Education Underserved Children With Asthma

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Education Underserved Children With Asthma

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Discuss About The Education Underserved Children With Asthma.

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Introduction
The current study focuses upon the aspect of evidence based nursing practices. The implementation of such practices could help in the improvement of the overall quality of the health and support services. Therefore, practising in an emergency department as a reporting nurse I need to apply a number of evidence based practices which will help in effective evaluation of the health condition of the patient. Additionally, implementation of the evidence based practices helps to reduce the rates of medical negligence. In the current study, a number of evidence based articles have been used to compare between nebulizer and spacer for less than 10 years children. For facilitating the purpose of comparison different types of study designs have been used such as randomised control deign, systematic review, qualitative and quantitative study design.
In the current study, evidence based literature have been used to compare the effective method of delivery of treatment to a 10 years old child affected with asthma secondary to bronchitis. The chid has been admitted to the emergency ward of the hospital and presented with the diagnosis of exacerbation of asthma. The patient has been suggested salbutamol for the treatment which could be delivered either though a nebulizer or through a spacer. The study here tries to compare the more effective mode of treatment for cure of the asthma within the patient. The salbutamol is a bronchodilator which relaxes the muscles of the airways, which leads to the lungs and improves the flow of air to and fro the lungs. The effect of the medicine could be felt immediately within 5 minutes of inhalation. It produces more quick effect upon inhalation as the vapours reach the lungs directly.
Literature review
The current study compares between the efficacy rates of nebulizers and metered dose inhalers in reducing the effects of asthma within children. It had been found through various randomised control studies that the metered dose inhalers were as effective as nebulizers for treatment of asthma within children. It has found that administering bronchodilators by nebulizers in emergency departments owing to the volume of the patient and restricted oxygen ports (Khoo eat al. 2009). The metered dose inhalers with spacers have been found to produce quick and more cost effective way of delivery of bronchodilators to the patient. It has been seen that the young children often find it difficult to coordinate inspiration with activation of the Metered dose inhalers. However, the spacer allows the children to inhale medications while normal breathing through a face mask. However, there are limitations with the particular study design as it has focused upon the mode of delivery of the drug rather than weighting the cumulative effects produced.
The second study adopted over here focuses upon the educating the patient population regarding the correct use of nebulizers which reduces the rate of hospital admission. Some of the particular intervention strategies which were used over here are- provision of home treatment for acute symptoms , home based asthma education, symptom recognition, , provision of appropriate asthma medication and nebulizer practice. It has been summed up from the results of the study that home based education had slight or no considerable effects in reducing the symptoms of asthma. In this case, a randomised control trial had been set up for comparison of the results obtained from the study.
In this respect, a quantitative study design had been employed for comparison of the different treatment modes and their methods of delivery. In the current a sample population of 47 children were selected who were provided with various types of spacers. The spacer types were further divided into AC+spacer and FH spacers. The children with AC+ spacers were discontinued on their daily anti-inflammatory drug delivery whereas the ones using the FH spacers continued with the daily anti-inflammation medicine. It was found that the children with the AC+ spacers took the inhalation activities more intently whereas the ones with FC+ spacers treated the device more life a toy. Hence, it could be summed up that the AC+ spacers were seen more as a medical device the encouraged the children to adopt a serious attitude during inhalation. Later, it was found that the AC+ Spacers followed compliance to good techniques. As suggested by Delgado et al. (2013) the quality of the spacers were seen to aid the relief the mechanism within the children.
In a study, the effects on respiratory mechanics and heamodyanamics of administered salbutamol through MDI and nebulizers were compared. A blind, randomised crossover study in 12 intubated infants and children were conducted. The patients under study were subjected to 0.15 mg/kg by SVN and four puffs (400 µg) by MDI plus spacer at a four hour interval. The passive respiratory mechanism was studied by occlusion technique and serum salbutamol concentrations were measured by liquid chromatography mass spectrometry (Butz et al., 2013). The results declared no significant change in respiratory mechanisms of the two administration methods.
A study has been conducted over here in order to review the affectivity of the MDI over nebulizers. In this respect 50 patients with severe respiratory disorder undergoing MDI spacer treatments were interviewed regarding the effects produced. It was seen that 96% of the patients preferred use of nebulizer over MDI. This could be attributed to the inefficiency of some of the patients in using MDI (Cates et al. 2016).

Conclusion
The current assignment compares the efficiency rates of nebulizer over MDI in controlling the severe bronchitis within the patients. It had been seen that many patient had found MDI to be more effective than nebulizer. However, it mainly rested upon the convenience of the patients, as some found using spacers difficult. Though, it had been seen to facilitate breathing within children.

References
Butz, A.M., Tsoukleris, M.G., Donithan, M., Zuckerman, I., Mudd, K.E., Thompson, R.E., Rand, C. and Bollinger, M.E., 2006. Effectiveness of nebulizer use–targeted asthma education on underserved children with asthma. Archives of pediatrics & adolescent medicine, 160(6), pp.622-628. doi:10.1001/archpedi.160.6.622
Cates, C.J., Crilly, J.A. and Rowe, B.H., 2013. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev, 2. DOI: 10.1002/14651858.CD000052.pub3
Colacone, A., Afilalo, M., Wolkove, N. and Kreisman, H., 1993. A comparison of albuterol administered by metered dose inhaler (and holding chamber) or wet nebulizer in acute asthma. Chest, 104(3), pp.835-841. DOI: https://doi.org/10.1016/0736-4679(94)90442-1
Delgado, A., Chou, K.J., Silver, E.J. and Crain, E.F., 2003. Nebulizers vs metered-dose inhalers with spacers for bronchodilator therapy to treat wheezing in children aged 2 to 24 months in a pediatric emergency department. Archives of pediatrics & adolescent medicine, 157(1), pp.76-80. doi:10.1001/archpedi.157.1.76
Garner, S.S., Wiest, D.B., Bradley, J.W. and Habib, D.M., 2002. Two administration methods for inhaled salbutamol in intubated patients. Archives of disease in childhood, 87(1), pp.49-53. Retrieved from : https://adc.bmj.com/content/87/1/49
Jenkins, S.C., Heaton, R.W., Fulton, T.J. and Moxham, J., 1987. Comparison of domiciliary nebulized salbutamol and salbutamol from a metered-dose inhaler in stable chronic airflow limitation. Chest, 91(6), pp.804-807. DOI: https://doi.org/10.1378/chest.91.6.804
Khoo, S.M., Tan, L.K., Said, N. and Lim, T.K., 2009. Metered-dose inhaler with spacer instead of nebulizer during the outbreak of severe acute respiratory syndrome in Singapore. Respiratory care, 54(7), pp.855-860. Retrieved from : https://rc.rcjournal.com/content/54/7/855.short
Murdzoska, J., 2006. Effect of a paediatric incentive spacer and reinforcement of inhalation technique training in preschool children. Retrieved from : https://ro.ecu.edu.au/theses_hons/1128/

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