- Phase: Begin Immediately/PACU Phase PHYSICIAN S Diagnosis Weight Allergies DETAILS Admit/Discharge/Transfer Patient Status Requested Location: CICU Patient Condition Acuity Level Critical Acuity Level Intermediate Communication Code Status Code Status: Full Code Code Status: DNR/AND (Allow Natural Death) Code Status: Care Limitation Order Taken by Signature: Page 1 of 15
- Phase: When Patient Arrives to Room PHYSICIAN S DETAILS Patient Care Vital Signs Per Unit Standards, q15min x 4, q30min x 2, then q1h x 4 until sheath discontinued. Per Unit Standards Perform Neurovascular Checks To: Bilateral Upper Extremities Bilateral Lower Extremities, q1h, for 12hrs then q2h for 12hrs then Per Unit Standards. Notify Nurse (DO NOT USE FOR MEDS) PA Catheter: Assess PAP, PCWP, CVP, SVR, PVR, CO, and CL q1h x 4 then q4h. Flush q24h with saline. Strict Intake and Output Per Unit Standards Patient Activity Bedrest Insert Urinary Catheter Criticore Foley Urinary Catheter Care Per Unit Standards Core Body Temperature Monitoring with Criticore Notify Nurse (DO NOT USE FOR MEDS) Assess groin incision and sheath site for hematoma q2h x 4 then qshift Warming Measures Treat hypothermia with warming blanket to keep Temp greater than 96.8 degrees F (36 C) Wound Care by Nursing Place Device at Bedside Femstop to bedside Maintain Gastric Tube Maintain Nasogastric - NG, Low Intermittent Suction Maintain Orogastric - OG, Low Intermittent Suction Maintain Chest Tube Notify Nurse (DO NOT USE FOR MEDS) If chest tube output is greater than ml/hr, order H&H, PT, PTT, and platelet count. Bedside Pacemaker Settings Communication Notify Provider of VS Parameters Temp Greater Than 101.5, RR Greater Than 28, RR Less Than 8, SpO2 Less Than 92, SBP Greater Than 180, SBP Less Than 100, HR Greater Than 120, HR Less Than 50 Notify Provider (Misc) Reason: Urine output less than 30 ml/hr. Order Taken by Signature: Page 2 of 15
- Phase: When Patient Arrives to Room PHYSICIAN S DETAILS Notify Provider (Misc) Reason: Blood Glucose greater than 180 or less than 60. Notify Provider (Misc) Reason: Onset of Chest Pain or Dyspnea. Dietary NPO Diet NPO NPO, Except Meds NPO, Except Meds, Except Ice Chips Oral Diet Clear Liquid Diet, Advance as tolerated to AHA ADA Diet IV Solutions NS IV, 75 ml/hr IV, 125 ml/hr IV, 150 ml/hr IV, 200 ml/hr 1/2 NS IV, 75 ml/hr IV, 125 ml/hr IV, 150 ml/hr IV, 200 ml/hr Volume Replacement LR (LR bolus) 1,000 ml, IV, iv soln, ONE TIME, PRN hypotension, Infuse over 1 hr Administer for systolic blood pressure less than 90mmHg or MAP less than 60mmHg. albumin human (albumin human 5% bolus) 12.5 g, IVPB, ivpb, ONE TIME, PRN hypotension, Infuse over 1 hr Administer for systolic blood pressure less than 90mmHg or MAP less than 60mmHg. May give up to 1,000 ml. Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. Antibiotics cefuroxime 1.5 g, IVPB, ivpb, q8h, x 2 dose Start 8 hours after the pre-op dose was administered. vancomycin 1 g, IVPB, ivpb, q12h, x 1 dose Start 12 hours after the pre-op dose was administered. Vasodilators nitroglycerin (nitroglycerin sublingual) 0.4 mg, SL, tab, q5minx3, PRN chest pain ***If chest pain continues, obtain STAT EKG and notify physician STAT*** Anti Platelets Order Taken by Signature: Page 3 of 15
- Phase: When Patient Arrives to Room PHYSICIAN S DETAILS 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 Begin 12 hours after loading dose. prasugrel 10 mg, PO, tab, Daily 5 mg, PO, tab, Daily clopidogrel 75 mg, PO, tab, Daily Begin 24 hours after loading dose. aspirin 81 mg, PO, tab ec, Daily 325 mg, PO, tab, Daily Hemodynamics DOBUTamine 250 mg/250 ml D5W IV Final concentration = 1 mg/ml (1,000 mcg/ml). Usual dose range is 2-20 mcg/kg/min. Notify physician if administered dose (rate) is greater than the usual dose range. Start at rate: mcg/kg/min milrinone 20 mg/100 ml NS IV Final concentration = 0.2 mg/ml (200 mcg/ml). If ordered, usual loading dose is 50 mcg/kg over 10 min. Usual maintenance dose range is 0.375-0.75 mcg/kg/min. Notify physician if administered dose (rate) is greater than the usual dose range. Start at rate: mcg/kg/min norepinephrine 4 mg/250 ml D5W IV Final concentration = 0.016 mg/ml (16 mcg/ml). Usual dose range is 0.5-30 mcg/min. Notify physician if administered dose (rate) is greater than the usual dose range. Continued on next page... Order Taken by Signature: Page 4 of 15
- Phase: When Patient Arrives to Room PHYSICIAN S DETAILS Start at rate: mcg/min Final concentration = 0.016 mg/ml (16 mcg/ml). Usual dose range is 0.5-30 mcg/min. Notify physician if administered dose (rate) is greater than the usual dose range. EPINEPHrine 4 mg/250 ml NS IV Final concentration = 0.016 mg/ml (16 mcg/ml). Usual dose range is 1-10 mcg/min. Notify physician if administered dose (rate) is greater than the usual dose range. Start at rate: mcg/min amiodarone 150 mg, IVPB, ivpb, ONE TIME, Infuse over 10 min amiodarone 900 mg/500 ml D5W IV Final concentration = 1.8 mg/ml. Usual maintenance dose is 33.3 ml/hr (1 mg/min) x 6 hr, then 16.7 ml/hr (0.5 mg/min) thereafter. If systolic blood pressure is less than 90 or heart rate is less than 60, hold infusion and notify physician. Start at rate: mg/min Other Medications famotidine 20 mg, PO, tab, BID pantoprazole 40 mg, PO, tab ec, Daily Do not crush or chew. Laboratory POC Blood Sugar Check Hemoglobin and Hematocrit STAT CBC PTT Prothrombin Time with INR Comprehensive Metabolic Panel Basic Metabolic Panel Potassium Level STAT Magnesium Level Glucose Random D Dimer HS Diagnostic Tests Order Taken by Signature: Page 5 of 15
- Phase: When Patient Arrives to Room PHYSICIAN S DETAILS EKG-12 Lead STAT, upon arrival to unit. EKG-12 Lead T+1;0500, In AM Notify Nurse (DO NOT USE FOR MEDS) EKG STAT PRN Chest Pain Echo Transthoracic (TTE) with contrast i (Echo Transthoracic (TTE) with contrast if needed) T+1, Routine DX Chest Portable Routine DX Chest Portable T+1;0500, Routine DX Chest PA & Lateral T+2;0500, Routine...Additional Orders Order Taken by Signature: Page 6 of 15
- Phase: 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 Order Taken by Signature: Page 7 of 15
- Phase: 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) *****IF acetaminophen ineffective/contraindicated, USE ibuprofen if ordered:***** 1,000 mg, PO, tab, q4h, PRN pain-mild (scale 1-3) *****IF acetaminophen ineffective/contraindicated, USE ibuprofen if ordered:***** acetaminophen 650 mg, rectally, supp, q4h, PRN pain-mild (scale 1-3) *****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) *****IF HYDROcodone-acetaminophen ineffective/contraindicated or NPO, USE ketorolac if ordered***** Continued on next page... Order Taken by Signature: Page 8 of 15
- Phase: DISCOMFORT MED PLAN PHYSICIAN S DETAILS 2 tab, PO, tab, q4h, PRN pain-moderate (scale 4-7) *****IF HYDROcodone-acetaminophen ineffective/contraindicated or NPO, USE ketorolac if ordered***** acetaminophen-codeine (acetaminophen-codeine #3) 1 tab, PO, q4h, PRN pain-moderate (scale 4-7) *****IF acetaminophen-codeine #3 ineffective/contraindicated or NPO, USE ketorolac if ordered***** 2 tab, PO, q4h, PRN pain-moderate (scale 4-7) *****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***** Order Taken by Signature: Page 9 of 15
- Phase: 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 acetaminophen 500 mg, PO, tab, q4h, PRN fever *****IF acetaminophen is ineffective/contraindicated, USE ibuprofen if ordered***** Continued on next page... Order Taken by Signature: Page 10 of 15
- Phase: DISCOMFORT MED PLAN PHYSICIAN S DETAILS 1,000 mg, PO, tab, q4h, PRN fever *****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 Order Taken by Signature: Page 11 of 15
- Phase: ELECTROLYTE MED PLAN PHYSICIAN S DETAILS Communication When placing the protocol order, do NOT order any meds unless you need IMMEDIATE electrolyte replacement therapy. Electrolyte Replacement Protocol ***See Reference Text*** Electrolyte Replacement Protocol (IV Potassium Replacement) Electrolyte Replacement Protocol (IV Sodium Phosphates Replacement) Electrolyte Replacement Protocol (IV Potassium Phosphates Replacement) Electrolyte Replacement Protocol (IV Magnesium Replacement) Electrolyte Replacement Protocol (Oral Potassium Replacement) Electrolyte Replacement Protocol (Oral Phosphates Replacement) Electrolyte Replacement Protocol (Oral Magnesium Replacement) Electrolyte Replacement Protocol (Aggressive Treatment Option) IV Solutions Replacement orders should only be used in patients with a serum creatinine less than 2 mg/dl, BUN less than 30 mg/dl, and urinary output greater than 30 ml/hr An infusion pump is required for all electrolyte infusions Only the selected electrolytes will be replaced per protocol IV POTASSIUM REPLACEMENT: *****Central line administration***** 20 meq, IVPB, ivpb, ONE TIME, Infuse over 1 hr, *Repeat serum potassium level 2 hours after the total replacement is completed. *ECG monitoring required for infusion rates > 10 meq/hr. *Check magnesium levels if potassium does not respond after 2 doses. CENTRAL LINE 20 meq/hr - [Serum Potassium 3.6-3.9 mmol/l] 40 meq, IVPB, ivpb, ONE TIME, Infuse over 2 hr, *Repeat serum potassium level 2 hours after the total replacement is completed. *ECG monitoring required for infusion rates > 10 meq/hr. *Check magnesium levels if potassium does not respond after 2 doses. CENTRAL LINE 20 meq/hr - [Serum Potassium 3.1-3.5 mmol/l] 60 meq, IVPB, ivpb, ONE TIME, Infuse over 3 hr, *Repeat serum potassium level 2 hours after the total replacement is completed. *ECG monitoring required for infusion rates > 10 meq/hr. *Check magnesium levels if potassium does not respond after 2 doses. CENTRAL LINE 20 meq/hr - [Serum Potassium 2.6-3 mmol/l] 80 meq, IVPB, ivpb, ONE TIME, Infuse over 4 hr, [Notify Physician if Serum Potassium < 2.6 mmol/l] **Repeat serum KCL level 2 hrs after the total replacement is completed. **ECG monitoring required for infusion rates > 10 meq/hr. **Check CENTRAL LINE 20 meq/hr - [Serum Potassium less than 2.6 mmol/l - notify physician] *****Peripheral line administration***** 20 meq, IVPB, ivpb, ONE TIME, Infuse over 2 hr, *Repeat serum potassium level 2 hours after the total replacement is completed. *ECG monitoring required for infusion rates > 10 meq/hr. *Check magnesium levels if potassium does not respond after 2 doses. PERIPHERAL LINE 10 meq/hr - [Serum Potassium 3.6-3.9 mmol/l] Order Taken by Signature: Page 12 of 15
- Phase: ELECTROLYTE MED PLAN PHYSICIAN S DETAILS 40 meq, IVPB, ivpb, ONE TIME, Infuse over 4 hr, *Repeat serum potassium level 2 hours after the total replacement is completed. *ECG monitoring required for infusion rates > 10 meq/hr. *Check magnesium levels if potassium does not respond after 2 doses. PERIPHERAL LINE 10 meq/hr - [Serum Potassium 3.1-3.5 mmol/l] 60 meq, IVPB, ivpb, ONE TIME, Infuse over 6 hr, *Repeat serum potassium level 2 hours after the total replacement is completed. *ECG monitoring required for infusion rates > 10 meq/hr. *Check magnesium levels if potassium does not respond after 2 doses. PERIPHERAL LINE 10 meq/hr - [Serum Potassium 2.6-3 mmol/l] 80 meq, IVPB, ivpb, ONE TIME, Infuse over 8 hr, [Notify Physician if Serum Potassium < 2.6 mmol/l] *Repeat serum KCL level 2 hours after the total replacement is completed. *ECG monitoring required for infusion rates > 10 meq/hr. *Check Mg l PERIPHERAL LINE 10 meq/hr - [Serum Potassium less than 2.6 mmol/l - Notify Physician] IV SODIUM PHOSPHATES REPLACEMENT: *****Use when only phosphorus needs replacement***** sodium phosphate 15 mmol, IVPB, ivpb, ONE TIME, Infuse over 2 hr, Repeat serum phosphorus level 6 hours after infusion is completed. [serum phosphorus 2-2.5 mg/dl] sodium phosphate 30 mmol, IVPB, ivpb, ONE TIME, Infuse over 4 hr, Repeat serum phosphorus level 6 hours after infusion is completed. [serum phosphorus 1-1.9 mg/dl] sodium phosphate 45 mmol, IVPB, ivpb, ONE TIME, Infuse over 6 hr, [Notify physician if serum phosphorus less than 1 mg/dl] *Repeat serum phosphorus level 6 hours after infusion is completed. [serum phosphorus less than 1 mg/dl - notify physician] IV POTASSIUM PHOSPHATES REPLACEMENT: *****Use when phosphorus AND potassium need replacement***** potassium phosphate 15 mmol, IVPB, ONE TIME, Infuse over 2 hr, **Repeat serum phosphorus level 6 hours after infusion is completed. **Each 15 mmol of phosphorus contains 22 meq of potassium. [serum phosphorus 2-2.5 mg/dl] potassium phosphate 30 mmol, IVPB, ONE TIME, Infuse over 4 hr, **Repeat serum phosphorus level 6 hours after infusion is completed. **Each 15 mmol of phosphorus contains 22 meq of potassium. [serum phosphorus 1-1.9 mg/dl] potassium phosphate 45 mmol, IVPB, ONE TIME, Infuse over 6 hr, [Notify Physician if serum phosphorus < 1 mg/dl] **Repeat serum phosphorus level 6 hours after infusion is completed. **Each 15 mmol of phosphorus contains 22 meq of potassium. [Notify Physician if serum phosphorus less than 1 mg/dl] Order Taken by Signature: Page 13 of 15
- Phase: ELECTROLYTE MED PLAN PHYSICIAN S DETAILS IV MAGNESIUM REPLACEMENT: magnesium sulfate 2 g, IVPB, ivpb, ONE TIME, Infuse over 60 min, Repeat serum magnesium level 2 hours after the infusion is completed. [serum magnesium level 1.3-1.6 mg/dl] magnesium sulfate 3 g, IVPB, ivpb, ONE TIME, Infuse over 90 min, Repeat serum magnesium level 2 hours after the infusion is completed. [serum magnesium level 1-1.2 mg/dl] magnesium sulfate 4 g, IVPB, ivpb, ONE TIME, Infuse over 120 min, [Notify Physician if serum magnesium level less than 1 mg/dl] **Repeat serum magnesium level 2 hours after the infusion is completed. [serum magnesium level < 1 mg/dl - notify physician] Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. ORAL POTASSIUM REPLACEMENT: *****For asymptomatic patients able to take ORAL supplementation***** 20 meq, PO, tab sa, ONE TIME, *Repeat serum potassium level 4 hours after the total replacement is completed. *Check magnesium levels if potassium does not respond after total replacement completed. [Serum Potassium 3.6-3.9 mmol/l] 20 meq, PO, tab sa, q2h, x 2 dose, *Repeat serum potassium level 4 hours after the total replacement is completed. *Check magnesium levels if potassium does not respond after total replacement completed. [Serum Potassium 3.1-3.5 mmol/l] 20 meq, PO, tab sa, q2h, x 3 dose, *Repeat serum potassium level 4 hours after the total replacement is completed. *Check magnesium levels if potassium does not respond after total replacement completed. [Serum Potassium 2.6-3 mmol/l] 20 meq, PO, tab sa, q2h, x 4 dose, [Notify Physician if Serum Potassium less than 2.6 mmol/l] **Repeat serum potassium level 4 hours after the total replacement is completed. **Check magnesium levels if potassium does not respond after total replaceme [Notify Physican if Serum Potassium <2.6 mmol/l] ORAL PHOSPHATE REPLACEMENT: *****For asymptomatic patients able to take ORAL supplementation***** potassium phosphate-sodium phosphate (potassium phosphate-sodium phosphate 250 mg-280 mg-160 mg oral powder for reconstitution) 2 packet, PO, BID, x 6 dose [serum phosphorus 2-2.5 mg/dl] Order Taken by Signature: Page 14 of 15
- Phase: ELECTROLYTE MED PLAN PHYSICIAN S DETAILS ORAL MAGNESIUM REPLACEMENT: *****For asymptomatic patients able to take ORAL supplementation***** magnesium lactate 168 mg, PO, tab, BID, x 6 dose, Repeat serum magnesium level with AM labs. [serum magnesium 1.3-1.6 mg/dl] Laboratory Potassium Level Phosphorus Level Magnesium Level Order Taken by Signature: Page 15 of 15