Pneumonia admission orders (all forms)

Generic equivalents are utilized unless checked.
CORE MEASURE REQUIREMENTS
Physician Name(s)
Admit to Dr.______________________________ Code Status
Code Status:________________________________________________________ Location
_________________________________________________________________ Diagnosis
Condition
Nursing Interventions
Vital Signs
Activity
Pulse oximetry per unit routine and record Interventions
Strict Recording of Intake and Output record Telephone Order(TOR)
PHYSICIAN INITIALS
DATE / TIME
rev Pneumonia Admission Orders Pg 1 of 4 public
Generic equivalents are utilized unless checked.
l CORE MEASURE REQUIREMENTS
Respiratory Therapy
Atrovent 0.5 mg nebulizer every ______ hours Albuterol 2.5mg nebulizer every ______ hours Atrovent 0.5 mg nebulizer every ______ hours PRN Shortness of Breath / Wheezing Albuterol 2.5mg nebulizer every ______ hours PRN Shortness of Breath / Wheezing American Diabetes Association_________kCal IV Fluids
Saline lock with 3 mL Normal Saline flush every 12 hours IVF:________________________ with __________ milliequivalents Potassium Chloride (KCL) / liter at ___________mL / hour times __________ hours Any other IV fluids:______________________________________________ Medications
Protocols
Scheduled
CAP Non - ICU
Antibiotics
Rocephin ( cefTRIAXone ) 1 gram IV piggyback every 24 hours PLUS Zithromax Rocephin ( cefTRIAXone ) 1 gram IV piggyback every 24 hours PLUS Doxycycline PCN allergy:
Levaquin ( levofloxacin ) 750 mg IV piggyback every 24 hours ( may change to PO CAP ICU Admission
Rocephin (cefTRIAXone) 1 gram IV piggyback every 24 hours PLUS Zithromax (azithromycin) 500 mg IV piggyback every 24 hours Rocephin (cefTRIAXone) 1 gram IV piggyback every 24 hours PLUS Levaquin (levofloxacin) 750 mg IV piggyback every 24 hours Send blood cultures times 2 if not collected in ER Telephone Order(TOR)
PHYSICIAN INITIALS
DATE / TIME
rev Pneumonia Admission Orders Pg 2 of 4 public
Generic equivalents are utilized unless checked.
CORE MEASURE REQUIREMENTS
Aspiration Pneumonia
Zosyn ( Piperacillin and Tazobactam ) 3.375 grams IV piggyback every 6 hours PCN allergy:
Cleocin ( Clindamycin ) 600mg IV every 6 hours Healthcare Associated Pneumonia (may choose one)
Zosyn ( Piperacillin and Tazobactam ) 4.5 grams IV piggyback every 6 hours PLUS Levaquin ( Levofloxacin ) 750 mg IV piggyback every 24 hours ( Pharmacy to adjust renal dosing ) PCN allergy:
Doripenem ( Doribax ) 500mg IV piggyback every 8 hours PLUS Levaquin (levofloxacin) 750mg IV piggyback every 24 hours ( Pharmacy to adjust renal dosing ) MRSA Suspected
Vancomycin ( Vancocin ) 15mg / kg IV every 12 hours ( Pharmacy to adjust ) VTE Prophylaxis
Lovenox (enoxaparin) 40 mg Subcutaneous every day OR if Creatinine Clearance less than 30 mL / min
Lovenox (enoxaparin) 30 mg Subcutaneous every day Anti-embolism Hose (TED) to bilateral lower extremeties Sequential compression devices to bilateral lower extremeties Anti-Inflammatory
Solu-MEDROL (methyIPREDNISolone) _______ mg IV every _________ hours PredniSONE _________ mg PO every ______ hours Expectorant
GuaiFENesin 600 mg ______tab(s) PO every 12 hours Ulcer Prophylaxis
Pepcid ( famotidine ) 20 mg PO every 12 hours Protonix ( pantaprazole ) 40 mg PO every 24 hoursPepcid ( famotidine ) 20 mg IV push every 12 hours Protonix ( pantaprazole ) 40 mg IV push every 24 hours Vaccines
l Pneumococcal Vaccine 0.5 mL IM 1 time only ( age 65 and over or high risk: *assess Influenza Vaccine 0.5 mL IM 1 time only ( age 50 and over or high risk: *assess from l October through end of March flu season* ) Other Medicines
Other: ________________________________________________________ ________________________________________________________ Telephone Order(TOR)
PHYSICIAN INITIALS
DATE / TIME
rev Pneumonia Admission Orders Pg 3 of 4 public
Generic equivalents are utilized unless checked.
l CORE MEASURE REQUIREMENTS
Adult Insulin Sliding Scale Protocol
Morphine Sulphate 2 mg IV push every 2 hours PRN severe pain HYDROcodone / APAP 5 / 325 mg 2 tabs PO every 6 hours PRN moderate pain HYDROcodone / APAP 5 / 325 mg 1 tab PO every 4 hours PRN mild pain Tylenol (Acetaminophen) 650 mg PO every 4 hours PRN temperature over 101.3 degrees Fahrenheit Colace (Ducosate Sodium) 100 mg PO two times per day PRN constipation Milk of Magnesia (magnesium hydroxide) 30 mL PO daily PRN constipation Zofran (ondansetron) 4 mg IV every 3 hours PRN Nausea / Vomiting Diagnostics
Radiology
Chest X-ray _________________________________________ _______________________________________________________________ Consults
Notify Physician
Heart Rate greater than ___________ or less than _________ Oxygen Saturation less than ____________________________% Systolic Blood Pressure less than _______________________ Diastolic Blood Pressure greater than _____________________ Telephone Order(TOR)
PHYSICIAN SIGNATURE
DATE / TIME
rev Pneumonia Admission Orders Pg 4 of 4 public

Source: http://www.gsmc.org/gshs/media/medialibrary/pdf/PneumoniaAdmissionOrders.pdf