-----------------------
Erikson: Industry vs. Inferiority

-Patient states math is her favorite subject. We made a game out of math problems on post-its until her mom arrived.

-Patient states she has lots of friends in her class, she talked about who her best friends were.

Maslow:

-Physiologic needs including calmly sitting so she is able to breath, drinking water since she is thirsty and SOB.

-Establishing safe people she can go to when she has difficulty breathing. Safe people to go to at school are the nurse, yard duties, teachers, or to tell a friend to go get help.

Psychosocial:

-Patient was walking by herself when she was having shortness of breath

-She named classmates who she is friends with

-She is close with her brother who is also at the same school

Nanda: Ineffective breathing pattern related to exercise manifested by wheezing, SOB, and difficulty breathing.

Assessment:

-Listened to breath sounds: Slight wheezing.

-Patient has an inhaler that she uses regularly at home

-Continued to check whether breathing was better, worse, or the same.

Nursing Interventions & Teaching:

-Called parent to bring the inhaler to school.

-Calmed student down, gave her water because she was also thirsty from running and allowed her to rest.

-Taught on importance of who to alert if she is having difficulty breathing and what she can do to help breathe easier.

Patient: J.A. Age: 10

Grade: 4th CC:

“I can’t breathe when I run”

Questions I asked:

-Can you sit down until you catch your breath?

What were you doing that made it hard for you to breathe?

How long has it been hard for you to breathe?

Do you have asthma?

What do you normally do when you can’t breathe?

Do you normally take any medications?

Do you have any medication with you or in the office?

(After sitting for a couple of minutes) Is it easier to breathe, harder to breathe, or the same?

-J.A. stated she felt she was able to breathe easier before her mom came with the inhaler. She was able to teach back education about how to properly use an inhaler.

-She said that she would try to carry the inhaler in her backpack so she has it at all times.

Culture-Hispanic, large, closely knit family. Typically do not go to seek medical care often.

Goals: J.A.’s breath sounds will improve, there will be no wheezing. She will demonstrate that she can breathe without SOB. She will show that she understands what to do and who to tell when she is feeling like she is having an asthma attack or SOB.

Outcomes: J.A’s lungs were clear on auscultation, no wheezing was heard.

What I should have done:

Asked if she had any allergies in addition to asthma

I explained to mom on the phone that she needs to fill out care plan for asthma. I should have insisted when the mom came in that she fill out the form and designate whether or not to keep an inhaler at school too.

Reason for Teaching:

-Older children (ages 11-16) are less likely to comply with prescribed medications and obtain regular care compared to younger children, and face unique social and economic challenges. Children in this age group are for the first time expected to assume responsibility for their own health. However, relatively few programs and resources have been developed for them. Kickin’ Asthma was designed to fill the need for a practical school-based curriculum that addresses the unique needs of older children and teenagers. Kickin’ Asthma stresses the concept of self-management and teaches the child to begin to take responsibility for their Asthma

Culture: The classroom was bilingual, I collaborated with teacher to incorporate Spanish terms for lice.

Teaching plan:

1. Welcome/Refreshments Food Serving items- 2 minute
2. Review 4 minutes
3. Prevention 4 minutes
4. Early Warning Signs Workbook page 5- 8 minutes
5. Triggers Workbook pages 6&7-8 min
6. Going to the Doctor 3 minutes
7. Deep Breathing exercise- 4 min
8. Trigger & Symptom Game
10 minutes
9. Wrap-Up 2 minutes • Total - 45 minutes

Erik Erikson
Sense of identity vs. diffusion
-Can think abstractly (see how control of asthma will benefit them in lifestyle)
-Peer groups important (in a group with asthma they feel like they are not alone)
-Sense of self/independence (they have the power to control their asthma symptoms)

Maslow:

Physiologic needs: Oxygen.
Breathing and controlling asthma symptoms would fall under physiological needs
Safety: It was important to tell students how to detect symptoms and identify and avoid asthma triggers.

Room for improvement:

In the future I would open with the Trigger and Symptom game to see what information they already know and to start off with something fun.

How did I do?

Overall it went really well. For the review activity with the poster

Students’ responses:

James Lick Middle School

8th Grade Students

Ages: 12-14 yr olds

Diagnosed with Asthma

Topic: Asthma Education

Thank you prize:

Pencil box to carry spacer in.

Props:

• Kicking Asthma Student Work Books

• Board Game- Triggers and Symptoms (I made it)

• Model of a bronchi

• Poster of airway.

• Spacer