CARD POST CARDIAC CATHETERIZATION PLAN

CARD POST CARDIAC CATHETERIZATION PLAN Diagnosis Weight PHYSICIAN S Allergies DETAILS Patient Care Intermittent Telemetry Continuous Telemetry (Intermediate Care) Vital Signs Per Unit Standards POC ACT If arterial sheath in place and ACT greater than 131 seconds, connect to pressure monitor. Notify Nurse (DO NOT USE FOR MEDS) If Brachial Approach: a. bed rest for 2 hrs, then up if BP stable with standing. b. leave forearm comfortable and mildly flexed. c. no circumferential dressing. Notify Provider of VS Parameters SBP Greater Than 180 consistently, SBP Less Than 90 consistently, HR Greater Than 110 Discontinue Arterial Sheath Discontinue at. Continue flat time for hours. Discontinue Venous Sheath Discontinue at. Continue flat time for hours. Notify Nurse (DO NOT USE FOR MEDS) If closure device fails, apply pressure for 20 min, then flat time 4 hours per sheath Fr size. If closure device fails, apply pressure for 20 min, then flat time 6 hours per sheath Fr size. Notify Nurse (DO NOT USE FOR MEDS) Check peripheral pulse and distal to the cath site. If pulse is absent, verify with Doppler and check Cath Lab Op Record and Progress Notes to see if this is a new finding. Notify Provider (Misc) Reason: If pulse is absent and extremity is cool, report to physician. Daily Weight Patient Activity Bedrest, Bed Position: HOB Greater Than or Equal to 30 degrees, Bedrest x 6 hrs with leg straight. Patient may lie on side with leg straight. Bedrest, Bed Position: HOB Greater Than or Equal to 30 degrees, Bedrest x hrs with leg straight. Patient may lie on side with leg straight. Strict Intake and Output Per Unit Standards Insert Urinary Catheter Foley, To: Dependent Drainage Bag, PRN Urinary Retention Discontinue Dressing Located: Card Cath Site, Remove in shower if possible and apply band-aid Page: 1 Card Post Cardiac Catheterization Plan Version: 6 Effective on: 04/27/16 Page 1 of 19

CARD POST CARDIAC CATHETERIZATION PLAN PHYSICIAN S DETAILS Convert IV to INT Communication Code Status Code Status: Full Code Code Status: DNR/AND (Allow Natural Death) Code Status: Care Limitation Notify Provider/Primary Team of Pt Admit Notify: physician or applicable PA/NP of room number by calling the physician s office, Upon Arrival to Unit Dietary Oral Diet Clear Liquid Diet Full Liquid Diet Regular Diet AHA Diet Clear Liquid Diet, Advance as tolerated to Regular Clear Liquid Diet, Advance as tolerated to AHA Clear Liquid Diet, Advance as tolerated to 1800 Calorie ADA ADA Diet 1800 Calories, AHA 1600 Calories, AHA 1800 Calories, Renal 1600 Calories, Renal IV Solutions 1/2 NS IV, 75 ml/hr IV, 125 ml/hr IV, 150 ml/hr IV, 200 ml/hr D5 1/2 NS IV, 75 ml/hr IV, 125 ml/hr IV, 150 ml/hr IV, 200 ml/hr D5NS IV, 75 ml/hr IV, 125 ml/hr IV, 175 ml/hr IV, 200 ml/hr NS (Normal Saline) IV, 75 ml/hr IV, 125 ml/hr IV, 150 ml/hr IV, 200 ml/hr NS (Normal Saline Bolus) 500 ml, IVPB, iv soln, ONE TIME, Infuse over 1 hr 1,000 ml, IVPB, iv soln, ONE TIME, Infuse over 1 hr Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. ***Medication Sentences are per dose. You will need to calculate a total daily dose if needed.*** Glycoprotein IIb/IIIa Inhibitors ***Patient must be on telemetry while receiving eptifibatide (Integrelin)*** eptifibatide 180 mcg/kg, IVPush, inj, ONE TIME, IV Bolus Recommended maximum dose is 22.6 mg Patient must be on telemetry while receiving eptifibatide (Integrelin) Page: 2 Card Post Cardiac Catheterization Plan Version: 6 Effective on: 04/27/16 Page 2 of 19

CARD POST CARDIAC CATHETERIZATION PLAN PHYSICIAN S DETAILS eptifibatide 75 mg/100 ml IV, x 18 hr Final concentration = 0.75 mg/ml Usual maintenance dose is 2 mcg/kg/min If creatinine clearance is less than 50 ml/min use 1 mcg/kg/min **Patient must be on telemetry while receiving eptifibatide (Integrelin)** Start at rate: mcg/kg/min abciximab 0.25 mg/kg, IVPush, inj, ONE TIME, Infuse over 5 min, for bolus abciximab 7.2 mg/250 ml NS IV Final concentration = 0.0288 mg/ml (28.8 mcg/ml). Usual mainenance rate is 0.125 mcg/kg/min for 12-24 hours. Recommended maximum rate is 10 mcg/min. Start at rate: mcg/kg/min Anti Platelets Loading Dose ticagrelor 180 mg, PO, tab, ONE TIME prasugrel 60 mg, PO, tab, ONE TIME clopidogrel 300 mg, PO, tab, ONE TIME 600 mg, PO, tab, ONE TIME Maintenance Dose ticagrelor 90 mg, PO, tab, BID prasugrel 10 mg, PO, tab, Daily 5 mg, PO, tab, Daily clopidogrel 75 mg, PO, tab, Daily aspirin 81 mg, PO, tab ec, Daily 325 mg, PO, tab, Daily Beta Blockers Page: 3 Card Post Cardiac Catheterization Plan Version: 6 Effective on: 04/27/16 Page 3 of 19

CARD POST CARDIAC CATHETERIZATION PLAN PHYSICIAN S DETAILS Contraindications Beta Blocker Allergy or Sensitivity Bradycardia or Heart Block Chronic Lung Disease -- Asthma Severe Hypotension Other (specify below in other reason) metoprolol 25 mg, PO, tab, BID 50 mg, PO, tab, BID 100 mg, PO, tab, BID carvedilol 6.25 mg, PO, tab, BID Administer with breakfast and dinner. 12.5 mg, PO, tab, BID Administer with breakfast and dinner. 25 mg, PO, tab, BID Administer with breakfast and dinner. Ace Inhibitors Contraindications ACEI or ARB Allergy to Both Allergy to One-Must Try the Other Angioedema Caused by an ACE or ARB Hyperkalemia Hypotension Moderate or Severe Aortic Stenosis Renal Artery Stenosis Worsening Renal Function Other (specify below in other reason) captopril 6.25 mg, PO, tab, TID Administer 1 hour before meals 12.5 mg, PO, tab, TID Administer 1 hour before meals 25 mg, PO, tab, TID Administer 1 hour before meals lisinopril 2.5 mg, PO, tab, Daily 5 mg, PO, tab, Daily 10 mg, PO, tab, Daily 20 mg, PO, tab, Daily ramipril 2.5 mg, PO, cap, Daily 5 mg, PO, cap, Daily 10 mg, PO, cap, Daily Statins Page: 4 Card Post Cardiac Catheterization Plan Version: 6 Effective on: 04/27/16 Page 4 of 19

CARD POST CARDIAC CATHETERIZATION PLAN PHYSICIAN S DETAILS Contraindications Statins Hypersensitivity Intolerance(myopathy, myalgia, myositis) Liver disease or elevated transaminases Pregnancy or breastfeeding atorvastatin 10 mg, PO, tab, Nightly 20 mg, PO, tab, Nightly 40 mg, PO, tab, Nightly 80 mg, PO, tab, Nightly pravastatin 10 mg, PO, tab, Nightly 20 mg, PO, tab, Nightly 40 mg, PO, tab, Nightly 80 mg, PO, tab, Nightly rosuvastatin 5 mg, PO, tab, Nightly 10 mg, PO, tab, Nightly 20 mg, PO, tab, Nightly 40 mg, PO, tab, Nightly simvastatin 5 mg, PO, tab, Nightly 10 mg, PO, tab, Nightly 20 mg, PO, tab, Nightly 40 mg, PO, tab, Nightly 80 mg, PO, tab, Nightly Laboratory Basic Metabolic Panel Routine, T;N CBC Routine, T;N CBC with Differential Routine, T;N Comprehensive Metabolic Panel Routine, T;N CK Routine, T;N, q8h 3 times Troponin T Routine, T;N, q8h 3 times Diagnostic Tests DX Chest Portable EKG-12 Lead EKG-12 Lead Every AM 3 days Respiratory Page: 5 Card Post Cardiac Catheterization Plan Version: 6 Effective on: 04/27/16 Page 5 of 19

CARD POST CARDIAC CATHETERIZATION PLAN PHYSICIAN S DETAILS Oxygen Therapy Via: Nasal cannula, Keep sats greater than: 92% Via: Simple mask, Keep sats greater than: 92% Via: Nonrebreather mask, Keep sats greater than: 92% Consults/Referrals Consult Cardiac Rehab Cardiac Rehab for Inpatient Phase I evaluation and treatment. Arrange Outpatient Cardiac Rehab Phase II evaluation and treatment....additional Orders Page: 6 Card Post Cardiac Catheterization Plan Version: 6 Effective on: 04/27/16 Page 6 of 19

DISCOMFORT MED PLAN PHYSICIAN S DETAILS Patient Care Perform Bladder Scan Scan PRN, If more than 250, Then: Call MD, Perform as needed for patients complaining of urinary discomfort and/or bladder distention present OR 6 hrs post Foley removal and patient has not voided. Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. phenol topical (Cepastat) 1 lozenge, PO, lozenge, q4h, PRN sore throat Do not exceed 6 lozenges in 24 hours dextromethorphan-guaifenesin (dextromethorphan-guaifenesin 20 mg-200 mg/10 ml oral liquid) 10 ml, PO, liq, q4h, PRN cough dexamethasone-diphenhydramin-nystatin-ns (Fred s Brew) 15 ml, swish & spit, liq, q2h, PRN mucositis While awake lidocaine topical (Lidocaine Viscous 2% mucous membrane solution) 15 ml, swish & spit, liq, q4h, PRN mucositis Analgesics acetaminophen 500 mg, PO, tab, q6h, PRN pain-mild (scale 1-3) ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF acetaminophen ineffective/contraindicated, USE ibuprofen if ordered:***** 1,000 mg, PO, tab, q4h, PRN pain-mild (scale 1-3) ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF acetaminophen ineffective/contraindicated, USE ibuprofen if ordered:***** acetaminophen 650 mg, rectally, supp, q4h, PRN pain-mild (scale 1-3) ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****If acetaminophen ineffective/contraindicated, USE ibuprofen if ordered:***** ibuprofen 400 mg, PO, tab, q6h, PRN pain-mild (scale 1-3) ***Do not exceed 3,200 mg of ibuprofen from all sources in 24 hours*** Give with food. Use if acetaminophen ineffective or contraindicated. HYDROcodone-acetaminophen (HYDROcodone-acetaminophen 5 mg-325 mg oral tablet) 1 tab, PO, tab, q4h, PRN pain-moderate (scale 4-7) ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF HYDROcodone-acetaminophen ineffective/contraindicated or NPO, USE ketorolac if ordered***** 2 tab, PO, tab, q4h, PRN pain-moderate (scale 4-7) ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF HYDROcodone-acetaminophen ineffective/contraindicated or NPO, USE ketorolac if ordered***** Page: 7 Card Post Cardiac Catheterization Plan Version: 6 Effective on: 04/27/16 Page 7 of 19

DISCOMFORT MED PLAN PHYSICIAN S DETAILS acetaminophen-codeine (acetaminophen-codeine #3) 1 tab, PO, q4h, PRN pain-moderate (scale 4-7) ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF acetaminophen-codeine #3 ineffective/contraindicated or NPO, USE ketorolac if ordered***** 2 tab, PO, q4h, PRN pain-moderate (scale 4-7) ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF acetaminophen-codeine #3 ineffective/contraindicated or NPO, USE ketorolac if ordered***** ketorolac 15 mg, IVPush, inj, q6h, PRN pain-moderate (scale 4-7), x 48 hr ***May give IM if no IV access*** Use if HYDROcodone-acetaminophen ineffective or contraindicated. 30 mg, IVPush, inj, q6h, PRN pain-moderate (scale 4-7), x 48 hr ***May give IM if no IV access*** Use if HYDROcodone-acetaminophen ineffective or contraindicated. morphine 2 mg, IVPush, inj, q4h, PRN pain-severe (scale 8-10) ***Slow IV Push*** *****IF morphine is ineffective/contraindicated, USE HYDROmorphone if ordered***** 4 mg, IVPush, inj, q4h, PRN pain-severe (scale 8-10) ***Slow IV Push*** *****IF morphine is ineffective/contraindicated, USE HYDROmorphone if ordered***** HYDROmorphone 1 mg, IVPush, inj, q4h, PRN pain-severe (scale 8-10) ***Slow IV Push*** Use if morphine ineffective or contraindicated. Antiemetics promethazine 25 mg, PO, tab, q4h, PRN nausea/vomiting *****IF promethazine is ineffective/contraindicated or patient is NPO, USE ondansetron if ordered***** ondansetron 4 mg, IVPush, soln, q8h, PRN nausea/vomiting Use if promethazine ineffective or contraindicated. Gastrointestinal Agents docusate 100 mg, PO, cap, Nightly, PRN constipation *****IF docusate is contraindicated or ineffective after 12 hours, USE bisacodyl if ordered***** bisacodyl 10 mg, rectally, supp, Daily, PRN constipation *****IF bisacodyl is contraindicated or ineffective after 6 hours, USE Fleet Enema if ordered***** Page: 8 Card Post Cardiac Catheterization Plan Version: 6 Effective on: 04/27/16 Page 8 of 19

DISCOMFORT MED PLAN PHYSICIAN S DETAILS sodium biphosphate-sodium phosphate (Fleet Enema) 132 ml, rectally, enema, Daily, PRN constipation loperamide 4 mg, PO, cap, ONE TIME, PRN diarrhea Initial dose after first loose stool 4 mg, PO, liq, ONE TIME, PRN diarrhea Initial dose after first loose stool loperamide 2 mg, PO, cap, as needed, PRN diarrhea 2 mg after each loose stool, up to 16 mg per day 2 mg, PO, liq, as needed, PRN diarrhea 2 mg after each loose stool, up to 16 mg per day Antacids Al hydroxide-mg hydroxide-simethicone (aluminum hydroxide-magnesium hydroxide-simethicone 200 mg-200 mg-20 mg/5 ml oral suspension) 30 ml, PO, susp, q4h, PRN indigestion Administer 1 hour before meals and nightly. simethicone 80 mg, PO, tab chew, q4h, PRN gas 160 mg, PO, tab chew, q4h, PRN gas Sedatives ALPRAZolam 0.25 mg, PO, tab, TID, PRN anxiety *****IF ALPRAZolam is ineffective/contraindicated or patient is NPO, USE LORazepam if ordered***** LORazepam 1 mg, IVPush, inj, q6h, PRN anxiety 0.5 mg, IVPush, inj, q6h, PRN anxiety zolpidem 5 mg, PO, tab, Nightly, PRN insomnia may repeat x1 in one hour if ineffective Antihistamines diphenhydramine 25 mg, PO, cap, q4h, PRN itching *****IF diphenhydramine PO is ineffective or patient is NPO, USE diphenhydramine inj if ordered***** diphenhydramine 25 mg, IVPush, inj, q4h, PRN itching Use if oral dose is ineffective or patient is NPO Anti-pyretics Page: 9 Card Post Cardiac Catheterization Plan Version: 6 Effective on: 04/27/16 Page 9 of 19

DISCOMFORT MED PLAN PHYSICIAN S DETAILS acetaminophen 500 mg, PO, tab, q4h, PRN fever ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF acetaminophen is ineffective/contraindicated, USE ibuprofen if ordered***** 1,000 mg, PO, tab, q4h, PRN fever ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF acetaminophen is ineffective/contraindicated, USE ibuprofen if ordered***** ibuprofen 200 mg, PO, tab, q4h, PRN fever Do not exceed 3,200 mg in 24 hours. Give with food. Use if acetaminophen is ineffective or contraindicated. 400 mg, PO, tab, q4h, PRN fever Do not exceed 3,200 mg in 24 hours. Give with food. Use if acetaminophen is ineffective or contraindicated. Anorectal Preparations witch hazel-glycerin topical (witch hazel-glycerin 50% topical pad) 1 app, topical, pad, as needed, PRN hemorrhoid care Wipe affected area *****IF witch hazel-glycerin or phenylephrine ointment ineffective/contraindicated, USE hydrocortisone-pramoxine foam if ordered***** phenylephrine topical (phenylephrine 0.25%-3% rectal ointment) 1 app, rectally, oint, q6h, PRN hemorrhoid care Apply to affected area *****IF witch hazel-glycerin or phenylephrine ointment ineffective/contraindicated, USE hydrocortisone-pramoxine foam if ordered***** hydrocortisone-pramoxine topical (hydrocortisone-pramoxine 1%-1% rectal foam) 1 app, rectally, foam, q8h, PRN hemorrhoid care apply to affected area Page: 10 Card Post Cardiac Catheterization Plan Version: 6 Effective on: 04/27/16 Page 10 of 19

HEPARIN INFUSION MED PLAN PHYSICIAN S DETAILS Patient Care Heparin Infusion Guidelines ***See Reference Text*** Communication Notify Nurse (DO NOT USE FOR MEDS) Obtain Xa Heparin (Anti-Xa) Level 6 hours after starting infusion and 6 hours after every rate change. Notify Provider (Misc) Reason: 2 consecutive Xa Heparin (Anti-Xa) levels are greater than 0.9 or less than 0.2 Notify Provider (Misc) Reason: If platelet count decreases by 50% of baseline or drops below 100,000 (100 K/uL) Notify Provider (Misc) Reason: If Hemoglobin decreases by 2 g/dl or more. Notify Provider (Misc) Reason: If signs of bleeding occur. Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed..medication Management Start date T;N Discontinue all other orders for heparin products (i.e. heparin subcutaneous, enoxaparin). Venous Thromboembolic Disorder Deep Vein Thrombosis, Pulmonary Embolism heparin 80 units/kg, IVPush, inj, ONE TIME For Bolus. Recommended maximum dose is 10,000 units. heparin 25,000 units/250 ml D5W IV Initiate at rate of 18 units/kg/hr. Initial maximum rate is 18 ml/hr (1,800 units/hr). Final concentration = 100 unit/ml. Refer to heparin protocol for specific dosing instructions. Start at rate: units/kg/hr Cardiac Unstable angina, ST elevation MI, non-st elevation MI heparin 60 units/kg, IVPush, inj, ONE TIME For Bolus. Recommended maximum dose is 5,000 units, or 4,000 units for ST elevation MI with thyrombolytics. heparin 25,000 units/250 ml D5W IV Initiate at rate of 12 units/kg/hr. Initial maximum rate is 10 ml/hr (1,000 units/hr). Final concentration = 100 unit/ml. Refer to heparin protocol for specific dosing instructions. Continued on next page... Page: 11 Card Post Cardiac Catheterization Plan Version: 6 Effective on: 04/27/16 Page 11 of 19

HEPARIN INFUSION MED PLAN PHYSICIAN S DETAILS Start at rate: units/kg/hr Neurological Ischemia/strokes with a suspected embolic source in which thrombolytics have NOT been given and a CT has confirmed NO cerebral hemorrhage No intial heparin bolus recommended. heparin 25,000 units/250 ml D5W IV Initiate at rate of 12 units/kg/hr. Initial maximum rate is 12 ml/hr (1,200 units/hr). Final concentration = 100 unit/ml. Refer to heparin protocol for specific dosing instructions. Start at rate: units/kg/hr Antidote See heparin infusion guidelines reference text for dosing. protamine mg, IVPush, inj, ONE TIME, PRN Laboratory Baseline Labs CBC STAT PTT STAT Prothrombin Time with INR STAT Daily Labs CBC Next Day in AM, T+1;0300, Every AM for 3 days Therapeutic Monitoring Anti Xa Level Page: 12 Card Post Cardiac Catheterization Plan Version: 6 Effective on: 04/27/16 Page 12 of 19

SLIDING SCALE INSULIN REGULAR PLAN PHYSICIAN S DETAILS Patient Care POC Blood Sugar Check Per Sliding Scale Insulin Frequency AC & HS AC & HS 3 days TID BID q12h q6h q6h 24 hr q4h q2h Sliding Scale Insulin Regular Guidelines Follow SSI Regular Reference Text Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. insulin regular (Low Dose Insulin Regular Sliding Scale) 0-10 units, subcut, inj, AC & nightly, PRN glucose levels - see parameters Low Dose Insulin Regular Sliding Scale 140-180 mg/dl - 2 units subcut 181-240 mg/dl - 3 units subcut 241-300 mg/dl - 4 units subcut 301-350 mg/dl - 6 units subcut 351-400 mg/dl - 8 units subcut If blood glucose is greater than 400 mg/dl, administer 10 units subcut, notify provider, and repeat POC blood sugar check in 1 0-10 units, subcut, inj, BID, PRN glucose levels - see parameters Low Dose Insulin Regular Sliding Scale 140-180 mg/dl - 2 units subcut 181-240 mg/dl - 3 units subcut 241-300 mg/dl - 4 units subcut 301-350 mg/dl - 6 units subcut 351-400 mg/dl - 8 units subcut If blood glucose is greater than 400 mg/dl, administer 10 units subcut, notify provider, and repeat POC blood sugar check in 1 0-10 units, subcut, inj, TID, PRN glucose levels - see parameters Low Dose Insulin Regular Sliding Scale 140-180 mg/dl - 2 units subcut 181-240 mg/dl - 3 units subcut 241-300 mg/dl - 4 units subcut 301-350 mg/dl - 6 units subcut 351-400 mg/dl - 8 units subcut If blood glucose is greater than 400 mg/dl, administer 10 units subcut, notify provider, and repeat POC blood sugar check in 1 Continued on next page... Page: 13 Card Post Cardiac Catheterization Plan Version: 6 Effective on: 04/27/16 Page 13 of 19

SLIDING SCALE INSULIN REGULAR PLAN PHYSICIAN S DETAILS 0-10 units, subcut, inj, q6h, PRN glucose levels - see parameters Low Dose Insulin Regular Sliding Scale 140-180 mg/dl - 2 units subcut 181-240 mg/dl - 3 units subcut 241-300 mg/dl - 4 units subcut 301-350 mg/dl - 6 units subcut 351-400 mg/dl - 8 units subcut If blood glucose is greater than 400 mg/dl, administer 10 units subcut, notify provider, and repeat POC blood sugar check in 1 0-10 units, subcut, inj, q4h, PRN glucose levels - see parameters Low Dose Insulin Regular Sliding Scale 140-180 mg/dl - 2 units subcut 181-240 mg/dl - 3 units subcut 241-300 mg/dl - 4 units subcut 301-350 mg/dl - 6 units subcut 351-400 mg/dl - 8 units subcut If blood glucose is greater than 400 mg/dl, administer 10 units subcut, notify provider, and repeat POC blood sugar check in 1 0-10 units, subcut, inj, q2h, PRN glucose levels - see parameters Low Dose Insulin Regular Sliding Scale 140-180 mg/dl - 2 units subcut 181-240 mg/dl - 3 units subcut 241-300 mg/dl - 4 units subcut 301-350 mg/dl - 6 units subcut 351-400 mg/dl - 8 units subcut If blood glucose is greater than 400 mg/dl, administer 10 units subcut, notify provider, and repeat POC blood sugar check in 1 Page: 14 Card Post Cardiac Catheterization Plan Version: 6 Effective on: 04/27/16 Page 14 of 19

SLIDING SCALE INSULIN REGULAR PLAN PHYSICIAN S DETAILS insulin regular (Moderate Dose Insulin Regular Sliding Scale) 0-12 units, subcut, inj, AC & nightly, PRN glucose levels - see parameters Moderate Dose Insulin Regular Sliding Scale 140-180 mg/dl - 3 units subcut 181-240 mg/dl - 4 units subcut 241-300 mg/dl - 6 units subcut 301-350 mg/dl - 8 units subcut 351-400 mg/dl - 10 units subcut If blood glucose is greater than 400 mg/dl, administer 12 units subcut, notify provider, and repeat POC blood sugar check in 1 0-12 units, subcut, inj, BID, PRN glucose levels - see parameters Moderate Dose Insulin Regular Sliding Scale 140-180 mg/dl - 3 units subcut 181-240 mg/dl - 4 units subcut 241-300 mg/dl - 6 units subcut 301-350 mg/dl - 8 units subcut 351-400 mg/dl - 10 units subcut If blood glucose is greater than 400 mg/dl, administer 12 units subcut, notify provider, and repeat POC blood sugar check in 1 0-12 units, subcut, inj, TID, PRN glucose levels - see parameters Moderate Dose Insulin Regular Sliding Scale 140-180 mg/dl - 3 units subcut 181-240 mg/dl - 4 units subcut 241-300 mg/dl - 6 units subcut 301-350 mg/dl - 8 units subcut 351-400 mg/dl - 10 units subcut If blood glucose is greater than 400 mg/dl, administer 12 units subcut, notify provider, and repeat POC blood sugar check in 1 0-12 units, subcut, inj, q6h, PRN glucose levels - see parameters Moderate Dose Insulin Regular Sliding Scale 140-180 mg/dl - 3 units subcut 181-240 mg/dl - 4 units subcut 241-300 mg/dl - 6 units subcut 301-350 mg/dl - 8 units subcut 351-400 mg/dl - 10 units subcut If blood glucose is greater than 400 mg/dl, administer 12 units subcut, notify provider, and repeat POC blood sugar check in 1 Continued on next page... Page: 15 Card Post Cardiac Catheterization Plan Version: 6 Effective on: 04/27/16 Page 15 of 19

SLIDING SCALE INSULIN REGULAR PLAN PHYSICIAN S DETAILS 0-12 units, subcut, inj, q4h, PRN glucose levels - see parameters Moderate Dose Insulin Regular Sliding Scale 140-180 mg/dl - 3 units subcut 181-240 mg/dl - 4 units subcut 241-300 mg/dl - 6 units subcut 301-350 mg/dl - 8 units subcut 351-400 mg/dl - 10 units subcut If blood glucose is greater than 400 mg/dl, administer 12 units subcut, notify provider, and repeat POC blood sugar check in 1 0-12 units, subcut, inj, q2h, PRN glucose levels - see parameters Moderate Dose Insulin Regular Sliding Scale 140-180 mg/dl - 3 units subcut 181-240 mg/dl - 4 units subcut 241-300 mg/dl - 6 units subcut 301-350 mg/dl - 8 units subcut 351-400 mg/dl - 10 units subcut If blood glucose is greater than 400 mg/dl, administer 12 units subcut, notify provider, and repeat POC blood sugar check in 1 insulin regular (High Dose Insulin Regular Sliding Scale) 0-14 units, subcut, inj, AC & nightly, PRN glucose levels - see parameters High Dose Insulin Regular Sliding Scale 140-180 mg/dl - 4 units subcut 181-240 mg/dl - 6 units subcut 241-300 mg/dl - 8 units subcut 301-350 mg/dl - 10 units subcut 351-400 mg/dl - 12 units subcut If blood glucose is greater than 400 mg/dl, administer 14 units subcut, notify provider, and repeat POC blood sugar check in 1 0-14 units, subcut, inj, BID, PRN glucose levels - see parameters High Dose Insulin Regular Sliding Scale 140-180 mg/dl - 4 units subcut 181-240 mg/dl - 6 units subcut 241-300 mg/dl - 8 units subcut 301-350 mg/dl - 10 units subcut 351-400 mg/dl - 12 units subcut If blood glucose is greater than 400 mg/dl, administer 14 units subcut, notify provider, and repeat POC blood sugar check in 1 Continued on next page... Page: 16 Card Post Cardiac Catheterization Plan Version: 6 Effective on: 04/27/16 Page 16 of 19

SLIDING SCALE INSULIN REGULAR PLAN PHYSICIAN S DETAILS 0-14 units, subcut, inj, TID, PRN glucose levels - see parameters High Dose Insulin Regular Sliding Scale 140-180 mg/dl - 4 units subcut 181-240 mg/dl - 6 units subcut 241-300 mg/dl - 8 units subcut 301-350 mg/dl - 10 units subcut 351-400 mg/dl - 12 units subcut If blood glucose is greater than 400 mg/dl, administer 14 units subcut, notify provider, and repeat POC blood sugar check in 1 0-14 units, subcut, inj, q6h, PRN glucose levels - see parameters High Dose Insulin Regular Sliding Scale 140-180 mg/dl - 4 units subcut 181-240 mg/dl - 6 units subcut 241-300 mg/dl - 8 units subcut 301-350 mg/dl - 10 units subcut 351-400 mg/dl - 12 units subcut If blood glucose is greater than 400 mg/dl, administer 14 units subcut, notify provider, and repeat POC blood sugar check in 1 0-14 units, subcut, inj, q4h, PRN glucose levels - see parameters High Dose Insulin Regular Sliding Scale 140-180 mg/dl - 4 units subcut 181-240 mg/dl - 6 units subcut 241-300 mg/dl - 8 units subcut 301-350 mg/dl - 10 units subcut 351-400 mg/dl - 12 units subcut If blood glucose is greater than 400 mg/dl, administer 14 units subcut, notify provider, and repeat POC blood sugar check in 1 0-14 units, subcut, inj, q2h, PRN glucose levels - see parameters High Dose Insulin Regular Sliding Scale 140-180 mg/dl - 4 units subcut 181-240 mg/dl - 6 units subcut 241-300 mg/dl - 8 units subcut 301-350 mg/dl - 10 units subcut 351-400 mg/dl - 12 units subcut If blood glucose is greater than 400 mg/dl, administer 14 units subcut, notify provider, and repeat POC blood sugar check in 1 Continued on next page... Page: 17 Card Post Cardiac Catheterization Plan Version: 6 Effective on: 04/27/16 Page 17 of 19

SLIDING SCALE INSULIN REGULAR PLAN PHYSICIAN S DETAILS insulin regular (Blank Insulin Sliding Scale) See Comments, subcut, inj, PRN glucose levels - see parameters If blood glucose is less than mg/dl, initiate hypoglycemia guidelines and notify provider. 70-139 mg/dl - units 140-180 mg/dl - units subcut 181-240 mg/dl - units subcut 241-300 mg/dl - units subcut 301-350 mg/dl - units subcut 351-400 mg/dl - units subcut If blood glucose is greater than 400 mg/dl, administer units subcut, notify provider, and repeat POC blood sugar check in 1 hour. Continue to repeat units subcut and POC blood sugar checks every 1 hour until blood glucose is less than 300 mg/dl, then HYPOglycemia Guidelines HYPOglycemia Guidelines ***See Reference Text*** glucose 15 g, PO, gel, as needed, PRN glucose levels - see parameters Use if patient is symptomatic and able to swallow. See hypoglycemia guidelines. glucose (D50) 25 g, IVPush, syringe, as needed, PRN glucose levels - see parameters Use if patient is symptomatic and unable to swallow / NPO with IV access. See hypoglycemia guidelines. glucagon 1 mg, IM, inj, as needed, PRN glucose levels - see parameters Use if patient is symptomatic and unable to swallow / NPO WITHOUT IV access. See hypoglycemia guidelines. Page: 18 Card Post Cardiac Catheterization Plan Version: 6 Effective on: 04/27/16 Page 18 of 19

VTE PROPHYLAXIS PLAN PHYSICIAN S DETAILS Patient Care VTE Guidelines See Reference Text for Guidelines ***If VTE Pharmacologic Prophylaxis not given, choose the Contraindications for VTE below and complete reason contraindi cated*** Contraindications VTE Active/high risk for bleeding Treatment not indicated Patient or caregiver refused Other anticoagulant ordered Anticipated procedure within 24 hours Intolerance to all VTE chemoprophylaxis Apply Elastic Stockings Apply to: Bilateral Lower Extremities, Length: Knee High Apply to: Left Lower Extremity (LLE), Length: Knee High Apply to: Right Lower Extremity (RLE), Length: Knee High Apply to: Bilateral Lower Extremities, Length: Thigh High Apply to: Left Lower Extremity (LLE), Length: Thigh High Apply to: Right Lower Extremity (RLE), Length: Thigh High Apply Sequential Compression Device Apply to Bilateral Lower Extremities Apply to Left Lower Extremity (LLE) Apply to Right Lower Extremity (RLE) Apply Pedal Pump Apply to Bilateral Feet Apply to Left Foot Apply to Right Foot Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. ***Recommended Trauma Dose = 30 mg, subcut, q12h*** ***Recommended Dose for Morbidly Obese Patients = 40 mg, subcut, q12h*** enoxaparin 40 mg, subcut, syringe, q24h 30 mg, subcut, syringe, q12h 30 mg, subcut, syringe, q24h, For CrCl less than 30 ml/min 40 mg, subcut, syringe, q12h, For BMI greater than 39 heparin 5,000 units, subcut, inj, q12h 5,000 units, subcut, inj, q8h fondaparinux 2.5 mg, subcut, syringe, q24h rivaroxaban 10 mg, PO, tab, In PM 20 mg, PO, tab, In PM warfarin 5 mg, PO, tab, QPM aspirin 81 mg, PO, tab chew, Daily 325 mg, PO, tab, Daily Page: 19 Card Post Cardiac Catheterization Plan Version: 6 Effective on: 04/27/16 Page 19 of 19