1. Admit to:
2. Diagnosis: Pleural effusion
3. Condition:
4. Vital Signs: q shift. Call physician if BP >160/90,<90/60; P>120, <50;
R>25, <10; T >38.5°C
5. Activity:
6. Diet: Regular.
7. IV Fluids: D5W at TKO
8. Extras: CXR PA and LAT, repeat after thoracentesis;left and right lateral
decubitus x-rays, ECG, ultrasound,PPD; pulmonary consult.
9. Labs: CBC, SMA 7&12, protein, albumin, amylase,ANA, ESR, INR/PTT, UA.
Cryptococcal antigen,histoplasma antigen, fungal culture.
Thoracentesis:
Tube 1: LDH, protein, amylase, triglyceride, glucose(10 mL).
Tube 2: Gram stain, C&S, AFB, fungal C&S (20-60mL, heparinized).
Tube 3: Cell count and differential (5-10 mL, EDTA).
Syringe: pH (2 mL collected anaerobically,heparinized on ice).
Bag or Bottle: Cytology.
Showing posts with label C.M.Pulmology. Show all posts
Showing posts with label C.M.Pulmology. Show all posts
Anaphylaxis
1. Admit to:
2. Diagnosis: Anaphylaxis
3. Condition:
4. Vital Signs: q1-4h; call physician if BP systolic >160,<90; diastolic >90, <60;
P >120, <50; R>25, <10; T>38.5°C
5. Activity: Bedrest
6. Nursing: O2 at 6 L/min by NC or mask. Keep patient in Trendelenburg's position,
No. 4 or 5 endotracheal tube at bedside.
7. Diet: NPO
8. IV Fluids: 2 IV lines. Normal saline or LR 1 L over 1-2h, then D5 ½ NS
at 125 cc/h.Foley to closed drainage.
9. Special Medications:
Gastrointestinal Decontamination:
-Gastric lavage if indicated for recent oral ingestion.
-Activated charcoal 50-100 gm, followed by cathartic.
Bronchodilators:
-Epinephrine (1:1000) 0.3-0.5 mL SQ or IM q10min or 1-4 mcg/min IV OR in severe life
threatening reactions,give 0.5 mg (5.0 mL of 1: 10,000 sln) IV q5-10min prn. Epinephrine,
0.3 mg of 1:1000 sln maybe injected SQ at site of allergen injection OR
-Albuterol (Ventolin) 0.5%, 0.5 mL in 2.5 mL NS q30min by nebulizer prn OR
-Aerosolized 2% racemic epinephrine 0.5-0.75 mL.
Corticosteroids:
-Methylprednisolone (Solu-Medrol) 250 mg IV x 1, then 125 mg IV q6h OR
-Hydrocortisone sodium succinate 200 mg IV x 1, then 100 mg q6h, followed by oral
prednisone 60 mg PO qd, tapered over 5 days.
Antihistamines:
-Diphenhydramine (Benadryl) 25-50 mg IV q4-6h OR
-Hydroxyzine (Vistaril) 25-50 mg IM or PO q2-4h.
-Famotidine (Pepcid) 20 mg IV/PO bid.
Pressors and other Agents:
-Norepinephrine (Levophed) 8-12 mcg/min IV, titrate to systolic 100 mmHg
(8 mg in 500 mL D5W) OR
-Dopamine (Intropin) 5-20 mcg/kg/min IV.
10. Extras: Portable CXR, ECG, allergy consult.
11. Labs: CBC, SMA 7&12.
2. Diagnosis: Anaphylaxis
3. Condition:
4. Vital Signs: q1-4h; call physician if BP systolic >160,<90; diastolic >90, <60;
P >120, <50; R>25, <10; T>38.5°C
5. Activity: Bedrest
6. Nursing: O2 at 6 L/min by NC or mask. Keep patient in Trendelenburg's position,
No. 4 or 5 endotracheal tube at bedside.
7. Diet: NPO
8. IV Fluids: 2 IV lines. Normal saline or LR 1 L over 1-2h, then D5 ½ NS
at 125 cc/h.Foley to closed drainage.
9. Special Medications:
Gastrointestinal Decontamination:
-Gastric lavage if indicated for recent oral ingestion.
-Activated charcoal 50-100 gm, followed by cathartic.
Bronchodilators:
-Epinephrine (1:1000) 0.3-0.5 mL SQ or IM q10min or 1-4 mcg/min IV OR in severe life
threatening reactions,give 0.5 mg (5.0 mL of 1: 10,000 sln) IV q5-10min prn. Epinephrine,
0.3 mg of 1:1000 sln maybe injected SQ at site of allergen injection OR
-Albuterol (Ventolin) 0.5%, 0.5 mL in 2.5 mL NS q30min by nebulizer prn OR
-Aerosolized 2% racemic epinephrine 0.5-0.75 mL.
Corticosteroids:
-Methylprednisolone (Solu-Medrol) 250 mg IV x 1, then 125 mg IV q6h OR
-Hydrocortisone sodium succinate 200 mg IV x 1, then 100 mg q6h, followed by oral
prednisone 60 mg PO qd, tapered over 5 days.
Antihistamines:
-Diphenhydramine (Benadryl) 25-50 mg IV q4-6h OR
-Hydroxyzine (Vistaril) 25-50 mg IM or PO q2-4h.
-Famotidine (Pepcid) 20 mg IV/PO bid.
Pressors and other Agents:
-Norepinephrine (Levophed) 8-12 mcg/min IV, titrate to systolic 100 mmHg
(8 mg in 500 mL D5W) OR
-Dopamine (Intropin) 5-20 mcg/kg/min IV.
10. Extras: Portable CXR, ECG, allergy consult.
11. Labs: CBC, SMA 7&12.
Hemoptysis
1. Admit to: Intensive care unit
2. Diagnosis: Hemoptysis
3. Condition:
4. Vital Signs: q1-6h. Orthostatic BP and pulse bid.
Call physician if BP >160/90, <90/60; P >130, <50; R>25,<10;
T >38.5°C; O2 sat <90%.
5. Activity: Bed rest with bedside commode. Keep patient in lateral decubitus,
Trendelenburg’s position,bleeding side down.
6. Nursing: Quantify all sputum and expectorated blood,suction prn.
O2 at 100% by mask, pulse oximeter. Discontinue narcotics and sedatives.
Have double lumen endotracheal tube available for use.
7. Diet:
8. IV Fluids: 1 L of NS wide open ($6 gauge), then transfuse PRBC, Foley to gravity.
9. Special Medications:
-Transfuse 2-4 U PRBC wide open.
-Promethazine/codeine (Phenergan with codeine) 5 cc
PO q4-6h prn cough. Contraindicated in massive hemoptysis.
-Initiate empiric antibiotics if bronchitis or infection is present.
10. Extras: CXR PA, LAT, ECG, VQ scan, contrast CT,
bronchoscopy. PPD, pulmonary and thoracic surgery consults.
11. Labs: Type and cross 2-4 U PRBC. ABG, CBC,
platelets, SMA7 and 12, ESR. Anti-glomerular basement
antibody, rheumatoid factor, complement, anti-nuclear
cytoplasmic antibody. Sputum Gram stain, C&S, AFB,
fungal culture, and cytology qAM for 3 days. UA,
INR/PTT, von Willebrand Factor. Repeat CBC q6h.
2. Diagnosis: Hemoptysis
3. Condition:
4. Vital Signs: q1-6h. Orthostatic BP and pulse bid.
Call physician if BP >160/90, <90/60; P >130, <50; R>25,<10;
T >38.5°C; O2 sat <90%.
5. Activity: Bed rest with bedside commode. Keep patient in lateral decubitus,
Trendelenburg’s position,bleeding side down.
6. Nursing: Quantify all sputum and expectorated blood,suction prn.
O2 at 100% by mask, pulse oximeter. Discontinue narcotics and sedatives.
Have double lumen endotracheal tube available for use.
7. Diet:
8. IV Fluids: 1 L of NS wide open ($6 gauge), then transfuse PRBC, Foley to gravity.
9. Special Medications:
-Transfuse 2-4 U PRBC wide open.
-Promethazine/codeine (Phenergan with codeine) 5 cc
PO q4-6h prn cough. Contraindicated in massive hemoptysis.
-Initiate empiric antibiotics if bronchitis or infection is present.
10. Extras: CXR PA, LAT, ECG, VQ scan, contrast CT,
bronchoscopy. PPD, pulmonary and thoracic surgery consults.
11. Labs: Type and cross 2-4 U PRBC. ABG, CBC,
platelets, SMA7 and 12, ESR. Anti-glomerular basement
antibody, rheumatoid factor, complement, anti-nuclear
cytoplasmic antibody. Sputum Gram stain, C&S, AFB,
fungal culture, and cytology qAM for 3 days. UA,
INR/PTT, von Willebrand Factor. Repeat CBC q6h.
Chronic Obstructive Pulmonary Disease
1. Admit to:
2. Diagnosis: Exacerbation of COPD
3. Condition:
4. Vital Signs: q4h. Call physician if P >130; R >30, <10;
T >38.5°C; O2 Sat <90%.
5. Activity: Up as tolerated; bedside commode.
6. Nursing: Pulse oximeter. Measure peak flow with
portable peak flow meter bid and chart with vital signs.
No sedatives.
7. Diet: No added salt, no caffeine. Push fluids.
8. IV Fluids: D5 ½ NS with 20 mEq KCL/L at 125 cc/h.
9. Special Medications:
-Oxygen 1-2 L/min by NC or 24-35% by Venturi mask,keep O2 saturation 90-91%.
Beta-Agonists, Acute Treatment:
-Albuterol (Ventolin) 0.5 mg and ipratropium (Atrovent)0.5 mg in 2.5 mL NS q1-2h
until peak flow meter $200-250 L/min, then q4h OR
-Albuterol (Ventolin) MDI 2-4 puffs q4-6h.
-Albuterol/Ipratropium (Combivent) 2-4 puffs qid.
Corticosteroids and Anticholinergics:
-Methylprednisolone (Solu-Medrol) 60-125 mg IV q6h or 30-60 mg PO qd.
Followed by:
-Prednisone 20-60 mg PO qd.
-Triamcinolone (Azmacort) MDI 2 puffs qid or 4 puffs bid.
-Beclomethasone (Beclovent) MDI 4-8 puffs bid with spacer,
followed by gargling with water OR
-Flunisolide (AeroBid) MDI 2-4 puffs bid OR
-Ipratropium (Atrovent) MDI 2 puffs tid-qid OR
-Fluticasone (Flovent) 2-4 puffs bid (44 or 110mcg/puff.
Aminophylline and Theophylline (second line therapy):
-Aminophylline loading dose, 5.6 mg/kg total body weight over 20 min
(if not already on theophylline);then 0.5-0.6 mg/kg ideal body weight/hr
(500 mg in 250 mL of D5W); reduce if elderly, or heart or liver
disease (0.2-0.4 mg/kg/hr). Reduce loading to 50-75% if already taking
theophylline(1 mg/kg of aminophylline will raise levels by 2 mcg/mL) OR
-Theophylline IV solution loading dose, 4.5 mg/kg total body weight,
then 0.4-0.5 mg/kg ideal body weight/hr.
-Theophylline long acting (Theo-Dur) 100-400 mg PO bid-tid (3 mg/kg q8h);
80% of daily IV aminophylline in 2-3 doses.
Acute Bronchitis
-Ampicillin 1 gm IV q6h or 500 mg PO qid OR
-Trimethoprim/sulfamethoxazole (Septra DS) 160/800mg PO bid or 160/800 mg
IV q12h (10-15 mL in 100cc D5W tid) OR
-Cefuroxime (Zinacef) 750 mg IV q8h OR
-Ampicillin/sulbactam (Unasyn) 1.5 gm IV q6h OR
-Doxycycline (Vibra-tabs) 100 mg PO/IV bid
-Azithromycin (Zithromax) 500 mg x 1, then 250 mg PO qd x 4
or 500 mg IV q24h OR
-Clarithromycin (Biaxin) 250-500 mg PO bid OR
-Levofloxacin (Levaquin) 500 mg PO/IV qd [250, 500mg] OR
-Sparfloxacin (Zagam) 400 mg PO x 1, then 200 mg PO qd [200 mg].
10. Symptomatic Medications:
-Docusate sodium (Colace) 100 mg PO qhs.
-Famotidine (Pepcid) 20 mg IV/PO q12h.
-Acetaminophen (Tylenol) 325-650 mg PO q4-6h prn headache.
-Zolpidem (Ambien) 5-10 mg qhs prn insomnia.
11. Extras: Portable CXR, PFT's with bronchodilators,ECG,
impedance cardiography,echocardiogram.
12. Labs: ABG, CBC, SMA7, UA. Theophylline level stat and after
12-24h of infusion.Sputum Gram stain and C&S, alpha 1 antitrypsin level.
2. Diagnosis: Exacerbation of COPD
3. Condition:
4. Vital Signs: q4h. Call physician if P >130; R >30, <10;
T >38.5°C; O2 Sat <90%.
5. Activity: Up as tolerated; bedside commode.
6. Nursing: Pulse oximeter. Measure peak flow with
portable peak flow meter bid and chart with vital signs.
No sedatives.
7. Diet: No added salt, no caffeine. Push fluids.
8. IV Fluids: D5 ½ NS with 20 mEq KCL/L at 125 cc/h.
9. Special Medications:
-Oxygen 1-2 L/min by NC or 24-35% by Venturi mask,keep O2 saturation 90-91%.
Beta-Agonists, Acute Treatment:
-Albuterol (Ventolin) 0.5 mg and ipratropium (Atrovent)0.5 mg in 2.5 mL NS q1-2h
until peak flow meter $200-250 L/min, then q4h OR
-Albuterol (Ventolin) MDI 2-4 puffs q4-6h.
-Albuterol/Ipratropium (Combivent) 2-4 puffs qid.
Corticosteroids and Anticholinergics:
-Methylprednisolone (Solu-Medrol) 60-125 mg IV q6h or 30-60 mg PO qd.
Followed by:
-Prednisone 20-60 mg PO qd.
-Triamcinolone (Azmacort) MDI 2 puffs qid or 4 puffs bid.
-Beclomethasone (Beclovent) MDI 4-8 puffs bid with spacer,
followed by gargling with water OR
-Flunisolide (AeroBid) MDI 2-4 puffs bid OR
-Ipratropium (Atrovent) MDI 2 puffs tid-qid OR
-Fluticasone (Flovent) 2-4 puffs bid (44 or 110mcg/puff.
Aminophylline and Theophylline (second line therapy):
-Aminophylline loading dose, 5.6 mg/kg total body weight over 20 min
(if not already on theophylline);then 0.5-0.6 mg/kg ideal body weight/hr
(500 mg in 250 mL of D5W); reduce if elderly, or heart or liver
disease (0.2-0.4 mg/kg/hr). Reduce loading to 50-75% if already taking
theophylline(1 mg/kg of aminophylline will raise levels by 2 mcg/mL) OR
-Theophylline IV solution loading dose, 4.5 mg/kg total body weight,
then 0.4-0.5 mg/kg ideal body weight/hr.
-Theophylline long acting (Theo-Dur) 100-400 mg PO bid-tid (3 mg/kg q8h);
80% of daily IV aminophylline in 2-3 doses.
Acute Bronchitis
-Ampicillin 1 gm IV q6h or 500 mg PO qid OR
-Trimethoprim/sulfamethoxazole (Septra DS) 160/800mg PO bid or 160/800 mg
IV q12h (10-15 mL in 100cc D5W tid) OR
-Cefuroxime (Zinacef) 750 mg IV q8h OR
-Ampicillin/sulbactam (Unasyn) 1.5 gm IV q6h OR
-Doxycycline (Vibra-tabs) 100 mg PO/IV bid
-Azithromycin (Zithromax) 500 mg x 1, then 250 mg PO qd x 4
or 500 mg IV q24h OR
-Clarithromycin (Biaxin) 250-500 mg PO bid OR
-Levofloxacin (Levaquin) 500 mg PO/IV qd [250, 500mg] OR
-Sparfloxacin (Zagam) 400 mg PO x 1, then 200 mg PO qd [200 mg].
10. Symptomatic Medications:
-Docusate sodium (Colace) 100 mg PO qhs.
-Famotidine (Pepcid) 20 mg IV/PO q12h.
-Acetaminophen (Tylenol) 325-650 mg PO q4-6h prn headache.
-Zolpidem (Ambien) 5-10 mg qhs prn insomnia.
11. Extras: Portable CXR, PFT's with bronchodilators,ECG,
impedance cardiography,echocardiogram.
12. Labs: ABG, CBC, SMA7, UA. Theophylline level stat and after
12-24h of infusion.Sputum Gram stain and C&S, alpha 1 antitrypsin level.
Asthma
1. Admit to:
2. Diagnosis: Exacerbation of asthma
3. Condition:
4. Vital Signs: q6h. Call physician if P >140; R >30, <10;
T >38.5°C; pulse oximeter <90%
5. Activity: Up as tolerated.
6. Nursing: Pulse oximeter, bedside peak flow rate before and
after bronchodilator treatments.
7. Diet: Regular, no caffeine.
8. IV Fluids: D5 ½ NS at 125 cc/h.
9. Special Medications:
-Oxygen 2 L/min by NC. Keep O2 sat >90%.
Beta Agonists, Acute Treatment:
-Albuterol (Ventolin) 0.5 mg and ipratropium (Atrovent)
0.5 mg in 2.5 mL NS q1-2h until peak flow meter
$200-250 L/min and sat $90%, then q4h OR
-Albuterol (Ventolin) MDI 3-8 puffs, then 2 puffs q3-6h prn,
or powder 200 mcg/capsule inhaled qid.
-Albuterol/Ipratropium (Combivent) 2-4 puffs qid.
Systemic Corticosteroids:
-Methylprednisolone (Solu-Medrol) 60-125 mg IV q6h;then 30-60 mg PO qd. OR
-Prednisone 20-60 mg PO qAM.
Aminophylline and Theophylline (second-line therapy):
-Aminophylline load dose: 5.6 mg/kg total body weight in 100 mL D5W IV
over 20min. Maintenance of 0.5-0.6 mg/kg ideal body weight/h (500 mg in 250 mLD5W);
reduce if elderly, heart/liver failure (0.2-0.4mg/kg/hr).
Reduce load 50-75% if taking theophylline (1 mg/kg of aminophylline will raise levels 2mcg/mL) OR
-Theophylline IV solution loading dose 4.5 mg/kg total
body weight, then 0.4-0.5 mg/kg ideal body weight/hr.
-Theophylline (Theo-Dur) 100-400 mg PO bid (3 mg/kg q8h); 80% of total
daily IV aminophylline in 2-3doses.
Inhaled Corticosteroids (adjunct therapy):
-Beclomethasone (Beclovent) MDI 4-8 puffs bid, with spacer 5 min after bronchodilator,
followed by gargling with water
-Triamcinolone (Azmacort) MDI 2 puffs tid-qid or 4 puffs bid.
-Flunisolide (AeroBid) MDI 2-4 puffs bid.
-Fluticasone (Flovent) 2-4 puffs bid (44 or 110mcg/puff); requires 1-2 weeks for full effect.
Maintenance Treatment:
-Salmeterol (Serevent) 2 puffs bid; not effective for acute asthma because
of delayed onset of action.
-Pirbuterol (Maxair) MDI 2 puffs q4-6h prn.
-Bitolterol (Tornalate) MDI 2-3 puffs q1-3min, then 2-3 puffs q4-8h prn.
-Fenoterol (Berotec) MDI 3 puffs, then 2 bid-qid.
-Ipratropium (Atrovent) MDI 2-3 puffs tid-qid.
Prevention and Prophylaxis:
-Cromolyn (Intal) 2-4 puffs tid-qid.
-Nedocromil (Tilade) 2-4 puffs bid-qid.
-Montelukast (Singulair) 10 mg PO qd.
-Zafirlukast (Accolate) 20 mg PO bid.
-Zileuton (Zyflo) 600 mg PO qid.
Acute Bronchitis
-Ampicillin/sulbactam (Unasyn) 1.5 gm IV q6h OR
-Cefuroxime (Zinacef) 750 mg IV q8h OR
-Cefuroxime axetil (Ceftin) 250-500 mg PO bid OR
-Trimethoprim/sulfamethoxazole (Bactrim DS), 1 tab PO bid OR
-Levofloxacin (Levaquin) 500 mg PO/IV PO qd [250,500 mg].
-Amoxicillin 875 mg/clavulanate 125 mg (Augmentin 875) 1 tab PO bid.
10. Symptomatic Medications:
-Docusate sodium (Colace) 100 mg PO qhs.
-Famotidine (Pepcid) 20 mg IV/PO q12h.
-Acetaminophen (Tylenol) 325-650 mg PO q4-6h prn headache.
-Zolpidem (Ambien) 5-10 mg qhs prn insomnia.
11. Extras: Portable CXR, ECG, pulmonary function tests
before and after bronchodilators; pulmonary rehabilitation;
impedance cardiography, echocardiogram.
12. Labs: ABG, CBC with eosinophil count, SMA7, B-type
natriuretic peptide (BNP). Theophylline levell stat and after
24h of infusion. Sputum Gram stain, C&S.
2. Diagnosis: Exacerbation of asthma
3. Condition:
4. Vital Signs: q6h. Call physician if P >140; R >30, <10;
T >38.5°C; pulse oximeter <90%
5. Activity: Up as tolerated.
6. Nursing: Pulse oximeter, bedside peak flow rate before and
after bronchodilator treatments.
7. Diet: Regular, no caffeine.
8. IV Fluids: D5 ½ NS at 125 cc/h.
9. Special Medications:
-Oxygen 2 L/min by NC. Keep O2 sat >90%.
Beta Agonists, Acute Treatment:
-Albuterol (Ventolin) 0.5 mg and ipratropium (Atrovent)
0.5 mg in 2.5 mL NS q1-2h until peak flow meter
$200-250 L/min and sat $90%, then q4h OR
-Albuterol (Ventolin) MDI 3-8 puffs, then 2 puffs q3-6h prn,
or powder 200 mcg/capsule inhaled qid.
-Albuterol/Ipratropium (Combivent) 2-4 puffs qid.
Systemic Corticosteroids:
-Methylprednisolone (Solu-Medrol) 60-125 mg IV q6h;then 30-60 mg PO qd. OR
-Prednisone 20-60 mg PO qAM.
Aminophylline and Theophylline (second-line therapy):
-Aminophylline load dose: 5.6 mg/kg total body weight in 100 mL D5W IV
over 20min. Maintenance of 0.5-0.6 mg/kg ideal body weight/h (500 mg in 250 mLD5W);
reduce if elderly, heart/liver failure (0.2-0.4mg/kg/hr).
Reduce load 50-75% if taking theophylline (1 mg/kg of aminophylline will raise levels 2mcg/mL) OR
-Theophylline IV solution loading dose 4.5 mg/kg total
body weight, then 0.4-0.5 mg/kg ideal body weight/hr.
-Theophylline (Theo-Dur) 100-400 mg PO bid (3 mg/kg q8h); 80% of total
daily IV aminophylline in 2-3doses.
Inhaled Corticosteroids (adjunct therapy):
-Beclomethasone (Beclovent) MDI 4-8 puffs bid, with spacer 5 min after bronchodilator,
followed by gargling with water
-Triamcinolone (Azmacort) MDI 2 puffs tid-qid or 4 puffs bid.
-Flunisolide (AeroBid) MDI 2-4 puffs bid.
-Fluticasone (Flovent) 2-4 puffs bid (44 or 110mcg/puff); requires 1-2 weeks for full effect.
Maintenance Treatment:
-Salmeterol (Serevent) 2 puffs bid; not effective for acute asthma because
of delayed onset of action.
-Pirbuterol (Maxair) MDI 2 puffs q4-6h prn.
-Bitolterol (Tornalate) MDI 2-3 puffs q1-3min, then 2-3 puffs q4-8h prn.
-Fenoterol (Berotec) MDI 3 puffs, then 2 bid-qid.
-Ipratropium (Atrovent) MDI 2-3 puffs tid-qid.
Prevention and Prophylaxis:
-Cromolyn (Intal) 2-4 puffs tid-qid.
-Nedocromil (Tilade) 2-4 puffs bid-qid.
-Montelukast (Singulair) 10 mg PO qd.
-Zafirlukast (Accolate) 20 mg PO bid.
-Zileuton (Zyflo) 600 mg PO qid.
Acute Bronchitis
-Ampicillin/sulbactam (Unasyn) 1.5 gm IV q6h OR
-Cefuroxime (Zinacef) 750 mg IV q8h OR
-Cefuroxime axetil (Ceftin) 250-500 mg PO bid OR
-Trimethoprim/sulfamethoxazole (Bactrim DS), 1 tab PO bid OR
-Levofloxacin (Levaquin) 500 mg PO/IV PO qd [250,500 mg].
-Amoxicillin 875 mg/clavulanate 125 mg (Augmentin 875) 1 tab PO bid.
10. Symptomatic Medications:
-Docusate sodium (Colace) 100 mg PO qhs.
-Famotidine (Pepcid) 20 mg IV/PO q12h.
-Acetaminophen (Tylenol) 325-650 mg PO q4-6h prn headache.
-Zolpidem (Ambien) 5-10 mg qhs prn insomnia.
11. Extras: Portable CXR, ECG, pulmonary function tests
before and after bronchodilators; pulmonary rehabilitation;
impedance cardiography, echocardiogram.
12. Labs: ABG, CBC with eosinophil count, SMA7, B-type
natriuretic peptide (BNP). Theophylline levell stat and after
24h of infusion. Sputum Gram stain, C&S.
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