Management of Asthma Exacerbations: School Treatment
Suggested Emergency Nursing Protocol for Students with Asthma Who Don't Have a Personal Asthma Action Plan
A student with asthma symptoms should be placed in an area where he/she can be closely observed. Never send a student to the health room alone or leave a student alone. Limit moving a student who is in severe distress. Go to the student instead.
See list of Possible Observations/Symptoms on back.
Immediate Assessment: Is student at high risk?
- Marked breathlessness, inability to speak more than short phrases, use of accessory muscles, or drowsiness.
- Risk factors for a fatal attack (see back).
If YES:
- Take Immediate Actions
- Treat with inhaled SABA.
- Call 911 (student to ED)
- Contact parent/guardian.
If NO:
If available, measure PEF: Is PEF < 50% of predicted or personal best?
-
If YES:
- Take Immediate Actions
- Treat with inhaled SABA.
- Call 911 (student to ED)
- Contact parent/guardian.
-
If NO:
- Check and record respirations, pulse, and PEF rate.
Initial Treatment
- Inhaled SABA: Up to two treatments 20 minutes apart of 2-6 puffs by MDI or nebulizer treatments. Medication must be authorized by a personal physician order or standing protocol signed by the school physician or public health physician.
- Restrict physical activity. Allow student to rest.
- Administer oxygen (if appropriate and available).
- Contact parent/guardian.
- Assess response after about 10 minutes.
Good Response
PEF ≥80% and no wheezing or dyspnea.
- Actions:
- Reassess after 3-4 hours.
- Follow school protocol for returning to class.
Incomplete Response
PEF 50-79% or persistent wheezing or dyspnea.
- Actions:
- Repeat inhaled SABA.
- Reassess after about 10 minutes.
- Call parent immediately if response remains incomplete.
Poor Response
PEF <50% or marked wheezing and dyspnea.
- Actions:
- Repeat inhaled SABA.
- Call 911 (Student to ED)
- Contact parent/guardian.
With parental permission, send a copy of the health room encounter report to the student's physician. Obtain a personal asthma action plan.
ED: emergency department
MDI: metered-dose inhaler
PEF: peak expiratory flow
SABA: short-acting beta2-agonist (quick-relief inhaler)
September 2008
Reprinted from the National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma 2007
Possible Observations/Symptoms (May include one or more of the following):
- Coughing, wheezing, noisy breathing, whistling in the chest.
- Difficulty or discomfort when breathing, tightness in chest, shortness of breath, chest pain, breathing hard and/or fast.
- Nasal flaring (nostril opens wide to get in more air).
- Can only speak in short phrases or not able to speak.
Risk Factors for Death from Asthma
Asthma history
- Previous severe exacerbation (e.g., intubation or ICU admission for asthma).
- Two or more hospitalizations for asthma in the past year.
- Three or more ED visits for asthma in the past year.
- Hospitalization or ED visit for asthma in the past month.
- Using >2 canisters of SABA per month.
- Difficulty perceiving asthma symptoms or severity of exacerbations.
- Other risk factors: lack of a written asthma action plan, sensitivity to Alternaria.
Social history
- Low socioeconomic status or inner-city residence.
- Illicit drug use.
- Major psychosocial problems.
Comorbidities
- Cardiovascular disease.
- Other chronic lung disease.
- Chronic psychiatric disease.
ED: emergency department
ICU: intensive care unit
SABA: short-acting beta2-agonist
September 2008
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