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Pre_cath_form

NO MEDICATION ABBREVIATIONS
UNAPPROVED ABBREVIATIONS
U, IU, QD, or qd, QOD or qod, qn, ug, BT, > or <, Allergies:
MEDICATION, DIET, TREATMENT, LAB ORDERS
1. Sign consent for: Left Right with Possible PCI 2. Old charts to accompany patient to cath lab 3. If patient had previous coronary bypass surgery, please obtain previous bypass surgery report. 4. Clip both groin areas. 5. Notify physician if patient has iodine/shellfish allergy. a. Benadryl 25mg IV x one dose b. Solumedrol 125mg IV x one dose c. Pepcid 20mg IV x one dose 6. IV: 0.9% saline at 100cc/hr 7. Chest x-ray, PA & Lat 8. EKG (if not done within 4 weeks, unless has had chest pain since last EKG) 9. Lab: (to be drawn if one has not been done within 1 week that is normal) CBC PT/INR PTT CMP Lipid Profile TSH T4 UA Serum Pregnancy test for women of potential child bearing age of 45 or less. 10.Call if BUN greater than 50, Cr greater than 1.4, PTT greater than 40, INR greater than 2, K+ less 11.If K+ 3-3.5, give KCL 40meq tab po q 6hrs x 2 doses. OK to give one dose with AM cardiac meds. 12. If morning case, NPO after midnight except meds. If afternoon case, patient may have light breakfast and clear liquids permitted and encouraged until 2 hrs prior to procedure. 13. Routine Vital signs 14. Activity: up ad lib 15. If patient has been on Coumadin, hold dose prior to planned catheterization. Obtain PT/INR at 0600. If on LMWH continue as scheduled. Document last dose on front of chart. 16. Pre-cath: a. Scheduled for Cath at: ___________________ b. Complete Cath check list c. On call to Cath Lab give: (check box to activate) Valium 10mg po x 1 (give one hr prior to cath) Benadryl 25mg po x 1 (give one hr prior to cath) [unless patient has contrast allergy, then Pepcid 20mg po x 1 (give one hr prior to cath) [unless pt has contrast allergy, then see #5 Tylenol #3, two po x 1 Plavix 300mg po _____(time) Prednisone 60mg po q 8hrs x 3 doses ASA 325mg po x 1 CONTINUED ON PAGE 2
Valid for 2007
PRE-CATHETERIZATION ORDERS
PAGE 1 OF 2
PATIENT STICKER
PHYSICIAN ORDERS
V:/dr orders PUBLIC/cardiovascular/pre cath/mro (8-06) NO MEDICATION ABBREVIATIONS
UNAPPROVED ABBREVIATIONS
U, IU, QD, or qd, QOD or qod, qn, ug, BT, > or <, Allergies:
MEDICATION, DIET, TREATMENT, LAB ORDERS
17. Record height and weight. 18. Have patient void prior to procedure. 19. For a Diabetic Patient: a. Patient to bring own insulin into hospital. Start IV of D5 ½ NS @ 100cc/hr, then give ½ of usual insulin dose pre-cath and ½ of dose post cath. b. If taking Glucophage/Glucovance: HOLD starting the day before the catheterization and do not resume until 48 hours after the catheterization. c. If taking oral anti-diabetic pills; take them in the morning of the catheterization 20. Nephro protection orders
(Use for all diabetics or pts with Creatinine greater than 1.4 or discretion of MD)
IV: 0.9% Normal Saline _________cc/hr for ________ hrs.
Mucomyst 600mg po q 6hrs x _____ dose including 1 dose post cath.
Notify cath lab of nephroprotective protocol
Physician Signature: __________________________________ Date: ____________
Valid for 2007
PRE-CATHETERIZATION ORDERS
PAGE 2 OF 2
PATIENT STICKER
PHYSICIAN ORDERS
V:/dr orders PUBLIC/cardiovascular/pre cath/mro (8-06) Single Orders & Pre-Operatives
_____ Number of Forms in Use
PRN Medications
Ord Date
REASSESSMENT GUIDELINES
15-30 minutes after IV analgesic
30-60 minutes after IM analgesic
60-90 minutes after PO analgesic
30-60 minutes after rectal analgesic
90-180 minutes after controlled release analgesic
FAITH REGIONAL HEALTH SERVICES
PRE-CATHETERIZATION
PATIENT STICKER
V:/dr orders PUBLIC/cardiovascular/pre cath/mro (8-06) PRE-CATHETERIZATION KARDEX
Inpatient / Observation / ASU / Outpatient
TREATMENTS / ACTIVITES / ORDERS
Sign consent for L R heart cath with possible PCI Old charts for accompany patient to cath lab Obtain report of previous bypass surgery if applies to patient Clip both groin areas / void before procedure Notify physician if patient has iodine / shellfish allergy Do EKG (if not done within 4 weeks, unless has had chest NPO after midnight if AM case except for meds, if afternoon case may have light breakfast and clear liquids permitted and encouraged until 2hrs prior to procedure Call if BUN is greater than 50, Cr greater than 1.4, PTT greater than 40, INR greater than 2, K+ less than 3 If K= 3 – 3.5 give KCL 40meq tab, po q 6hrs x 2 doses. OK Family Information Release: Yes No
Exceptions:
IV FLUIDS
Education
Completed
Initials
Braden __________________ Due ______________ V:/dr orders PUBLIC/cardiovascular/pre cath/mro (8-06)

Source: http://65-123-188-226.dia.static.qwest.net/pre_cath_form.pdf

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