Download Admission Orders for Intracerebral Hemorrhagic Stroke

*GBH__*
GBH
ADMISSION ORDERS FOR INTRACEREBRAL HEMORRHAGIC STROKE









Admit to ________________________ ( ICU / CVU) DATE & TIME ___________________________
Attending:________________________ Resident: _____________________________
Diagnosis ___________________________________________________
Condition ___________________________  Allergies
___________________________
Weight _______________kg
IV fluids: NS @ __________ml/hr
Elimination: □ Bathroom privileges ad lib □Bedpan □ Use of bedside commode with transfer training
□ Foley to drainage with Urine for C/S obtained upon insertion
Vital Signs and Neuro Checks using the MEND Scale:
Every 1 hr x 24 hours, then
Every 2 hours (FOR ICU PATIENTS)
Every 4 hours (FOR NON ICU PATIENTS)
Any change in patient status call physician.
Activity: _____________________________________
□ No lifting or pulling of shoulder on affected side



Nasal 02: titrate to greater than 95% saturation
□ HOB elevated 30 degrees □
Turn every 2 hours
□
Discontinue oxygen if saturation above 95%
Diet: Dysphagia screening completed by RN prior to ANY oral intake or medications given:
□
□
□
YES
□
NO
__________________RN Signature
_______________Date/Time
DIET: ______________________
NPO until clinical bedside dysphagia exam performed by speech pathologist.
Fall Precautions
VTE Prophylaxis: Refer to Deep Vein Thrombosis Prophylaxis Assessment and Orders Form


Up with assistance only
Monitor Cardiac Rhythm: EKG (if not already done)
Pass:


□
SCD
Blood Pressure Management
Systolic Blood Pressure greater than or equal to 180
OR
Mean Arterial Pressure (MAP) greater than 130 contact House
Officer IMMEDIATELY
(Target MAP 110 mm Hg or target B/P 160/90)
Initial Mean Arterial Pressure greater than 130
1. Consult MD IMMEDIATELY
2. Give Labetolol 10mg IV over 1-2 minutes.
3. May repeat Labetolol 10 mg IV or double the bolus every 10
minutes for a MAXIMUM DOSE OF 300mg.
4. OR begin Nicardipine IV drip protocol (ICU only)
5. Initiate continuous blood pressure monitoring
6. If response unsatisfactory consult MD
HOLD LABETOLOL FOR ACUTE ASTHMA OR CHF
EXACERBATION OR FOR HEART RATE LESS THAN 50 OR
FOR RHYTHM OF 2ND OR 3RD DEGREE HEART BLOCK.
1. Consult MD immediately
2. Begin Nicardipine IV drip protocol
3. Titrate for MAP of 110
4. Continuous Blood Pressure Monitoring
Admission Orders for Intracerebral Hemorrhagic Stroke
*«PatientNumber»*
Page 1 of 3
Revised 11/2008
1
ACCT# «PatientNumber» DOB:«BirthDate» «Gender» «Age»
«PatientName» «AdmitDate» «AdmitTime»
MR#«MedicalRecordNumber» «AttendingDoctorName»
*GBH__*
GBH
ADMISSION ORDERS FOR INTRACEBERAL HEMORRHAGIC STROKE








For Diabetic patients: Check blood glucose before each meal and at HS. If blood glucose is greater than 140
on two consecutive readings call House Officer for instructions.
Notify physician of ALL admission blood glucose greater than 140.
Consult PT, OT, ST for evaluation and treatment upon admission.
Consult Nutrition Services for evaluation and dietary education.
Consult Case Management for discharge planning.
Notify Stroke Coordinator (5-4243).
Consult Stroke Educator for Stroke Education (5-4613).
Provide Stroke Education: Types of Stroke, Complications, Personal Modifiable Stroke Risk Factors, Stroke Warning
Signs and Symptoms; FAST; How to Activate EMS:911; Need for Follow up after Discharge; Prescribed Medications;
Smoking Cessation; Heart Healthy Diet
Diagnostics to be performed in AM:
□
□
□
□
□
□

MRI Brain & MRA Brain and Neck without contrast: Stroke protocol
MRI Brain without contrast, without MRA Dx: Stroke
CT of Brain without contrast for follow up of intracerebral hemorrhagic stroke
Carotid Duplex Ultrasound for Dx: Stroke
Echocardiogram for Dx: Stroke: Dr. ____________________ to read.
CTA brain and neck for Dx: Stroke
Medications


r-tPA (Alteplase) not indicated due to hemorrhagic stroke.
Antiplatelet Therapy not indicated due to hemorrhagic stroke.
□
Lorazepam 1 mg IV every 20- 30 minutes prior to imaging procedure for agitation. May repeat X ______
□
STATIN: _______________________________________________
(Consider Statin for LDL greater than or equal to 100mg/dL; For Diabetic patients LDL greater than 70)
□
□
□
□
□
ACE Inhibitor: _____________________________________________________
Thiazide Diuretic: _________________________________________________
Laxative: _________________________________________________________
Phenergan 12.5 mg PO/IV (diluted in 50 ml normal saline) every 4 hours PRN nausea
Acetaminophen 1000 mg PO/PR every 4-6 hours PRN temp greater than 101.5 or for headache
NOT TO EXCEED 4 GRAMS DAILY
Admission Orders for Intracerebral Hemorrhagic Stroke
Page 2 of 3
Revised 11/2008
*«PatientNumber»*
ACCT# «PatientNumber» DOB:«BirthDate» «Gender» «Age»
«PatientName» «AdmitDate» «AdmitTime»
2
MR#«MedicalRecordNumber» «AttendingDoctorName»
3
*GBH__*
GBH
ADMISSION ORDERS FOR INTRACEBERAL HEMORRHAGIC STROKE
□
Other Medications:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
__________________________________

□
□
□
□
□
□
□
□

Labs:
CBC w/diff, Platelets,
PT/PTT/INR
Basic Metabolic Profile
□
□
□
Daily
Daily
Daily
CKMB, Troponin every 8 hrs x 3
Fasting Lipid Profile (if not already done)
Hgb A1C (if not already done)
□ Urine C&S
_____________
UA
□
□
2 Hour Glucose Tolerance Test
____________
□ _______________
Pneumovax Vaccination Protocol
Consult: ______________________________________________________
Consult: _______________________________________________________
□
Verbal orders read back x 1 and verified.
□
Telephone orders, read back x 2, and verified.
MD SIGNATURE:___________________________________________________________
_________________
DATE & TIME
Admission Orders for Intracerebral Hemorrhagic Stroke
*«PatientNumber»*
Page 3 of 3
Revised 11/2008
4
ACCT# «PatientNumber» DOB:«BirthDate» «Gender» «Age»
«PatientName» «AdmitDate» «AdmitTime»
MR#«MedicalRecordNumber» «AttendingDoctorName»