Download Gastrointestinal Bleeding - Western Maryland Health System

WESTERN MARYLAND HEALTH SYSTEM Provider Orders Reminder: ALL MEDICATION ORDERS REQUIRE DOSE, ROUTE, FREQUENCY DO NOT USE ABBREVIATIONS
Page 1 of 3 Gastrointestinal Bleeding Medications Antibacterial Prophylactic Agents: Cephalosporins, 3rd­Generation cefTRIAXone 1 gram intravenously every 24 hours Anti­ulcer Agents: Proton Pump Inhibitors pantoprazole loading dose 80 milligram intravenously once pantoprazole drip 80 milligram 8 milligram/hour intravenously CONTINUOUS Gastrointestinal Prokinetic Agents erythromycin 250 milligram intravenously once Stress Ulcer Prophylaxis Agents: Histamine­2 Receptor Antagonists famotidine 20 milligram intravenously every 12 hours Vasoactive Agents octreotide acetate loading dose 25 microgram intravenously once octreotide acetate drip 25 microgram/hour intravenously CONTINUOUS Antibacterial Agents ciprofloxacin 400 milligram intravenously every 12 hours metroNIDAZOLE 500 milligram intravenously every 8 hours Corticosteroids methylPREDNISolone 40 milligram intravenously every 8 hours Other
Respiratory Blood gas, arterial Blood gas, venous Other
Laboratory Blood Bank TYPE AND SCREEN TYPE/XMATCH RBC UNITS , _____ units FRESH FROZEN PLASMA , _____ units and reason wanted: Physician/Date/Time: _________________________ Nurse/Date/Time: _______________________ Secretary/Date/Time: ________________________ Full page of orders requires only one physician, one nurse and one clerical signature Original to Patient's Chart
Original: 10/2013
Revised:
Reviewed:
Fax to Pharmacy Form #: 16.1­001
WESTERN MARYLAND HEALTH SYSTEM Provider Orders Reminder: ALL MEDICATION ORDERS REQUIRE DOSE, ROUTE, FREQUENCY DO NOT USE ABBREVIATIONS
Page 2 of 3 Hematology Complete blood cell count with automated white blood cell differential , if not already obtained Hemoglobin and hematocrit every 4 hours every 6 hours every 8 hours every 12 hours one hour after last unit of PRBCs infused Occult blood, stool, guaiac Partial thromboplastin time (PTT), activated , if not already obtained Prothrombin time (PT) and international normalized ratio (INR) , if not already obtained Panels Basic metabolic panel Hepatic function panel Renal function panel Serology Helicobacter pylori antibody Hepatitis panel, acute Stool Studies CLOSTRIDIUM DIFFICILE TOXIN Culture, stool CRYPTOSPORIDIUM/GIARDIA Other
Radiology Computed Tomography CT angiography, abdomen CT,ABDOMEN PELVIS W/WO CONT IV and oral contrast CT,ABDOMEN PELVIS W/O CONT Oral contrast only CT,ABDOMEN PELVIS W/O CONT No oral contrast General Radiography XR,BARIUM SWALLOW/ESOPHAGUS XR,GASTROGRAPHIN SWALLOW XR,AIR CONTRAST UPPER GI W/KUB XR,UPPER GI SERIES W/SM BOWEL XR,GASTROGRAPHIN UPPER GI XR,SMALL BOWEL SERIES ONLY XR,BARIUM ENEMA XR,AIR CONTRAST BARIUM ENEMA Physician/Date/Time: _________________________ Nurse/Date/Time: _______________________ Secretary/Date/Time: ________________________ Full page of orders requires only one physician, one nurse and one clerical signature Original to Patient's Chart
Original: 10/2013
Revised:
Reviewed:
Fax to Pharmacy Form #: 16.1­001
WESTERN MARYLAND HEALTH SYSTEM Provider Orders Reminder: ALL MEDICATION ORDERS REQUIRE DOSE, ROUTE, FREQUENCY DO NOT USE ABBREVIATIONS
Page 3 of 3 XR,ABD FLAT W/ERECT OR DECUB XR,ABD FLAT/ERECT W/CHEST 1VW Nuclear Medicine Nuclear medicine, gastrointestinal blood loss imaging tagged red blood cell scan Ultrasonography Ultrasound, abdomen Other
Diagnostic Tests Cardiology 12­lead ECG Other
Consults Consult to gastroenterology Consult to general surgery Consult to interventional radiology ­ Visceral angiogram, selective Other
Nursing Orders Assessments Cardiac monitor Contingency Notify provider if stool for occult blood is positive if INR is greater than 2 Oxygen saturations less than 90% Change in mental status for systolic blood pressure less than 90 or greater than 170 Chest pain Hemoglobin drops less than 7.0 or more than 1 grams from last recorded value urine output is less than 30 ml/hr Interventions Elevate head of bed 30 degrees 45 degrees Nasogastric/orogastric tube insertion/management to low intermittent suction to gravity Other
Physician/Date/Time: _________________________ Nurse/Date/Time: _______________________ Secretary/Date/Time: ________________________ Full page of orders requires only one physician, one nurse and one clerical signature Original to Patient's Chart
Original: 10/2013
Revised:
Reviewed:
Fax to Pharmacy Form #: 16.1­001