Microsoft word - pediatric asthma orders.doc

PEDIATRIC ASTHMA / RAD EXACERBATION
Height ____________ cm Weight_________ kg 1. Admit to:____________________________________________ 2. Diagnosis:___________________________________________ 3. Condition:___________________________________________ 4. Vital signs: HR, RR, BP, temperature, weight and height, pulse oximetry on admission followed by continuous pulse oximetry and routine vital signs with blood pressure each shift. 7. Supplemental O2 (via nasal cannula or mask as appropriate) to maintain O2 saturation greater than or equal to 90%. 8. Laboratory testing:
9. Imaging studies:
Chest x-ray PA and lateral, Indication:______________________ 10. If the patient has not yet received ipratropium bromide give: Albuterol 2.5 mg WITH ipratropium bromide 0.5 mg nebulized x 2, 30 minutes apart. 11. Upon arrival to floor from ED, or after above albuterol and ipratropium bromide treatments, do asthma severity score. If initial score is 11-15:
Albuterol continuous nebulized treatment 7.5 mg/hr for 2 hours, with continuous CR monitoring, every 60 minute vital signs and asthma score and every 30 minute assessment. If asthma score is less than 11 after 2 hours, may go to intermittent PLACE LABEL HERE
YORK HOSPITAL YORK, PA
PHYSICIAN’S TREATMENT RECORD
PEDIATRIC INPATIENT ASTHMA/
REACTIVE AIRWAY DISEASE
Form 5249 PEDS ASTHMA 10/09 Page 1 of 3
If score is still 11 or above, repeat continuous nebulized albuterol
7.5 mg/hour for up to 2 additional hours for a maximum of 4 hours total (for ED and pediatric inpatient unit) with every 60 minute vital signs and asthma score and every 30 minute assessment. If more than 4 hours of continuous albuterol is required, contact physician for patient transfer from the pediatric unit. If initial score is 6-10, begin intermittent dosing of albuterol with dose
and delivery method as checked below at a frequency of q 2 hours with q 1 hour prn. If initial score is 0-5, begin intermittent dosing of albuterol with dose
and delivery method as checked below at a frequency of q 4 hours with q 2 hours prn. 12. Albuterol MDI dosing:
Patients < 12 months of age: albuterol MDI with spacer and mask Patients > 12 months of age to 48 months: albuterol MDI with Patients ≥ 4 years of age to 8 years of age: albuterol MDI with spacer (with mask if necessary) 6 puffs inhaled. Patient ≥ 8 years of age: albuterol MDI with spacer 8 puffs inhaled 13. Albuterol nebulizer dosing:
14. Asthma severity score should subsequently be performed by respiratory therapy prior to each scheduled albuterol treatment. y If score is 6-10, frequency of albuterol dosing should be q 2 y If score is 0-5, albuterol dosing should be q 4 hours with q 2 At any time, if score is 0-5 and patient is sleeping comfortably, hold albuterol treatment until patient wakens. 15. Perform daily peak flows, if developmentally appropriate. 16. If prednisone, prednisolone, methylprednisolone or dexamethasone not Prednisone 2mg/kg PO, dose ________mg [MAX = 60 mg] Prednisolone (15 mg/5mL) 2mg/kg PO, dose______mg [MAX = 60 mg] if can not swallow a tablet Methylprednisolone 2 mg/kg IV, ______mg [MAX = 125 mg] if inability to tolerate PO or requested by physician due to asthma severity PLACE LABEL HERE
YORK HOSPITAL YORK, PA
PHYSICIAN’S TREATMENT RECORD
PEDIATRIC INPATIENT ASTHMA/
REACTIVE AIRWAY DISEASE
Form 5249 PEDS ASTHMA 10/09 Page 2 of 3
Twelve hours after initial loading dose of prednisone, prednisolone or Prednisone 2 mg/kg/day PO (if can swallow a tablet): dose ________mg [MAX = 60 mg] q 24 hours Prednisolone (15 mg/5mL) 2 mg/kg/day PO (if can not swallow a tablet) : Methylprednisolone 1 mg/kg IV, ______mg [MAX = 60 mg] q 12 hours if inability to tolerate PO or requested by physician due to asthma severity. 17. Acetaminophen 15 mg/kg /dose: _______mg PO/PR every 4 hours PRN for temp > 100.4 °F and fussy, MAX of 5 doses in 24 hours 18. Asthma education by respiratory therapy, nursing staff and Child Life, using educational materials (including information on Camp Green Zone, if age appropriate). 19. Asthma action plan to be completed upon discharge. PLACE LABEL HERE
YORK HOSPITAL YORK, PA
PHYSICIAN’S TREATMENT RECORD
PEDIATRIC INPATIENT ASTHMA/
REACTIVE AIRWAY DISEASE
Form 5249 PEDS ASTHMA 10/09 Page 3 of 3

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