Admitting MD: IV Fluids 1000 ml 0.9% sodium chloride IV to run at ml/hr x liters ml: 5%dextrose IV to run at ml/hr x liters.

Transcription

1 ALL T BE WRITTEN WITH A BALL POINT PEN AND INCLDE DATE, TIME, AND PHYSICIAN S SIGNATRE. (EXCLDING IV Fluids and MEDICATIONS) IC Admission Orders Page 1 of 5 DATE: TIME: Admitting MD: Diagnosis: Comorbidities/History CAD PVD COPD Smoker CA CVA Trauma HTN CHF DM Sepsis CRF ESRD Hemodialysis Trauma Cardiomyopathy Immunosuppressed Poor Nutrition Acute Coronary Syndrome Activities Bed rest Other Diet: Consults: Cardiology/ Dr. Renal/ Dr. Pulmonary/ Dr. GI/Dr. G/ Dr. Neurologist/ Dr. Nuerosurgeon/ Dr. Psychiatry/Dr. ID/Dr. Surgical/ Dr. for Central Line Other: Physician s Order Form (Page 1 of 5) IC Admission Order Set IVF and MEDICATION ONLY IVF and MEDICATION ONLY IVF and MEDICATION ONLY IVF and MEDICATION ONLY IV Fluids 1000 ml 0.9% sodium chloride IV to run at ml/hr x liters ml: 5%dextrose IV to run at ml/hr x liters. Add 20 meq 40 meq Potassium chloride to each liter of IV fluid. Other IV fluids; Anticoagulation Enoxaparin (Lovenox) - See attached order form. _ DVT Prophylaxis Tedhose/Pneumatic Stockings Sequential Compression Device Heparin See attached order form. Enoxaparin (Lovenox) - See attached order form. Stress lcer/gi Bleed Prophylaxis Zantac 50 mg IV q 8 hours. Pantoprazole (Protonix) 40 mg IV q 24 hours. Sulcralfate (Carafate) 1 gram via NG/OG Tube every 6 hours.

2 ALL T BE WRITTEN WITH A BALL POINT PEN AND INCLDE DATE, TIME, AND PHYSICIAN S SIGNATRE. (EXCLDING IV Fluids and MEDICATIONS) IC Admission Order Set Page 2 of 5 Dietary PT/OT Social Service: Code Status: Full ACLS No Defibrillation No Intubation No Chest Compressions No ACLS Interventions (Do Not Resuscitate): continue care as ordered. Other Treatments: Vital Signs Routine per IC/CC Protocol Pulse Oximetry Nasal Canula 2 6 liters/hr as needed to maintain oxygen saturation > 90%. Foley Catheter to drainage bag. Weights Every other day Daily OG Tube Intermittent Suction Gravity Clamp Venous Thromboembolism Prophylaxis BiPap Settings: IVF and MEDICATION ONLY IVF and MEDICATION ONLY IVF and MEDICATION ONLY IVF and MEDICATION ONLY Pain Morphine Sulfate 1 4 mg IV every 1 hour PRN for mild pain. Morphine Sulfate 5 8 mg IV every 1 hour PRN for moderate pain. Morphine Sulfate 9 12 mg IV every 1 hour PRN for severe pain. Morphine Sulfate mg IV every hour PRN for Nausea Ondansetron (Zofran) 4 mg IV every 8 hours PRN for nausea. Promethazine (Phenergan) mg IV every 4 hours PRN for nausea. Properidol (Inapsine) mg IV every 4 hours PRN for nausea. Other: Other Medications Physician s Order Form (Page 2 of 5) IC Admission Order Set

3 ALL T BE WRITTEN WITH A BALL POINT PEN AND INCLDE DATE, TIME, AND PHYSICIAN S SIGNATRE. (EXCLDING IV Fluids and MEDICATIONS) IC Admission Order Set Page 3 of 5 Ventilator Settings: FiO2 TV PEEP AC PS Rate Ventilator Bundle (for all ventilator patients): HOB 30 degrees. Daily sedation wakeup. Daily assessment for weaning from ventilator. Oral Care every 2 hours (with antiseptic solution). ABG every morning Additional Pulmonary Orders: STAT Labs and Diagnostics: CBC (auto diff) Liver Panel CBC (manual diff) A PT/PTT D-Dimer Finger Stick for BS Lactate ABG BNP CHEM 7 Magnesium Phosphorus Amonia Calcium LDH Physician s Order Form (Page 3 of 5) IC Admission Order Set IVF and MEDICATION ONLY IVF and MEDICATION ONLY IVF and MEDICATION ONLY IVF and MEDICATION ONLY POTASSIM REPLACEMENT PROTOCOL (NOT for use with Renal Patients) Check potassium level. Discontinue potassium protocol if serum creatinine is greater than 3 mg/dl and call physician for orders. Once potassium is WNL, ask physician for oral potassium order. If potassium level LESS THAN 3.5 mg/dl: Central Line: Infuse Potassium Chloride 40 meq IV in 100 ml NSS over 2 hours. Peripheral Line: Infuse Potassium Chloride 20 meq IV in 100 ml NSS x 2 doses over 4 hours of total dose of 40 meq. Infuse at 50 ml/hr. Repeat Potassium Level 3 hours after infusion complete. If potassium level 3.5 mg/dl 3.9 meq/l: Central Line: Infuse Potassium Chloride 20 meq in 100 ml NSS over 1 hour. Peripheral Line: Infuse Potassium Chloride 20 meq in 100 ml NSS over 2 hours. Repeat Potassium Level 3 hours after infusion complete. If potassium level GREATER THAN 5.5 meq/l: STOP ALL ORAL AND IV POTASSIM AND NOTIFY PHYSICIAN.

4 ALL T BE WRITTEN WITH A BALL POINT PEN AND INCLDE DATE, TIME, AND PHYSICIAN S SIGNATRE. (EXCLDING IV Fluids and MEDICATIONS) IC Admission Order Set Page 4 of 5 STAT Labs and Diagnostics continued: CPK, MB, Troponin Chem 20 Culture rine Sputum Stool Blood x CT Scan of: With Contrast: IV Oral NGT OGT PEG Rectal WithOT Contrast Portable CXR ltrasound of Echocardiogram to interpret study. EKG AM Labs and Diagnostics: CBC (auto diff) Liver Panel CBC (manual diff) A PT/PTT D-Dimer Lactate ABG BNP CHEM 7 Magnesium Phosphorus Ammonia Calcium LDH CPK, MB, Troponin Accucheck Every Culture rine Sputum rine Stool Other: CT Scan of: With Contrast: IV Oral WithOT Contrast IVF and MEDICATION ONLY IVF and MEDICATION ONLY IVF and MEDICATION ONLY IVF and MEDICATION ONLY MAGNESIM REPLACEMENT PROTOCOL (NOT for use with Renal Patients) Check Magnesium Level. If magnesium level mg/dl: Infuse 2 gram Magnesium Sulfate in 250 ml Repeat serum Magnesium Level 8 hours after If magnesium level mg/dl: Infuse 4 grams Magnesium Sulfate in 250 ml Repeat serum Magnesium Level 8 hours after If magnesium level mg/dl: Infuse 6 grams Magnesium Sulfate in 250 ml Repeat serum Magnesium Level 8 hours after completion. If magnesium level LESS THAN 1.2 mg/dl WITH Seizures: Infuse 4 grams Magnesium Sulfate in 250 ml D5W at a maximum rate of 3 ml/min. Physician s Order Form (Page 4 of 5) IC Admission Order Set

5 ALL T BE WRITTEN WITH A BALL POINT PEN AND INCLDE DATE, TIME, AND PHYSICIAN S SIGNATRE. DATE TIME (EXCLDING IV Fluids and MEDICATIONS) IC Admission Order Set Page 5 of 5 AM Labs and Diagnostics continued: Portable CXR ltrasound of Echocardiogram to interpret study. EKG TORB: MD Signature: IVF and MEDICATION ONLY IVF and MEDICATION ONLY IVF and MEDICATION ONLY IVF and MEDICATION ONLY For Torsades de Pointes: Bolus 1 gram magnesium Sulfate in 50 ml D5W over 5 to 60 minutes. Follow with 0.5 mg to 1 gram per hour titrated to control Torsades. Discontinue after level is normal. Repeat Serum Magnesium 8 hours after Vaccine Order Pneumonia Vaccine Influenza Vaccine Wound Care Bundle MD Signature: Physician s Order Form (Page 5 of 5) IC Admission Order Set