TNMC PEDIATRICS OPD 9, WEDNESDAY 1 PM, RECURRENT RESPIRATORY CLINIC

Recurrent Respiratory Pediatric Clinic

AR/BA/CLD/CAR/INF/OTHERS, NAME: ADDRESS: OTHER CONTACT : AGE OF FIRST SYMPTOM: AGE AT PROFORMA: No:__________ DOB: MOBILE: Date of Proforma:

WORKING DIAGNOSIS :__________________________________________________________________ MODIFIED DIAGNOSIS: SNEEZER COUGHER RUNNY NOSE SEASONAL PERENNIAL DAY NIGHT SHINERS CREASE RDS MAS TB HIV INFECTIONS NEBULISATIONS FREQUENCY FREQUENCY HC: TL/HT: WEIGHT: Birth history: WHEEZER DISTRESS SCORE EXERCISE InD ALLERGEN NOISY BREATHING NOCTURNAL

EPISODIC ADMISSIONS OTHER ALLERGY A SALUTE HYPOCa LT MALACIA CHD VENTI ADMISSIONS SYMPTOM FREQUENCY FREQUENCY SAM: SOCIOECONOMY: FAMILY HISTORY:

GERD BREATH COUNT

OTHER CLINICAL SIGNS/SYMPTOMS: PND/OTITIS,FEVERS , DNS,ITH,sinusitis, tonsils, nodes , chest deformity, spine issues, rickets , hypotonia ETC SPECIFIC EXAMINATION FINDINGS: MILD INTERMITTENT; MILD PERSISTANT, MODER. PERSISTANT, SEVER. PERSISTANT, ACUTE SEVERE A. COUGH VARIANT A., BRONCHIOLITIS/WARI/EARLY WHEEZER/TRANSIENT WHEEZER/PERSISTENT WHEEZER , SINUSITIS/BRONCHITIS/ADENOIDITIS/TONSILITIS/FB/ NASAL POLYPS/WA-CARDIAC/WA-GER, IMUNODEFICIENCY/ILD/CLD/PIBO/Bronchictasis/ RLD OTHERS HB MT XRC CT PFT BEST PEFR AEC KOCHS W/U IgE XR NECK/PNS ECHO RAST/SKIN TEST /OTHER ESR CRP

PLAN: oral/inhalational, IEC, STEROID info, COMPLIANCE CHECK, DEFAULT CHECK, HOME MONITORING,HOME THERAPY VISIT EMERGENCY DEPARTMENT FOR ANY ISSUES BEYOND RRC OPD HOURS, VISIT AS ADVICED/ EVERY 3 MONTHS ANY OTHER:

TNMC PEDIATRICS OPD 9, WEDNESDAY 1 PM, RECURRENT RESPIRATORY CLINIC

Patient diary format for home monitoring: IF PRESENT, * IF SEVERE SYMPTOMS, 0 IF NO SYMPTOMS DAY = 10 AM TO 10 PM. NIGHT =10 PM TO 10 AM, TO CHART EARLY MORNING LAST 24 HOUR RECALL. DATE NOSE COUGH WHEEZE/NOISE BREATHLESS PEFR FEVER MDI SYMPTOMS CHART DAY NIGHT DAY NIGHT DAY NIGHT DAY NIGHT

Its difficult to plan the therapy without proper symptom frequency in last 2 weeks prior to visit. Night dominance suggests HRAD. Day dominance suggest infection. Frequent night symptoms warrants steroids. Recent onset symptoms, pls check MDI if empty or if fever present. FOLLOW UP NOTES AND THERAPY DATE NEW SYMPTOMS CONTROL OVER STEP UP/DOWN OTHER THERAPY/INV REQUIRED LAST 2 WEEKS
Nose Cough Breathless Fever Pain Refusal to feed

Controlled Uncontrolled Day control Night night control

Rescue: MDI Controller MDI:

PEFR

PLAN THERAPY FOR 4 WEEKS. FOLLOW UP WITH SYMPTOM DIARY FOR FIRST FEW WEEKS. RAPID STEP UP AND SLOW STEP DOWN. TEACH THE PARENTS. ONCE STEPPED UP, DONT CHANGE FOR 4/6 WEEKS. AT LEAST 3 MONTHLY F/U IF SYMPTOM FREE. IF SYMPTOMATIC INSIST FREQUENT F/U. DETA ILED EVALUATIONS IF TREATMENT FAILS. www.breathingdiary.com CALL DR SK FOR ANY QUERIES 9869405747