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    COPD Follow Up

    Uploaded by

    e-MedTools
    The chronic obstructive lung disease (COPD) follow up MedicalTemplate is suitable for any health care provider that manages patients with COPD. This one page template contains detailed checklists for the severity of COPD symptoms, current and planned COPD therapy, and other features helpful for a comprehensive COPD treatment plan.

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    © All Rights Reserved
    Download as PDF or read online from Scribd

    COPD Follow Up

    Uploaded by

    e-MedTools
    3K views1 page
    The chronic obstructive lung disease (COPD) follow up MedicalTemplate is suitable for any health care provider that manages patients with COPD. This one page template contains detailed checklists for the severity of COPD symptoms, current and planned COPD therapy, and other features helpful for a comprehensive COPD treatment plan.

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    © © All Rights Reserved

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    The chronic obstructive lung disease (COPD) follow up MedicalTemplate is suitable for any health care provider that manages patients with COPD. This one page template contains detailed checklists for the severity of COPD symptoms, current and planned COPD therapy, and other features helpful for a comprehensive COPD treatment plan.

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Download as pdf
    3K views1 page

    COPD Follow Up

    Uploaded by

    e-MedTools
    The chronic obstructive lung disease (COPD) follow up MedicalTemplate is suitable for any health care provider that manages patients with COPD. This one page template contains detailed checklists for the severity of COPD symptoms, current and planned COPD therapy, and other features helpful for a comprehensive COPD treatment plan.

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Download as pdf
    of 1

    COPD Patient Evaluation Patient Name DOB MRN

    Date Chief Complaint or Reason For Visit


    Time
    ROS WNL See HPI HPI Symptom Severity and Frequency
    Constitutional ‰ ‰ ‰Asymptomatic with usual activity FEV1 FEV1
    Eyes ‰ ‰  ‰Symptomatic with usual activity
    FVC
     ‰Symptomatic with minimal activity
    ENT/mouth ‰ ‰ 
    ‰At risk >80% t 70%
    Resp ‰ ‰ 
    ‰Symptomatic at rest ‰Mild >79% <70%
    CV ‰ ‰  ‰Recent antibiotic use ‰Moderate 50-79% < 70%
    GI ‰ ‰  ‰Recent oral steroid use
    GU ‰ ‰  ‰Recent ED visits ‰Severe 30-49% < 70%
    Musc ‰ ‰ ‰Recent hospital admissions ‰Very <30% < 70%
    Skin/breasts ‰ ‰ ‰Weight loss/Decreased appetite Severe

    Neuro ‰ ‰ Physical Exam ‰Checkedwww.e-medtools.com


    box indicates findings are within normal limits
    General ‰ Alert Vital signs Temp Pulse BP RR Pulse ox at rest
    Endo ‰ ‰ With exercise
    Heme/lymph ‰ ‰ ENT ‰ Nasal mucosa ‰ Dentition ‰ Oropharynx Mallampati ‰I ‰II ‰III ‰IV
    Allergy/Immun ‰ ‰ Neck ‰ Palpation ‰www.e-medtools.com
    Thyroid ‰ No JVD
    Psych ‰ ‰ Resp ‰ Auscultation ‰ Percussion ‰Respiratory effort ‰Palpation ‰Chest wall
    History No changes See HPI CV ‰ Clear S1 S2 ‰ No murmur ‰ No gallop ‰No rub ‰ Peripheral pulses ‰ No peripheral edema
    Allergies ‰ ‰ GI ‰No palpable masses ‰ No hepatosplenomegaly ‰ No hepatojugular reflux
    PMSH ‰ ‰ Lymph ‰ Lymph nodes Tobacco Use
    www.e-medtools.com
    Social ‰ ‰ Musc ‰Tone ‰ Gait ______ # Packs X ______ # Yrs
    
    Family ‰ ‰ Extrem ‰ Digits ‰Never smoked
    COPD Therapy Skin ‰ No rashes, ecchymoses, nodules, ulcers ‰Quit
    Current New ‰Unwilling to quit
    ‰Willing to consider quitting
    Short-acting beta ‰ ‰ Neuro ‰ Orientation www.e-medtools.com
    ‰Affect ‰Quit, but resumed smoking
    agonist
    ‰Willing to quit within 1 month
    Inhaled steroid ‰ ‰ Impression and Plan Tests to be ordered
    Long-acting beta ‰ ‰ ‰Bronchoscopy
    agonist ‰Pulmonary Function Testing
    Long acting anti- ‰ ‰ www.e-medtools.com ‰Methacholine challenge
    cholinergic ‰6 Minute Walk Test
    ‰Sleep study
    Theophylline ‰ ‰ ‰CXR
    Oral steroids ‰ ‰ ‰Chest CT ‰without contrast
    Antibiotics ‰ ‰ www.e-medtools.com ‰Echocardiogram with
    ‰Bubble study ‰PA pressures
    Nicotine ‰ ‰ ‰Cardiopulmonary Stress Test
    replacement
    ‰Pulmonary Rehabilitation
    Buproprion ‰ ‰ ‰Surgical eval for lung reduction
    Nicotine receptor ‰ ‰ ‰Bone density evaluation
    blocker ‰Pneumococcal vaccine
    CPAP ‰ ‰ ‰Influenza vaccine
    ‰Labs

    Education and Instruction


    BiPap ‰ ‰
    Oxygen Therapy ‰Smoking cessation
    Follow up ‰Peak flow meter use
    ‰Inhaler use
    ‰Importance of vaccinations
    ‰Risks of alcohol, narcotics and BZD
    Signature ‰Medication side effects
    CODE STATUS: ‰ Full code ‰ Do Not Attempt Resuscitation ‰Supplemental oxygen for air travel
    Data Reviewed ‰ ER Notes ‰ Old Chart ‰EMS Note ‰ECG ‰Nursing Notes & Vitals log ‰ Labs ‰ X Rays ‰MRI ‰US ‰CT
    Care Coordinated With ‰ER MD ‰HCPOA ‰Primary Care MD ‰Case Management ‰Social Worker ‰Pharmacy
    ©MB and RR 2006, 2007 www.e-medtools.com

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