Name

Age

Date of birth

Medical record

Admission Status

Name of attending

Phone number of attending

Asthma Exacerbation Associated Diagnoses

Condition

Code Status

Allergies

Diet

If diet according to ADA, please specify amount of calories

If other, please specify

Bed rest with bedside commode

Bathroom privileges

Up ad lib

Vital signs every 4 hrs then every shift

Notify MD for: T> 101.5, HR > 120, BP < 90/60 or > 180/110, Pulse ox < 90%, decrease level of consciousness or respiratory distress

I&O

Albuterol nebulizer every__hrs and prn

Methylprednisone 125 mg IV bolus now, then 80 mg IVP every 8 hrs

Tylenol 500 mg 2 tabs PO every 4 hrs prn temp > 101 or pain

Ambien 10 mg PO at bedtime prn insomnia

If Albuterol, please specify frequency

IV lock; flush per routine

IV__@ mL/hr

If IV @mL/hr, please specify @mL/hr

Admission: hemogram, basal metabolic profile

ABG if pulse ox < 90% or if severe respiratory distress or decreased LOC develops

CXR on admission

Pulse ox upon arrival to floor and with neb treatments

Peak flow measurement pre and post neb treatments

Consult

Signature

Print Name

Date and Time