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: |
| |
| |
| |
| |
| |
|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 |
| |
| |
| |
| |
|Recommendations: |
|Expected date of next visit: | | | | | |
| | | | | | |
|CRTT, RCP signature: | |Date: | |
| | | |signature | | |
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