*** UNCHECKED BOXES AND LINED THRU ORDERS ARE NOT APPLICABLE
ALLERGIES:
ADMITTING DIAGNOSIS: Asthma Exacerbation
Intrauterine Pregnancy
ADMIT TO:  [  ] Antepartum
[  ] LDRP
[  ] ICU
ACTIVITY:  [  ]Bedrest with bathroom privileges with assitance  
[  ]Other:__________________________________________________________________
MONITORING:  Vital Signs every hour until stable for 4 hours then every 4 hours
Continuous Fetal Monitoring
Notify M.D. for maternal fever over 100.4° F, vaginal bleeding, fetal distress, labor, abdominal tenderness
Spot pulse ox on arrival to floor and with nebulizer treatments.
 PEFR pre and post nebulizer treatments; record on chart.
 [  ] If patient does not have peak flow meter please provide one with instructions on its   use.
LABS:   [  ] CBC with differental
[  ] Chem 12
[  ] ABG if pulse ox < 90%, respiratory distress or altered consciousness.
[  ] Theophyilline level
RADIOLOGY:  [  ] OB Ultrasound for fetal weight and AFI
[  ] CXR
[  ] Echocardiogram
IV THERAPY:  [  ] Saline lock with 0.9% NaCL, 3 mL flush every 8 hours and before and after medications
[  ] Lactated Ringers 1000 mL to run at 125 mL/hour
MEDICATIONS: 

O2 @      [ ] 2      [ ] 4      [ ] 6       Liters/min via      [ ] NC      or      [ ] FM.
[  ]Albuterol ______ mg (suggested dose 2.5)  in 3 ml NaClby nebulizer every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed
Prenatal vitamin 1 tab PO daily
Docusate Sodium (Colace) 100 mG PO BID PRN constipation
Ferrous Sulfate 325 mG POTID
[  ]Prednisone 40 mg TID  for 48 hours, then 60 mg / day until PEF reaches 70% of predicted personal best.
[  ] Prednisone 60 mg PO Q daily for  ____days (3 to 10 days)
[  ] Methylprednisolone (Solumedrol) 125 mg IV bolus followed by 80 mg IVPB Q 8 hr.
[  ]Ceftriaxone (Rocephin) 1 gram IVPB every 24 hours
[  ] Azithromycin (Zithromax) 500 mg IV over 1 hour daily for two days then 500 mg mg PO daily to complete a 10 day course
[ ] Tylenol 500 mg 1-2 PO Q 4-6 hr prn pain/T > 101°F.
[  ] MOM 30 mL PO every 12 hours PRN constipation
[  ] Aluminum Hydroxide / Magnesium Hydroxide (Maalox) 30 mL PO every 4 hours PRN indigestion
[  ] Zaleplon (Sonata) 5 mG PO HS PRN insomnia
[  ] Acetaminophen 650 mG PO every 4 hours PRN mild-mod pain (level 1 6)
[  ] Other: ______________________________________________________________  

DIET:  [  ] NPO until stable, then regular diet
[  ] Clear liquid diet
[  ] Other: ______________________________________________________________
CALL PHYSICIAN FOR COMPLAINTS OF:
  Urine output less than 30 mL per hour *Absence of DTRs
Respiratory rate less than 12 or greater than 25 per minute
Chest pain
 02 Sat less than 90% on room air
Decreased loss of consciousness
Respiratory distress
Date:____________    Time:_____________   Physician Signature:_________________________    [  ] RBO

Date:____________    Time:_____________    Noted: _______________________________________
 
PATIENT I.D. LABEL

 

 

 

ASTHMA EXACERBATION  PHYSICIAN ORDERS

Managing Asthma During Pregnancy: Recommendations for Pharmacologic Treatment--Update 2004