ADULT POST NEUROLOGIC INTERVENTION ORDERS 2 of 4
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- Harry Whitehead
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1 9 Actual 9 Estimated DOWNTIME INTERVENTION 1 of 4 Weight kg 9 Actual 9 Estimated Height cm ALLERGIES: REFER TO ALLERGY PROFILE/ POWERCHART Admit to Dr.: Bed Type: Dx: ( ) Check, circle and/or fill in all orders to be implemented as appropriate (see page 4 for abbreviation key). DIET 9 NPO 9 Progress as tolerated CHECKS 9 VS & neurochecks q 15 min x 4, then q 30 min x 2, then q1h 9 Assess site for bleeding, hematoma, and pulses with VS check 9 HOB at 30 degrees, ambulate at w/ assistance, discontinue indwelling catheter when OOB 9 Call MD if arrhythmia/ekg change, hematoma/bleeding, change in neuro/circulatory status, HR less than 50 or greater than 100 bpm LABS 9 CBC, frequency: 9 BMP, frequency: 9 PT/aPTT/INR, frequency: Response Test: 9 ASA 9 Clopidogrel (Plavix) 9 Troponin I q8h x 3 Lipid panel Study Patient: 9 No 9 Yes, Platelet count before beginning Eptifibatide, 4h after initiation, 12h after initiation, and q12h thereafter until discontinued DIAGNOSTICS (indication) 9 CXR: 9 CT: 9 Carotid Dopplers: 9 TEE: 9 EKG 9 Daily TCD 9 Daily portable upright CXR while intubated MAINTENANCE FLUID 90.9% NaCl ml/hr 9 PLUS 20 meq/liter KCl 9150 meq NaHCO 3 in 850 ml D5W ml/hr MEDICATIONS EXISTING MEDICATIONS: Complete Medication History Reconciliation Form KH01116/Powerchart Medication History Anticoagulation 9 Heparin stroke protocol (KH00184) start : 9 Enoxaparin 1 mg/kg SC q12h Blood Pressure Control Desired BP range, administer/titrate the following PRN 90.9% NaCl 250 ml bolus over min q h PRN 9 Albumin 5% (12.5 g/ 250 ml) q h PRN 9 Phenylephrine drip IV PRN 9 Dopamine drip IV PRN 9 Labetalol mg (range 5-20 mg) IV q min PRN 9 Hydralazine mg (range mg) IV/IM q h PRN 9 Nicardipine drip IV PRN (9 25 mg/ 250 ml 0.9% NaCl; 9 50 mg/ 250 ml 0.9% NaCl; mg/ 250 ml 0.9% NaCl) 9 Nitroprusside drip IV PRN Initials Place STAT barcode sticker within this box only on form copy being scanned
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3 DOWNTIME INTERVENTION 2 of 4 ( ) Check, circle and/or fill in all orders to be implemented as appropriate. DVT Prophylaxis 9 Heparin 5000 units SC q8h 9 SCD Antiplatelet Therapy 9 Eptifibatide (Integrilin) 180 mcg/kg IV load x 1 9 Eptifibatide (Integrilin) 2 mcg/kg/min IV drip Date and Time Started: Date and Time Started: Hold Eptifibatide and call MD if platelet count falls below 100,000 9 Clopidogrel 600 mg PO/NG load x 1 9 ECASA 650 mg PO load x 1 (regular release if NG) 9 Clopidogrel 75 mg PO/NG daily 9 ECASA 325 mg PO daily (regular release if NG) 9 ASA 300 mg PR daily if patient NPO 9 ECASA 81 mg PO daily (regular release if NG) Anticonvulsant Therapy/ Prophylaxis 9 Fosphenytoin mg IV load x 1 9 Phenytoin mg PO/NG q h 9 Fosphenytoin mg IV q h 9 Other dose route interval Statin Therapy (Hyperlipidemia) 9 Rosuvastatin 20 mg PO daily 9 Pravastatin (Pravachol) mg (20-80 mg) PO/NG qhs GI Prophylaxis 9 Famotidine (Pepcid) 20 mg PO/IV/NG q12h 9 Pantoprazole (Protonix) 40 mg IV/PO daily Analgesia dose route interval 9 Severe pain: 9 Moderate pain: 9 APAP 650 mg PO/NG/PR q4h PRN Electrolyte Protocol 9 Utilize Electrolyte Replacement Protocol (#TX IV s and Meds 33 PTC) Subarachnoid Hemorrhage 9 Nimodipine 60 mg PO/NG q4h x 21 d 9 Magnesium sulfate 12.5 g in 250 ml 0.9% 11.5 ml/hr x 14 d Other Medications 9 Docusate sodium (Colace) 100 mg PO/NG bid stool softener 9 Polyethylene Glycol (Miralax) 17 g PO/NG bid laxative 9 Ondansetron (Zofran) 4 mg IV q4h PRN nausea Initials Place STAT barcode sticker within this box only on form copy being scanned
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5 DOWNTIME INTERVENTION 3 of 4 ( ) Check, circle and/or fill in all orders to be implemented as appropriate. Additional Medications dose route interval indication a. b. c. d. e. f. g. h. i. j. ADDITIONAL NURSING 9 TORB From: Date: Time: Signature: NOTED BY RN Date: Time: Signature: PROVIDER Date: Time: Print Name/Stamp: Signature: TORB = Telephone Orders Read Back Place STAT barcode sticker within this box only on form copy being scanned
6 DOWNTIME INTERVENTION 4 of 4 ABBREVIATION = at APAP = Acetaminophen aptt = Activated Partial Thromboplastin Time ASA = Aspirin bid = twice a day BMP = Basic Metabolic Panel BP = Blood Pressure bpm = beats per minute CBC = Complete Blood Count CT = Computerized Tomography CXR = Chest X-ray d = day(s) DAW = Dispense as Written DVT = Deep Vein Thrombosis Dx = Diagnosis D5W = Dextrose 5 percent in water ECASA = Enteric Coated Aspirin EKG = Electrocardiogram g = gram(s) GI = Gastrointestinal h = hour HOB = Head of Bed HR = Heart Rate hs = at bed IM = intramuscular INR = International Normalized Ratio IV = intravenous KCl = Potassium Chloride mcg/kg = microgram per kilogram mcg/kg/min = microgram per kilogram per minute MD = Medical Doctor meq = milliequivalent meq/liter = milliequivalent per liter mg = milligram(s) mg/kg = milligram per kilogram min = minute(s) ml = milliliter(s) ml/hr = milliliters per hour NaCl = Sodium Chloride NaHCO 3 = Sodium Bicarbonate NG = Nasogastric Tube NPO = Nothing By Mouth NS = Normal Saline OOB = Out of Bed PO = by mouth PR = per rectum PRN = as needed PT = Prothrombin Time q = every q h = every hour(s) q min = every minute(s) SC = subcutaneous SCD = Sequential Compression Device TCD = Transcranial Dopplers TEE = Transesophageal Echocardiogram VS = Vital Signs w/ = with x = s
ADULT TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) TELEMETRY BED TRANSFER ORDERS 1 of 4
TELEMETRY BED TRANSFER 1 of 4 9 Actual 9 Estimated Patient ID Area Weight kg 9 Actual 9 Estimated Height cm ALLERGIES: REFER TO ALLERGY PROFILE/ POWERCHART Transfer to: 10 South Attending Physician: Diagnosis:
OBSTETRIC ADMISSION ORDERS 1 of 4
OBSTETRIC ADMISSION 1 of 4 Actual Estimated Weight kg Actual Estimated Height cm ALLERGIES: REFER TO ALLERGY PROFILE/ POWERCHART ADMIT TO: Labor and Delivery ( ) Check, circle and/or fill in all orders
Acute Stroke with Alteplase Administration Order Set
Review Due Date: 2017 October PATIENT CARE DERS Weight: Adverse Reactions or Intolerances Drug No Yes (list) Food No Yes (list) _ Latex No Yes Admission Admit to Neurology service: Dr. Critical Care Diagnosis:
GENERAL SURGICAL ADULT POST-OPERATIVE ORDERS 1 of 4
down ADULT POST-OPERATIVE 1 of 4 9 Actual 9 Estimated Patient ID Area Weight kg 9 Actual 9 Estimated Height cm ALLERGIES: REFER TO ALLERGY PROFILE/ POWERCHART Admit to: Post Anesthesia Care Unit (PACU),
ADULT CARDIAC SURGERY TELEMETRY BED TRANSFER ORDERS 1 of 4
ADULT CARDIAC SURGERY TELEMETRY BED TRANSFER 1 of 4 9 Actual 9 Estimated Attending Surgeon: Medical Record Number Weight kg 9 Actual 9 Estimated Height cm ALLERGIES: REFER TO ALLERGY PROFILE/ POWERCHART
Routine, Every 2 hours, Starting today, If temperature greater than 38.5 C initiate Evaluation for Possible Sepsis Physician Order #829
Height Weight Allergies General Vital Signs [X] Frequent vital signs Indication: Q15 minutes x (# of occurrences): 4 Q30 minutes x (# of occurrences): 4 Q1 hour x (# of occurrences): Q2 hours x (# of occurrences):
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PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Condition/Status Patient Status Inpatient Patient Status: Inpatient, Level of Care: Intensive Care (8) Place in Observation Patient Status: Outpatient- Refer for Observation Status,
Standard Precautions Droplet Precautions Standard Precautions Contact Precautions Droplet Precautions Standard Precautions Neutropenic Precautions
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DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available at: BMC-B BMC-D BMC-N BMC-S Vital Signs Vital Signs Q4H (DEF)* Q2H Q1H Vital Signs Orthostatic Activity Activity Bedrest, for 12 hours then Up ad lib (DEF)* Bedrest, for 24
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- Phase: Begin Immediately/Emergency Center Weight PHYSICIAN S Allergies Admit/Discharge/Transfer Patient Status Requested Location: MICU, Pt Status: Inpatient (LOS > 2 midnights) Requested Location: 5E
Physician s Order Form. Physician s Order Form. Telemetry/Progressive Care Orders. Continued on next page. >>>>>>> Continued on next page.
DATE: TIME: DATE TIME INTRAVENOS FLID and MEDICATION Status: Admit to Telemetry Admit to Progressive Care nit Transfer to Progressive Care nit Note: Discontinue Previous Orders Transfer to Telemetry nit
ADULT CARDIOTHORACIC POST-OPERATIVE ORDERS 1 of 5
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DRUG ALLERGIES WT: KG
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ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked DRUG AND TREATMENT ORDERS
DRUG AND TREATMENT Available at: BMC-B BMC-D BMC-N BMC-S Vital Signs Vital Signs Q4H (DEF)* Q2H Q1H Vital Signs Orthostatic Activity Activity Bedrest, for 12 hours then Up ad lib (DEF)* Bedrest, for 24
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PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
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*111* attach patient label here
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