Download Cardioversion Pre and Post Procedure Orders

PLACE LABEL HERE
CARDIOVERSION
PRE and POST PROCEDURE
ORDERS
The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.
Initial all handwritten order modifications and the bottom of each page when indicated (multipage).
PRE-PROCEDURE
1.
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7.
NPO after midnight (except for medications)
Obtain 12-lead EKG
Labs:  CBC  Chem 7  PT / INR  PTT  Mg
Notify physician if K+ < 3.7 or INR < 2.0
Start IV with NS at KVO
Place patient on cardiac monitor
Place patient on O2 at 2 liters per minute via nasal cannula and maintain O2 sat > 92%
Medication during procedure:
 Fentanyl __________ mcg IV or IM (circle one)
 Versed (midazolam) __________ mg IV
 Diprivan (propofol) ONLY ADMINISTERED BY ANESTHESIA, dose documented on
Anesthesia record
POST-PROCEDURE
8.
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Vital signs per Moderate Sedation Policy (# 520-29)
Obtain 12 lead EKG post cardioversion
Diet as tolerated after procedure
Discharge patient home / nursing floor following procedure once patient has met PAR score /
discharge criteria
ADDITIONAL ORDERS:
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Date
___________________
Time
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Physician Signature
__________
PID Number
Send copy to pharmacy
*1-21317*
1
FORM 1-21317 REV. 02/2012
Page 1 of
PLACE LABEL HERE
CARDIOVERSION
PRE and POST PROCEDURE
ORDERS
Send copy to pharmacy
*1-21317*
1
FORM 1-21317 REV. 02/2012
Page 1 of