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