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Heart failure - diastolic

Physician Orders
Adult Pneumonia, Community Acquired
Admission Height:_________ Admission Weight:_________

Amission Status
Admit to inpatient to Dr. _______________________service. IV Fluids
Assign to observation status to Dr. ________________ service Dextrose 5% with 0.9% NaCl @ __________mL/hr Admit Location
Dextrose 5% with 0.45% NaCl @ _________mL/hr □ Medical floor □ Telemetry monitor □ ICU Sodium Chloride 0.9% @ ____________mL/hr Allergies
Additives _________________________________ Saline lock flush per protocol ______________________________________________ Medications
Code Status
Antibiotics
Beta-Lactam (3rd-Generation Cephalosporin,
Partial Code (□ Intubation □ Defibril ation □ ACLS Meds Penicillin) + Macrolide
Cephalosporins, 3rd-Generation
 Do Not Resuscitate (allow natural death) cefTRIAXone / ROCEPHIN 1 gram intravenously every Nursing Orders
Vital Signs
Macrolides
azithromycin / ZITHROMAX 500 milligrams intravenously every 24 hours times 2 days, then 500 milligrams orally Activity/Positioning
azithromycin / ZITHROMAX 500 milligrams intravenously Ambulate with Assistance TID with O2 walker Bed rest □ BRP □ BSC azithromycin / ZITHROMAX 500 milligrams orally daily clarithromycin / BIAXIN 500 milligrams orally two times daily Assessments
Quinolones
levofloxacin / LEVAQUIN 750 milligrams orally every 24 hours Glucose: finger stick q___________________________ levofloxacin / LEVAQUIN 750 milligrams intravenously Assess smoking status & provide smoking education Contingency
Notify physician for Temp >101 F, HR < 60 or > 120, Antipyretics
RR < 8 or >30, SBP < 90 or >180, acetaminophen / TYLENOL 650 milligrams orally Urine Output < 120 ml for 4 hrs, Pulse Ox <90% □ every 4 hours □ every 6 hours as needed for fever >100.4 Interventions: GI/ GU
acetaminophen / TYLENOL 650 milligrams rectally □ every 4 hours □ every 6 hours as needed for fever >100.4 Analgesics
Respiratory
Mild Pain (1- 3)
Oxygen and Oximetry
ace minophen / TYLENOL 650 milligrams orally Oxygen via _______________________ at _____________ □ every 4 hours □ every 6 hours as needed for pain maintain O2 sat at______% via pulse Oximetry or per O2 protocol ace minophen / TYLENOL 650 milligrams rectally □ every 4 hours □ every 6 hours as needed for pain ibuprofen / MOTRIN 400 milligrams orally Blood Gases
 Arterial Blood Gas _______________________ Moderate Pain (4- 6)
□ 5/500 □ 7.5/500 □ 10/500 tablet orally □ every 4 hours □ every 6 hours as needed for pain Cardiac _____________________________ □ 5/325 □ 7.5/325 □ 10/325 tablet orally Diabetic__________________________________ □ every 4 hours □ every 6 hours as needed for pain  Regular _________________________________  Other __________________________________ □ every 4 hours □ every 6 hours as needed for pain Physician Orders
Adult Pneumonia, Community Acquired
Admission Height:_________ Admission Weight:_________
VTE: Prophylaxis – General Measures
Severe Pain (7 - 10)
 Ambulate – TID with assistance with O2 walker start today Graded compression stockings -TED Hose □ every 4 hours □ every 6 hours as needed for pain □ knee high □ thigh high (call measurements to pharmacy) HYDROmorphone / DILAUDID 1 milligram subcutaneously □ every 4 hours □ every 6 hours as needed for pain morphine _____ milligram intravenously VTE: Unfractionated Heparin
heparin 5,000 units subcutaneously every 8 hours Antidotes and Rescue Agents
heparin 5,000 units subcutaneously every 12 hours naloxone / NARCAN _____ (0.2-2) mil igram VTE: Low -Molecular-Weight Heparin
intravenously every ______min. (2-3) as needed for for opiate reversal. May repeat times one. Give if decreased enoxaparin / LOVENOX 40 milligrams subcutaneously daily mentation and/or RR < 10 and notify physician STAT enoxaparin / LOVENOX 30 milligrams subcutaneously daily Sedatives
(dose for patients with CrCl < 30 mL/min) LORazepam / ATIVAN 1 milligram intravenously Laboratory
CBC now and every other day while on Heparin or Lovenox LORazepam / ATIVAN 1 milligram orally 2 times a day CBC with auto diff Now and _________________ zolpidem / AMBIEN 5 milligrams orally daily, at bedtime Culture, blood now two separate sites zolpidem /AMBIEN 10 milligrams orally daily, at bedtime Bronchodilators
albuterol / PROVENTIL MDI ______puffs (use spacer) every ______hours as needed for wheezing Cardiology
albuterol 2.5 mg/0.5 mL neb solution /PROVENTIL via Radiology/Imaging
nebulizer every _______hours as needed for wheezing Levalbuterol / XOPENEX 0.63 mg neb solution via Physician Consults
nebulizer every _____ hours as needed for wheezing Reason _________________________________ Smoking Cessation Medications
nicotine 7 mg/24 hr transdermal film, extended Reason__________ ____________________________ Other Consults
nicotine 14 mg/24 hr transdermal film, extended nicotine 21 mg/24 hr transdermal film, extended Laxatives
magnesium hydroxide / MILK OF MAGNESIA 30 milliliters orally daily as needed for constipation
Other Orders:

docusate sodium / COLACE 100 milligrams orally 2 times daily bisacodyl / DULCOLAX 5 milligrams orally daily bisacodyl / DULCOLAX 10 milligrams suppository rectally daily as needed for constipation □TO/VO Read Back & Verified________________________________________ Date/Time: _________________________ Physician _____________________________________________ Date/Time: _____________________ Version 11/11/2010

Source: http://kentucky.prod2.bonsecours.com/includes/modules/portal/Adult_Pneumonia_Community_Acquired_11-11-10_OLBH.pdf

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