Asthma Education

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Asthma is a pretty common diagnosis, not just on the respiratory unit where I work, but everywhere! I had asthma as a kid and I know lots of other kids around me had it too. It was something pretty “normal” to me growing up and I never really thought twice about what it was, why I had it, and I loved that it came with the perk of not having to run the mile in P.E. Even while working in the ER, a chief complaint of asthma was not a high priority compared to everything else coming into the department  (unless the patient had a very bad asthma attack).

Seeing more and more asthmatics come onto my unit now in the “winter” months down here in Miami, I began doing lots of research on different asthma education resources. I found tons of resources just by typing in “asthma education for children” in Google.

Here are just a few I found:

The list goes on and on and on, however, after a couple of asthma teachings using these resources, I felt like something was missing. I wanted to my patients to reach specific goals I had for them which were not always all covered by the resources I found.

My goals for my asthma lesson plan are:

  • What part of the body is affected by asthma (lungs)
  • How many lungs they have (you’ll be surprised how many older school aged kids have told me 1!)
  • What happens when you have an asthma attack (bronchial tubes become tighter)
  • What can cause an asthma attack (identifying triggers)
  • How can you help lungs/airways feel better if you have asthma (long-term medicine/quick relief medicine)
  • and what are the symptoms you might feel when you are in the green, yellow, or red zone (self-awareness)

I mixed some pages from various resources I found online and also created some pages myself to help me get my message across the way I feel is best for my patients. While creating my new asthma education packet, I still felt like I was missing an effective concrete example demonstrating the difference between healthy lungs and lungs experiencing an asthma attack. That’s when I created the activity below!

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  • While going over our asthma education packet, the patient and I cut out lungs from the packet (the best  printable version of lungs I found were from this website: http://learncreatelove.com/printable-lungs-craft/ ).
  • Then the patient and I will glue the lungs onto paper lunch bags. In an effort to save paper/materials, we make 1 lung with asthma and 1 lung without asthma vs 2 lungs with asthma and 2 lungs without asthma.
  • After we glue the lungs onto the paper bag, we tape a smoothie straw into one lung and a cocktail straw into the other lung. I have the patient then blow into the healthy lung and suck the air out a few times. Then I have the patient blow into the lung with asthma and such the air out a few times as well. This way, the patient can clearly experience the difference in breathing and how it is much more difficult to breathe during an asthma attack than when lungs are healthy. *Check with the patient’s nurse before doing this activity to make sure the patient is clinically stable enough to do breathing exercises. You wouldn’t want to exacerbate them!*
  • After this activity the patient and I then continue with the education packet (triggers, medicines, etc.)

There are TONS of resources on asthma out there – asthma books, asthma camps, asthma videos, asthma games…look on the child life forum too! As a reinforcer, I also created an asthma memory game to make patients more aware of common terminology usually associated with asthma (albuterol, pulmonologist, inhaler, spacer, etc.). I also encourage them to download (with their parent’s permission) an app called “Widzy pets” which centers around asthma education in a fun way.

What are some ways you help your patients learn about asthma?

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Favorite find of the month

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As any child life specialist knows, finding a doll with plastic hair is like finding a hidden gem! Due to infection control precautions, cloth dolls or dolls with hair (barbie) should not be used in between patients because they are not able to be properly cleaned/sanitized. I was so excited when I found this Aladdin for 2 reasons:

1. his plastic hair making him easy to clean and maintain

2. Aladdin is a boy making him more relatable and engaging for my boy patient’s

I placed a PICC line on him for now but who knows, maybe in the future, he’ll need an IV or help me demonstrate an OR prep or a breathing treatment. I am so excited to have him by my side!

You can find your own Aladdin doll on  Amazon !

Cystic fibrosis teaching

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Recently I had a school-aged boy diagnosed with cystic fibrosis (CF) admitted to my unit for a “tune up”. He told me he was in the hospital because he had CF and when I asked him what CF was he said: “I don’t know what it is but I know that I have it…”. I asked him if he wanted to learn a little about what CF was and he agreed! Right away I went to grab a Huxi book, some crayons, and coincidentally I found a panda stuffed animal in our prize closet. We read through the book and talked a lot about mucus and the parts that it effects in a person’s (or panda’s) body with CF.

After we talked about mucus, then things got really fun… we made slime (aka, mucus)! There’s nothing school-aged boys love more than making gross, icky, gooey, slimy mucus. I wanted to make slime with him so that he could have a concrete example of how sticky and gooey mucus can be. While we were squishing the slime around in our hands he began to ask questions like “how do we get rid of mucus?”. I answered his question by asking him about things he does at home – breathing treatments, enzymes, wearing his vest, etc. We also talked about other ways he can help his body get rid of mucus like eating healthy and being active.

I am so glad I had the opportunity to teach my little patient about CF & that we both had so much fun!

 

Worth it: 003

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I found this hidden in my drafts & thought it would be great to post for today’s throwback Thursday! This was written about a year ago when I was still working in the pediatric emergency room. I love this post because stories like these happen all of the time thanks to child life specialists!

(The patient’s name has been changed for privacy.)

When I walked into 6-year-old Bettys room to do an IV teaching, she was nowhere in sight. I asked mom if she was in the bathroom when Betty started to scream from under the sink.  (Side note: Can you imagine being so scared that you hide under a sink?! )”No!” “I don’t want the needle!” “You’re not going to pinch me!” I then crouched down and sat in front of Betty to introduce myself; “Hi, Betty – my name is Diane and I’m a Child Life Specialist. I don’t have any needles with me, but I did bring my bubbles. Do you like blowing bubbles?” Betty nodded. We started to blow bubbles and Betty hesitantly popped them from under the sink. After a little, I said “why don’t you come out from under the sink so that you can pop them better… I’ll make a big one for you!” “Okay!” Betty said & came right out from under the sink.

As we continued to pop bubbles, I started to ask Betty about her  hospital experience. It was her first time, she felt very sick, and she was very worried they might give her a shot.  I validated her feelings and then began to talk to Betty about the different ways we were going to help her feel better while she was in the hospital. I told her about the urine test she did, the flu test she did, the strep test she did, and about her upcoming IV. Betty was now aware that the IV meant that there was going to be a “pinch” involved and that the most important rule for getting her IV was that she could not move her arm because her veins (aka, blue tunnels) are very slippery. Betty also made the decision to play on the iPad while they started her IV so that she didn’t have to watch, and she wanted her nurse to count to 3 before the pinch.

Our plan was in place. I told Betty I would go let her nurse know that she was ready and she nodded & hopped up on the bed. Betty did GREAT with her IV, you would have never thought she was hiding under the sink screaming just 10 minutes before. I was so proud of her and how brave she was with getting her IV!

 

Favorite find of the month

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Probably just like most of you reading this, I’m a sucker for child life-y apps! This month’s favorite find is an app called “Okee in Medical Imagining” created by the Royal Children’s Hospital all the way in Melbourne, Australia. This very cute & child friendly app gives it’s users an insiders view on different radiology tests and procedures – focusing on the 5 senses (what will i see? hear? feel? taste? smell?). The wording is very clear and concise, perfect for parents to read to their child or for kids to read on their own. Aside from the educational side, there are also fun games for the younger population that focuses on things like holding still, taking deep breaths, filling up with “glow ink” (contrast), finding broken bones on an x-ray, decorating your own CT machine, giving finding sea stars inside a jellyfish with an ultrasound, venturing in the MRI submarine, and even games for nuclear medicine and fluoroscopy!

 For more information about the app visit: http://www.rch.org.au/okee/

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Practice EKG

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I recently had a pre-school patient be very anxious about getting an EKG. Simply explaining what an EKG is wasn’t enough for this concrete thinker, so we did some medical play! I brought in my teaching doll, Eliza, and we practiced putting foam shapes on Eliza’s chest. He got to place the stickers and remove them afterwards. We also made sure to tell Eliza the rule about laying still like a statue so the computer can make sure the stickers are on right & listen to his heart! Then, we put some stickers on ourselves & practiced laying still like a statue. Once I saw that he was more comfortable with the stickers and holding still, I showed him the silly stickers the nurse was going to use & assured him that they we just little sticky stickers like my foam shapes. During the EKG I stuck around and reminded the patient to lay still like a statue just like Eliza & told him what a great job he was doing. The EKG was a success & my little guy did great!

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Favorite apps

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I just recently got approval to use an iPad as a tool for distraction and education with my patients. I am so grateful to finally be able to use this amazing tool! Here are some of my favorite apps that I’ve been using:

Medi toons is my go-to app when doing appy teachings for older kids and parents. it’s a free app that shows videos about different (mostly gastro) conditions.

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This app was recently reviewed by one of my favorite child life bloggers, child life mommy. It’s a [free] app that helps teach little ones to control their frustration by remembering to breathe, think, and then do!
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Wellapets is an awesome [free] app about asthma! This interactive game does a great job of promoting asthma education in a fun way.

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This is my go to app for MRI & CT scan teachings. Just last week I had a 9yo patient that was going to have an MRI. He’d had them before but was always been sedated for them. I showed him what the MRI machine sounded like with this app & thanks to that, he said he didn’t need any medicine to do his MRI this time. Thanks, Simply Sayin’!

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Disney Junior Appisodes is a forever favorite. This app features familiar beloved characters in an interactive & colorful display. This is ideal for lengthy procedures & really engages children in the appisode.

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Caillou’s check up app has been a very popular pick on my iPad. So popular I decided to splurge a bit ($4.99) and unlock all of the “levels” (you get the first level for free). With this app you’re able to help Caillou with his doctor’s office check up: taking his temperature, height, weight, etc.

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I downloaded this app just as a filler to have more choices for my toddler population and for some reason it’s also been a very popular choice amongst my patients. It’s a simple free little app in which you’re given tasks to complete such as  puzzles, picking the largest fish, picking the smallest fish, etc. while calming, ocean-themed music plays in the background. I’m very impressed with this app and it’s popularity!

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And finally, Skylanders Lost Islands. This free app is VERY popular with wide age range of my male patients. It’s great for the younger ones because it plays a 4-5minute video upon starting which is very dramatic and engaging. For my older boys, it’s a fun and interactive game with familiar characters.

Worth it: 001

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  Often times when people learn about what I do I get sympathetic responses and gasps with comments like “that is so sad”, “I could never do that”, “how are you able to emotionally handle such a sad job”. And while yes, sometimes situations can be VERY sad, there are always more good days that bad days! Just to prove that, I’ve decided to share some stories of the good days that make it all worth it! 

IMG_6241             Earlier this week, I was helping a 7 year old girl with an IV start (I work in the ER) which she’s had many times before so she immediately started crying and screaming when the doctor told her she was going to need one. I heard the commotion from the nurses station so I quickly grabbed my “bag of tricks” and went right into her room. We talked for a little bit while the nurse was setting up; about school, things she likes to do for fun, favorite foods, her family, and Halloween plans. Once I noticed that she had become more comfortable, I brought up the IV. We came up with a plan all based on her choices of how she would like things to happen…

  • She and I would play on the iPad while they did it
  • The iPad would block the view because she did not want to see
  • The nurse would first look on her left arm rather than her right arm
  • The nurse would count to three and poke AFTER three
  • She would follow the 1 rule which is: do not move your arm.


          The time came for the IV start and she did AMAZING! She did so great that mom started crying saying that in 7 years, this was the first time that she hasn’t had to be held down while she kicked and screamed. Not only was everyone in the room extremely proud of her, she was SO proud of herself! You could see it in her face how HAPPY she was that she didn’t need to have help to hold still. The mother thanked me for everything I had done but really, it was all her daughter! By giving her choices when she felt there weren’t any, she regained control over the situation and chose what she felt would be best for her. 

Papoose Prep

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While not very Child Life friendly, it is sometimes necessary to use a papoose with younger patients in the ER for procedures such as facial lacerations. Up until now, when prepping these little ones for their procedure I’ve told them about being wrapped up like a cocoon but it usually didn’t matter what I told them as soon as the papoose was brought into the room. So, I decided to make a doll-sized papoose so that I can show these little ones about their upcoming cocoon and they can practice putting a doll in & out of it and using the velcro straps! Materials UsedHaving made the papoose out of a mailer and duct tape, it’s easy to wipe down in between patients. The Velcro is also an awesome detail to show them since the real Papoose has tons of it. The Papoose in our ER is blue so to make it as realistic as possible, I used blue duct tape. The metallic pink is from the mailer I used (its actually an ipsy mailer!) This was a nice touch because being pink & blue it can be used with boys and girls without getting annoyed looks from pre-schoolers for having brought the “wrong” color.

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Papoose’s are never fun but are sometimes necessary to keep both the patient and the physician safe when doing delicate work with sharp tools. Hopefully my papoose prep can help ease the fear and anxiety little ones feel when needing to get into their own little cocoon. One more thing, before I’m shunned for having a Barbie that cannot be easily cleaned in the papoose, let me assure that she was just modeling the papoose for Adventuresinchildlife!  I still need to find an appropriate toy to use with patients. 

Favorite find of the month

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I thought I’d post my favorite find of the month a couple of days early this time around – before it’s no longer available! A few months back you might remember my post about prepping little ones for x-rays. I’ve been using my “cooper gets an x-ray” book along with a little camera to teach those concrete thinkers about picture taking & the mysteries that lie in that dark, “scary”, radiology department.

Well, this month I found an awesome little “camera” – LED flash & all – at Bath & Bodyworks. As child life specialists, were always carrying a million things in our pockets (I know I am) so the thing I loved most about this little camera is that it’s also a case for your hand sanitizer and a keychain! It’s a very fancy upgrade from my tiny spongebob camera and I can use it for many different things!

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Bath & Bodyworks – camera pocketpac case