Routine, Every 2 hours, Starting today, If temperature greater than 38.5 C initiate Evaluation for Possible Sepsis Physician Order #829
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- Ann Beasley
- 6 years ago
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![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](/docs-images/78/78727740/images/1-0.jpg "occurrences): Q4 hours x (# of occurrences): Then: Q1h Until discontinued, Starting today [X] Check temperature [X] Asses Arterial access and distal pulses, Every 2 hours, Starting today, If")
1 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): Q4 hours x (# of occurrences): Then: Q1h Until discontinued, Starting today [X] Check temperature [X] Asses Arterial access and distal pulses, Every 2 hours, Starting today, If temperature greater than 38.5 C initiate Evaluation for Possible Sepsis Physician Order #829 Indication: Q15 minutes x (# of occurrences): 4 Q30 minutes x (# of occurrences): 4 Q1 hour x (# of occurrences): Q2 hours x (# of occurrences): Q4 hours x (# of occurrences): Then: Q1h Until discontinued, Starting today Monitoring [X] Document Device Monitoring Per Impella Flow Sheet [X] Hemodynamic monitoring, Per protocol Notify Physician [X] For Impella flow less than *** L/Minute, for greater than 10 minutes, or if flow state unresolved [X] For signs of hemolysis or hematuria. Impella may need to be repositioned., For Impella flow less than *** L/Minute, for greater than 10 minutes, or if flow state unresolved, For signs of hemolysis or hematuria. Impella may need to be repositioned. Page 1 of 5
2 [X] If improper Impella positioning is suspected. Follow troubleshooting guidelines per operator manual [X] Notify attending Cardiologist for any signs of active bleeding or if unable to obtain blood sample, If improper Impella positioning is suspected. Follow troubleshooting guidelines per operator manua, Notify attending Cardiologist for any signs of active bleeding or if unable to obtain blood sample Activity [X] Strict Bed rest [X] Knee Immobilizer [X] Elevate HOB, Patient may be rolled from side to side. Leg with pump insertion site must be kept straight., Elevate HOB: Less than 30 degrees SAH, SCH, SFH, SJMC Nursing Interventions [X] 1:1 Nursing Required While on Impella Device [X] Apply Dressing [X] Continue to check ACT every hour, goal range = /sec while on heparin [X] Check aptt every 6 hours, begin 6 hours after initiation of heparin infusion, Dry, sterile dressing to site, Use ACT for heparin dose adjustments per Attending Cardiologist., Use ACT to adjust heparin (ideal goal range for aptt = seconds) Harrison Nursing Interventions [X] 1:1 Nursing Required While on Impella Device [X] Apply Dressing [X] Check aptt every 6 hours, begin 6 hours after initiation of heparin infusion, Dry, sterile dressing to site, Use ACT to adjust heparin (ideal goal range for aptt = seconds) Resuscitation [X] Nursing communication, 1) Initiate CPR per ACLS guidelines as indicated 2) Obtain portable chest x-ray or echocardiogram per physician discretion 3) Decrease performance level to P2 as soon as possible 4) Impella does not have to be stopped or unplugged to defibrillate Labs SAH, SCH, SFH, SJMC Chemistry [ ] CK total and CKMB Every 2 hours, Starting today with First Occurrence Include Now For 4 Occurrences [ ] Troponin I Every 2 hours, Starting today with First Occurrence Include Now For 4 Occurrences [ ] B-type natriuretic peptide Start now, Starting today For 1 Occurrences [ ] B-type natriuretic peptide Morning draw, Starting tomorrow For 3 Occurrences Page 2 of 5
3 [ ] Basic metabolic panel Start now, Starting today For 1 Occurrences [ ] Basic metabolic panel Morning draw, Starting tomorrow For 3 Occurrences Harrison Chemistry [ ] CK total and CKMB Now then every 6 hours, Starting today For 3 Occurrences [ ] Troponin I Now then every 6 hours, Starting today For 3 Occurrences [ ] Pro Brain Natriuretic Peptide Start now, Starting today For 1 Occurrences [ ] Pro Brain Natriuretic Peptide Morning draw, Starting tomorrow For 3 Occurrences [ ] Basic metabolic panel Start now, Starting today For 1 Occurrences [ ] Basic metabolic panel Morning draw, Starting tomorrow For 3 Occurrences SAH, SCH, SFH, SJMC Hematology [ ] CBC, no diff (hemogram) Harrison Hematolgy [ ] CBC, no diff (hemogram) Morning draw, Starting today For 1 Occurrences [ ] Haptoglobin Morning draw, Starting today For 1 Occurrences SAH, SCH, SFH, SJMC Coagulation [ ] POCT activated clotting time, For Until specified, Per protocol [ ] Protime-INR For Until specified Per protocol [ ] Activated partial thromboplastin time [ ] Fibrinogen [ ] POCT occult blood stool,, While on heparin Harrison Coagulation [ ] Protime-INR For Until specified Per protocol [ ] Activated partial thromboplastin time Once, Starting today For 1 Occurrences Upon arrival to unit [ ] Activated partial thromboplastin time [ ] Fibrinogen [ ] POCT occult blood stool,, While on heparin Microbiology [X] Blood culture [X] Wound culture and gram stain Specimen Source: Required Page 3 of 5
4 [X] Respiratory culture and gram stain [X] Urine culture For temperatures greater than 38.5 C (oral temperature or equivalent). For Until specified Imaging Imaging [X] X-ray chest AP portable STAT, Daily imaging, Starting today For 1 On arrival to unit Reason for Exam: Required Is the patient pregnant? Required Reason for Exam (USE SIGNS AND SYMPTOMS): Transport Mode: Transport Mode: Bed [ ] X-ray chest AP portable, Daily imaging, Starting tomorrow For 3 Occurrences Every AM Reason for Exam: Required Is the patient pregnant? Required Reason for Exam (USE SIGNS AND SYMPTOMS): Transport Mode: Transport Mode: Bed Cardiac Studies Cardiac Studies [ ] ECG 12 lead, Daily, Starting today Reason for Exam (Signs & Symptoms): Required ECG every am while on device support [ ] ECG 12 lead, Reason for Exam (Signs & Symptoms): Required For chest pain [ ] Echocardiogram, Once, Starting today For 1 Occurrences Portable: Yes Portable Echocardiogram on arrival to unit for LVAD placement assessment Device Maintenance Device Maintenance [ ] Change Cassette every 72 hours, Change Cassette every 72 hours [ ] heparin 25,000 units in D20W 500 ml 4-20 ml/hr, Other, Continuous PRN, other Purge solution, infusion tubing change every 24 hours [ ] Dextrose 20% infusion ml/hr, Intravenous, Continuous, Starting Today at 1300 For impella device. Rat is /hr auto adjusted by the Impella Page 4 of 5
5 Medications Anticoagulation [ ] heparin infusion 50 units/ml in 0.45% NaCl 12 Units/kg/hr, IntraVENous, Continuous Use standard heparin infusion concentration of 50 units/ml and infusion pump. [X] Hold Heparin infusion, Hold Heparin infusion for active, life-threatening bleeding or per Attending Cardiologist [X] Heparin hold or dose adjustment, Heparin hold or dose adjustment must be reassessed at least every 4 hours by the Attending Cardiologist Date: Time: Printed Name of Ordering Provider: Provider Signature: Date: Time: RN Acknowledged: Page 5 of 5
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