Asthma 23
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Pulmonary Disorders
Asthma
1. Admit to:
2. Diagnosis: Exacerbation of asthma
3. Condition:
4. Vital signs: q6h. Call physician if P >140; R >30, <10; T >38.5
C; pulse
oximeter <90%
5. Activity: Up as tolerated.
6. Nursing: Pulse oximeter, bedside peak flow rate before and after bron-
chodilator treatments.
7. Diet: Regular, no caffeine.
8. IV Fluids: D5 1 NS at 125 cc/h.
9. Special Medications:
-Oxygen 2 L/min by NC. Keep O
2
sat >90%.
Beta Agonists, Acute Treatment:
-Albuterol (Ventolin) 0.5 mg and ipratropium (Atrovent) 0.5 mg in 2.5 mL NS
q1-2h until peak flow meter
200-250 L/min and sat
90%, then q4h OR
-Albuterol (Ventolin) MDI 3-8 puffs, then 2 puffs q3-6h prn, or powder 200
mcg/capsule inhaled qid.
-Albuterol/Ipratropium (Combivent) 2-4 puffs qid.
Systemic Corticosteroids:
-Methylprednisolone (Solu-Medrol) 60-125 mg IV q6h; then 30-60 mg PO qd.
OR
-Prednisone 20-60 mg PO qAM.
Aminophylline and Theophylline (second-line therapy):
-Aminophylline load dose: 5.6 mg/kg total body weight in 100 mL D5W IV
over 20min. Maintenance of 0.5-0.6 mg/kg ideal body weight/h (500 mg in
250 mL D5W); reduce if elderly, heart/liver failure (0.2-0.4 mg/kg/hr).
Reduce load 50-75% if taking theophylline (1 mg/kg of aminophylline will
raise levels 2 mcg/mL) OR
-Theophylline IV solution loading dose 4.5 mg/kg total body weight, then 0.4-
0.5 mg/kg ideal body weight/hr.
-Theophylline (Theo-Dur) PO loading dose of 6 mg/kg, then maintenance of
100-400 mg PO bid-tid (3 mg/kg q8h); 80% of total daily IV aminophylline
in 2-3 doses.
Inhaled Corticosteroids (adjunct therapy):
-Beclomethasone (Beclovent) MDI 4-8 puffs bid, with spacer 5 min after
bronchodilator, followed by gargling with water
-Triamcinolone (Azmacort) MDI 2 puffs tid-qid or 4 puffs bid.
-Flunisolide (AeroBid) MDI 2-4 puffs bid.
-Fluticasone (Flovent) 2-4 puffs bid (44 or 110 mcg/puff); requires 1-2 weeks
for full effect.
