Here is a sample asthma action plan you can use for a child in preschool, day care, etc child care asthma. To determine the zones on your asthma action plan, you have to monitor your own asthma control all the time. Jan 09, 2020 the nursing care plan goals for asthma focuses on preventing the hypersensitivity reaction, controlling the allergens, maintaining airway patency and preventing the occurrence of reversible complications. Make an appointment with your asthma care provider within two days of an er. The goal of asthma selfmanagement is to achieve better health through controlling and preventing asthma attacks. What we have is a wide range of versatile collection of emergency action plan templates that can be used to keep check of any kind of asthma. It has instructions related to cleanliness are required to follow in general if your kid is suffering from this disease and also other blank blocks to add symptoms, frequency of flareups etc. Many people with asthma are allergic to the dried droppings and remains of cockroaches. For more information contact the asthma society of canada at.
Follow the yellow and red zone plans for rescue medicines according to. An asthma action plan or management plan is a written plan that you create with your childs doctor to help control your childs asthma. These simple rules can give you peace of mind when breathing problems flare. Take the following medicines every day to keep asthma under good control. See the reverse side for things you can do to avoid your asthma triggers. Your action plan wont cure your childs asthma, but it can make a huge difference in how well he keeps it under control. You have no symptoms of asthma and can do usual activities. Minnesota department of healths interactive asthma action plan is a computerbased program that uses information entered by the healthcare provider to create a personalized plan for each patient. Cdc asthma asthma action plan apr 24, 2009 people with asthma should have an asthma action plan the asthma action plan shows your daily treatment, such as what kind. Asthma action plan engpdf asthma and allergy foundation. The asthma action plan includes information related to treatment regimes and patient selfmanagement. Action plan that will help you learn the steps to selfmanage your asthma so you can live a life as symptomfree as possible. To download straight to your computer, right click and choose save target as.
Click on the star next to the asthma action plan to mark it as a favorite and have it appear in the patients. The goal of an asthma action plan is to reduce or prevent flareups and emergency department visits. An individualized asthma action plan indicates the steps that must be taken to keep your asthma from getting worse. Learn quickly how to recognise early warning signs and always have your emergency medical kit containing your action plan, adrenalineepinephrine autoinjector and other medications recommended by your. Ambulatory workflow bulletin creating an asthma action plan. Merely noting the symptoms would not help to cure this disease. Use it along with any other information you get from your health care team about managing your copd every day.
The zones correspond to the colors of a traffic light. This could include teachers, school nurses, and after school care staff. Electronic, fillable pdf versions of asthma action plans. Access the asthma action plan outside of the bpa via the more activities button 1. Written asthma action plans are one of the most effective asthma. Your personalised asthma action plan has all the information and tips you need to stay well. Your action plan will help you and your caregivers to quickly recognize and act to treat your. Asthma action plan library national asthma council australia. Aug 23, 2018 an asthma action plan is a written series of steps and management techniques that should be used when a patient with asthma experiences worsening in symptoms of the condition. Our template is below, along with links to alternative. Developing an asthma action plan asthma health information. Jan 10, 2011 the following action plan can help you sort through all the information you need to know and give you a starting point get your child the help he or she needs. If you cannot contact your doctor, go directly to the emergency room.
Asthma can be of different types and the causes can also vary from allergies to genetic build up. An asthma action plan should include some basic details, to begin with. The nursing care plan goals for asthma focuses on preventing the hypersensitivity reaction, controlling the allergens, maintaining airway patency and preventing the occurrence of reversible complications. I need to see my asthma nurse every six months parents get the most from your childs action plan make it easy for you and your family to find it when you need it take a photo and keep it on your mobile and your childs mobile if they have one stick a copy on your fridge door share your. Allergens animal dander some people are allergic to the flakes of skin or dried saliva from animals with fur or feathers. An asthma action plan is a set of instructions your doctor will give to you and your family. These should be excluded in the students environment as much as possible. The asthma action plan chosen should be appropriate for the persons age, educational status, language and culture.
Fillintheblank pdf form 1 mb4 pages the 2012 revised dc asthma action plan fillintheblank pdf form is now available in english and spanish based on the national heart, lung, and blood institute s 2007. Asthma symptom action plan this asthma symptom action plan will help you manage youryour childs asthma. An asthma action plan is a written series of steps and management techniques that should be used when a patient with asthma experiences worsening in symptoms of the condition. Intermittent mild persistent moderate persistent severe persistent heshe has had many or severe asthma attacksexacerbations school staff. Asthma action plan blue cross blue shield association. An action plan is based on zones defined by your symptoms, your peak flow, or both. The process of developing a written asthma action plan is important, as this should be a discussion of the persons individual asthma and its management. It will tell you how to keep your asthma under control and prevent asthma.
Asthma action plan mild intermittent mild persistent moderate persistent severe persistent colds exercise animals other 1. Jun 04, 2014 cdc asthma asthma action plan apr 24, 2009 people with asthma should have an asthma action plan the asthma action plan shows your daily treatment, such as what kind. Click on more activities button and follow the path below. Use poison baits, powders, gels, or paste for example, boric acid. You may experience other symptoms, and your doctor may recommend other actions, than those listed. This plan will help you know what to do when asthma is in control and when asthma symptoms start to act up.
Since the severity of reactions is often unpredictable, its essential you have an individualised action plan for anaphylaxis, developed with and signed by your doctor or nurse practitioner. Here is a sample asthma action plan you can use for students in school. Asthma action plans also tell school and other caregivers about your childs asthma. Electronic, fillable pdf versions of asthma action plans click below to open forms.
Specialty formsasthma formsselect the age appropriate asthma action plan. Asthma action plans national asthma council australia. This asthma action plan template is specifically designed for kids in pdf format. Connect with us 1200 first street, ne, washington, dc 20002 phone. Encourage patientfamily to continue followup with their clinician every 1 to 6 months even if asthma is well controlled. This plan gives you directions that you can follow when youyour child are feeling good, when youyour child start to have asthma symptoms, and when youryour child symptoms worsen. Your child should have regularly scheduled asthma check ups and should be seen after any emergency room or hospital visit by their primary care.
It will tell you how to keep your asthma under control and prevent asthma flareups sometimes called asthma attacks. Follow the yellow and red zone plans for rescue medicines according to asthma symptoms. Asthma action plan for adults american lung association. Provide general information that readers should know about. Canadian respiratory my copd action plan guidelines copd. Written asthma action plans are one of the most effective asthma interventions available. Green zone doing well breathing is good no coughing, wheezing, chest tightness, or shortness of breath during the day or night, and able to do usual activities work, play, and exercise, and peak flow is more than. The following action plan can help you sort through all the information you need to know and give you a starting point get your child the help he or she needs.
Asthma action plan check all items that trigger your asthma and things that could make your asthma worse. Here are the basic guidelines to remember when formulating an asthma action plan. The colors of a traffic light will help you use your asthma medicines. Maryland asthma action plan prevention and health promotion. Pdf asthma action plancpg version with self management tips.
Here are eight 8 nursing care plans and nursing diagnosis for asthma. Nasogastric orogastric gastrostomy percutaneous endoscopic gastrostomy jejunostomy 2. Authorization for student possession and use of an epinephrine autoinjector in accordance with orc 33. Hp asthma action plans by national asthma council australia. An asthma action plan should have information that details the course of action when such asthma aggravations occur.
Work with your doctor to make an asthma action plan what is a pdf document. The asthma action plan chosen should be appropriate for the persons age, treatment regimen, asthma severity, culture, language, literacy level, and ability to selfmanage. Following a written asthma action plan can help your child do normal everyday activities without. Asthma and allergy foundation of america 1235 south clark street suite 305, arlington, va 22202 phone. Apr, 2020 minnesota department of healths interactive asthma action plan is a computerbased program that uses information entered by the healthcare provider to create a personalized plan for each patient. Discuss the plan at each visit and change it as needed. Perform skin or blood allergy tests for all patients with persistent asthma. These tools for asthma control were created following the evidencebased guidelines. Your action plan is a written contract between you and your health care team. In addition to the academy and dhmhs recommendation for using the asthma action plan, a study published in thorax by drs. Your action plan tells you what to do when you are in each zone. Our library includes some of the many different written asthma action plans available. However, if i am not sleepy at this time, i should wait until i am aware of the sensation of sleepiness is present. To view and download templates, go to our asthma action plan library.
How to use an asthma action plan develop your plan. In each zone, your asthma action plan will give you doctorwritten instructions on how to handle each situation. Every person with asthma needs to have a personalized asthma action plan. What we have is a wide range of versatile collection of emergency action plan templates that. Asthma action plan national heart, lung, and blood institute. Merely noting the symptoms would not help to cure this disease if you do not know what actually you should take note of. Gibson and powell confirmed that using a written asthma action plan improves health outcomes for persons with asthma.