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 hours then Up ad lib Up Ad Lib Diet NPO No exceptions Comments: Notify Provider once Bedside Swallow Screen is passed for diet orders Nursing Orders Quality Measures STK Patient Education Stroke/TIA, document education daily in I-View NIH Stroke Scale (NIHSS) On Admit and on Discharge Modified Rankin Scale On Admit and on Discharge Elevate Head of Bed 30 Degrees Flat in Bed Flat in Bed as tolerated for 24 hours, then HOB as desired. HOB 15-30 degrees IF at risk for airway obstruction, aspiration or increased ICP Bedside Swallow Screen Raise HOB to 90 degrees briefly to perform bedside swallow screen. If patient fails screen, keep NPO including po medications until cleared by SLP; for alternate medication routes. Blood Glucose Monitor POC Q6H, while NPO then QID AC and HS. If patient is non-diabetic, may discontinue in 24 hours IF no insulin given Cardiac Monitor Neuro Checks Q4H (DEF)* Q2H Q1H Page 1 of 6
DRUG AND TREATMENT Temperature Greater Than 38 degrees C (100 F) Other (See Special Instructions) Blood Glucose LESS Than 60 mg/dl OR GREATER Than 400 mg/dl Other (See Special Instructions) Any occurrence of Atrial Fibrillation and obtain 12 lead ECG stat Other (See Special Instructions) Deterioration of neurologic status Systolic Blood Pressure Greater Than 220 mmhg (DEF)* Systolic Blood Pressure Greater Than 180 mmhg Systolic Blood Pressure Greater Than Diastolic Blood Pressure Greater Than 120 mmhg (DEF)* Diastolic Blood Pressure Greater Than 105 mmhg Diastolic Blood Pressure Greater Than SCD Medications ***(NOTE)***Order the appropriate medications OR select a reason from the dropdown box for medication not being given Reason for Oral Factor Xa Inhibitor Reason Stroke VTE Mechanical Prophylaxis Not Ordered Reason Stroke VTE Pharmacological Prophylaxis Not Ordered Reason Stroke VTE Prophylaxis Not Ordered Reason IV Thrombolytic Therapy Not Initiated aspirin 325 mg tab EC PO DAILY, Clinical Instructions: Do NOT give if intracranial hemorrhage. May give PO IF bedside swallowing screen passed (DEF)* 300 mg supp PR ONCE, Clinical Instructions: Do NOT give if intracranial hemorrhage 324 mg tab chew NG TUBE DAILY Comments: Use 4 81mg tabs. Reason Aspirin Not Given on Arrival Reason Aspirin Not Prescribed at Discharge aspirin-dipyridamole (Aggrenox) 1 cap PO cap ER BID Reason Antithrombotics Not Given by End Day 2 Reason Antithrombotic Therapy Not Prescribed Discharge acetaminophen (Tylenol) 325 mg tab PO BID Reason Statin Not Prescribed at Discharge Reason LDL-c Not Done Page 2 of 6
DRUG AND TREATMENT atorvastatin (Lipitor) 40 mg tab PO DAILY (DEF)* 20 mg tab PO DAILY rosuvastatin (Crestor) 20 mg tab PO BEDTIME Hold Medication Hold Next Dose Detail: Other (specify in Special Instructions), No sedatives or sleeping pills for 24 hours (DEF)* Hold Next Dose Detail: Other (specify in Special Instructions), No sedatives or sleeping pills for 48 hours acetaminophen (Tylenol) 650 mg tab PO Q6H, PRN Other (see comment) (DEF)* Comments: PRN Pain Mild or Temperature GREATER than 100 degfgive if GREATER Than 4 hours since last dose acetaminophen given. 650 mg supp PR Q6H, PRN Other (see comment) Comments: PRN Pain Mild or Temperature GREATER than 100 degfgive if GREATER Than 4 hours since last dose acetaminophen given. 650 mg tab chew NG TUBE Q6H, PRN Other (see comment) Comments: PRN Pain Mild or Temperature GREATER than 100 degfgive if GREATER Than 4 hours since last dose acetaminophen given. insulin aspart (Novolog) unit inj SUBCUT Q6H Comments: For Non- Diabetic patients: May discontinue in 24 H if no insulin given. Blood Glucose Administer 180-229: 1 unit, 230-279: 2 units, 280-329: 3 units, 330-379: 4 units, 380-429: 5 units, Blood Glucose > 430: 6 units and notify physician Reason Alcohol/Substance Abuse Medication Not Prescribed Reason Tobacco Cessation Med Not Given IV Solutions Sodium Chloride 0.9% (Normal Saline Bolus) 10 ml/kg IVPB bag ONCE, Duration: 1 dose, Rate: 250 ml/hour Comments: Administer 1 dose and discontinue. Max Dose 1000 ml. Sodium Chloride 0.9% (Normal Saline) IV bag 100 ml/hour (DEF)* IV bag 75 ml/hour IV bag 50 ml/hour Laboratory Sedimentation Rate (ESR) Homocysteine Level Page 3 of 6
DRUG AND TREATMENT ANA Screen Serum B12 level Vitamin D Hemoglobin A1C TSH Serum CRP Lipid Profile Early AM, ONCE Comments: Patient needs to be fasting Liver Profile Comments: If not already done CBC. Early AM, DAILY BMP Early AM, DAILY Urinalysis Routine, ONCE Urine Culture Routine, ONCE Toxicology Screen 12 - Urine Routine, ONCE Troponin Platelet Function Assay Expedite/ASAP, Blood, ONCE Platelet P2Y12 Monitoring Expedite/ASAP, Blood, ONCE Radiology ***(NOTE)***IF Kidney function is within normal limits, no contrast allergy and able to have MRI CT Angio Head/Neck w/wo Contrast MR Brain w/o Contrast ***(NOTE)***If kidney function within normal limits, CONTRAST ALLERGY PRESENT and able to have MRI: MR Brain w/o Contrast Page 4 of 6
DRUG AND TREATMENT MR Angio Head w/o Contrast MR Angio Neck w/ Contrast ***(NOTE)***If kidney function within normal limits, no contrast allergy and UNABLE to have MRI: CT Angio Head/Neck w/wo Contrast +24 Hours CT Head w/o Contrast ***(NOTE)***If ABNORMAL kidney function and able to have MRI: MR Brain w/o Contrast MR Angio Head w/o Contrast US Carotid Doppler Scan ***(NOTE)***If ABNORMAL kidney function and UNABLE to have MRI: US Carotid Doppler Scan US Transcranial Doppler Scan Stroke, Pending Discharge - No, ONCE +24 Hours CT Head w/o Contrast Respiratory Oxygen Therapy. Nasal Cannula, 2, if O2 Sat Less than 94% Pulse Oximetry (Continuous) Special Instructions: Reposition pulse oximetry probe Q8H and assess skin that has been in contact with probe Cardiology ECG Standard Routine, If not done in ED. ECG Standard Stat, 12 Lead ECG for any occurrence of atrial fibrillation Echo 2-D and M-Mode with Bubble Study Consults Neurology, Stroke Patient Neuropsychology, Stroke, Contact Dr. Rossilli (904-547-1115) Comments: Consult should not delay discharge Rehab Medicine, Stroke, Contact Adria Johnson (904-345 - 7373) Endovascular Neurosurgery, Stroke Page 5 of 6
DRUG AND TREATMENT Cardiology, Stroke Social Work Consult Consult Physical Therapy Stroke Patient Consult Occupational Therapy Stroke Patient Consult Speech Therapy Stroke Patient Dietitian Consult Consult Diabetes-Adult Consult Palliative Care, Adult Consult Hospice Consult Wound Care Consult Pharmacy Page 6 of 6