Republic of the Philippines

Province of Batangas
Provincial Health Office
MARTIN MARASIGAN MEMORIAL HOSPITAL
Cuenca, Batangas

CLINICAL PATHWAY FOR BRONCHIAL ASTHMA

Patients Name: Attending Physician:

Age:
Date: Time of Arrival:
Level of Care 1ST HOUR EMERGENCY ROOM 1ST 24 HOURS 2ND TO 3RD HOSPITAL DAY 4TH HOSPITAL DAY
Documentation Triage Record Complete
o Patients Clinical History
o Monitor Vital Signs o Monitor Vital Signs o Monitor Vital Signs
o Monitor Vital Signs
o Check for any of the following o Check for any of the following o Check for any of the following
o Check for any of the following
signs and symptoms signs and symptoms signs and symptoms
signs and symptoms
o Tachypnea o Tachypnea o Tachypnea
o Tachypnea
o Chest Indrawing o Chest Indrawing o Chest Indrawing
o Chest Indrawing
Assessment o Fever o Fever o Fever
o Fever
o Abnormal Chest Sounds o Abnormal Chest Sounds o Abnormal Chest Sounds
o Abnormal Chest Sounds
o Crackles o Crackles o Crackles
o Crackles
o Rhonchi o Rhonchi o Rhonchi
o Rhonchi
o Wheezes o Wheezes o Wheezes
o Wheezes
o Grunting o Grunting o Grunting
o Grunting
o CBC
o RBS, NA, K, CREA o Blood Culture Sputum o Blood Culture Sputum o Blood Culture Sputum
CLINICAL
o ABG o CT-scan of chest in some cases o CT-scan of chest in some cases o CT-scan of chest in some cases
EXAMINATION
o ECG that is not seen in CXR that is not seen in CXR that is not seen in CXR
o Chest X-ray
o Hook to Cardiac monitor and o Hook to Cardiac monitor and o Hook to Cardiac monitor and o Hook to Cardiac monitor and
pulse Oximeter pulse Oximeter pulse Oximeter pulse Oximeter
PROCEDURES o Insert IVF o Insert IVF o Insert IVF o Insert IVF
o Assess vital signs every 4 hours o Assess vital signs every 4 hours o Assess vital signs every 4 hours o Assess vital signs every 4 hours
o Seek pulmonologist consult Seek pulmonologist consult Seek pulmonologist consult Seek pulmonologist consult
o Bed Rest with Isolation o Bed Rest with Isolation o Bed Rest with Isolation o Bed Rest with Isolation
MOBILIZATION
Precaution Precaution Precaution Precaution
DIET o Nothing per orem while having o Nothing per orem while having o Nothing per orem while having o Adequate dietary intake for
difficulty of breathing difficulty of breathing difficulty of breathing 24hours
o Take precautions against o Adequate dietary intake for o Adequate dietary intake for
aspiration 24hours 24hours
 CLINICAL PATHWAY FOR BRONCHIAL ASTHMA
o Encourage oral fluid intake

Level of Care 1ST HOUR EMERGENCY ROOM 1ST 24 HOURS 2ND TO 3RD HOSPITAL DAY 4TH HOSPITAL DAY
o Give IV fluids
o May give Hydrocortisone Bolus
o If with probable bacteria
MEDICATIONS o May give Aminophylline Bolus o Completion of Antibiotics
infection may give antibiotics.
o If with probable bacterial
infection may give antibiotics.
o Relief of the following signs and o Relief of the following signs and
symptoms: symptoms:
o Relief of the following signs and o Relief of the following signs and
o Tachypnea o Tachypnea
symptoms: symptoms:
o Chest Indrawing o Chest Indrawing
o Tachypnea o Tachypnea
o Fever o Fever
o Chest Indrawing o Chest Indrawing
o Abnormal Chest Sounds o Abnormal Chest Sounds
o Fever o Fever
PHYSIOLOGIC o Crackles o Crackles
o Abnormal Chest Sounds o Abnormal Chest Sounds
OUTCOME o Rhonchi o Rhonchi
o Crackles o Crackles
o Wheezes o Wheezes
o Rhonchi o Rhonchi
o Grunting o Grunting
o Wheezes o Wheezes
o Able to tolerate PO medications o Able to tolerate PO medications
o Grunting o Grunting
o Improved sense of Well being o Improved sense of Well being
o Oral medications tolerated o Oral medications tolerated

o Explain Treatment and o Explain Treatment and o Explain Treatment and

o Explain Treatment and procedures to client and family procedures to client and family procedures to client and family
procedures to client and family o Provide family and client with o Provide family and client with o Provide family and client with
o Provide family and client with psychological and emotional psychological and emotional psychological and emotional
EDUCATION
psychological and emotional support support support
support o Patient and family are able to o Patient and family are able to o Patient and family are able to
verbalize understanding of verbalize understanding of verbalize understanding of
discharge instructions discharge instructions discharge instructions
DISCHARGE o Improved client oxygen o Improved client oxygen o Improved client oxygen o Discuss discharge plan with
PLANNING saturation (-) use of accessory saturation (-) use of accessory saturation (-) use of accessory patient and family
muscle for breathing muscle for breathing muscle for breathing o Check list prior to discharge
o Patient is clinically stable o Patient is clinically stable o Medications and prescriptions
O2 Sat 99% O2 Sat 99% o Discharge Summary
BP 120/90 BP 120/90 o Home Instructions
Temp 36.5C to 37.5 C Temp 36.5C to 37.5 C
PR 60 to 100 PR 60 to 100
RR 16-22 RR 16-22

o Nurses charting completed o Nurses charting completed

CLINICAL PATHWAY FOR BRONCHIAL ASTHMA
o Transfer to tertiary hospital; o Transfer to tertiary hospital;
Consent for transfer signed Consent for transfer signed