meditech template order sets - observation manual · page 16 of 51 tia general • neuro status...
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Meditech Template Order Sets September 2016
Table of Contents General Orders ............................................................................................................................................ 2 Chest Pain .................................................................................................................................................... 6 Asthma / COPD ........................................................................................................................................... 9 Syncope ..................................................................................................................................................... 11 GU Infection / Stone .................................................................................................................................. 12 Hypo / Hyperglycemia ............................................................................................................................... 14 Insulin Sliding Scale ................................................................................................................................... 15 TIA ............................................................................................................................................................. 16 Pyelnephritis .............................................................................................................................................. 19 Soft Tissue Infection ................................................................................................................................... 20 DVT ............................................................................................................................................................ 22 Closed Head Injury .................................................................................................................................... 24 GI / Hyperemesis ....................................................................................................................................... 25 SVT / Tachyarrhythmia ............................................................................................................................... 30 GI Bleed ..................................................................................................................................................... 32 CHF ............................................................................................................................................................ 34 Pneumonia ................................................................................................................................................. 39 Headache ................................................................................................................................................... 42 Allergic Reaction ........................................................................................................................................ 43 Pharyngitis / Tonsillitis ............................................................................................................................... 44 Low Back Pain ............................................................................................................................................ 45 Anemia ....................................................................................................................................................... 48 Diverticulitis ............................................................................................................................................... 49 Dizzy / Vertigo ........................................................................................................................................... 50 Hypetension Urgency ................................................................................................................................ 51
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General Orders
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Chest Pain
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Asthma / COPD
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Syncope
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GU Infection / Stone
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Hypo / Hyperglycemia
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Insulin Sliding Scale
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TIAGeneral
• Neuro Status Monitoring, Order every 2 hours for 24 hours, then every 4 hours • NIH Stroke Scale Order • On admission, with new onset of symptoms, and daily with morning assessment
Medications
• Anticoagulants o LowMolecularWeight Heparins
§ Enoxaparin - 1 milligram/kilogram subcutaneously every 12 hours 1 milligram/kilogram subcutaneously once a day
o Unfractionated Heparin § Heparin - 5000 unit subcutaneously every 8 hours
• Antihypertensives: o AngiotensinConverting Enzyme Inhibitors
§ Lisinopril - 5 milligram orally once a day 10 milligram orally once a day 20 milligram orally once a day 40 milligram orally once a day
o BetaBlockers § Metoprolol tartrate - 25 milligram orally 2 times a day 50 milligram orally
2 times a day 100 milligram orally 2 times a day • LipidRegulating Agents:
o Patients with cerebrovascular disease in the presence of CHD or symptomatic atherosclerotic disease should be treated with an HMGCoA reductase inhibitor to reduce LDLC levels to less than 100 mg/dL (2.59 mmol/L; less than 70 mg/dL [1.813 mmol/L] for veryhighrisk patients); secondary goals of therapy include normalizing triglycerides and reducing non–HDLC levels to less than 130 mg/dL (3.367 mmol/L)
o HMGCoA Reductase Inhibitors § Pravastatin - 10 milligram orally once a day, in the evening 20 milligram
orally once a day, in the evening 40 milligram orally once a day, in the evening
§ Atorvastatin - 40 milligram orally once a day, in the evening • Platelet Inhibitors:
o Avoid the use of GpIIbIIIa receptor inhibitors outside the setting of a clinical trial
o For patients with acute ischemic stroke, do not use clopidogrel alone or in combination with aspirin within 48 hours of symptom onset
o Combination Agents § Aggrenox - 1 capsule orally 2 times a day
o Salicylates § Aspirin should be administered within 48 hours of admission and
prescribed upon discharge for patients who do not have an
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indication for warfarin (eg: nonrheumatic atrial fibrillation, atrial flutter, or prosthetic heart valves)
§ Aspirin - 81 milligram orally once a day 325 milligram orally once a day § Aspirin - 300 milligram rectally once a day for patients that are NPO
o Thienopyridines § Clopidogrel - 75 milligram orally once a day
Laboratory • Cardiac Markers
o TroponinI - every 3 hours times 2, draw now and in 3 hours • Chemistry
o Homocysteine, serum o Thyroid stimulating hormone (TSH) o Aspartate aminotransferase (AST) if not done in ED o Alanine aminotransferase (ALT) if not done in ED
• Hematology o Avoid the routine ordering of tests to identify coagulation defects (eg,
activated protein C resistance/factor V Leiden mutation, anticardiolipin antibodies, lupus anticoagulant, protein C deficiency, protein S deficiency)
o Erythrocyte sedimentation rate (ESR) o Platelet count, automated o Prothrombin time (PT) and international normalized ratio (INR) Partial
thromboplastin time (PTT), activated • Microbiology
o Culture, blood Culture, urine • Panels
o Lipid panel • Urine Studies
o Toxicology drug screen o URINALYSIS W/ REFLEX CULTURE o URINALYSIS CATH W/ REFLEX CULTURE
• Radiology o CTA,NECK o CT,BRAIN W/WO CONTRAST
• General Radiography o Avoid the routine use of a chest radiograph o PORTABLE, CHEST SINGLE VIEW o XR, CHEST 2 VIEWS
• Magnetic Resonance Studies o MRI,HEAD WO/W, o MRA HEAD, NECK if no contraindications to gadolinium o MRI,HEAD W/WO CONTRAST o MRI,HEAD W/O CONTRAST o MRA,HEAD ANGIO W/WO CONTRAST
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o MRA,NECK ANGIO WITH CONTRAST • Ultrasonography
o US,CAROTID DUPLEX BILATERAL • Diagnostic Tests
o Cardiology § 12lead ECG § 2D ECHO W/DOPP AND COLOR FLOW § 2D ECHO W/DOPP AND COLOR FLOW with bubble study
• Consults o Consult to cardiology o Consult to neurology
• Nursing Orders Assessments o Patients with ischemic stroke should undergo a swallowing study before
taking any foods, fluids, or medications by mouth o Dysphagia screening order
• Contingency o Notify provider if blood glucose is less than 80 or greater than 140
milligram/deciliter of any increase in NIH Stroke score • Interventions
o Antiembolism Stockings Knee high
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Pyelnephritis
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Soft Tissue Infection
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DVT
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Closed Head Injury
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GI / Hyperemesis
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SVT / Tachyarrhythmia
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GI Bleed
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-the rest of the Blood Product order set is there just not on the screenshot
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CHF
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Pneumonia
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Headache
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Allergic Reaction
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Pharyngitis / Tonsillitis
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Low Back Pain
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Anemia
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Diverticulitis
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Dizzy / Vertigo
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Hypetension Urgency
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