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RT Consult Form Side #2

This document provides guidelines for determining the appropriate level and frequency of aerosol therapy based on a patient's pulmonary and surgical status, symptoms, and oxygen requirements. Patients are assessed and given a total score that corresponds to a triage number. The triage number then determines the recommended frequency of bronchodilator treatments, with more frequent treatments prescribed for patients with higher triage numbers and worse symptoms and status.

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Rick Frea
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3K views

RT Consult Form Side #2

This document provides guidelines for determining the appropriate level and frequency of aerosol therapy based on a patient's pulmonary and surgical status, symptoms, and oxygen requirements. Patients are assessed and given a total score that corresponds to a triage number. The triage number then determines the recommended frequency of bronchodilator treatments, with more frequent treatments prescribed for patients with higher triage numbers and worse symptoms and status.

Uploaded by

Rick Frea
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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GUIDELINES FOR DETERMINING AEROSOL THERAPY & FREQUENCY:

Chart Assessment:
Points 0 X 1 X 2 X 3 X 4 X Total
Pulmonary No History Smoking History of History of Severe or
Status Smoking History <10 Pulmonary Acute Acute
Pack years disease Exacerbation Exacerbation
Surgical No Surgery General Abdominal Thoracic Thoracic w/
Status Surgery Surgery Surgery Pulmonary
Disease
Chest Clear or Chronic Infiltrates Infiltrates in Infiltrates
X-Ray None Radiographic Atelectasis more than with
changes Pleural one lobe Pulmonary
Effusions Disease
Patient Assessment:
Points 0 X 1 X 2 X 3 X 4 X Total
Respiratory Regular Dyspnea on Rapid Increased Severe SOB
Pattern Pattern Exertion Shallow Work of Use of
Breathing Breathing Accessory
>24 Muscles
Mental Alert Lethergic, Confused, Minimal Non
Status Orientated Follows does follow Response Responsve
Cooperative Commands Commands to
Stimuli
Breath Clear to Decreased Crackles/ Wheezing Audible
Sounds Auscultation LS Rhonchi Wheezing/
Absent
Cough Strong Strong Weak Weak No
Spontaneous Productive Cough, no Cough spontaneous
Non- Rhonchi With Cough with
Productive Rhonchi Rhonchi
Level Ambulatory Ambulatory Non- Paraplegic Quadraplegic
Activity W/ Assist Ambulatory
O2 No O2 1-2 LPM 3-6 LPM >50% 100%
Requirements <100%
Assessment total_________________
Determining Triage #: Triage #________________________
E. Frequency of Bronchodilator (Based on triage #)
Assessment Triage # Triage # Frequency
Total 1 Q2 & PRN 0.5cc Ventolin and Q4 2.5mg Atrovent
>20 1 2 Q4 & PRN 0.5cc Ventolin and Q8 0.5mg Atrovent
16-19 2 3 QID & PRN 0.5cc Ventolin and/or 0.5 mg Atrovent
11-15 3 4 Q6 PRN 2.5mg Ventolin or 2 puffs Ventolin MDI if
6-10 4 MDI criteria met or consider discontinuing therapy. Also
0-5 5 consider 2 puffs Atrovent QID or 2 puffs Combivent QID.

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