MATILDA GARCIA

MATILDA GARCIA

1. Nursing Care

   • Health Promotion & Disease Prevention
     • Encourage mother to focus on Matilda's strengths
     • Involve teachers, school nurse, coaches, friends, relatives in helping to manage her asthma
     • Keep up to date with vaccinations - especially pneumonia and influenza
     • Scheduled regular clinical check-ups
     • Identify and prevent triggers
   • Education
     • Educate mother on smoking cessation
     • Include mother in her treatment and management
     • Breathing and relaxation techniques
     • Emergency plan in case of adverse events (i.e. siblings how to call 911)
     • Educate on symptoms and triggers of an asthma attack
     • Provide resources (i.e. Asthma.ca)
     • Purpose and action of medication
     • Peak-flow monitoring
     • Encourage her biking activities and additional non-strenuous physical activities
     • Proper inhalation technique
   • Health Assessment
     • Spirometer
     • Full physical
     • Emotional, Physical, Mental, and Spiritual Comprehensive Questionnaire
     • Allergy testing and environmental sampling
     • Oxygen Therapy
     • Full Respiratory Assessment
   • Tanners Model
     • NOTICE
       • Audible breathing, difficulty catching breath, prominent chest rising
       • Mother worried about her child's state and is stressed about their financial wellbeing
     • INTERPRET
       • Inflamed respiratory tract - Asthma
       • Patient is stressed and struggles to cope with her asthma
       • Further education about her asthma and how to manage it.
     • RESPOND
       • Administer medications
       • Patient Education
       • Refer patient and her mother to support programs and additional interproffessional aid
       • Identify her barriers, strengths, and facilitators
       • Help recognize patients goals and limitations
     • REFLECT
       • Bronchodilator relaxes inflamed respiratory tract
       • Educate and discuss with Matilda and her mother about further measures, such as the next check-up.
       • Interprofessional consultations
   • Help identify her strengths and to build on them
   • Help the family make use of the resources available

2. Asthma

   • Medication
     • Bronchodilator (Salbutamol)
     • Allergy Medication (Xolair)
     • Supplementary Oxygen
     • Systemic corticosteroids
   • Symptoms
     • Cough, wheezing, prolonged expiration
     • Dyspnea (Shortness of Breath)
     • Increased mucus
     • Chest tightness
     • Retractions
     • Sleep apnea
   • Triggers
     • Emergency Situations
       • Signs of Asthma Emergency:
         • Rapid or worsening of shortness of breath or wheezing
         • Tightness of chest
         • Excessive coughing and wheezing
       • No improvement after using a quick-relief inhaler (i.e albuterol)
       • SOB when doing minimal physical activity
     • Second hand smoke environment
     • Air pollutants, chemicals, pollen, cold air
     • Physical Activity
     • Strong odours
     • Stress
     • Animal fur/ hair
   • Chronic inflammation of airways and production of extra mucus
   • Can be well managed
   • Can change over time
   • Affects all ages
     • Commonly occurs in young age

3. Social Determinants of Health

   • Income and Social Status
     • Household income manageable, but some months are hard to make ends meet
     • Mother works full time - paid under 50k/yr
   • Education
     • Grade 2
     • Has trouble with physical education and math
     • Attends Williamsburg Public School
       • School population consists of 110 students
       • Low to middle class student attandence
     • Teacher says she is very intelligent and kind
   • Personal Health and Coping Skills
     • Tries to keep busy with activities like gardening, art, and playing with siblings
     • Keeps a bullet journal, consisting of her drawings, daily thoughts, and memorable moments.
     • Often visits school counselor to talk about her feelings
       • "Disappointed she cannot run around and play with her friends due to her asthma"
       • "Sad that mom is always working, and dad is passed away"
     • Visits her neighbours Iguana, Maximus
     • Playing with her friends
     • Art and English class
   • Early Childhood Development
     • Attends an after school program with siblings - waits for mother to pick them up after work
       • Games, crafts, and snacks are provided
       • Art Club
     • Physical activity limited due to asthma; within normal BMI for her age
     • Has a good relationship with mother and siblings
     • Often bikes to destinations when walking is too far; good moderate exercise (doesn't exacerbate asthma)
   • Family
     • No secondary family
     • Mother smokes inside home; all living in a second hand smoke environment
     • Single Mother with 4 minor children under 18yrs old
       • Has a grandmother living in the master bedroom
         • Has a high fall risk: 40
           • Slipped in the bath mutliple times
     • Home: small, but fits all 5 members well; located in urban East London, ON

4. Personal Meaning

   • Anxiety & Depression
     • Feelings of limitation, helplessness and embarassment
       • Can be overcome with teaching on management and how to have a good QOL with asthma
       • Feeling a lack of support with her medical challenges
         • Poor illness management: missing medication doses, inadequate or incorrect use of inhalers , lack of follow-through on recommendations for environmental control of allergens
   • Matilda is unsure of her purpose in life; even though she has bad days and feels sad, she tries to stay positive and keep busy
   • She looks up to athletes with asthma such as Alberto Salazar and Amy Van Dyken
   • Highly values her family and friends

5. Quality of Life

   • Barriers
     • Asthma symptoms interfere with sleep habits and physical activity
     • Managing asthma can be stressful and challenging
     • Poor accessability
       • Transportation
       • Income
       • Time
       • Location
     • Financial Challenges
       • Inadequate insurance coverage
       • Poor housing conditions
     • Young age - Limits her independence and self care
   • Facilitators
     • Family and peers
     • Likes going to school; enjoys English and Art
     • Resiliency - has a positive outlook on life despite challenges
     • Willingness to learn more about asthma and manage her symptoms
     • Open to sharing and communicating about life struggles
     • Hobbies such as gardening and drawing

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