Acute Exacerbation Copd/asthma -Adult Page 2
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1
2ACUTE EXACERBATION
COPD/AsTHMA -ADULT
®
ADMIssION ORDERs,
PAgE 2 OF 2
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□
Allergy/sensitivities and Reactions:
Height: __________
Weight: _________
kg
lb
□
□
□
□
Inches
Cm
Actual
Estimated
-
.
please utilize medication reconciliation form for evaluation of pre
admission medications
8. Medications:
May substitute hospital formulary drug
T
IV access: Saline lock, flush per protocol.
IV ______________________at ______ml/hr
T
£
sTEROIDs:
£
Methylprednisolone (Solu-Medrol) 60 mg every 6 hours IV push times 8 doses then convert to prednisone
60 mg orally once daily. Notify physician if unable to take oral meds.
Prednisone ______mg orally every ____ hours
£
BRONCHODILATORs:
Albuterol 2.5 mg per nebulizer every 4 hours around the clock and as needed for dyspnea times 24 hours.
£
Modify per local respiratory therapy protocol.
£
Ipratropium bromide (Atrovent®) 0.5 mg every 4 hours around the clock per nebulizer times 24 hours. Modify
per local respiratory therapy protocol (for COPD admission).
Tiotropium (Spiriva®) ONE 18 mcg capsule. Administer 2 puffs of the contents of one capsule once daily with
£
the Handihaler inhalation device. Discontinue Ipratropium bromide.
T
Convert from nebulizer to MDI with spacer when able to tolerate.
ANTIBIOTICs (consider for acute exacerbation COPD)
Azithromycin (Zithromax®) 500 mg orally once daily for 3 days.
£
sMOKINg CEssATION:
Nicotine Patch ___ mg (14 or 21 mg ) apply topical once daily
£
_____________________________________________________________________________________
£
OTHER MEDICATIONs:
£
Montelukast (Singulair®) 10 mg orally daily in the evening
Theophylline (Theodur®) ____mg orally every ___hours
£
Guaifenesin & Dextromethorphane (Robitussin - DM®) 5 ml orally every 6 hours as needed for cough
£
(not to exceed 40 ml in 24 hours)
Docusate sodium (Colace®) 100 mg orally twice daily
£
T
Maalox® 30 ml (or therapeutic equivalent) orally every 4 hours as needed for heartburn
T
Acetaminophen (Tylenol®) 650 mg orally every 4 hours as needed for discomfort. (Maximum 4 grams/24 hrs)
Milk of magnesia 30 ml orally daily as needed for constipation
T
VTE prophylaxis - Use separate VTE Prophylaxis for Adult Patient standing Orders
glycemic control - Use separate Adult Insulin standing Orders
Date/Time:
Phone order taken by and read back by:
Transcriber's Signature:
Date/Time:
Prescriber's Printed Name:
Noting Nurse's Signature:
Date/Time:
Beeper Number/ID Number Date/Time:
Prescriber's signature:
Acute Exacerbation COPD/Asthma - Adult
Form transmitted to pharmacy: Date/Time:_____________ By:______________
Admission Orders Page 2 of 2
sO-047
10-6000-229 REV 9/26/08
Original - Chart
Copy or transmit to pharmacy
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