Asthma

Asthma Care Plan

Disease Process

• Surveillance
  • Assess and verify that patient and patient's legal representative (if any) and/or HIPAA authorized representative received written notice/document of patient's rights and responsibilities in a language the patient understands at SOC visit or by the second visit.
  • Assess respiratory status including lung sounds, respiratory rate, depth, rhythm, use of accessory muscles, cough and sputum, s/s of infection and level of dyspnea.
  • Evaluate respiratory symptom log(s).
  • Assess oral/nasal membranes for irritation from inhalers or inhaled medications.
  • Assess (since the last visit or encounter) if patient experienced S/S outside target or goal range (via reported symptoms, symptom logs, telehealth), if changes in plan of care and for overall perception of how condition is being managed.
  • Assess (since the last visit or encounter) if the patient used the ER, Hospital or unplanned physician office visit.
• Teaching, Guidance and Counseling
  • Provide contact phone numbers and who to contact during evenings and weekends for symptoms/concerns.
  • Provide teaching techniques and strategies that enhance and promote health literacy (improved knowledge and compliance with care requirements).
  • Evaluate knowledge of S/S to report to RN/Therapist or Physician and those that need immediate medical attention. (Refer to Zone/Red Flag Plan). Use Teach Back Method to determine comprehension. Ask patient to repeat IN THEIR OWN WORDS.
  • Instruct on use of respiratory symptom log.
  • Instruct on S/S of an asthmatic episode and measures to take for relief - Asthma Action Plan, and to have Asthma Action Plan available at all times.
  • Instruct on S/S of respiratory infection to report.
  • Instruct on definition of disease process, potential causes and basic treatment or rehab goals.
  • Instruct on S/S of hypoxemia (increased dyspnea, restlessness, confusion, agitation, pale or gray skin) and if present when to notify RN or physician.
  • Evaluate compliance with Asthma Action Plan.
  • Instruct on status asthmaticus emergency protocol.
  • Instruct on self-monitoring measures and management related to respiratory distress (dyspnea levels with activity, signs/symptoms of lung infection or other respiratory changes, and if applicable, quick-relief inhaler use frequency, peak flow readings and/or pulse oximetry) and to call RN or physician if symptoms outside target occur.
  • Instruct on difference between an asthmatic attack and status asthmaticus.
  • Evaluate compliance with self-monitoring activities and appropriate follow-up for abnormal findings.
  • Instruct on importance of telling others (family, friends, co-workers, caregivers, all healthcare professionals) about your asthma and your Asthma Action Plan.
  • Evaluate ability to manage health status independently.

Test/Treatment

• Surveillance
  • Evaluate effectiveness of respiratory treatments (other than oxygen).
  • Evaluate Peak Flow diary.
• Treatment, Procedure
  • Perform procedure to obtain lab specimens as ordered.
  • Administer procedure/test/treatment as ordered.
  • Perform/obtain PULSE OXimetry reading as ordered.
  • Teaching, Guidance and Counseling
  • Instruct on use of medications/treatments (other than oxygen) as ordered to improve respiratory symptoms.
  • Instruct on respiratory equipment set-up, use and supplies as ordered.
  • Instruct on purpose and use of peak flow meter.
  • Provide several new Peak Flow diaries and obtain used diaries for patient record.
  • Evaluate return demonstration of peak flow meter.
  • Evaluate return demonstration of respiratory treatment administration as ordered, instruct as needed.
  • Instruct on use of humidification to thin secretions.
  • Instruct on and demonstrate adaptive breathing techniques to reduce respiratory distress or improve dyspnea.
  • Evaluate return demonstration of adaptive breathing techniques to reduce respiratory distress or improve dyspnea.
  • Instruct to increase peak flow readings if S/S of respiratory infections are present.
  • Instruct on maintenance, cleaning, and care of respiratory equipment.
  • Evaluate compliance with adaptive breathing techniques (pursed-lip, diaphragm, HUFF, etc.).
  • Evaluate compliance with respiratory treatments.
  • Evaluate compliance with care, cleaning, and maintenance of respiratory equipment.

Medications

• Surveillance
  • Assess (ask to see all medication & supplements) whether correct medications/supplements are in home. Review with patient/caregiver and reconcile medications, identify medication issues, make corrections and emphasize changes in regimen. Leave up-to-date medication profile and schedule in the home.
  • Evaluate inhaler administration technique.
  • Assess for medication effectiveness/symptom control, side effects, compliance, other issues and for medication changes, review and update medication profile (reconcile medications) as needed.
• Teaching, Guidance and Counseling
  • Instruct on purpose, action and side effects and how to monitor effectiveness of one or two medication/supplements and how and when to report medication problems.
  • Instruct on strategies to improve medication self-administration (pill box / medi-planner / med pre-fill) and simplification plan to support a manageable system and compliance.
  • Instruct on why it is important for current healthcare providers (including pharmacies) to have a complete list of medication/supplements; and why it is recommended to use one pharmacy.
  • Instruct to avoid anti-anxiety medications that affect respiration.
  • Instruct on use of steroids and tapering schedule, if appropriate.
  • Instruct on importance of rinsing mouth after using corticosteroid inhalers to prevent mouth sores or secondary infections.
  • Evaluate knowledge of the importance for a realistic plan for refilling medications before running out and evaluate if the patient/caregiver has a plan in place.
  • Instruct not to take any over-the-counter medications or supplements without consulting physician.
  • Instruct potential adverse cardiac effects of overuse (more than 5 or 6 times/day) or abuse of PRN (short acting) inhalers.
  • Instruct on when to obtain refills and maintenance of inhaler.
  • Evaluate and update medication profile with patient / caregiver and evaluate knowledge of actions, doses, side effects and times of medications to continue following discharge.
  • Evaluate and ensure current list of medications is left in home before discharge from services.

Nut/Hyd/Elim

• Surveillance
  • Assess nutritional/hydration status and dietary/fluid intake.
  • Assess urinary function/status.
  • Assess gastrointestinal (GI) status for nausea, vomiting, diarrhea, constipation, fecal impaction or incontinence.
• Teaching, Guidance and Counseling
  • Instruct to drink 8 to 10 cups of fluid daily, unless restricted, to provide adequate hydration and to loosen secretions.
  • Instruct on foods that may cause allergic reactions that may trigger an asthma attack.
  • Instruct on appropriate food choices and provide rationale; provide sample menus; and assist with meal planning.
  • Instruct to avoid gas-forming foods to prevent gastric distention, pressure on diaphragm and decreased lung expansion.
  • Evaluate compliance with diet/fluid requirements.
  • Evaluate compliance with avoidance of foods known to be asthma triggers for patient.
  • Instruct on strategies to increase nutritional intake to maintain an adequate nutritional status.

Activity

• Surveillance
  • Assess current activity and tolerance levels, ability to perform ADLs/IADLs, and level of assistance needed.
• Teaching, Guidance and Counseling
  • Instruct on activities that may provoke an asthmatic episode.
  • Instruct on body positioning (semi fowlers, high fowlers and leaning over bed table) to enhance upper airway availability.
  • Instruct on importance of frequent rest periods, pacing activities and avoiding overexertion.
  • Instruct on and demonstrate use of semi Fowlers or full Fowler's position to decrease dyspnea and orthopnea (improve breathing).
  • Instruct to use inhaler before activity/exercise and perform activity when systemic bronchodilator is at optimal effect.
  • Instruct on importance of controlled breathing during exercise/ambulation.
  • Instruct on energy conservation techniques, importance of frequent rest periods and avoid overexertion.
  • Evaluate compliance with activity schedule.
  • Evaluate compliance with energy conservation techniques.
  • Evaluate compliance with taking frequent rest periods, pacing activities and avoiding overexertion.
  • Evaluate compliance with use of inhaler before activity and performing activity when systemic bronchodilator is at optimal effect.
  • Instruct on importance of maintaining consistent exercise/activity schedule, give examples of exercises that are allowed.

Safety

• Surveillance
  • Assess safety of home environment, for falls or injury and for other safety issues or precautions, and recommend modifications or instruct as appropriate.
  • Assess for correct/safe equipment use including assistive devices used in transfer activities.
  • Teaching, Guidance and Counseling
  • Instruct on procedures to take in the event of a natural disaster (fire, hurricane, tornado, etc.), evacuation plan.
  • Instruct on basic home safety precautions to prevent injuries/falls.
  • Instruct on principles of Standard Precautions (proper handling/disposal of items coming in contact with body fluids).
  • Instruct on environmental asthma triggers to avoid.
  • Instruct to avoid use of powders and aerosol products to avoid bronchospasm.
  • Evaluate compliance with Standard Precautions.
  • Evaluate compliance with home safety precautions to prevent injuries/falls.
  • Instruct on home modification to eliminate or reduce Asthma triggers, especially to bedroom.
  • Instruct on importance of avoiding crowds, people with respiratory infections and other measures to prevent respiratory infection.
  • Evaluate compliance with safe use, care, storage and disposal of equipment, supplies, medications.
  • Evaluate compliance with avoidance of asthma triggers.
  • Instruct on importance of medical-alert identification jewelry and procedure to obtain.
  • Evaluate compliance with controlling and avoiding environmental risk factors and stressors that may precipitate exacerbation.
  • Evaluate compliance with avoiding crowds, people with respiratory infections and other measures to prevent respiratory infection.
  • Evaluate ability to maintain care/safety in home environment.

Psychosocial

• Surveillance
  • Assess patient/caregiver psychosocial, emotional, coping, alertness and sleep status.
  • Assess barriers to care (cultural, financial, cognitive, caregiver, environment, other), and identify plan to address barriers, and implement action plan and involve patient in action plan.
  • Assess ability to purchase necessary medications, supplies, food, etc., needed for treatment.
  • Assess family/social support systems in place and adequacy of support systems.
  • Evaluate perception of progress toward addressing primary concerns and goals for care.
  • Assess for stress or feelings of depression related to diagnosis.
  • Teaching, Guidance and Counseling
  • Instruct on and evaluate return demonstration of relaxation/breathing techniques.
  • Instruct on emotional responses that may exacerbate symptoms of asthma: laughter, stress, anxiety.
  • Instruct on importance of identifying and avoiding stressful situations.
  • Instruct on use of positive coping strategies (i.e., writing down and/or talking about concerns, relaxation - music, favorite TV show, doing enjoyable activities, etc.).

Interteam/Community

• Care Management
  • Instruct on, review plan of care including disciplines, visit frequencies, discharge plan and support involvement of patient/family in plan of care.
  • Provide the patient/caregiver written care planning instructions, based on the signed Plan of Care, to keep in the home within 5 days of Initial Assessment.
  • IF POST-INPATIENT, Instruct on importance of scheduling and attending physician follow-up appointment within 7 days of inpatient discharge.
  • Identify barriers and assist in making and attending appointment(s) or provide phone numbers and time frames.
  • Provide opportunity to practice and role play questions for PCP/ specialist in preparation for follow-up visits or next scheduled visit.
  • Instruct on the importance of a Personal Health Record (PHR), its components, and the need to share with all healthcare providers.
  • Evaluate need for and/or initiate case communication or documentation of communication.
  • Assess for next physician appointment (Date).
  • Evaluate plan of care including visit calendar with patient/caregiver and identify if changes are needed.
  • Evaluate and update patient's Personal Health Record (PHR) with changes in medications, diet, activity, allergies, s/s to monitor, etc.
  • Instruct on use American Lung Association for information and support services.
  • Evaluate knowledge of and agreement with discharge plans.
  • Instruct on how and why to reorder or obtain supplies, medications, equipment and lab tests.
  • Instruct on importance of follow-up with physician/other services.
  • Evaluate plan to access community/family support for long-term care needs, as appropriate.