hemorrhagic stroke plan - university medical center · umc health system patient label here...

UMC Health System Patient Label Here

HEMORRHAGIC STROKE PLAN

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

Patient Status Pt Status: Inpatient (LOS > 2 midnights) Pt Status: Observation (LOS < 2 midnights)

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

Patient Care

Vital Signs Per Unit Standards, Every 15 min x 2 hrs; then every 30 min x 6 hrs; then every 1 hr x 16 hrs

Perform Neurological Checks See Special Instructions, Every 15 min x 2 hrs; then every 30 min x 6 hrs; then every 1 hr x 16 hrs

Daily Weight

Nursing Swallowing Screen Perform prior to PO intake. If pt fails swallow screening order Swallow Evaluation by Speech Language Pathology.

Patient Activity Bedrest, Bed Position: HOB Greater Than or Equal to 30 degrees Assist as Needed, Bed Position: HOB Greater Than or Equal to 30 degrees Up to Bedside Commode Only, Bed Position: HOB Greater Than or Equal to 30 degrees

Seizure Precautions

Strict Intake and Output Per Unit Standards

Continuous Telemetry (Intermediate Care)

Intermittent Telemetry

Communication

Notify Nurse (DO NOT USE FOR MEDS) Complete a Stroke Scale at onset of symptoms, at discharge, and with any change in neuro status.

Notify Provider of VS Parameters (Notify Provider if VS) Temp Greater Than 101, RR Greater Than 24, RR Less Than 10, SpO2 Less Than 90, SBP Greater Than 150, SBP Less Than 90, DBP Greater Than 100, DBP Less Than 50, HR Greater Than 120, HR Less Than 50

Notify Provider (Misc) Reason: Change in neurological status, problems swallowing, or signs of bleeding.

Dietary

Please choose only ONE diet type below.

NPO Diet T;N, NPO, until AFTER swallow/dysphagia screening performed.

TO Read Back Scanned Powerchart Scanned PharmScan

Order Taken by Signature: _________________________________________________________________________ Date ____________________________ Time ____________________________

Physician Signature: ___________________________________________________________________________ Date ____________________________ Time ____________________________

Page: 1 Hemorrhagic Stroke Plan Version: 4 Effective on: 09/12/14

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PHYSICIAN ORDERS


ORDER ORDER DETAILS

Oral Diet Clear Liquid Diet Full Liquid Diet Regular Diet AHA Diet

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

IV Solutions

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

NS + 20 mEq KCl/L IV, 75 mL/hr IV, 125 mL/hr IV, 150 mL/hr IV, 200 mL/hr IV, mL/hr

NS + 40 mEq KCl/L IV, 75 mL/hr IV, 125 mL/hr IV, 150 mL/hr IV, 200 mL/hr IV, mL/hr

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

mannitol (mannitol 20% intravenous solution) 0.25 g/kg, IVPB, iv soln, ONE TIME, Infuse over 30 min g, IVPB, iv soln

Vasoactive Agents

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

phenylephrine 10 mg/250 mL NS Start at rate:______________mcg/min IV

DOPamine 400 mg/250 mL D5W Start at rate:______________mcg/kg/min IV

Blood Pressure Management

labetalol 10 mg, IVPush, inj, q10min, PRN other To maintain MAP < 130 mmHg in patients with history of hypertension OR MAP < 110 mmHg in the immediate postoperative period. mg, IVPush, inj To maintain MAP < 130 mmHg in patients with history of hypertension OR MAP < 110 mmHg in the immediate postoperative period.





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PHYSICIAN ORDERS


ORDER ORDER DETAILS

enalapril 1.25 mg, IVPush, inj, q6h, PRN hypertension To maintain MAP < 130 mmHg in patients with history of hypertension OR MAP < 110 mmHg in the immediate postoperative period. 1.25 mg, IVPush, inj, q4h, PRN hypertension To maintain MAP < 130 mmHg in patients with history of hypertension OR MAP < 110 mmHg in the immediate postoperative period. mg, IVPush, inj, q6h, PRN hypertension To maintain MAP < 130 mmHg in patients with history of hypertension OR MAP < 110 mmHg in the immediate postoperative period. mg, IVPush, inj, q4h, PRN hypertension To maintain MAP < 130 mmHg in patients with history of hypertension OR MAP < 110 mmHg in the immediate postoperative period.

hydrALAZINE 10 mg, IVPush, inj, q6h, PRN hypertension To maintain MAP < 130 mmHg in patients with history of hypertension OR MAP < 110 mmHg in the immediate postoperative period. 10 mg, IVPush, inj, q4h, PRN hypertension To maintain MAP < 130 mmHg in patients with history of hypertension OR MAP < 110 mmHg in the immediate postoperative period. mg, IVPush, inj, q6h, PRN hypertension To maintain MAP < 130 mmHg in patients with history of hypertension OR MAP < 110 mmHg in the immediate postoperative period. mg, IVPush, inj, q4h, PRN hypertension To maintain MAP < 130 mmHg in patients with history of hypertension OR MAP < 110 mmHg in the immediate postoperative period.

niCARdipine 20 mg/200 mL IV Final concentration = 0.1 mg/mL (100 mcg/mL). Usual Dose Range is 5-15 mg/hr. Notify physician if administered dose (rate) is greater than the usual dose range. Start at rate:______________mg/hr

nitroPRUSSIDE 50 mg/250 mL D5W IV Final Concentration = 0.2 mg/mL (200 mcg/mL). Usual Dose Range is 0.1 - 10 mcg/kg/min. Protect from Light. Notify physician if administered dose (rate) is greater than the usual dose range. Start at rate:______________mcg/kg/min

Lipid Management

Contraindications Statins Hypersensitivity Intolerance(myopathy, myalgia, myositis) Liver disease or elevated transaminases Other





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PHYSICIAN ORDERS


ORDER ORDER DETAILS

simvastatin 5 mg, PO, tab, Nightly 10 mg, PO, tab, Nightly 20 mg, PO, tab, Nightly 40 mg, PO, tab, Nightly 80 mg, PO, tab, Nightly

atorvastatin 10 mg, PO, tab, Nightly 20 mg, PO, tab, Nightly 40 mg, PO, tab, Nightly 80 mg, PO, tab, Nightly

Antiepileptics

fosphenytoin 17 mg/kg, IVPB, ivpb, ONE TIME Infuse over 10 minutes

OR:

fosphenytoin mg, IVPB, ivpb Infuse over 10 minutes

phenytoin mg, IVPush, inj

levETIRAcetam mg, IVPB, ivpb

Laboratory

CBC with Differential Next Day in AM, T+1;0300

Sed Rate Next Day in AM, T+1;0300

Prothrombin Time with INR Next Day in AM, T+1;0300

PTT Next Day in AM, T+1;0300

Lipid with Calculated LDL Next Day in AM, T+1;0300, Comment: FASTING

Comprehensive Metabolic Panel Next Day in AM, T+1;0300

Basic Metabolic Panel Next Day in AM, T+1;0300

Magnesium Level Next Day in AM, T+1;0300

Phosphorus Level Next Day in AM, T+1;0300





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PHYSICIAN ORDERS


ORDER ORDER DETAILS

Phenytoin Level Total (Dilantin Level) Next Day in AM, T+1;0300

Syphilis Screen Next Day in AM, T+1;0300

***Perform pregnancy test if patient is premenopausal female.***

Beta HCG Serum Qualitative STAT

Diagnostic Tests

Echo Transthoracic (TTE) with contrast i (Echo Transthoracic (TTE) with contrast if needed)

EKG-12 Lead

VL Carotid Doppler (Vascular Lab)

DX Chest PA & Lateral

CT Head w/o Other (specify below), Hemorrhagic Stroke Evaluation

CT Head w/

MRI Head w/o

MRI Head w/

MRA Head w/o

Modified Barium Swallow

Respiratory

Respiratory Care Plan Protocol

Arterial Blood Gas

Physical Medicine and Rehab

Consult Speech Therapy for Eval & Treat Swallow Evaluation & Treatment, Hemorrhagic Stroke Evaluation

Consult PT Mobility for Eval & Treat Hemorrhagic Stroke Evaluation

Consult Occ Therapy for Eval & Treat Hemorrhagic Stroke Evaluation

Consults/Referrals

Consult MD Service: Neurology, Reason: Hemorrhagic Stroke Evaluation

Consult MD Service: Neurosurgery, Reason: Hemorrhagic Stroke Evaluation

Consult Dietician for Other Nutrition Ne (Consult Dietician for Other Nutrition Needs) Hemorrhagic Stroke Evaluation

...Additional Orders





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PHYSICIAN ORDERS


ORDER ORDER DETAILS





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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, q24h 30 mg, subcut, syringe, q12h 40 mg, subcut, syringe, q12h

heparin 5,000 units, subcut, inj, q12h 5,000 units, subcut, inj, q8h

fondaparinux 2.5 mg, subcut, syringe, Daily

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





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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

warfarin 5 mg, PO, tab, QPM

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





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SLIDING SCALE INSULIN PROTOCOL PLAN

PHYSICIAN ORDERS


ORDER ORDER DETAILS

Patient Care

Accucheck 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

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, 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.Continued on next page....TO Read Back Scanned Powerchart Scanned PharmScan




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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

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, 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

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, 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

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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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 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.Continued on next page....





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PHYSICIAN ORDERS


ORDER ORDER DETAILS

0-12 units, subcut, inj, TID, 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, BID, 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.

insulin regular (High Dose Insulin Sliding Scale) 0-14 units, subcut, inj, AC & nightly, 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 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; 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 physicianContinued on next page....





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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;

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, q2h, 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 0-14 units, subcut, inj, TID, 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 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 physicianContinued on next page....TO Read Back Scanned Powerchart Scanned PharmScan




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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.





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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, 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, q4h, PRN cough

dexamethasone-diphenhydrAMIN-nystatin-NS (Fred’s Brew) 15 mL, swish & spit, q2h, PRN mucositis While awake

lidocaine topical (Lidocaine Viscous 2% mucous membrane solution) 15 mL, swish & spit, q4h, PRN mucositis While awake

Analgesics

acetaminophen 1,000 mg, PO, tab, q4h, PRN pain-mild, Pain 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:***** 500 mg, PO, tab, q4h, PRN pain-mild, Pain 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, Pain 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:*****

*****IF acetaminophen ineffective/contraindicated, USE ibuprofen if ordered:*****

ibuprofen 400 mg, PO, tab, q6h, PRN pain-mild, Pain Scale 1-3 ***Do not exceed 3,200 mg of ibuprofen from all sources in 24 hours*** Give with food. Use if acetaminophen is ineffective or contraindicated.

HYDROcodone-acetaminophen (HYDROcodone-acetaminophen 5 mg-325 mg oral tablet) 2 tab, PO, tab, q4h, PRN pain-moderate, Pain 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***** 1 tab, PO, tab, q4h, PRN pain-moderate, Pain 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*****Continued on next page....





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DISCOMFORT MED PLAN

PHYSICIAN ORDERS


ORDER ORDER DETAILS

*****IF HYDROcodone-acetaminophen ineffective/contraindicated or NPO, USE ketorolac if ordered*****

ketorolac 30 mg, IVPush, inj, q6h, PRN pain-moderate, x 48 hr, Pain Scale 4-7 ***May give IM if no IV access*** Use if HYDROcodone-acetaminophen (Lortab) ineffective or contraindicated. 15 mg, IVPush, inj, q6h, PRN pain-moderate, x 48 hr, Pain Scale 4-7 ***May give IM if no IV access*** Use if HYDROcodone-acetaminophen (Lortab) ineffective or contraindicated.

morphine 4 mg, IVPush, inj, q4h, PRN pain-severe, Pain Scale 8-10 ***Slow IV Push*** *****IF morphine is ineffective/contraindicated, USE HYDROmorphone if ordered***** 2 mg, IVPush, inj, q4h, PRN pain-severe, Pain Scale 8-10 ***Slow IV Push*** *****IF morphine is ineffective/contraindicated, USE HYDROmorphone if ordered*****

*****IF morphine is ineffective/contraindicated, USE HYDROmorphone if ordered.*****

HYDROmorphone 1 mg, IVPush, inj, q4h, PRN pain-severe, Pain 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*****

*****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*****

*****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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DISCOMFORT MED PLAN

PHYSICIAN ORDERS


ORDER ORDER DETAILS

*****IF bisacodyl is contraindicated or ineffective after 6 hours, USE Fleet Enema if ordered*****

sodium biphosphate-sodium phosphate (Fleet Enema) 1 ea, rectally, enema, Daily, PRN constipation *****IF bisacodyl is contraindicated or ineffective after 6 hours, USE Fleet Enema if ordered*****

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 160 mg, PO, tab chew, q4h, PRN gas 80 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*****

*****IF ALPRAZolam is ineffective/contraindicated or patient is NPO, USE LORazepam if ordered*****

LORazepam 1 mg, IVPush, inj, q6h, PRN anxiety *****IF ALPRAZolam is ineffective/contraindicated or patient is NPO, USE LORazepam if ordered***** 0.5 mg, IVPush, inj, q6h, PRN anxiety *****IF ALPRAZolam is ineffective/contraindicated or patient is NPO, USE LORazepam if ordered*****

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*****





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DISCOMFORT MED PLAN

PHYSICIAN ORDERS


ORDER ORDER DETAILS

*****IF diphenhydrAMINE PO is ineffective or patient is NPO, USE diphenhydrAMINE injection if ordered*****

diphenhydrAMINE 25 mg, IVPush, inj, q4h, PRN itching *****IF diphenhydrAMINE PO is ineffective or patient is NPO, USE diphenhydrAMINE injection if ordered*****

Anti-pyretics

acetaminophen 1,000 mg, PO, tab, q4h, PRN fever ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF acetminophen is ineffective/contraindicated, USE ibuprofen if ordered***** 500 mg, PO, tab, q4h, PRN fever ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF acetminophen is ineffective/contraindicated, USE ibuprofen if ordered*****

*****IF acetminophen is ineffective/contraindicated, USE ibuprofen if ordered*****

ibuprofen 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. 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.

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*****

*****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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hemorrhagic stroke plan - university medical center · umc health system patient label here...

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