admit sepsis plan - begin immediately - lubbock,...

UMC Health System Patient Label Here

Admit Sepsis Plan - Begin Immediately

PHYSICIAN ORDERS

Weight ____________________________________________ Allergies ________________________________________________________

Place an "X" in the Orders column to designate orders of choice AND an "x" in the specific order detail box(es) where applicable.

ORDER ORDER DETAILS

Admit/Discharge/Transfer

Request Patient Bed Requested Location: MICU, Pt Status: Inpatient (LOS > 2 midnights) Requested Location: SICU, Pt Status: Inpatient (LOS > 2 midnights) Requested Location: Floor, Pt Status: Inpatient (LOS > 2 midnights)

Patient Condition Acuity Level Intermediate Acuity Level Critical

Acuity Level Floor Status

Communication

Code Status Code Status: Full Code Code Status: DNR - Do Not Resuscitate Code Status: DNI - Do Not Intubate Code Status: DNR/DNI - Do Not Resuscitate or Intubate Code Status: Partial Resuscitative Effort

Notify Provider/Primary Team of Pt Admit In AM Upon Arrival to Unit Now

MedicationsMedication sentences are per dose. You will need to calculate a total daily dose if needed.

SIRS: Meets two or more of the following criteria: - HR greater than 90 bpm -Temperature greater than 100.4 F (38 C) or less than 96.8 F (36 C) - WBC greater than 12.000 or less than 4000 -RR greater than 20 per min or PaCO2 less than 32 mmhg

Sepsis: SIRS + Infection Confirmed Infection or Suspected Infection

Initiate antibiotics within three hours of an EC Admission or one hour of an ICU Transfer.

Follow up with cultures and sensitivity results and adjust antibiotics accordingly.

ANTIBIOTICS AS FOLLOWS: (Consult pharmacy for appropriate dosing based on age, weight, and renal function.

Consult Pharmacy Reason: Dose Medication

Antibiotics

Sepsis Antibiotics Reference ***See Reference Text***

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Order Taken by Signature: _________________________________________________________________________ Date ____________________________ Time ____________________________

Physician Signature: ___________________________________________________________________________ Date ____________________________ Time ____________________________

Page: 1 of 17 Admit Sepsis Plan Version: 6 Effective on: 08/12/15

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Dx ________________________________________________


Admit Sepsis Plan - When Pt. Arrives to Room

PHYSICIAN ORDERS


ORDER ORDER DETAILS

Patient Care

Vital Signs Per Unit Standards

Patient Activity Bedrest Bedrest | Bathroom Privileges

Bedrest | Up to Bedside Commode Only Up Ad Lib/Activity as Tolerated | Assist as Needed

ICU Progressive Mobility Protocol ***See Reference Text***

Set Up for Central Line Placement

Obtain Consent Consent for: Central Line Insertion

Set Up for Arterial Line Placement

Obtain Consent Consent for: Arterial Line Insertion

Insert Urinary Catheter Criticore, To: Dependent Drainage Bag Foley, To: Dependent Drainage Bag

Urinary Catheter Care

Central Venous Pressure Monitoring (CVP Monitoring) Per Unit Standards Per Unit Standards with ScvO2

Apply Minimally Invasive Hemodynamic Mon (Apply Minimally Invasive Hemodynamic Monitoring Device)

Strict Intake and Output

Sepsis PCT Algorithm ***See Reference Text***

Communication

Notify Provider of VS Parameters Temp Greater Than 100.4, Temp Less Than 96.8, RR Greater Than 20, MAP Less Than 65, ScvO2 less than 70%

Notify Provider (Misc) (Notify Provider of Results) Reason: WBC greater than 12,000 or less than 4,000.

Notify Provider (Misc) (Notify Provider of Results) Reason: PaCO2 less than 32 mmhg

Notify Provider (Misc) Reason: Urine Output less than 0.5 mL/kg/hr

SIRS: Meets two or more of the following criteria: - HR greater than 90 bpm -Temperature greater than 100.4 F (38 C) or less than 96.8 F (36 C) - WBC greater than 12.000 or less than 4000 -RR greater than 20 per min or PaCO2 less than 32 mmhg

Sepsis: SIRS + Infection Confirmed Infection or Suspected Infection

Dietary





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PHYSICIAN ORDERS


ORDER ORDER DETAILS

Oral Diet Regular Diet Full Liquid Diet Clear Liquid Diet Mechanically Altered Diet Renal Diet AHA Diet

ADA Diet 1800 Calories, AHA 1600 Calories, AHA 1800 Calories 1600 Calories

NPO Diet NPO NPO, Except Meds

NPO, Except Ice Chips NPO, Except Meds, Except Ice Chips

IV Solutions

NS (NS bolus) 20 mL/kg, IVPB, iv soln, ONE TIME, Infuse over 30 min

NS IV, mL/hr IV, 200 mL/hr IV, 150 mL/hr IV, 125 mL/hr IV, 75 mL/hr


Initiate antibiotics within three hours of an EC Admission or one hour of an ICU Transfer.

Notify Provider (Misc) Reason: Patient has arrived to unit

Follow up with cultures and sensitivity results and adjust antibiotics accordingly.

ANTIBIOTICS AS FOLLOWS: (Consult pharmacy for appropriate dosing based on age, weight, and renal function.

Consult Pharmacy Reason: Dose Medication

GI Prophylaxis

pantoprazole 40 mg, PO, tab ec, Daily Do not crush or chew. 40 mg, per tube, liq, Daily **Follow Administration Instructions Carefully**

With a nasogastric (NG) tube or gastrostomy tube in place: Remove the plunger from the barrel of a 60 mL catheter-tip syringe. Throw away the plunger.

Connect the catheter tip of the syringe to a 16 French (or larger) tube. Hold the syringe attached to the tubing as high as possible

while giving PROTONIX oral suspension to prevent any bending of the tubing. Empty the contents of the packet into the barrel of the syringe.

Add 10 mL of apple juice and gently tap or shake the barrel of the syringe to help empty the syringe. Do this again at least two more times using the same amount of apple juice (10 mL) each time. No granules should be left in the syringe. 40 mg, IVPush, inj, Daily

IVP over 2 min. Reconstitute with 10mL NS. Stable for 2 hrs at room temp after reconstitution.

Blood Pressure Management





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PHYSICIAN ORDERS


ORDER ORDER DETAILS

norepinephrine 4 mg/250 mL D5W Start at rate:______________mcg/min IV

Notify Nurse (DO NOT USE FOR MEDS) Notify provider if needing to add another vasopressor.

Laboratory

CBC with Differential

Prothrombin Time with INR

PTT

Comprehensive Metabolic Panel

Lactic Acid Level Routine q6h for 24 hr

Magnesium Level

Phosphorus Level

CKMB

CK

Troponin T

Cortisol Random

Microbiology/Virology

Notify Nurse (DO NOT USE FOR MEDS) Obtain all cultures prior to starting antibiotics.

Culture Blood

Culture Blood

Culture Sputum with Gram Stain

Culture Urine

Culture Wound with Gram Stain

Diagnostic Tests

DX Chest Portable

EKG-12 Lead

Respiratory

Respiratory Care Plan Guidelines

Arterial Blood Gas Additional Tests: Lactate

Physical Medicine and Rehab

Consult Occ Therapy for Eval & Treat

Consult PT Mobility for Eval & Treat

...Additional Orders





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Admit Sepsis Plan - When Pt. Arrives to Room - Type and Screen Plan

PHYSICIAN ORDERS


ORDER ORDER DETAILS

Laboratory

BB Blood Type (ABO/Rh)

BB Antibody Screen





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Admit Sepsis Plan - When Pt. Arrives to Room - VTE Prophylaxis Plan

PHYSICIAN ORDERS


ORDER ORDER 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 Patient low risk for VTE Patient is ambulatory Patient Refusal Family/Caregiver Refusal

Cont IV heparin day of/after admission Anticoag therapy not warfarin for Afib Warfarin prior to admit; on hold r/t INR Risk of Bleeding Thrombocytopenia Active Bleeding Alteplase Administered w/in 24 hrs IV Heparin w/in 24 hrs of Surgery

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


***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/hr 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

***If you order RIVAROXABAN for your patient, please indicate the reason below***





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Admit Sepsis Plan - When Pt. Arrives to Room - VTE Prophylaxis Plan

PHYSICIAN ORDERS


ORDER ORDER DETAILS

Reason for Oral Factor Xa Inhibitor Reason: Atrial fibrillation Reason: Persistent atrial fibrillation Reason: Paroxysmal atrial fibrillation Reason: Atrial flutter

Reason: Hx Afib/flutter - NA w/in 8wks post CABG Reason: Partial hip arthroplasty Reason: Total hip arthroplasty Reason: Total hip replacement Reason: Total knee arthroplasty Reason: Total knee replacement

rivaroxaban 10 mg, PO, tab, In PM 20 mg, PO, tab, In PM, for A-fib/Secondary Prevention for DVT

warfarin 5 mg, PO, tab, QPM

aspirin 81 mg, PO, tab chew, Daily 325 mg, PO, tab, Daily





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UMC Health System

Admit Sepsis Plan - When Pt. Arrives to Room-

SLIDING SCALE INSULIN PROTOCOL PLAN

PHYSICIAN ORDERS

Weight ____________________________________________ Allergies ________________________________________________________


ORDER ORDER 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 Protocol Follow SSI Reference Text


insulin regular (Low Dose Insulin Sliding Scale) 0-10 units, subcut, inj, AC & nightly, PRN glucose levels - see parameters

Low Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician

70-110 - 0 units; 111-150 - 0 units; 151-200 - 2 units subQ; 201-250 - 3 units subQ; 251-300 - 4 units subQ; 301-350 - 6 units subQ; 351-400 - 8 units subQ;

Greater than 400 - 10 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physician. 0-10 units, subcut, inj, q6h, PRN glucose levels - see parameters

Low Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician


Greater than 400 - 10 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physician. 0-10 units, subcut, inj, q4h, PRN glucose levels - see parameters

Low Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician 70-110 - 0 units; 111-150 - 0 units; 151-200 - 2 units subQ; 201-250 - 3 units subQ; 251-300 - 4 units subQ; 301-350 - 6 units subQ; 351-400 - 8 units subQ;Greater than 400 - 10 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physician.



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Patient Label Here

Dx _____________________________________________________

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Patient Label Here UMC Health System



PHYSICIAN ORDERS


ORDER ORDER DETAILS

0-10 units, subcut, inj, q2h, PRN glucose levels - see parameters Low Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician


Greater than 400 - 10 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physician. 0-10 units, subcut, inj, TID, PRN glucose levels - see parameters Low Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician


Greater than 400 - 10 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physician. 0-10 units, subcut, inj, BID, PRN glucose levels - see parameters Low Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician


Greater than 400 - 10 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physician.





UMC Health System



PHYSICIAN ORDERS


ORDER ORDER DETAILS

insulin regular (Moderate Dose Insulin Sliding Scale) 0-12 units, subcut, inj, AC & nightly, PRN glucose levels - see parameters Moderate Dose Insulin Sliding Scale

Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician

70-110 - 0 units; 111-150 - 2 units subQ; 151-200 - 3 units subQ; 201-250 - 4 units subQ; 251-300 - 6 units subQ; 301-350 - 8 units subQ;

351-400 - 10 units subQ; Greater than 400 - 12 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300; then resume normal accucheck and sliding scale routine. Call physician. 0-12 units, subcut, inj, q6h, PRN glucose levels - see parameters Moderate Dose Insulin Sliding Scale









351-400 - 10 units subQ;

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Patient Label Here






PHYSICIAN ORDERS


ORDER ORDER DETAILS

0-12 units, subcut, inj, TID, PRN glucose levels - see parameters Moderate Dose Insulin Sliding Scale



351-400 - 10 units subQ; Greater than 400 - 12 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300; then resume normal accucheck and sliding scale routine. Call physician. 0-12 units, subcut, inj, BID, PRN glucose levels - see parameters Moderate Dose Insulin Sliding Scale



351-400 - 10 units subQ; Greater than 400 - 12 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300; then resume normal accucheck and sliding scale routine. Call physician.

insulin regular (High Dose Insulin Sliding Scale) 0-14 units, subcut, inj, AC & nightly, PRN glucose levels - see parameters High Dose Insulin Sliding Scale


70-110 - 0 units; 111-150 - 3 units subQ; 151-200 - 4 units subQ; 201-250 - 6 units subQ; 251-300 - 8 units subQ;

301-350 - 10 units subQ; 351-400 - 12 units subQ; Greater than 400 - 14 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physician 0-14 units, subcut, inj, q6h, PRN glucose levels - see parameters High Dose Insulin Sliding Scale

Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician; 70-110 - 0 units; 111-150 - 3 units subQ; 151-200 - 4 units subQ; 201-250 - 6 units subQ; 251-300 - 8 units subQ;

301-350 - 10 units subQ; 351-400 - 12 units subQ;

Order Take By Signature: __________________________________________________________________________ Date ____________________________ Time____________________________

Physician Signature: ____________________________________________________________________________ Date ____________________________ Time ____________________________


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PHYSICIAN ORDERS


ORDER ORDER DETAILS

0-14 units, subcut, inj, q4h, PRN glucose levels - see parameters High Dose Insulin Sliding Scale

Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician;


301-350 - 10 units subQ; 351-400 - 12 units subQ; Greater than 400 - 14 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physician 0-14 units, subcut, inj, q2h, PRN glucose levels - see parameters High Dose Insulin Sliding Scale



301-350 - 10 units subQ; 351-400 - 12 units subQ; Greater than 400 - 14 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physician 0-14 units, subcut, inj, TID, PRN glucose levels - see parameters High Dose Insulin Sliding Scale


70-110 - 0 units; 111-150 - 3 units subQ; 151-200 - 4 units subQ; 201-250 - 6 units subQ; 251-300 - 8 units subQ; 301-350 - 10 units subQ; 351-400 - 12 units subQ; Greater than 400 - 14 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physician 0-14 units, subcut, inj, BID, PRN glucose levels - see parameters

High Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician.

70-110 - 0 units; 111-150 - 3 units subQ;

151-200 - 4 units subQ; 201-250 - 6 units subQ; 251-300 - 8 units subQ; 301-350 - 10 units subQ; 351-400 - 12 units subQ; Greater than 400 - 14 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physician.

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PHYSICIAN ORDERS


ORDER ORDER DETAILS

insulin regular (Blank Insulin Sliding Scale) See Comments, subcut, inj, PRN glucose levels - see parameters Blood glucose is less than ___; Initiate hypoglycemic protocol and Call physician; 70-110 - __ units;

111-150 - __ units subQ; 151-200 - __ units subQ; 201-250 - __ units subQ; 251-300 - __ units subQ; 301-350 - __ units subQ; 351-400 - __ units subQ; Greater than 400 - __ units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG less than ___, then resume normal accucheck and sliding scale routine. Call physician

HYPOglycemia Protocol

HYPOglycemia Protocol If BS is less than 70 mg/dL, and patient SYMPTOMATIC, give 6 oz. of juice PO (if applicable) and/or follow HYPOglycemia Protocol meds.

glucose (D50) 25 g, IVP, syringe, as needed, PRN glucose levels - see parameters Patient unable to swallow / NPO WITH IV access. Dextrose 50% 50 mL IV.

Recheck BG in 15 -20 minutes. Repeat treatment until blood glucose greater than 100 mg/dL. If not NPO provide additional snack once able to swallow.

glucose 15 g, PO, gel, as needed, PRN glucose levels - see parameters

glucagon 1 mg, IM, inj, as needed, PRN glucose levels - see parameters

Patient UNABLE to swallow / NPO WITHOUT IV access. Administer Glucagon 1 mg IM or SubQ. Contact physician for further orders. Establish IV access with saline lock. Recheck BG every 15 to 20 minutes. Use aspiration precautions as glucagon may cause nausea and vomiting.






Admit Sepsis Plan - When Pt. Arrives to Room - Discomfort Med Plan

PHYSICIAN ORDERS


ORDER ORDER 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.


phenol-menthol topical (phenol-menthol 2.9%-0.12% (Cepastat) lozenge) 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*****





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PHYSICIAN ORDERS


ORDER ORDER 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*****





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PHYSICIAN ORDERS


ORDER ORDER 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





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PHYSICIAN ORDERS


ORDER ORDER 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





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admit sepsis plan - begin immediately - lubbock,...

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