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PHILHEALTH CLINICAL PATHWAYS CLINICAL GUIDELINES DENGUE CLINICAL PATHWAY Assessment Diagnostics Treatments Teaching 1st 30 min 2nd 30 min Ascertained with fever of 2-7 days duration with any of the following: skin flushing rashes headache retro-orbital pain myalgia/arthralgia, CBC taken Risk factors for hemorrhagic tendency assessed. 3rd 30 min Platelet ct less than 100,000, do PTT and blood typing Platelet ct greater than 100,000 discharge and advised to do serial CBC daily Admit if: platelet count is less than 100,000 OR if with any of the ff. regardless of the platelet count spontaneous bleeding persistent abdominal pain persistent vomiting changes in mental status restlessness weak rapid pulse cold clammy skin circumoral cyanosis difficulty of breathing seizures hypotension narrowing of pulse pressure. Give information on Dengue fever and measures to control infection at home ADMITTING ORDERS Admitting Impression: Dengue Fever Concomitant diagnosis: ____________________________ Please admit to room of choice under the service of Dr. ________________ Diet: __________________________________ Vital signs: Lab: – – – – – – – – – every 4 hours every _____________ CBC blood typing PTT SGPT Urinalysis Chest x-ray PA and lateral Na, K BUN, Creatinine Others: __________________________ __________________________ ADMITTING ORDERS • IVF: __________________________ Other medications: _________________________________________________ _________________________________________________ • Ancillary Therapy: _________________________________________________ _________________________________________________ _________________________________________________ • • • Referral to other services: Hematology _________________________________________________ Others _________________________________________________ • • • • • • Inform attending physician(s) and resident-on-duty of patient’s room number Refer for any undue development. ______________________ Signature over printed name Attending Physician URINARY TRACT INFECTION Assessment Diagnostics 1st 30 min 2nd 30 min Ascertained with 1 or more of the ff: dysuria, frequency, hematuria, fever, flank pain, lower abdominal pain AND no vaginal discharge, absent vaginal irritation Routine urinalysis ordered Risk factors assessed: DM pregnancy 3rd 30 min 4th 30 min Urine culture and sensitivity for the ff: Schedule for renal ultrasound if with any of the ff: gross hematuria obstructive symptoms persistent infection history or symptoms suggestive of urolithiasis Blood culture if with sepsis May be sent home with oral antibiotic OR Admit if: uncomplicated pyelonephritis in women and unable to take oral antibiotics pregnant women with acute pyelonephritis complicated UTI Management worsening signs and symptoms pregnant women acute uncomplicated pyelonephritis suspected complicated UTI. ADMITTING ORDERS • • • • • • Admitting Impression: Urinary Tract Infection Concomitant diagnosis: ____________________________ • Lab: Please admit to room of choice under the service of Dr. ________________ Diet: __________________________ Vital signs: __ every 4 hours __every hour every _____________ – – – – – • • • Urinalysis CBC Urine culture Chest x-ray PA and lateral BUN, Creatinine Na, K Urine culture Others: __________________________ • • • • • • • • • • • • • • • • ADMITTING ORDERS Antibiotics: Cefuroxime 1.5 gms. IV infusion for 30 minutes every 8 hours Co-amoxiclav 1.2 gms. IV infusion for 30 minutes every 8 hours Ampicillin/sulbactam 1.5 gms. IV infusion for 30 minutes every 8 hours Piperacillin/tazobactam 4.5 gms. IV infusion for 30 min every 8 hours Ticarcillin/clavulanate 3.2 gms. IV infusion for 30 min every 8 hours Ertapenem 1 grm IV infusion for 30 min every 24 hours Meropenem 1 gm. IV infusion for 30 min every 8 hours Imipenem 500 mgs. IV infusion for 30 min every 6 hours Ciprofloxacin 400 mgs. IV infusion for 30 min every 12 hours Administer after negative skin test Others: _________________________________________________ _________________________________________________ _________________________________________________ Other medications: _________________________________________________ ADMITTING ORDERS • • • • • • • • • • • • • • • • Ancillary Therapy: _________________________________________________ _________________________________________________ Referral to other services: Infectious Disease Nephrology Others: _________________________________________________ _________________________________________________ _________________________________________________ Inform attending physician(s) and resident-on-duty of patient’s room number Refer for any undue development. ______________________ Signature over printed name Attending Physician COMMUNITY ACQUIRED PNEUMONIA CLINICAL DIAGNOSIS • • • • • Cough Fever Difficulty of breathing Chills Within the past 24 hours to less than 2 weeks CLINICAL DIAGNOSIS Associated with • Tachypnea (RR > 20 breaths/min) • Tachycardia (HR > 100/min) • Fever (T > 37.8oC) With at least one of the ff: • Diminished breath sounds • Rhonchi • Crackles • Wheeze DIAGNOSTIC TESTS • Chest Xray • Gram stain and culture of appropriate pulmonary secretions • Pre-treatment Blood Cultures ADMITTING ORDERS • • • • • • • Admitting Impression: Community-acquired pneumonia, moderate-risk Concomitant diagnosis: ____________________________ Please admit to room of choice under the service of Dr. ___________________ Diet as tolerated Vital signs: every 4 hours every _____________ Lab: Chest x-ray PA and lateral CBC Sputum GS, C/S Blood Culture BUN, Creatinine Serum Na+ Serum K+ Others: __________________________ ADMITTING ORDERS • IVF: ________________________ • Antibiotics: Co-amoxiclav 1.2 gm IV infusion for 30 minutes every 8 hours Ampicillin/sulbactam 1.5 g IV infusion for 30 minutes every 8 hours Azithromycin 500 mg IV infusion for 2-3 hours every 24 hrs 1 tablet 2x a day Cefuroxime 750 mg IV every 8 hours Clarithromycin 500 mg IV infusion for 2-3 hours q 12 o Others: _________________________________________________ ADMITTING ORDERS • Other medications: • Pneumococcal vaccine prior discharge • Influenza vaccine prior to discharge ________________________________________________ _________________________________________________ • Ancillary Therapy: • O2 inhalation ____________________________________ • Others: _________________________________________________ ADMITTING ORDERS • • • • • Referral to other services: Infectious Disease____________________________________________ Pulmonary ____________________________________________ Others: ____________________________________________ Inform attending physician(s) and resident-on-duty of patient’s room number • Refer for any undue development. • • = • _____________________ • Signature over printed name • Attending Physician • CAP SEVERE ADMITTING ORDERS • • • • • • • Admitting Impression: Community-acquired pneumonia, high risk Concomitant diagnosis: ____________________________ Please admit to ICU under the service of Dr. ___________________ Diet as tolerated Vital signs: every 1 hour every _____________ Lab: Chest x-ray PA and lateral CBC Sputum GS, C/S Blood Culture BUN, Creatinine Serum Na+ Serum K+ Others: __________________________ ADMITTING ORDERS • IVF: ___________________________ • Antibiotics: • * Pls modify dose if creatinine is elevated • Piperacillin/tazobactam 4.5 g IV infusion for 30 min every 8 hours * • Ticarcillin/clavulanate 3.2 g IV infusion for 30 min every 8 hours * • Meropenem 1 g IV infusion for 30 min every 8 hours * • Imipenem 500 mg IV infusion for 30 min every 6 hours* • Amikacin 500 mg IV infusion for 30 min every 24 hours* • Levofloxacin 500 mg IV infusion for 30 minutes every 24 hours* • Azithromycin 500 mg IV infusion for 2 hours every 24 hours* • Clarithromycin 500 mg IV infusion for 2 hours every 12 hours o • Others: _________________________________________________ • _________________________________________________ ADMITTING ORDERS • Other medications: • Pneumococcal vaccine prior discharge • Influenza vaccine prior to discharge ________________________________________________ _________________________________________________ • Ancillary Therapy: • O2 inhalation ____________________________________ • Others: _________________________________________________ ADMITTING ORDERS • • • • • Referral to other services: Infectious Disease____________________________________________ Pulmonary ____________________________________________ Others: ____________________________________________ Inform attending physician(s) and resident-on-duty of patient’s room number • Refer for any undue development. • • = • _____________________ • Signature over printed name • Attending Physician •