Clinical Corner
The sudden worsening and narrowing of airway, causing coughing, wheezing and you can't breathe.
Exacerbation
A. Airway
B. Breathing
C. Circulation
Talks in phrases, Prefers sitting to lying, Not agitated
The initial assessment protocol and signs of a mild asthmatic arriving in ER
Maybe written ways to modify risk at home
Maybe written ways to lessen "flare - up"
Short term prescription of OCS
Maybe instructions to f/up with doctor
Discharge orders (discussion)
Discussion with person that drove the asthmatic to ER/ED/AC
(limited education discussion)
MD
DO
IC Pulmonologists
PA
Resident
Fellow
Chief Resident
Health care professionals who dx, treat, and dictate an asthmatics ER visit
7-14 days of continuous monitoring with high dose OCS, oxygen treatments, and lung function tests
Hospital stay and treatment of an admitted severe asthma patient
The term asthma patients use in the ER instead of "exacerbation"
"Flare - Up"
Drowsiness
Confusion
Silent chest
Talks in words, Sits hunched forwards, Agitated
The initial assessment protocol and signs a "flare - up" is severe; consult IC, start SABA, Oxygen, anti-inflammatory (Solu-Medrol); possible Intubation w/other comorbidities (SCA, MI, cardiac related) very rare
Chart review reveals acute visit is chronic and this is 2nd visit in a year to ER
Not controlled
Patient is probably severe asthmatic
Oversee patient admissions, discharges, and transfers
Liaison among nurses, physicians, patients and families, management
Provides patient assessment, maintains files, charts
Case Manager
Charge Nurse (Lead Nurse, Unit Supervisor)
ER Nurse Educator/Manager
Short term prescription of OCS
Names of specialists w/n network OR the type of specialist to follow up with regarding hospitalization
Discharge orders and consult
Intake person gathers patient hx, last hospital visit, pain level, current medications and gives to who? This is also the person that determines who is seen first?
Triage Nurse
Chief Resident
Charge Nurse
Admitting Nurse
May occur in waiting room prior to being admitted to hospital when asthmatic can talk, is not confused
Breathing treatment (oxygen, heliox)
OCS
Daily journal of inhaler use, how feeling, how breathing, and jotting down rescue inhaler/nebulizer use
Asthma Action Plan
What a recent admitted and discharged asthmatic is instructed to do but must do on their own - this is not pre-arranged
Follow up w/ their physician, specialists
Fills ER prescription
PC, IM provides prescription refill with another controller
Says, everything's fine, just had a "flare up)
"Frequent Flyer"
Revolving door of asthma sufferers without:
Asthma Action Plan
Hospital Protocol for Continuity of Care
Patient Education upon discharge in hospital (protocol/education algorithm)
CBC with Differential