Which instruction should the nurse include in the discharge teaching plan for a client with asthma?

Your child has asthma, which causes the airways of the lungs to swell and narrow. Now that your child is going home from the hospital, follow the health care provider's instructions on how to care for your child. Use the information below as a reminder.

In the hospital, the provider helped your child breathe better. This likely involved giving oxygen through a mask and medicines to open the lung airways.

Your child will probably still have asthma symptoms after leaving the hospital. These symptoms include:

• Wheezing and coughing that may last up to 5 days
• Sleeping and eating that may take up to a week to return to normal

You may need to take time off work to care for your child.

Make sure you know the asthma symptoms to watch out for in your child.

You should know how to take your child's peak flow reading and understand what it means.

• Know your child's personal best number.
• Know your child's peak flow reading that tells you if their asthma is getting worse.
• Know your child's peak flow reading that means you need to call your child's provider.

Keep the phone number of your child's provider with you.

Triggers may make asthma symptoms worse. Know which triggers make your child's asthma worse and what to do when this happens. Common triggers include:

• Pets
• Smells from chemicals and cleaners
• Grass and weeds
• Smoke
• Dust
• Cockroaches
• Rooms that are moldy or damp

Know how to prevent or treat asthma symptoms that arise when your child is active. These things might also trigger your child's asthma:

• Cold or dry air.
• Smoky or polluted air.
• Grass that has just been mowed.
• Starting and stopping an activity too fast. Try to make sure your child warms up before being very active and cools down after.

Understand your child's asthma medicines and how they should be taken. These include:

• Control medicines that your child takes every day
• Quick-relief asthma drugs when your child has symptoms

No one should smoke in your house. This includes you, your visitors, your child's babysitters, and anyone else who comes to your house.

Smokers should smoke outside and wear a coat. The coat will keep smoke particles from sticking to clothes, so it should be left outside or away from the child.

Ask people who work at your child's day care, preschool, school, and anyone else who takes care of your child, if they smoke. If they do, make sure they smoke away from your child.

Children with asthma need a lot of support at school. They may need help from school staff to keep their asthma under control and to be able to do school activities.

There should be an asthma action plan at school. The people who should have a copy of the plan include:

• Your child's teacher
• The school nurse
• The school office
• Gym teachers and coaches

Your child should be able to take asthma medicines at school when needed.

School staff should know your child's asthma triggers. Your child should be able to go to another location to get away from asthma triggers, if needed.

Call your child's provider if your child is having any of the following:

• Hard time breathing
• Chest muscles are pulling in with each breath
• Breathing faster than 50 to 60 breaths per minute (when not crying)
• Making a grunting noise
• Sitting with shoulders hunched over
• Skin, nails, gums, lips, or area around the eyes is bluish or grayish
• Extremely tired
• Not moving around very much
• Limp or floppy body
• Nostrils are flaring out when breathing

Also call the provider if your child:

• Loses their appetite
• Is irritable
• Has trouble sleeping

Pediatric asthma - discharge; Wheezing - discharge; Reactive airway disease - discharge

Jackson DJ, Lemanske RF, Bacharier LB. Management of asthma in infants and children. In: Burks AW, Holgate ST, O'Hehir RE, et al, eds. Middleton's Allergy: Principles and Practice. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 50.

Liu AH, Spahn JD, Sicherer SH. Childhood asthma. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 169.

National Heart, Lung, and Blood Institute website. National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the diagnosis and management of asthma. www.nhlbi.nih.gov/health-topics/guidelines-for-diagnosis-management-of-asthma. Updated September 2012. Accessed August 7, 2020.

Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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