Standardization: Hampton Roads Asthma Action Plan/Authorization for Medication.
Asthma Action Plan - stlouischildrens.org · Asthma Action Plan Green Zone: Well • No signs of...
Transcript of Asthma Action Plan - stlouischildrens.org · Asthma Action Plan Green Zone: Well • No signs of...
Asthma Action PlanGreen Zone: Well•Nosignsofasthma•Abletodonormalactivities•Noproblemswhilesleeping
•Peakflowabove:_______
*Rinsemouthafterthismedicine
Give these medicines every day:
MEDICINE: HOW MUCH: WHEN:
Yellow Zone: Watch Out!
Early Signs of Asthma:•Coldsymptoms•Coughingdayornight•Wheezingdayornight• Funnyfeelinginchest
•Myfirstsign:______________
•Peakflow:______________
Red Zone: EMERGENCY!
Late Signs of Asthma:•Tightchest•Breathinghardorfast•Usingneckorstomachmusclestobreathe
•Constantcoughing•Troubletalkingorwalking•Vomiting•Lipsornailsblue
•Peakflowbelow:_______
(above80%ofbest)
(50-80%ofbest)
(below50%ofbest)
Patient/Parent/Guardian Signature Date
RN/MD Signature Date
Phone number of Doctor or Nurse:
Day: __________________________
Night: _________________________
Original 1995. Revised 10/12. Copyright © 2012
First—give:
Albuterol 2-4puffsor1nebulizer 1-3timesinfirsthour
Call your Doctor or Nurse if not in Green Zone after first hour.
Next — if asthma is better after first hour, you may give:
Albuterol 2-4puffsor1nebulizer every4hoursasneeded
Call your Doctor or Nurse if:
Albuterolneededmoreoftenthanevery4hours.Albuterolneededevery4hoursformorethan1day.
Keep taking other Green Zone medicines.
First—givenow : Albuterol6puffsor1nebulizer
ANDcall your Doctor or Nurse.
Next — ifyoucannotreachyourDoctororNurseimmediately, give: Albuterol6puffsor1nebulizer
AND go to the nearest emergency room or call 911.
(oralsteroid)