Download Antihypertensive Protocol Orders

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Physician Orders ADULT
Antihypertensive Protocol Orders
[R] = will be ordered
T= Today; N = Now (date and time ordered)
Height: ___________cm Weight: __________kg
[ ] No known allergies
Allergies:
[ ]Medication allergy(s):_____________________________________________________________________
for
[ ] Latex allergy
[ ]Other:__________________________________________________________________
T;N
[R] Antihypertensive Protocol Initiate
Order
Patient Care
[ ] Arterial Blood Pressure Monitoring T;N, Mean Arterial Pressure Monitoring - _______ (Baseline MAP) x 0.75 =
________ (25% reduction) Comment: Reduce MAP by NO MORE THAN 25%
within the first 2 hours of infusion initiation.
T;N, P, R, BP q15 min, Comment: Once MAP goal reached, target 6 hour BP Goal
[ ] Vital Signs
range of 150-170 / 90-100;reduce BP gradually without exceeding goal range
[ ]
Nursing Communication
[ ]
Nursing Communication
T;N, Antihypertensive Protocol: After 6 hour goal is achieved begin scheduled and
PRN medications in order to maintain BP goal range of 140-160 / 90-100 mmHg
[ ]
T;N, Antihypertensive Protocol: 12 hours after oral medications started and BP
goal achieved, begin to wean continuous infusion while utilizing PRN's.
Continuous Infusion
Choose one intravenous antihypertensive medication
NOTE: Nitroglycerin may be the preferred drug for patients with acute coronary syndromes or CHF.
NitroGLYcerin drip
50mg/250ml, IV Piggyback, Routine, T;N, 5 mcg/min, Comment:. Titrate by 5
mcg/min as often as every 5 minutes to desired effect specified by MD or goal
MAP range is achieved. Maximum dose is 200 mcg/min. Comment: Continue
infusion to achieve a 6 hour BP range of 150-170 / 90-100. Begin to wean
continuous infusion 6-12 hours after beginning oral medications.
NOTE: Nitroprusside should not be used in patients with hepatic/renal dysfunction or neurosurgical patients.
[ ]
NitroPRUsside drip
[ ]
[ ]
50mg/250ml, IV Piggyback, Routine, T;N,(48 hr),0.3 mcg/kg/min, Comment:
Titrate by 0.5 mcg/kg/min as often as every 5 minutes to desired effect specified
by MD or goal MAP range is achieved. If rate exceeds 2 mcg/kg/min, call
physician and consider alternative agent. Maximum dose is 4 mcg/kg/min.
Automatic discontinuation after 48 hrs. Continue infusion to achieve a 6 hour BP
range of 150-170 / 90-100. Begin to wean continuous infusion 6-12 hours after
beginning oral medications.
NOTE: Nicardipine may be the preferred agent.
NiCARdipine drip:
40mg/200ml, IV, Routine, T;N, Titrate, Comment: Titrate by 2.5 mg/hr as often as
every 15 minutes to desired effect specified by MD or goal MAP range is achieved.
Maximum dose is 15 mg/hr. Continue infusion to achieve a 6 hour BP range of
150-170 / 90-100. Begin to wean continuous infusion 6-12 hours after beginning
oral medications.
clevidipine infusion
25mg / 50mL,IV, Routine,T;N, Titrate, Comment: Begin at 1mg/hr; Titrate by
doubling dose every 90 seconds until approaching desired BP as specified by MD
then every 5-10 min to maintain desired effect. Continue infusion to achieve a 6
hour BP range of 150-170 / 90-100. Begin to wean continuous infusion 6-12 hours
after beginning oral medications.Max dose is 16 mg/hr. Conc: 0.5 mg/mL
*111*
PT Anti-Hypertensive Protocol 23039- QM0209
Ver3 Rev031715
Page 1 of 2
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Physician Orders ADULT
Anti-Hypertensive Protocol Orders
[R] = will be ordered
T= Today; N = Now (date and time ordered)
[ ]
labetalol
[ ]
hydrALAZINE
[ ]
hydrALAZINE
[
[
[
[
hydrochlorothiazide
amLODIpine
metoprolol (lopressor)
lisinopril
]
]
]
]
[ ]
Creatinine
[ ]
[ ]
Notify Physician Once
Consult Pharmacist
__________________
__________________
Date
Time
Medications
10mg, IV, q30 min, PRN, Routine, T;N, For systolic BP greater than 160 mmHg,
Use as first choice to achieve hemodynamic parameters.
10mg, IV, q4h, PRN, Routine, T;N, for systolic BP greater than 160 mmHg
Comment: Use if labetalol 10mg ineffective, then if no response, call MD for
further orders
20mg, IV, q4h, PRN, Routine, T;N, for systolic BP greater than 160 mmHg
Comment: Use if hydrALAZINE 10mg ineffective, then if no response, call MD for
further orders
25mg, Tab, PO, QDay, Routine, T;N
10mg, Tab, PO, QDay, Routine, T;N
25mg, Tab, PO, bid, Routine, T;N
10mg, Tab, PO, QDay, Routine, T;N
Laboratory
STAT, T;N, once, blood, Nurse Collect
Consults/Notifications
T;N, if labetalol and/or hydralazine ineffective, call MD for further orders
T;N, STAT, Evaluate patient and notify physician if nitroprusside regimen exceeds
48hrs in duration.
_________________________________________________
Physician's Signature
PT Anti-Hypertensive Protocol 23039- QM0209
Ver3 Rev031715
Page 2 of 2
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MD Number