Download congestive heart failure admission orders

 3560
Print All
Physician Order Set PATIENT LABEL General Location c Admit to ICU d
e
f
g
Responsible Service/Physicians:
Diagnosis:
Type of heart failure - check all that apply c Acute systolic
d
e
f
g
c Acute diastolic
d
e
f
g
c Chronic systolic
d
e
f
g
c Chronic diastolic
d
e
f
g
c Admit to Medical/Surgical with Telemetry:
d
e
f
g
CONGESTIVE HEART FAILURE ADMISSION ORDERS g
c Acute on chronic systolic d
e
f
c Acute on chronic diastolic
d
e
f
g
g
c Acute on Chronic systolic and diastolic d
e
f
Vital Signs c VS - Routine d
e
f
g
Allergies:
Activity c Ambulate d
e
f
g
c Bed rest d
e
f
g
c Bed rest with bathroom privileges d
e
f
g
c Bed rest with bedside commode d
e
f
g
c Up ad lib d
e
f
g
c Up to chair d
e
f
g
Nursing Orders Assessments b Daily weights c
d
e
f
g
b Strict intake and output c
d
e
f
g
c Measure orthostatic blood pressure daily d
e
f
g
Interventions c For recurrent chest pain - bed rest, STAT EKG, give SL NTG as ordered and notify physician d
e
f
g
Urinary Catheter Initiation Orders Link Contingency c Notify physician if medications are held due to abnormal vital signs d
e
f
g
b Dr. Rapid per Protocol c
d
e
f
g
Respiratory c Oxygen Therapy per protocol Source d
e
f
g
c Blood gas, arterial d
e
f
g
c Biphasic positive airway pressure (BIPAP) d
e
f
g
Patient/Caregiver Education c Print - Congestive Heart Failure patient education and documentation from Physician Work Center and give to patient and family d
e
f
g
c Print "Cardiopulmonary Resuscitation (CPR) Anytime" from Physician Work Center and give to patient and family d
e
f
g
Physician Name (Type):
rev dso 02/12 nmt 12/31/10 Page 1 of 4 Pager Number: Physician Order Set PATIENT LABEL CONGESTIVE HEART FAILURE ADMISSION ORDERS Diet c Diet, cardiac - Heart Healthy AHA diet Evidence d
e
f
g
c Diet, low sodium - 2 gm d
e
f
g
c Diet, diabetic d
e
f
g
mL/day c Diet, fluid restricted
d
e
f
g
Medications Inotropic Agents Evidence c DOBUTamine 500 mg/250 mL (2 mg/mL)
d
e
f
g
c DOPamine 800 mg/250 mL (3.2 mg/mL)
d
e
f
g
c Milrinone 20 mg/100 mL (0.2 mg/mL) (PRIMACOR)
d
e
f
g
mcg/Kg/min IV continuous infusion mcg/Kg/min IV continuous infusion mcg/Kg/min IV continuous infusion (House Staff may initiate milrinone therapy
only under the supervision of a cardiology staff member or fellow) Platelet Inhibitors Evidence aspirin c 81 mg PO Daily d
e
f
g
c 325 mg PO Daily d
e
f
g
clopidogrel (PLAVIX) c 75 mg PO Daily d
e
f
g
prasugrel (EFFIENT) c 10 mg PO Daily d
e
f
g
c 5 mg PO Daily d
e
f
g
ticagrelor (BRILINTA) c 90 mg PO BID
d
e
f
g
Note: To continue different doses than those listed here, please use "Medication Reconciliation Form" on Page 4
Beta-Blockers Consider initiating beta blocker therapy when patient is clinically stable. carvedilol (COREG) c 3.125 mg PO BID with meals d
e
f
g
c 6.25 mg PO BID with meals d
e
f
g
Antihypertensives - Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors) Evidence If SBP is less than 100 mmHg, hold ACE Inhibitor and notify physician. lisinopril (PRINIVIL) c 2.5 mg PO Daily d
e
f
g
c 5 mg PO Daily d
e
f
g
c 10 mg PO Daily d
e
f
g
captopril (CAPOTEN) c 3.125 mg PO q8h d
e
f
g
c 6.25 mg PO q8h d
e
f
g
c 12.5 mg PO q8h d
e
f
g
Antihypertensives - Angiotensin Receptor Blockers (ARB) Evidence If SBP is less than 100 mmHg, hold ARB and call physician. valsartan (DIOVAN) c 40 mg PO q12h d
e
f
g
c 80 mg PO q12h d
e
f
g
candesartan (ATACAND) c 4 mg PO Daily
d
e
f
g
c 8 mg PO Daily
d
e
f
g
Physician Name (Type):
rev dso 02/12 nmt 12/31/10 Page 2 of 4 Pager Number: Physician Order Set PATIENT LABEL CONGESTIVE HEART FAILURE ADMISSION ORDERS Diuretics
furosemide (LASIX) Evidence c
d
e
f
g
mg IV x1 dose Now g 20 mg PO Daily c
d
e
f
c 40 mg PO Daily d
e
f
g
c 80 mg PO Daily d
e
f
g
spironolactone (ALDACTONE) Evidence c 12.5 mg PO Daily d
e
f
g
c 25 mg PO Daily d
e
f
g
eplerenone (INSPRA) Evidence c 25 mg PO Daily d
e
f
g
Stress Ulcer Prophylaxis Agents Stress ulcer prophylaxis recommended for patients who require mechanical ventilation for greater than 48 hours
Evidence Stress ulcer prophylaxis also indicated for patients with ONE for the following: coagulopathy (or anticoagulated), history of recent
gastrointestinal bleed, spinal cord injury, GLASCOW coma scale less than 11, burns covering greater than 35% body surface area, organ
transplant, hepatic failure, multiple trauma, short bowel syndrome Prophylaxis also indicated for patients with TWO of the following: sepsis, ICU stay greater than 1 week, occult bleeding for 6 days or more, use
of high dose steroids (hydrocortisone equivalent of greater than 250 mg/day) Avoid prophylaxis in patients who do not meet criteria
pantoprazole (PROTONIX) c 40 mg PO daily d
e
f
g
c 40 mg IV daily d
e
f
g
famotidine (PEPCID) c 20 mg PO q12h d
e
f
g
c 20 mg IV q12h d
e
f
g
Deep Venous Thrombosis Prophylaxis Protocol Form Laboratory Hematology c CBC with differential - In AM daily. Discontinue after day three blood draw d
e
f
g
c aPTT d
e
f
g
c PT and INR d
e
f
g
Chemistry c Creatine kinase, MB isoenzyme (CK-MB) , and Troponin-I, at 6 and 12 hrs after initial set of cardiac enzymes obtained d
e
f
g
c Hemoglobin A1c (HbA1c) - If not been done in past three months d
e
f
g
c Thyroid stimulating hormone (TSH) - (not needed if known or recently determined) d
e
f
g
c B-type natriuretic peptide (BNP) - (not need if known or recently determined) d
e
f
g
c C-reactive protein (CRP), cardiac, high-sensitivity d
e
f
g
c Magnesium (Mg) level, serum d
e
f
g
c Phosphorus level, serum d
e
f
g
Urine Studies c Urinalysis (UA) with microscopy d
e
f
g
Physician Name (Type):
rev dso 02/12 nmt 12/31/10 Page 3 of 4 Pager Number: Physician Order Set PATIENT LABEL CONGESTIVE HEART FAILURE ADMISSION ORDERS Panels c CMP on admission d
e
f
g
c BMP - In AM daily. Discontinue after day three blood draw d
e
f
g
c Fasting lipid profile (not needed if known or recently determined) d
e
f
g
Therapeutic Drug Levels/Toxicology c Digoxin level d
e
f
g
c FK-506 (Tacrolimus level) d
e
f
g
Diagnostic Tests Cardiology c Echocardiogram routine transthoracic (if not done)
d
e
f
g
Evidence - Echocardiogram Order Form (REQUIRED)
g
c 12-lead ECG - reason:
d
e
f
Consults c Consult Dietary - congestive heart failure “CHF” Salt & Fluid Restriction. d
e
f
g
c Consult to discharge planning
d
e
f
g
Medication Reconciliation Form Additional Orders 1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Physician Name (Type):
Physician Signature (required):______________________
rev dso 02/12 nmt 12/31/10 Page 4 of 4 Pager Number: Date:_____________ Time:_____________ Print All