Asthma Practice Pathway
Child with Acute Asthma Exacerbation
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Discharge to Home
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DETERMINE SEVERITY LEVEL OF EXACERBATION/STEROIDS
MD/CRNP/RN/RT Respiratory Assessment
H & P
Start Prednisone or Prednisolone unless contraindicated
Discontinue inhaled corticosteroid medications
Further Diagnostic Testing
Sample Patient Progression
Use Asthma Order Set
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Initiate Discharge Planning:
  • Case Management
  • Asthma Education Plan
  • Asthma Care Plan
  • PCP Contact
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Mild, Moderate, or Severe?
Pathway Documentation
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Severe
Continuous Albuterol Dosages
>20 kg3 ml/hr
>10-20 kg2.25 ml/hr
5-10 kg1.5 ml/hr
Additional Medications
Consider Ipatropium bromide
Prednisone / Prednisolone / Methylpred
Assessment
Respiratory q 1 hour
HR, RR q 1 hour, PRN
Continuous pulse oximetry, CRM
Hydration status IV & PO
Progression
Moderate assessment for 2 hours
Then advance to moderate
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Moderate
Albuterol Dosages
>20 kg8 puffs q 2 hours
10-20 kg6 puffs q 2 hours
5-10 kg4 puffs q 2 hours
Additional Medications
Discontinue Ipatropium bromide
Continue Prednisone / Prednisolone
Assessment
Respiratory q 2 hours
HR, RR q 2 hours
Discontinue CRN
Pulse oximetry per protocol
Hydration Status W&PO
Progression
Mild assessment for 4 hours
with treatment
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Mild
Albuterol Dosages
First q 4 hoursSecond q 4 hours (Home Dose)
>20 kg8 puffs2 puffs
10-20 kg6 puffs2 puffs
5-10 kg4 puffs2 puffs
Additional Medications
Continue home dose every 4 hours
until discharge
Continue Prednisone
Restart / initiate ICS as needed
Assessment
Respiratory q 4 hours
HR, RR q 4 hours
Pulse oximetry PRN
Oral intake, hydration status
Progression
Discharge after home dose
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After any change in status
(moderate, severe) reassessment every hour until tolerating new interval
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Date Posted: June 2011
Revised: September 2013, November 2013
Authors: M. Magnusson, MD, M. McCloskey, RN
Evidence Reviews
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