Download ACUTE CORONARY SYNDROME (ACS)

r*PHYSORDE*r
HALIFAX HEALTH
303 N. Clyde Morris Blvd., Daytona Beach, FL 32114
1041 Dunlawton Ave., Port Orange, FL 32127
PHYSICIAN’S ORDERS
Patient Name
Adm. Date
Date of Birth
MR #
Dr.
Age
Visit #
ACUTE CORONARY SYNDROME (ACS)
(NDOSACS)
ALLERGIES:
Page 1 of 3
HIGH RISK / DO NOT USE ABBREVIATIONS: U, IU, MS, MSO4, MgSO4, QD, QOD.
ALWAYS WRITE OUT INTENDED MEANING AND USE METRIC. DO NOT USE A ZERO AFTER A DECIMAL; ALWAYS USE A ZERO BEFORE A DECIMAL.
DATE
TIME
CK’D
(✔)
X CHECK BOX TO INITIATE ORDER
❑
Patient Status: (select only one)
❑ Admit to Inpatient. I certify that inpatient services are necessary.
❑ Place in Observation
❑ Case Management Protocol
Attending Physician is________________________________________________________
Unit/Floor: ❑ IMC ❑ CIC ❑ 10 Telemetry Diagnosis:_____________________________
Consult:_________________________________________________________________________
1. LABORATORY:
❑ CPK with MB every six hours times 3, including labs drawn in ED
❑ Troponin every six hours times 3 − UNSTABLE ANGINA ONLY, including labs drawn in ED
❑ CBC with Diff, BMP, PT/PTT, LFT, TSH, fasting lipid profile if not done in ED
❑ CBC with Diff 3 hours after Integrilin initiated. Notify physician if platelet count less
than 100,000
2. EKG:
❑ 12−Lead EKG every six hours times 3, including EKGs done in ED
❑ 12−Lead EKG with change in chest discomfort or rhythm change
❑ Attach CRM/powerheart to patient on transfer
3. DIET:
❑ NPO except meds for 4 hours, then advance to full liquid diet as tolerated, 4gm sodium
40gm fat, NO caffeine
❑ Other: _________________________________, NO caffeine.
4. PATIENT CARE:
❑ Activity: Bedrest with bathroom privileges/bedside commode if in critical care
❑ Activity: __________________________________________________________________
❑ Notify physician for: • Nausea and/or vomiting unresolved after medication
• Recurrent chest pain
• Change in CPK/MB or Troponin result from negative to positive
• Systolic BP less than 90 or _____ mmHg, HR less than 45 or _____ bpm
• Significant rhythm change
5. RESPIRATORY THERAPY:
❑ Oxygen 2 liters via nasal cannula for 24 hours, titrate to mask if SaO2 less than 90%
6. CONTINUOUS INTRAVENOUS INFUSION:
❑ IV Nitroglycerin, titrate for pain or at _______mcg/min. Keep SBP greater than 90 mmHg
DO NOT TITRATE OFF WITHOUT ORDER.
❑ Integrilin bolus 180mcg/kg over 2 minutes. REVIEW INTEGRILIN CONTRAINDICATIONS
ON PAGE 3 OF ORDER SHEET. Integrilin continuous infusion at 2mcg/kg/min (MAX
280mcg/min) if calculated creatinine clearance 50ml/min or greater using ACTUAL body
weight. REDUCE continuous infusion dose to 1mcg/kg/min if calculated creatinine clearance
less than 50ml/min using ACTUAL body weight. DO NOT USE INTEGRILIN IF SERUM
CREATININE greater than 4.
❑ Peripheral saline lock or infuse D5W at KVO rate.
PHYS ORDER
(CONTINUED ON PAGE 2)
ALL ORDERS TO PHARMACY
Page 1 of 3
HMC − 1568 − 3/10
r*PHYSORDE*r
HALIFAX HEALTH
303 N. Clyde Morris Blvd., Daytona Beach, FL 32114
1041 Dunlawton Ave., Port Orange, FL 32127
PHYSICIAN’S ORDERS
Patient Name
Adm. Date
Date of Birth
MR #
Dr.
Age
Visit #
ACUTE CORONARY SYNDROME (ACS)
(NDOSACS)
ALLERGIES:
Page 2 of 3
HIGH RISK / DO NOT USE ABBREVIATIONS: U, IU, MS, MSO4, MgSO4, QD, QOD.
ALWAYS WRITE OUT INTENDED MEANING AND USE METRIC. DO NOT USE A ZERO AFTER A DECIMAL; ALWAYS USE A ZERO BEFORE A DECIMAL.
DATE
TIME
CK’D
(✔)
❑ CHECK BOX TO INITIATE ORDER
X
7. MEDICATIONS:
❑ *Aspirin (uncoated) 325mg PO NOW if not already given today (unless allergic).
Enteric coated Aspirin 325mg PO daily (unless allergic).
May use Aspirin 300mg Suppository if PO route not available.
❑ Clopidogrel (Plavix) 600mg PO loading dose, then Clopidogrel (Plavix) 75mg PO daily
❑ Nitroglycerin ointment _______inches every _______hour(s)
*Beta Blocker: (give first dose NOW if not already given)
❑ Metoprolol ________mg PO every _______hour(s).
Hold for SBP less than 90 or _________mmHg, HR less than 50 or _______ bpm
❑ Other: _________________________________________________________________
❑ *ACE inhibitor or ARB: _____________________________________________________
❑ Calcium Channel Blocker: ____________________________________________________
❑ Statin (if indicated): _________________________________________________________
Anticoagulation:
❑ Lovenox: (DO NOT GIVE IF CREATININE greater than 4) 1mg/kg subcutaneously every
12 hours = _______ mg. If creatinine clearance less than 30ml/min, change interval to
every 24 hours (but use same dose)
OR
❑ Heparin Infusion Protocol for MI
• PRN MEDICATIONS:
❑ Nitroglycerin tab 0.4mg 1 SL every 5 minutes times 3 PRN chest pain
❑ Morphine Sulfate 2mg IVP every 30 minutes PRN chest pain
❑ Morphine Sulfate _______mg IVP every ______hour PRN severe pain
❑ Tylenol 325mg 2 tabs every 6 hours PRN headache or temp greater than 101
❑ Colace 100mg PO twice daily PRN constipation. Hold for loose stools.
❑ Xanax 0.25mg PO every 8 hours PRN anxiety
❑ Zofran 4 mg IVP every 6 hours PRN nausea/vomiting
8. ADDITIONAL ORDERS:
❑ Provide cardiac education and discharge instructions
❑ *Provide smoking cessation counseling
❑ Refer to cardiac rehab
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Physician Signature:__________________________________________ Dictation #:__________________
PHYSICIANS: PLEASE REMEMBER TO USE YOUR DICTATION NUMBER WITH YOUR SIGNATURE.
PHYS ORDER
ALL ORDERS TO PHARMACY
Page 2 of 3
HMC − 1568 − 3/10
r*PHYSORDE*r
HALIFAX HEALTH
303 N. Clyde Morris Blvd., Daytona Beach, FL 32114
1041 Dunlawton Ave., Port Orange, FL 32127
PHYSICIAN’S ORDERS
Patient Name
Adm. Date
Date of Birth
MR #
Dr.
Age
Visit #
ACUTE CORONARY SYNDROME (ACS)
CONTRAINDICATIONS TO
EPTIFIBATIDE (INTEGRILIN) USE:
1.
A history of bleeding diathesis, or evidence of active abnormal bleeding within the previous 30 days
2.
Severe hypertension (SBP greater than 200mmHg or DBP greater than 110mmHg) not adequately controlled
on antihypertensive therapy
3.
Major surgery within the preceding 6 weeks
4.
History of stroke within 30 days or any history of hemorrhagic stroke
5.
Current or planned administration of another parenteral GPIIb/IIIA inhibitor
6.
Dependency on renal dialysis
7.
Known hypersensitivity to any component of the product
PHYS ORDER
Page 3 of 3
HMC − 1568 − 3/10