Steps

Rationale/Points of Emphasis

1a Perform hand hygiene and gather the necessary supplies.

Reduces transmission of microorganisms. Promotes efficient time management and provides organized approach to the procedure.

1b Select the peak flowmeter. Label the device with the child’s patient identifier information.

Use a low-range peak flowmeter is for small children, and a standard-range peak flowmeter is for older children and adolescents. The same meter should be used consistently.

2 Have the child stand if able; otherwise, have the child sit up straight with shoulders back. Have the child empty the mouth of any solids or liquids.

Provides for full expansion of the lungs for an accurate assessment.

3 Put the gauge on the meter to zero or at the bottom of the scale (Figure 83-1).

Provides for an accurate assessment on the gauge/meter.

Figure 83-1 Peak flowmeter.

4a Have the child blow out to clear the airways.

Clears the airways to allow for a complete/full breath in.

KidKare Have the child role-play huff cough, huff cough onto a mirror or blowing out candles on an imaginary cake. Demonstrate to the child the process and then have him or her return the demonstration so that when you are ready to perform the test, the child can clear the airways appropriately.

4b Have the child take a deep breath in and then place the mouthpiece into the mouth (lips around the mouthpiece), keeping the tongue away from the mouthpiece. Next, have the child blow out as hard and fast as he or she can. (Be sure your fingers are not in the way of the slide/gauge of the peak flowmeter.) Document the number.

To ensure obtaining the most accurate measurement.

4c Repeat steps 4a and 4b a minimum of two more times and record.

Some children may need additional attempts due to many factors such as learning curve, fatigue, and cooperation.

4d Select the best of three readings and document this in the medical record and in the child’s peak flow zone diary/log/worksheet. Also make notations regarding any current symptoms, activities, and/or medications.

By keeping a diary that reflects symptoms, medications, and PEF measurements across a period of time, the asthma care provider can make adjustments to your management plan to optimize control of asthma.

5 Compare the value obtained for the PEF with the orders/parameters. Assess where the current reading falls with regard to the child’s personal best percentage. Initiate pre-established management plan to administer medication if child’s results are in yellow or red zone. Obtain feedback from the family about the child’s past performance efforts as compared with current effort and progress.

For anything less than a value within the child’s green zone, the healthcare prescriber will have previously established a management plan to be followed by the child.

caREminder

Factors that may influence the child’s “personal best” include child’s degree of effort, prior experience, ability to cooperate (regardless of age), and fatigue. Peak flow measurements are one tool used in the evaluation process.

6 Clean peak flowmeter per manufacturer’s recommendations.

Standard precaution to reduce transmission of microorganisms.

7 Perform hand hygiene. Return the equipment to a secure area.

Reduces transmission of microorganisms. The equipment should be easily located for next use.