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Asthma — History and Physical — Clinical Pathway: Inpatient

Asthma Clinical Pathway — Inpatient

History

Past Medical History
  • Time of onset of exacerbation
  • Potential triggers
  • Severity of symptoms compared with previous exacerbations
  • Response to treatments prior to admission
  • Estimate number of asthma-related (past year/lifetime):
    • Office visits
    • ED visits
    • Hospitalizations
    • ICU admissions/need for intubation
Medications
  • All current medications, time of last dose:
    • Number of courses of systemic steroids in the last year
    • Adherence with controller medications, use of spacer
Persistent Symptoms
  • In the last four weeks, prior to current exacerbation:
    • Use of rescue medication (albuterol, levalbuterol, ICS/formoterol)
    • Nighttime symptoms
    • Exercise intolerance
  • Presence of complicating illnesses (pulmonary, cardiac)
  • Diseases aggravated by steroid therapy (diabetes, hypertension, ulcers, psychosis)

Physical

General
  • Vital signs, pulse oximetry
  • Level of alertness
  • Hydration status
  • Presence of cyanosis, pallor
Respiratory
  • Respiratory distress
  • Wheezing, decreased aeration
  • Identify complications:
    • Pneumonia
    • Pneumothorax
    • Pneumomediastinum
  • Rule out upper airway obstruction (croup, foreign body, etc.)

 

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