PAgE 1 OF 2
1. ADMIT TO UNIT: _______________________
DIAgNOsIs: (check applicable)
Acute exacerbation of COPD
Acute exacerbation of asthma
PRIMARY CARE PHYsICIAN ______________________
Consult: Dr. _____________________________
Palliative Care consult: goal setting & symptom Management
H&P to be done by H&P Service.
For COPD exacerbation: Case manager (or Pulmonary Rehab as designated) to screen for pulmonary rehab
(Acute exacerbation COPD)
Begin evaluation for home oxygen if pulse ox on Day 2 continues at less than 89% on room air.
Order home oxygen per oxygen requirement study.
3. Laboratory studies:
Check to be sure all Emergency Dept. initial orders are complete and results are posted on the chart.
If any of these orders are not complete, do them now: CBC with differential, BUN/CR, LYTES, GLUCOSE
Labs in A.M.: _______________________________________.
4. Ancillary orders:
Pulse ox on admission to unit then per Oxygen Therapy guideline/protocol.
Oxygen _________________________________. Titrate to maintain oxygen saturation greater than or
equal to 92%. Re-evaluate need in 24 hrs per Oxygen Therapy guideline/protocol.
For Asthma exacerbation: Peak flows by Respiratory Therapy daily in a.m. Respiratory Therapy to instruct patient
in use of Peak Flow Meter at home.
2 View Chest XRay if not done in ED. Reason: ________________________________________________
Progress as tolerated.
Obtain old medical records.
Vital Signs and breath sounds per unit protocol
Obtain & record admission height & weight.
Remove foley catheter in AM if in place unless history of long term indwelling catheter. Monitor urine
output & notify physician if no output in 8 hours.
Nursing pneumococcal and influenza vaccination screen and administration per local protocol.
Nursing and Respiratory Therapy to provide patient education prior to discharge, re: oral/inhaled medications,
when to contact physician. Give Healthy Living Guide to Living with Asthma or COPD.
Smoking cessation counseling if positive history of smoking: Tips to quit smoking, Smoking resources and
Quitting smoking video.
Phone order taken by and read back by:
Prescriber's Printed Name:
Noting Nurse's Signature:
Beeper Number/ID Number Date/Time:
Acute Exacerbation COPD/Asthma - Adult
Form transmitted to pharmacy: Date/Time:_____________ By:______________
Admission Orders Page 1 of 2
Original - Chart
Copy or transmit to pharmacy
10-6000-229 REV 9/26/08