Respirator Therapy Consult



DHS: Seniors and People with Disabilities

State Operated Community Program

SOCP Nurse Tools:

|Respiratory Therapy Consult |Date: |      |

|Client name: |      |DOB: |      |House: |      |

|Medical history:       |

|Evaluation: | Breath sounds |Respiratory rate: |      |Per minute. |

| | |Heart rate: |      |Per minute. |

| | |Sp02 |      |% on |      |

|Treatment evaluation:       |

|Therapies: |

|Oxygen:       |

|Aerosol:       |

|Small Volume Nebulize (SVN):       |

|Metered Dose Inhaler (MDI):       |

|Chest Physiotherapy (CPT):       |

|Other:       |

|Equipment: |

|Oxygen |

|Tracheostomy tube |

|Percussor/Vibrator |

| |

|Other: |

|      |

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|Current Respiratory Therapy orders: |

|Limited Code Status |

|SNV Abluterol Q6 hrs PRN |

|O2 titrate for sp02>90% |

| |

|Cool aerosol to tracheostomy @ HS and PRN |

|RT consult Q 6 months |

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|Recommendations:       |

|Expected date of next visit: |      | | | | |

| | | | | | |

|CRTT, RCP signature: | |Date: | |

| | | |signature | | |

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