Young children with asthma more likely to revisit EDs
An asthma action plan is needed
Children under 2 years old with asthma are more likely than other children to return to the ED within seven days, according to a recent analysis of 4,228 visits.1
"ED nurses may want to spend additional time with parents of younger children to ensure they are comfortable with identifying asthma symptoms and can manage them effectively," says Christine M. Walsh-Kelly, MD, the study's lead author and associate professor of pediatrics at the Medical College of Wisconsin in Milwaukee.
These patients may not even have a definitive asthma diagnosis, says Cindy Debiak, RN, BS, CPN, SANE-A, pediatric coordinator for the ED at Helen DeVos Children's Hospital in Grand Rapids, MI. "Young children don't have enough of a history that documents an asthma diagnosis. There are so many potential diagnoses of a young child presenting with breathing problems. We are often left to manage their current symptoms when what's really needed is a long-term care management plan," she reports.
To improve care of these patients, consider these items:
• Children normally have much smaller airways than adults.
Rosie Rodriguez-Henderson, RN, MHL, advanced clinician in the pediatric ED at Baptist Children's Hospital in Miami, says, "This is very important to keep in mind and is a major difference between the adult and the child. The smaller the child, the smaller the airway."
Remember that children's airways are different from adults, says Rodriguez-Henderson. "Continuously assess and reassess for improvements or deterioration in the child's respiratory status," she says. "Use pulse oximetry to monitor oxygen levels in the body, and intervene as needed when the child's respiratory status declines."
• Review the treatment plan upon discharge.
"Encourage questions. Ask the parents, or child, if age-appropriate, to repeat the information you have given them," says Rodriguez-Henderson.
• Keep the child's prior history in mind.
Children shouldn't simply be treated and released for repeated episodes of coughing and wheezing, says Debiak.
"Look at how many times they have been seen in your emergency room for the same symptoms," says Debiak. "If the patient is in for the sixth time for the same concern, why not pursue the child obtaining a primary care provider to get to the root of the problem? The provider can then develop an asthma action plan."
First, ask if the child has a primary care provider and if the answer is "no," be sure to include a referral in your discharge instructions.
• Advocate for a consult with a respiratory therapist.
"Treating a child in the emergency room is a team effort. Call in your respiratory team to assess the patient," says Debiak. This could be overlooked in a busy ED, she says, especially if the ED does not have a respiratory therapist working along with the team in the ED.
"Their expertise makes them the ideal person to assess respiratory problems, especially if they have experience with children," says Debiak.
Reference
- Walsh-Kelly CM, Kelly KM, Drendel AL, et al. Emergency department revisits for pediatric acute asthma exacerbations: Association of factors identified in an emergency department asthma tracking system. Ped Emerg Care 2008; 24:505-510.
Keep children calm during your assessment
Evaluating a young child with asthma symptoms can be challenging, says Rosie Rodriguez-Henderson, RN, MHL, advanced clinician in the pediatric ED at Baptist Children's Hospital in Miami.
"It is important to try and keep them as calm as possible during your assessment, so you can see how well the child is breathing and hear lung sounds," Rodriguez-Henderson says. She recommends these interventions:
- sitting at the child's eye level so they don't feel overpowered by your presence;
- keeping the child close to their parents or primary caregiver from home at all times;
- talking to them in an age-appropriate level;
- explaining the treatments you are providing and why they are important;
- telling them that you are there to help them, not hurt them;
- asking them questions about themselves so you can continue to assess while they are distracted;
- offering "toys, toys and more toys! Provide crayons and paper and ask them to draw for you," says Rodriguez-Henderson.
How to avoid inaccurate respiratory rates for kids
If you are assessing the respiratory rate of a young child, you need to count for at least a minute to be accurate.
"This is because of the variability of rates in young children," says Cindy Debiak, RN, BS, CPN, SANE-A, pediatric coordinator for the ED at Helen DeVos Children's Hospital in Grand Rapids, MI. "Also, do as much as you can before you touch the child. You can assess work of breathing, respiratory rate, and color with the child being held by the caregiver."
Children under 2 years old with asthma are more likely than other children to return to the ED within seven days, according to a recent analysis of 4,228 visits.1You have reached your article limit for the month. Subscribe now to access this article plus other member-only content. TESTING
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