Pneumonia Admission

Patient Name: HEOTEST, TOMMY

Age: 34 years Gender: M Location: 2WB W235 01 Height: 185.4 cm Weight: 79.5 kgs BMI: 23.1 Serum Creatinine: ?? Date Drawn: 09/09/2011 06:35am
Ordering Clinician: PATERSON

Admission

Admit to provider:
Patient Status:
Location or specify in blank: (specify):
Telemetry monitoring
Condition:
Provider must sign paper Resuscitation Status Order Set for DNR
Code status:
Isolation precautions:

Diagnosis

Diagnosis:

Consents and Consults

Consult pulmonology (specify reason and group):
Consult infectious disease (specify reason and group):
Consult hospitalist (specify reason and group):
Other (specify reason and group):

Vital Signs

Vital signs

Allergies

Add allergy:
Remove allergy:

Activity

Up ad lib
Ambulate in hall
Ambulate with assist
Up to chair
Ambulate and up to chair
Out of bed with assist
Bedrest with BRP
Bedrest with BSC
Bedrest

Nursing Orders

Launch DVT Prophylaxis iForm
Document immunization status for pneumococcal and flu vaccine
Fluzone: Influenza vaccine per CDC guidelines if not contraindicated 0.5 ML IM ONCE prior to discharge
Pneumovax: Pneumococcal vaccine per CDC guidelines if not contraindicated 0.5 ML IM ONCE prior to discharge
Measure weight and record in kilograms
Record height
Launch blood glucose management iForm for ordering insulin and finger stick blood sugar
Measure intake and output
Insert IV with site care management
Insert INT with site care management
Insert urinary cath with cath care management
Bladder scan
Straight cath
Turn, cough and deep breathe
Collect sputum in bedside cup for observation and remove cup daily
Elevate HOB greater than or equal to 30 degrees

Respiratory

RT will manage oxygen per RT protocol if evaluate and treat is selected

Xopenex reminder - assess the patient for risk of adverse side effects from Albuterol and order xopenex outside of this orderset

Respiratory therapy to evaluate and treat
Oxygen per protocol
Oxygen via nasal cannula, adjust to keep oxygen saturation greater than 90 percent
Oxygen via Venturi mask
Oxygen via nonrebreather mask
High humidity
CPAP/BIPAP via home settings
Continuous positive airway pressure (CPAP) specify settings
Biphasic positive airway pressure (BIPAP) specify settings
Check pulse oximetry
Continuous pulse oximetry
Incentive spirometry Q2H
Arterial blood gas
Flutter valve
Peak flows
Metered dose inhaler education before discharge
Institute oxygen weaning to home baseline O2 rate
Titrate O2 to keep sat greater than 90 percent
Launch respiratory iForm

albuterol 0.5% soln for neb [PROVENTIL, VENTOLIN] 2.5 MG INHALATION
albuterol 0.5% soln for neb [PROVENTIL, VENTOLIN] 2.5 MG INHALATION Q2H PRN for shortness of breath or wheezing
ipratropium soln for neb [ATROVENT] 0.5 MG INHALATION
ipratropium soln for neb [ATROVENT] 0.5 MG Q2H INHALATION PRN for shortness of breath or wheezing
budesonide respules [PULMICORT] 0.5 MG Q12H INHALATION

Diet

NPO NOW
NPO after midnight
Clear liquid
Full liquid
Regular
Diabetic
Cardiac, includes low sodium, low cholesterol
Launch diet iForm for additional diets including tube feeding

IV Fluids

None
NS
1/2 NS
D5W
D5W NS
D5W 1/2 NS
LR
Choose rate: ML/HR Other: ML/HR
Add 20 MEQ potassium chloride to each liter
Launch IV fluid iForm for additional IV fluid choices

Special Studies

General Radiology

Chest single view, portable Reason:
Chest single view, portable Reason:
Chest PA and lateral Reason:
Chest PA and lateral Reason:
Abdominal single view (KUB)
Abdominal single view (KUB) NEXT AM
Reason for abdominal exam:

Cardiology

12-lead EKG
12-lead EKG
Reason for EKG:
12-lead EKG PRN CHEST PAIN

Medications

Give oral medications via NG tube when available

PRN Medications

Maximum dose of acetaminophen is 4 GM in 24 hours. When selecting dose of HYDROcodone or oxyCODONE choose a higher dose rather than increasing number of tablets to prevent acetaminophen toxicity.

Analgesics: Mild Pain (Pain Scale 1 to 3)

acetaminophen [TYLENOL] 650 MG ORAL EVERY 6 HRS PRN for mild pain or fever
acetaminophen supp [TYLENOL] 650 MG RECTAL EVERY 6 HRS PRN for mild pain or fever
ibuprofen [MOTRIN] ORAL for mild pain
ibuprofen [MOTRIN] ORAL EVERY 8 HRS PRN for mild pain
traMADol [ULTRAM] 50 MG ORAL EVERY 8 HRS PRN for mild pain

Analgesics: Moderate Pain (Pain Scale 4 to 6)

ketorolac [TORADOL] IV EVERY 6 HRS PRN for moderate pain; for a maximum of 8 doses, maximum of 15 MG in patients greater than 65 years
HYDROcodone-acetaminophen [NORCO] ORAL for moderate pain
HYDROcodone 7.5 MG-acetaminophen 500 MG /15 ML elixir [LORTAB] for moderate pain

Analgesics: Severe Pain (Pain Scale 7 to 10)

Launch PCA iForm

HYDROcodone-acetaminophen [NORCO] ORAL for severe pain
oxyCODONE [ROXICODONE] ORAL for severe pain
oxyCODONE-acetaminophen [PERCOCET] ORAL for severe pain
morphine IV for severe pain
HYDROmorphone [DILAUDID] IV for severe pain; ATTENTION: 1 MG of HYDROmorphone [DILAUDID] is equal to 7 MG of morphine

Antidotes and Rescue Agents

naloxone [NARCAN] 0.2 MG IV PRN for opiate reversal; the dose may be repeated at 2 minute intervals, start O2 at 2 L per nasal cannula, titrate to keep O2 sats greater than 90, and call the physician for respiratory rate less than 8 per minute or patient is in respiratory distress

Antiemetics

ondansetron [ZOFRAN] IV EVERY 8 HRS PRN for nausea/vomiting
promethazine [PHENERGAN] ORAL EVERY 4 HRS PRN for nausea/vomiting
promethazine supp [PHENERGAN] RECTAL EVERY 4 HRS PRN for nausea/vomiting
promethazine [PHENERGAN] IM EVERY 4 HRS PRN for nausea/vomiting
metoclopramide [REGLAN] EVERY 6 HOURS for nausea/vomiting

Laxatives

magnesium hydroxide 400 MG/5 ML oral suspension [MILK OF MAGNESIA] 30 ML ORAL for constipation
bisacodyl [DULCOLAX] ORAL DAILY PRN for constipation
bisacodyl [DULCOLAX] 10 MG RECTAL DAILY PRN for constipation
docusate sodium [COLACE] 100 MG ORAL BID
magnesium citrate 300 ML ORAL ONCE PRN for constipation
polyethylene glycol 3350 MG oral powder [MIRALAX] 17 GM ORAL DAILY for constipation, in 8 ounces of water
mineral oil enema [FLEET] 1 ENEMA RECTAL ONCE PRN for constipation

Sedatives and Antihistamines

diazepam [VALIUM] EVERY 4 HRS PRN for agitation or anxiety
LORazepam [ATIVAN] EVERY 4 HRS PRN for agitation
ALPRAZolam [XANAX] ORAL for anxiety
temazepam [RESTORIL] ORAL AT BEDTIME PRN for insomnia
zolpidem [AMBIEN] ORAL AT BEDTIME PRN for insomnia, maximum of 5 MG in patients greater than 65 years old, may repeat 1 time before 2 AM as needed
hydrOXYzine pamoate [VISTARIL] 25 MG ORAL AT BEDTIME PRN for insomnia
diphenhydrAMINE [BENADRYL] AT BEDTIME PRN for insomnia; not for use in patients greater than 65 years old
diphenhydrAMINE [BENADRYL] EVERY 6 HRS PRN for itching

Community Acquired Options Other

guaiFENesin 100 MG/5 ML syrup [ROBITUSSIN] 400 MG ORAL EVERY 4 HOURS
guaiFENesin 100 MG/5 ML syrup [ROBITUSSIN] ORAL EVERY 4 HRS PRN for congestion
guaiFENesin [MUCINEX] ORAL EVERY 12 HOURS
guaiFENesin [MUCINEX] 1200 MG ORAL EVERY 12 HRS PRN for congestion
dextomethorphan 10MG-guaiFENesin 100 MG/5 ML liq [ROBITUSSIN DM] 10 ML ORAL EVERY 4 HOURS for cough and congestion

Community Acquired Option 1

Launch pneumonia antibiotics iForm

cefTRIAXone [ROCEPHIN] 1 GM IV
azithromycin [ZITHROMAX] 500 MG EVERY 24 HOURS

Community Acquired Option 2

ciprofloxacin [CIPRO] ORAL
ciprofloxacin [CIPRO] 400 MG IV
levofloxacin [LEVAQUIN]

Stress Ulcer Prophylaxis Agents

famotidine [PEPCID] 20 MG EVERY 12 HOURS
pantoprazole [PROTONIX] 40 MG ORAL DAILY
aluminum-magnesium-simethicone suspension [MAALOX/MYLANTA] 30 ML ORAL EVERY 4 HRS PRN for dyspepsia

Additional Medications

nicotine patch [NICODERM] TDERMAL DAILY for smoking cessation (remove for insomnia)

Laboratory

Cardiac Markers

CK with CKMB x 3
CK with CKMB Q6H x 2 if first cardiac markers are performed in ED TIMED Q6H
Troponin x 3
Troponin x 2 if first cardiac markers are performed in ED TIMED Q6H

Panels

Comprehensive metabolic panel (CMP)
Comprehensive metabolic panel (CMP)
Basic metabolic panel (BMP)
Basic metabolic panel (BMP)
Basic metabolic panel plus Mg and PO4 (BMP with MG and PO4)
Basic metabolic panel plus Mg and PO4 (BMP with MG and PO4)
Hepatic panel
Hepatic panel

Hematology

Complete blood cell count without differential
Complete blood cell count without differential
Complete blood cell count with automated differential
Complete blood cell count with automated differential
Complete blood cell count with manual differential
Complete blood cell count with manual differential
Prothrombin time (PT) with international normalized ratio (INR)
Prothrombin time (PT) with international normalized ratio (INR)
Partial thromboplastin time (PTT), activated
Partial thromboplastin time (PTT), activated

Chemistry

B-type natriuretic peptide
B-type natriuretic peptide
Creatine phosphokinase CPK
Creatine phosphokinase CPK
D-dimer quantitative
D-dimer quantitative
Glucose, serum, random
Glucose, serum, random
Lactate dehydrogenase (LDH), serum
Lactate dehydrogenase (LDH), serum
Lactic acid
Lactic acid
Lipase level, serum
Lipase level, serum
Magnesium (Mg) level, serum
Magnesium (Mg) level, serum
Phosphorus level, serum
Phosphorus level, serum
Protein level, total, serum
Protein level, total, serum

Microbiology

Do not hold antibiotics for sputum culture results

Blood culture x 2 STAT Q15MIN
Sputum culture and gram stain
MRSA screen

Urine Studies

Urinalysis with reflex culture
Pnemococcal antigen, urine
Legionella antigen, urine

Influenza Testing

Influenza screen

Consults

Nutritional consult