 480 or higher, his yellow zone is 300 to 474, and his red zone is below 300. His peak flow reading is 445. How is Peter doing? Which zone is he in, and what does this mean? 18

19 Peter s Plan: Address the Episode Peter has already taken two puffs of his quickrelief medication, albuterol. Continue to monitor Peter and reassess his peak flow levels in 20 to 30 minutes. We have already had Peter take two puffs of his quick-relief medication, albuterol, prior to getting his peak flow meter reading. We will continue to monitor Peter and reassess his peak flow levels in 20 to 30 minutes. 19

20 Peter s Plan: Check the Status Twenty minutes later, Peter s wheezing seems to have subsided and his breathing appears to be evening out. He uses his peak flow meter again, and has a reading of 487. What does this mean? Twenty minutes later, Peter s wheezing seems to have subsided and Peter s breathing is evening out. He uses his peak flow meter again and gets a reading of 487. What does this mean according to his asthma action plan? 20

21 Peter s Plan: Take Action Again Peter s reading of 487 indicates he is back in the Green Zone. What should you do now? Peter s reading of 487 indicates that he is back in the green zone. What are your next steps? 21

22 Peter s Plan: Continue Monitoring Continue to monitor Peter s condition for the rest of the day. Update his parents on his condition, including all responses taken in the course of the day. Keep your supervisor or administrator updated on Peter s condition as well as the response steps taken. Peter s asthma symptoms appear to be improving, but it is important to monitor his symptoms for the rest of the day. Equally important is to update Peter s parents and your supervisor on his condition and all the steps taken to monitor and respond to his asthma episode. This will not only help Peter s parents continue to monitor Peter s condition and his care, but is also an opportunity for you and your supervisor to evaluate your response to the situation. 22

23 Great Job Helping Peter You stayed calm and followed his asthma action plan. After going home for the day, Peter s parents continued to monitor his condition, with no additional issues. Peter returned the next day ready to go. Great job helping Peter! You stayed calm and followed his asthma action plan. Because Peter s parents were informed of the day s events, they continued to monitor his condition for the rest of the day and did not encounter any additional issues. Peter returned to school the next day, without any problems, and ready to go! 23

24 Symptoms of an Asthma Emergency Extreme difficulty breathing Bluish color to the lips and face Decreased level of alertness, such as severe drowsiness or confusion, during an asthma attack Rapid pulse Severe anxiety due to shortness of breath Sweating Not all responses to asthma episodes progress as smoothly as they did for Peter. Asthma episodes can escalate to full blown asthma emergencies. In these cases, recognition of more severe symptoms and a quick, appropriate response is key. In addition to indicated readings from a peak flow meter, some additional physical symptoms that are signs of an asthma emergency are: Extreme difficulty breathing Bluish color to the lips and face Decreased level of alertness, such as severe drowsiness or confusion, during an asthma attack Rapid pulse Severe anxiety due to shortness of breath Sweating 24

25 What to Do in the Case of an Asthma Emergency? Follow the student s asthma action plan and administer medication as directed. Call 9-1-1, notify your supervisor or administrator and the child s parents. Continue to monitor the student s condition through the peak flow meter and follow the asthma action plan until medical assistance arrives. Ensure that a copy of the student s asthma action plan with notes of any actions taken by staff goes with the student when medical assistance arrives. Notify the student s parent or guardian when the student leaves campus and is on the way to a medical facility. If you are faced with a student experiencing an asthma emergency: Follow the student s asthma action plan and administer medication as directed. Call 9-1-1, notify your supervisor and the student s parents immediately. Continue to monitor the student s condition through the peak flow meter and follow the asthma action plan until medical assistance arrives. Ensure that a copy of the student s asthma action plan with notes of any actions taken by staff goes with the student when medical assistance arrives. Notify the student s parent or guardian when the student leaves campus and is on the way to a medical facility. 25

26 Today You Learned How to: Recognize asthma symptoms and triggers. Follow an asthma action plan to help a student during an asthma episode or asthma emergency. Use a quick-relief inhaler. Use a peak flow meter. Today, you learned how to assist students with asthma by: Recognizing asthma symptoms and triggers. Following an asthma action plan to help a student during an asthma episode or asthma emergency. Learning how to use a quick-relief inhaler. Learning how to use a peak flow meter. 26

27 Congratulations! Congratulations! You have reached the end of the Asthma II: Responding to Asthma Episodes training. You will now have the opportunity to take a quiz to test the knowledge you have acquired in this training. If you receive a passing score, a completion certificate will be ed to you at the address you provided. If you don t receive a passing score, you will have the opportunity to take the test again at any time. Following the quiz, you will be asked to complete a brief feedback survey. After you complete the survey, you will be able to access sample California After School Resource Center library resources and additional information about asthma. You may start the quiz by selecting the quiz link. Thank you for your participation. 27