Physician Orders ADULT: Atrial Fib/Flutter Plan

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Transcription:

Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: Atrial Fib/Flutter Phase, When to Initiate: Atrial Fib/Flutter Phase Non Categorized Problem: Atrial fibrillation Problem: Atrial flutter Admission/Transfer/Discharge Patient Status Initial Inpatient T;N, Admitting Physician: Reason for Visit: Bed Type: Specific Unit: Care Team: Anticipated LOS: 2 midnights or more Patient Status Initial Outpatient T;N, Attending Physician: Reason for Visit: Bed Type: Specific Unit: Outpatient Status/Service OP-OBSERVATION Services Notify Physician-Once Notify: physician, Notify For: room number upon arrival to unit Monitor and Record T,P,R,BP, q4h(std) Monitor and Record T,P,R,BP, q6h(std) Activity Out Of Bed Up Ad Lib Bedrest w/brp Food/Nutrition American Heart Association Diet Consistent Carbohydrate Diet CARD Atrial Fib-Flutter Plan 20402 QM1108 PP Rev021318 Page 1 of 5 *111*

Caloric Level: 1800 Calorie Patient Care INT Insert/Site Care q4day Educate/Instruct Method Topic: atrial fib Educate/Instruct Method: Topic: congestive heart failure Telemetry Medications Digoxin digoxin 0.5 mg, Injection, IV Push, once, STAT +6 Hours digoxin 0.25 mg, Injection, IV Push, once, Routine digoxin 0.5 mg, Tab, PO, once, STAT +6 Hours digoxin 0.25 mg, Tab, PO, once, Routine +1 Hours digoxin 0.125 mg, Injection, IV Push, QDay, Routine +1 Hours digoxin 0.125 mg, Tab, PO, QDay, Routine Calcium Channel Blockers +1 Hours diltiazem 12 hour extended release 120 mg, ER Capsule, PO, bid, Routine +1 Hours diltiazem 24 hour extended release 120 mg, ER Capsule, PO, QDay, Routine 80 mg, Tab, PO, bid, Routine 120 mg, ER Tablet, PO, QDay, Routine 5 mg, Injection, IV Push, q10min, PRN Other, specify in Comment, Routine Comments: PRN ventricular rate greater than 120 sustained, not to exceed 20 mg in 1 hr +1 Hours diltiazem 125mg/D5W for infusion (IVS)* Dextrose 5% in Water 100 ml, IV, Routine, Titrate CARD Atrial Fib-Flutter Plan 20402 QM1108 PP Rev021318 Page 2 of 5 *111*

Comments: Initial Rate: 5 mg/hr; Titration Parameters: 2.5 mg/hr as often as every 15 min to keep HR less than 110 bpm and maintain SBP greater than 90 mm Hg; Max Rate: 15 mg/hr; Conc: 1 mg/ml diltiazem (additive) 125 mg, 25 ml, EB Beta Blockers +1 Hours metoprolol tartrate 25 mg, Tab, PO, bid, Routine +1 Hours atenolol 25 mg, Tab, PO, QDay, Routine Anticoagulants/Antiplatelets VTE MEDICAL Prophylaxis Plan(SUB)* +1 Hours aspirin 325 mg, DR Tablet, PO, QDay +1 Hours warfarin 5 mg, Tab, PO, QDay, Routine +1 Hours enoxaparin 1 mg/kg, Injection, Subcutaneous, q12h, Routine For CrCl <30ml/min order dose below:(note)* +1 Hours enoxaparin 1 mg/kg, Injection, Subcutaneous, QDay, Routine, CrCl<30ml/min Comments: CrCl < 30 ml/min Antiarrhythmics +1 Hours amiodarone 150 mg, Injection, IV Piggyback, once, Routine, ( infuse over 10 min ) +1 Hours amiodarone 450mg infusion (IVS)* Sodium Chloride 0.9% 250 ml, IV, Routine, See Comments Comments: Infuse at 1 mg/min ( 33 ml/hr ) for 6 hours, then decrease rate to 0.5 mg/min ( 17 ml/hr ). amiodarone (additive) 450 mg +1 Hours sotalol 80 mg oral tablet 80 mg, Tab, PO, bid, Routine Laboratory BMP Magnesium Level CARD Atrial Fib-Flutter Plan 20402 QM1108 PP Rev021318 Page 3 of 5 *111*

CBC Lipid Profile Routine, T+1;0400, once, Type: Blood Comments: fasting STAT, T;N, once, Type: Blood STAT, T;N, once, Type: Blood Routine, T+1;0400, once, Type: Blood Time Study, T;N, q3h x 3 occurrence, Type: Blood Time Study, T;N, q3h x 3 occurrence, Type: Blood PT/INR Routine, T+1;N, qam, Type: Blood PTT Routine, T+1;N, qam, Type: Blood BNP BNP Pro Diagnostic Tests EKG Start at: T;N, Priority: Routine Chest 1 View T;N, Routine, Portable Chest 2 Views T;N, Routine, Stretcher Consults/Notifications/Referrals Pharmacy Consult - Warfarin Dosing Date Time Physician s Signature MD Number CARD Atrial Fib-Flutter Plan 20402 QM1108 PP Rev021318 Page 4 of 5 *111*

*Report Legend: DEF - This order sentence is the default for the selected order GOAL - This component is a goal IND - This component is an indicator INT - This component is an intervention IVS - This component is an IV Set NOTE - This component is a note Rx - This component is a prescription SUB - This component is a sub phase, see separate sheet R-Required order CARD Atrial Fib-Flutter Plan 20402 QM1108 PP Rev021318 Page 5 of 5 *111*

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