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Sample action plan for downloading and printing

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An action plan for managing bronchiectasis symptoms showing three levels of severity (well, sick, and very sick) with corresponding emoji faces, symptoms, and recommended actions, including spaces for patient details and medical information.
transcribeTranscript

This image shows a Bronchiectasis Action Plan with 3 health status levels indicated by emoji faces:

WELL (Green, happy face):

  • Sleeping well
  • Eating well

SICK (Orange, sad face):

  • Coughing more
  • Tired
  • Not eating
  • More phlegm/mucous 

Action: Considering reducing sports/active play if they are out of puff 
Action: See your family doctor to get 2 weeks of antibiotics

VERY SICK (Orange, distressed face):

  • Coughing lots
  • Sore chest
  • Lots of phlegm/mucous
  • Out of puff/breath
  • Fever 

Action: Go to your nearest emergency department 
Action: Consider taking a break from sports until they are well

The form includes spaces for:

  • Patient name
  • Physiotherapist name
  • Nurse name
  • PHYSIO (multiple lines)
  • MEDICATIONS (multiple lines)

The bottom of the form shows logos for Auckland Asthma Respiratory Foundation and orthland District Health Board, with a website reference to bronchiectasisfoundation.co.nz.

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