Action Plan For Asthma Form

Action Plan For Asthma

A Guideline for Managing Your Asthma

An action plan for asthma can assist you to identify early warning signs or symptoms, and how to act accordingly to prevent an asthma attack. 
This action plan is for: _____________________________
Date of plan : ____ / ____ / _____
Doctor’s Name: ____________________ Phone No: _______
Hospital  or ER Address / Phone No: ___________________________________________
___________________________________________________________________
My Personal Asthma Triggers ( √ )
  • __ Pollen
  • __ Mold
  • __ Dust
  • __ Cats
  • __ Dogs
  • __ Fumes
  • __ Cold air
  • __ Smoke
  • __ Other: ____________________________
INSTRUCTIONS: This plan is divided into 3 zones, green, yellow, and red, similar to the colors on a traffic light. If you are in the GREEN zone, then you’re doing well. You probably don’t need to do anything other than take your daily medicines as prescribed.
If you are in the YELLOW zone, it means you are getting a warning. Yellow means that your asthma may be getting worse and you are probably having a flare up. Action is needed to prevent an asthma attack.
If you are in the RED zone, you are in danger, and you MUST take emergency action, as described on the plan, right away!
The steps you need to follow are listed in each zone. If you have any questions about your Asthma Action Plan, be sure to discuss it with your doctor before you get into the yellow or red zones.
—————————————————————————————————————————————————-

GREEN ZONE-Doing Well!

Symptoms:
  • You feel good
  • You have no cough, wheezing, or other breathing problems
And / Or… Peak Flow Readings Are:
At least 80% or more of my best peak flow, which would be _________
My best peak flow is __________________
Take these medicines every day (name/dose/how often):
  1. _____________________________________________
  2. _____________________________________________
  3. _____________________________________________
—————————————————————————————————————————————————-

YELLOW ZONE-Your Asthma Is Getting Worse

Symptoms:
  • You are having mild cough, wheezing, chest tightness or shortness of breath
  • You sometimes wake up at night due to asthma
  • You can do some of your usual activities, but not all
Or Peak Flow Readings Are:
only 50 to 80% of my best peak flow: ___________________________
Actions to Take:
  1. Keep taking your daily medicine
  2. Next, add the following quick-relief medicine: __________________________
  3. If your symptoms do not improve, call your doctor
—————————————————————————————————————————————————-

Red Zone-Medical Alert

Symptoms:
  • You are very short of breath & actively wheezing
  • You cannot do your usual activities
  • Quick-relief medicine is not relieving your symptoms
  • You’ve been in the YELLOW zone for 24 hours with no improvement
Or Peak Flow Readings Are:
less than 50% of your best peak flow: __________________
Actions to Take:
  1. Keep taking your daily medicine
  2. Next, add the following quick-relief medicine: __________________________
  3. Call your family doctor NOW
  4. If you are still in RED zone after 15 minutes AND not able to contact your doctor, then immediately GO TO THE NEAREST HOSPITAL OR CALL AN AMBULANCE!
Extreme Danger Signs: If you see any of these, you must get emergency help immediately:
  • Lips or fingernails turning blue or purplish (cyanosis)
  • Trouble walking or talking
  • Chest sucking in
  • Nostrils flaring open
—————————————————————————————————————————————————-

Comments

Post a Comment

Popular posts from this blog

Basic Procedure of Nebulization

Image
Bronchial asthma is a life-threatening respiratory problem that does not exempt anyone. This condition can affect both men and women, young and old. As a matter of fact, it has been enlisted by the World Health Organization as one of the top leading cause of mortality and morbidity cases across the globe. In line with this, several therapeutic regimens and preventive measures were designed to control the number of cases. Among these favorable treatment procedures is the use of nebulization (a dispenser that turns a liquid into a fine mist). This procedure is also used as a primary treatment for other respiratory problems that involve thick and tenacious sputum. So, what is nebulization and how it is used properly? Learning the Basic Keys of Nebulization Nebulization is classified as a dependent nursing care because it requires a doctor’s order to administer medicine for asthmatic patients. However, nurses can educate the folks of the patient (parents or adults) on
Read more

Medication Side Effects

A substance that has a physiological effect when ingested or otherwise introduced into the body, in particular a medicine with intended results (like for asthma treatment), may cause a number of unwanted side effects. These effects can occur when you start a new asthma medication, decrease or increase the dose of a asthma medication, or when you stop using a asthma medication. A side effect that happens in 1% or more of people taking a specific medication is considered by medical researchers to be caused by that particular medication. Examples of common medicine side effects include nausea, vomiting, fatigue, dizziness, dry mouth, headache, itching, and muscle aches and pains. Some side effects may be severe and require medical attention, while others may be mild and of little concern. Severe or annoying side effects are one of the main reasons why people stop taking their medications. If you are having worrisome side effects, your doctor may want to change your dose, try a di
Read more

Asthma Medicines

Asthma Controller Medicines Asthma controller medicines assists in preventing asthma symptoms when taken daily as prescribed. These preventive asthma medicines include several different types. Each works in it’s special ways, and some are more suitable for certain levels of asthma severity. Check out the more suitable one below:- Inhaled Steroids Inhaled steroids, also known as inhaled corticosteroids or ICS for short, have become the main medicine type in asthma treatment for persistent asthma in children and adults. They are more safe in terms of side effects, effective and make a significant difference in the quality of life for people who have asthma. Asthma Leukotriene Modifiers Asthma Leukotriene modifiers are asthma controller medications that are sometimes used in combination with, or instead of, inhaled steroids for people whose asthma is moderate to severe. They are also called Asthma Leukotriene Antagonists. Asthma Long-Acting Beta Agonists Asthma Long Actin
Read more