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Admit to: observation

Admission Order Set
Page 1 of 2
Status: OUTPATIENT OBSERVATION & SERVICES
Level of Care: Med Surg (3 South 4 North) IMC/DOU (2 North 2 South) Tele (2 North 2 South)  ICU  CCU Can be
transported w/o RN unless otherwise stated Needs to be transported w/ RN Respiratory isolation (place in neg pressure room)
DIAGNOSIS : _____________________________________________________________________
CONDITION: Stable Fair Guarded Critical Case Management Eval Social Worker Eval Financial Counselor Eval
Vitals: Per protocol Orthostaticx1 Neuro checks Q____H
Activity: Up adlib Bed rest Bed rest with bathroom privileges Pt. eval and treat Ot eval and treat Speech eval and
treat Swal ow eval and treat
Precautions: Fal Seizure Aspiration Suicide Sitter 1 to one 1 Sitter (for suicidal pt admitted to floor)
Allergies: NKDA Latex Sulfa PCN _______________________
Code status: Full code DNR (fil Blue DNR form) limited resuscitation (fil Blue DNR form)
Diet: Regular AHA Renal Consistent carbohydrate Clear Liquids NPO except med NPO ________________
IVF: Saline Lock 0,9 NS AT KVO 0,9 NS AT________ml/hr ___________________
NURSING: Spo2 on ra after ambulation Strict I&Os Daily weight Foley catheter with care Diabetic teaching Peg site
care (if applicable) Smoking cessation if indicated Pneumococcal and influenza vaccine per hospital protocol
Notify MD if: Temp: below 36.1 above 38.5 SBP below 95 above 180 DBP below 35 above 110 Pulse below 50 above 110
SPO2 below 90 on RA Urine output less than 30 ml in 2 hours
RESPIRATORY: IS Q1 While awake Notify MD if SPO2 below 90 on RA ___________________
DVT Prophylaxis: Heparin 5000 units subcutaneously Q8hrs Enoxoparin (Lovenox) 40mg subcutaneous daily (decrease to 30 mg if
Creatinine clearance less than 30mL/min) SCDs to BLE SCDs to BLE if dopplers negative (BLE venous dopplers notify md if abnormal order venous dopplers only if box SCDs to BLE if dopplers negative is checked) Ambulate tid GI Prophylaxis: Pantaprazole (Protonix) 40 mg PO daily Pepcid 20mg PO bid
HTN: Hydralazine 5mg IV Push Q4Hrs prn SBP above 180 or DBP above 110
Nausea:  Ondansetron (Zofran) 4mg IV Push Q4Hrs prn nausea vomiting  Reglan 5mg IV Push Q6Hrs prn nausea vomiting
Insomnia: Zolpidem (Ambien) 5mg po Qhs prn Insomnia, may repeatx1 Restoril 7.5mg po Qhs prn Insomnia, may repeatx1
Temperature: Acetaminophen 650 mg po q4h prn temperature over 101 Cooling blanket PRN fever Bear hugger (heating
blanket) for hypothermia
PAIN: Acetaminophen 650 mg po q4h prn mild pain ______________________________Q4HPRN for moderate pain
______________________________Q4HPRN for severe pain
Admission Order (08/30/12)
Admission Order Set
Page 2 of 2
GI: Docusate (Colace) 100mg po daily bid (Hold for diarrhea) Dulcolax supp 10mg pr daily prn constipation
Miralax 17 gm po daily (hold for diarrhea) Lactulose 30ml po daily prn constipation Loperamide (Imodium) 2mg po prn diarrhea after each loose stool up to 16mgday Aluminum/Magnesium/Simethicone (Maalox) 10 ml po Q4h prn heart burn Simethicone 80mg po Q6h prn flatulence Calcium Carbonate Chewable (Tums) 1000mg po Q4h prn heart burn max 15 tablets/day ANXIETY: ____________________________________________________________________ Q6h prn for anxiety prn for anxiety
Diagnostics:
Morning Labs: cbc bmp chem12 renal panel BCP lipid panel TSH HgbA1C CK&troponin
Point of care glucose testing AC&HS with lispro insulin supplemental scale as below If Glucose <60 Dextrose 50%, 50mL (25Gms) IV Push x1 & notify MD 61 – 70: if able to take PO give juice/snack, if unable to take PO, Dextrose 50%, 25mL (12.5Gms) IV Push x1 & notify MD Please choose below scale or order custom  Blood glucose (mg/dL)
Lispro Insulin subcut.
Blood glucose (mg/dL)
Lispro Insulin subcut.
Notify MD if glucose above 300mg/dL on 2 consecutive readings if pt has AMS, respiratory depression do stat point of care glucose test and notify MD TO/VO: _______________________________ Print MD Name: _____________________________
Required read back completed: MD Signature: ______________________________
Date: __________ Time: __________ Date: __________ Time: __________
Admission Order (08/30/12)

Source: https://communicate.chw-interactive.org/cm/media/documents/admisson_order_set.pdf

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Medical Oxygen 99.5% Consumer Medicine Information What is in this leaflet? This leaflet answers some common questions about Medical Oxygen. It contains only some information, and does not take the place of talking to your doctor or appropriate healthcare professional. All medicines may assist you, but sometimes there are risks. Your doctor or healthcare professional has we

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