Doctor’s orders

1. Admit inpatient to:  Telemetry  Meridian 6 (satellite telemetry) OR if critically ill  to ICU  to CCU
2. Attending Physician:
3. Condition:
4. Code Status:
5. Allergies/Intolerances:
6. Diet:
 Initiate nursing bedside swallow screen if po medications ordered. Ok to give po meds with sips of water only if
 Diet per Speech Pathology swallow evaluation 7. Activity:  HOB up 30°  Bed Rest X 12 hrs then per PT  OOB with Assist until PT Evaluation  Bed Flat
8. Vital Signs:  every 4 hrs x 72hrs, then every 8 hrs
 Notify MD if:
 SBP > 200 or < 100, DBP > 100 or <50
9. Neuro assessment:
 Every 2hrs x 8hrs, then every 4hrs x 72hrs, then once daily

 Notify MD of any neurological changes
10. NIH Stroke Scale:  On admit, prn neuro status change and at discharge
11. I&O:  Every 8 hrs
12. Oxygen:
 Initiate oxygen protocol to keep SpO2 > 92%
 Notify MD if >4L O2 required to maintain sats>92%
 RT per Pulmonary Treatment Protocol
13. IVF:  Initiate IV protocol Start 0.9% NS @ ______ml/hr
14. Labs:
 UA with C&S if positive leukocytes  CBC  CMP  ESR
 PT / INR  HgA1C  CBC w/diff  Cardiac enzymes
 Fasting Lipid Panel  Type and screen (all tPA patients)  PTT  Other:_________________
*consider hyper-coag work up (see back of orders for reference)
15. Imaging/Testing:
 CT head w/o contrast Date: __________
 MRI Brain w/o contrast Date: __________  MRA angiogram head and neck Date: _______  Lower extremity venous duplex Date: __________  Trans-esophageal Echocardiogram Date: _____  Echocardiogram with bubble study Date: __________ PHYSICIAN INITIAL:
American Stroke Association MS01-01-335 03/10/10 rev. 06/07/12 ISCHEMIC STROKE ORDERS
16. Medications:
 Acetaminophen 650 mg every 4 hrs PO/PR, PRN for temp > ________ or discomfort.  Ranitidine (Zantac) 50 mg IV every 8 hrs; Change to 150 mg PO every 12hrs when tolerating PO  Pantoprazole (Protonix) 40 mg IV every day; Change to 40mg PO every day only when tolerating PO (Do NOT

administer if patient is taking Plavix)
 Analgesic: ________________________________________  Antiemetic:________________________________________  Sleep/Anxiety:________________________________________  Bowel Care: ________________________________________  Statin:__________________________ (if LDL >70 - Core Measure #6)
 Diabetic Management: See adult inpatient subcutaneous insulin orders: Please Flag for Physician
17. Antiplatelet/Antithrombotic Therapy: (to be given by end of hospital day 2 – Core Measure #5)
NOTE: DO NOT start until CT results called to MD
 Aspirin 325 mg PO today then daily -OR-  Aspirin 81mg PO today then daily -OR-
 Clopidogrel (Plavix) 75 mg PO today then daily  Aspirin/Dipyridamole (Aggrenox) 25/200 mg PO BID  Warfarin (Coumadin) ____mg PO today then daily 18. VTE Prophylaxis: (to be started the day of or the day after hospital admission - Core Measure #1)
 Intermittent Pneumatic Compression (IPC)  Enoxaparin (Lovenox) 40 mg SQ every day If contraindicated, provide reason ____________________________________________________ Pharmacy may adjust for CR CL < 30 ml/min for patients without Alteplase (TPA) and may adjust for CR CL<39 ml/min for patients with Alteplase (TPA). No pharmacologic prophylaxis for patients with hemorrhagic stroke sooner than 72 hours or earlier with neurology recommendation only. PHYSICIAN INITIAL:
American Stroke Association MS01-01-335 03/10/10 rev. 06/07/12 ISCHEMIC STROKE ORDERS
19. Therapy Consults: (Core Measure #10)
 Speech Pathology consult – Evaluate and treat, RN to complete bedside swallow screen prior to oral medications and Speech Pathology assessment  Physical therapy consult – Evaluate and treat  Occupational therapy consult – Evaluate and treat 20. Other Consults:
 Case Management for Discharge/Rehab Planning Needs  Physiatry consult - Fax order and face sheet to Physiatry consult number 1-888-797-3422 (1-888-79R-EHAB) 21. Patient and Family Education (Core Measure #8)
 Stroke Education (individualized)
Provide education to patient and/or caregiver about: 1. Activation of Emergency Medical System 4. Patient’s specific risk factors for stroke  Antithrombotic/Anticoagulant Education PHYSICIAN SIGNATURE:
American Stroke Association MS01-01-335 03/10/10 rev. 06/07/12

For Physician Reference Only
Hyper-Coag work up for consideration:
Protein S and C
Anticardiolipin Antibody
Factor V Leiden
Lupus Anticoagulant
Prothrombin Gene Mutation
Antithrombin III
American Stroke Association MS01-01-335 03/10/10 rev. 06/07/12


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Microsoft word - consensus statement.doc

Consensus Statement on Emergency Contraception Twenty-four experts from around the world, representing the fields of research, policy, may need these methods occasionally. Millions communications, women’s advocacy and of unwanted pregnancies could be averted if medicine, gathered at the Rockefeller emergency contraceptives were widely Foundation Conference in Bellagio, Italy,

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