Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
PLACE LABEL HERE HYPERTONIC (3%) SALINE FOR ACUTE SYMPTOMATIC HYPONATREMIA ORDERS The following orders will be implemented. Orders with a “” are choices and are NOT ordered unless checked. Initial all handwritten order modifications and the bottom of each page when indicated (multipage). 1. Do you expect that the patient’s condition will require a hospital stay that will cross two midnights (includes the time spent in outpatient- ED, surgery, OBS) and the patient has medical necessity for an inpatient admission? Yes, admit as inpatient, proceed to # 2 No, place in observation 2. If admitted as inpatient, Inpatient Physician Certification: Diagnosis: ________________________________________________________________________________ Level of Care: Critical Intermediate Unit Preference: ICU IMCU/PCU Neuro ICU Neuro IMCU 3. Telemetry: If patient Medical/Surgical, must complete form # 36084 4. Isolation: Contact Droplet Airborne For: _________________ 5. Consults: Critical Care: Nephrology for management of 3% saline (Optional) Intermediate Care: Nephrology for management of 3% saline (Required) 6. STAT Diagnostics, IF NOT DONE IN THE LAST 4 HOURS CMP, Magnesium, Urine sodium, Urine Osmolality Other Diagnostics: Sodium Level q 2 hrs x 2 then q 4 hrs or continue q 2 hr monitoring while on 3% saline (first level in 2 hrs) Serum osmolality in AM Random serum cortisol in AM TSH and Free T4 in AM 7. Notify nephrologist/intensivist of each sodium result (Correction rate of serum sodium should not be > 1 mmol/L every 2 hours or > 10 mmol/L in 24 hours) or Notify nephrologist/intensivist if sodium level has changed > 1 mmol/L in 2 hrs or ≥ 10 mmol/L in 24 hrs 8. Vital signs per unit routine 9. Neuro checks: Critical Care: Neuro checks q 1 hr while 3% saline is infusing Intermediate Care: Neuro checks q 2 hrs x 24 hrs then q 4 hrs while 3% saline is infusing 10. Intake/Output: Critical Care: q 1 hr while 3% saline is infusing Intermediate Care: q 2 hrs while 3% saline is infusing 11. Urinary Catheter to urometer for critically ill/strict I&O. Maintain catheter while on hypertonic saline, then DC per Foley catheter removal standing orders (form # 31620). 12. Foley catheter removal and voiding assessment/interventions standing orders (form # 31620) 13. Notify nephrologist/intensivist if uop > 200 ml/hr for 2 consecutive hours 14. Place 2 large bore IVs if possible. Nursing to assess IV sites q 2 hrs while 3% saline infusing 15. Fluid Restriction: No water pitchers at bedside and restrict to 1,000 ml/day or _____ ml/day 16. Diet: NPO or Regular Cardiac 17. Activity (advance as tolerated): Diabetic______ calories Renal Bedrest w/ BSC Bedrest w/ BRP Up ad lib May shower Order writer’s initials _______ Copy to pharmacy *3-39732* Strict Bedrest FORM 3-39732 REV. 09/2016 Page 1 of 2 PLACE LABEL HERE HYPERTONIC (3%) SALINE FOR ACUTE SYMPTOMATIC HYPONATREMIA ORDERS The following orders will be implemented. Orders with a “” are choices and are NOT ordered unless checked. Initial all handwritten order modifications and the bottom of each page when indicated (multipage). SCHEDULED MEDICATIONS (Evalutate sodium deficit): 18. Hypertonic Saline: Bolus: 3% Saline Bolus 100 ml or _____ ml over 10 min IV STAT x 1 Infusion: 3% Saline _____ ml over ____ hours IV STAT x 1 or 3% Saline _____ ml/hr x ____ hrs (max of 18 hrs) PRN MEDICATIONS: See policy 520-06 for range orders and pain intensity guidelines. 19. Electrolyte Replacement Protocol (form # 21340) 20. Mild Pain, Temp >100.5F, HA: Tylenol (acetaminophen) 650 mg po or PR q 4 hrs prn 21. Moderate Pain: Norco (HYDROcodone/acetaminophen) 5/325 mg or 10/325mg 1 tab po q 4 hrs prn. DC if Percocet ordered. or If patient cannot take tablet, Hycet elixir (HYDROcodone/acetaminophen 7.5/325 mg/15 ml) 15 ml po q 4 hrs prn instead of Norco. DC if Percocet ordered. or Percocet (oxyCODONE/acetaminophen) 5/325 mg or 10/325 mg 1 tab po q 4 hrs prn. DC if Norco ordered. and/or Toradol (ketorolac) 30 mg IV (or IM if no IV access) q 6 hrs prn (15 mg if CrCl 31-50, > 65 y/o old or < 50 kg) or 10 mg po q 6 hrs prn (max combined duration of IV and po ketorolac is 5 days). DC if CrCl < 30. 22. Severe Pain (Begin when Epidural or PCA has been discontinued) Morphine 1-2 mg IV q 3 hrs prn, DC if CrCl < 30. Hold for excessive sedation. DC if Dilaudid ordered. or Dilaudid (HYDROmorphone) 0.25-0.5 mg IV q 3 hrs prn. If CrCl < 30, dose at 0.25 mg. Hold for excessive sedation. DC if Morphine ordered. 23. Nausea/Vomiting: Zofran (ondansetron) 4 mg IV or po q 6 hrs prn If N/V persists, add Reglan (metoclopramide) 10 mg IV q 6 hrs prn (5 mg if > 65 y/o) Melatonin 5 mg po q HS prn 24. Sleep: or Ambien (zolpidem) 5 mg (female or males ≥ 65 y/o) or 5-10 mg (male < 65 y/o) po at HS prn 25. Indigestion: Maalox XS (aluminum/magnesium/simethicone) 30 ml po four times daily prn 26. Stool Softener: Colace (docusate) 100 mg po bid prn; if patient has not had a bowel movement Milk of Magnesia (MOM) 30 ml po daily prn 27. Constipation: If no BM after 48 hrs, and/or Dulcolax (biscodyl) 10 mg per rectum daily prn Senokot-S (docusate/senna) 2 tablets po at bedtime nightly 28. Cough: Robitussin (guaifenesin) 15 ml po q 4 hrs prn 29. Sore Throat: Chloraseptic (phenol/sodium phenolate) throat spray q 2 hrs prn __________ ______________ _________________________________ __________ Date Time Physician Signature PID Number Copy to pharmacy FORM 3-39732 REV. 09/2016 Page 2 of 2