Download Emer Stroke Adult

Unique Plan Description: Emer Stroke Adult
Plan Selection Display: Emer Stroke Adult
PlanType: Medical
Version: 18
Begin Effective Date: 2/12/2015 15:41
End Effective Date: Current
Available at all facilities
Emer Stroke Adult
Vital Signs/Monitoring
Patient Monitor
Telemetry | Cardiorespiratory and Pulse Oximetry, May be Off Monitor for N/A
Comments: Record data every 5 minutes until patient is stable, then every 15 minutes.
Neurological Checks
with Vital Signs, For patients to be admitted to the ICU or to receive tPA, Q1HR (DEF)*
with Vital Signs, For patients to be admitted to the floor, Q4HR
Nursing
Saline Lock Insertion
Saline Lock, 18 gauge or larger antecubital (DEF)*
Saline Lock
Saline Lock, Large bore IV
Saline Lock, 2 Large bore IV
Saline Lock, Ultrasound guided peripheral IV
PIV Flush - Normal Saline Flush.
10 mL, INJ, PRN, PRN Other (see comment)
Comments: Flush device with each use. If not in continuous use, PIV must be flushed a
minimum of every 8 hours.
Nursing Swallow Assessment
Before administering any PO medication, perform bedside swallow test with 30 ml water. Notify
physician of result and record appropriately., ONCE
Continuous Infusions
NS IVF
1,000 mL, 75 mL/hr, IV, Injection
Medications
Before administering any PO medication, perform bedside swallow test with 30mL water. Notify physician of
result and record appropriately.(NOTE)*
Options for blood pressure control to bring BOTH systolic BP < 185 and diastolic BP < 110:(NOTE)*
nitroglycerin topical ointment
1 gm, topical, Ointment, ONCE (DEF)*
Comments: 1 gram = 1 inch
2 gm, topical, Ointment, ONCE
Comments: 1 gram = 1 inch
*****OR*****(NOTE)*
labetalol IV
10 mg, IV, Injection, ONCE (DEF)*
20 mg, IV, Injection, ONCE
*****OR*****(NOTE)*
niCARdipine 0.1 mg/mL in NS 250 mL IV Drip (mg/hr) (IVS)*
NS IV Drip - INET parameters
IV, 2.5 mg/hr = Titration Increment, 5 min = Titration Interval
Comments: Titrate to goal MAP below ____.Hold for SBP less than ____.*conc: 0.1 mg/
mL*
niCARdipine ADDITIVE - INET
25 mg, 5, mg/hr
niCARdipine 0.2 mg/mL in NS 250 mL IV Drip (mg/hr) (IVS)*
NS IV Drip - INET parameters
IV, 2.5 mg/hr = Titration Increment, 5 min = Titration Interval
Comments: Titrate to goal MAP below ____.Hold for SBP less than ____.*conc: 0.2 mg/
mL*
niCARdipine ADDITIVE - INET
50 mg, 5, mg/hr
TISSUE PLASMINOGEN ACTIVATOR (tPA) ORDERS:(NOTE)*
ORDER tPA USING PAPER ORDER SETS. SEND VIA ORDERCOMM OR FAX TO PHARMACY.(NOTE)*
Do not give heparin or aspirin unless decision is made NOT to give tPA(NOTE)*
Reason IV Thrombolytic Therapy Not Initiated
Other Analgesia/Anti-Emetic Medications:(NOTE)*
acetaminophen oral solid
650 mg, PO, Tab, ONCE (DEF)*
975 mg, PO, Tab, ONCE
fentanyl IV
50 mcg, IV, Injection, ONCE
hydromorphone IV
1 mg, IV, Injection, ONCE
morphine IV
4 mg, IV, Injection, ONCE
oxycodone-acetaminophen 5-325mg oral solid-Percocet
1 tab, PO, ONCE (DEF)*
2 tab, PO, ONCE
ondansetron IV
4 mg, IV, Injection, ONCE (DEF)*
8 mg, IV, Injection, ONCE
ondansetron oral solid
4 mg, PO, Dissolve Tablet, ONCE (DEF)*
8 mg, PO, Dissolve Tablet, ONCE
Common PRN and Routine Medications Adult Subphase(SUB)*
Laboratory
************ Point of Care ************(NOTE)*
Capillary Blood Glucose
ONCE
Comments: Notify MD of glucose results.
Chemistry Panel POC
ONCE
Cardiac Panel POC
ONCE
Hemoglobin POC
By Hemocue, ONCE
POC Urinalysis
Urine, Emergent collect, ONCE
Urine Pregnancy POC
ONCE
Comments: hCG Urine
************ Laboratory Tests ************(NOTE)*
ABG w/Meas Sat
Blood, Emergent collect, ONCE
Basic Metabolic Panel
Blood, Emergent collect, ONCE
Blood Culture Site 1
Blood Venipuncture, Emergent collect, ONCE (DEF)*
Blood from Intravascular Line, Emergent collect, ONCE
Blood Culture Site 2
Blood Venipuncture, Emergent collect, ONCE (DEF)*
Blood from Intravascular Line, Emergent collect, ONCE
CBC with Diff
Blood, Emergent collect, ONCE
Comprehensive Metabolic Panel
Blood, Emergent collect, ONCE
PT/INR/APTT
Blood, Emergent collect, ONCE
Urinalysis
Urine, Emergent collect, ONCE
Urine Culture
Urine Clean Catch Midstream, Urgent collect, ONCE (DEF)*
Urine Catheterized, Urgent collect, ONCE
Suprapubic Bladder Aspirate, Urgent collect, ONCE
Urine Pedibag, Urgent collect, ONCE
Respiratory
Oxygen Therapy
Nasal Cannula, Keep SPO2 greater/equal 90%, Improve Oxygenation (DEF)*
Nasal Cannula, 2 L/min, Keep SPO2 greater/equal 90%, Improve Oxygenation
Nasal Cannula, 4 L/min, Keep SPO2 greater/equal 90%, Improve Oxygenation
Nasal Cannula, Keep SPO2 greater/equal 92%, Improve Oxygenation
Oxygen Therapy
Aerosol Face Mask, 28% FiO2, Keep SPO2 greater/equal 90%, Improve Oxygenation (DEF)*
Aerosol Face Mask, 40% FiO2, Keep SPO2 greater/equal 90%, Improve Oxygenation
Trach Collar, 28% FiO2, Keep SPO2 greater/equal 90%, Improve Oxygenation
Trach Collar, 40% FiO2, Keep SPO2 greater/equal 90%, Improve Oxygenation
Venti Face Mask, 28% FiO2, Keep SPO2 greater/equal 90%, Improve Oxygenation
Venti Face Mask, 40% FiO2, Keep SPO2 greater/equal 90%, Improve Oxygenation
Oxygen Therapy
Nonrebreather Mask, Keep SPO2 greater/equal 90%
Radiology/Imaging
XR Chest 1 View Frontal
Emergent, Reason: Code Stroke, Transport Mode: Portable, Emergency Services Adult
Comments: Code Stroke
XR Chest 2 Views
Emergent, Emergency Services Adult
Comments: Code Stroke
CT Head or Brain w/o Contrast
Emergent, Emergency Services Adult
Comments: Code Stroke
MRI Brain w/o Contrast
Emergent, Emergency Services Adult
Comments: Code Stroke
MRI Brain w/ Contrast
Emergent, Emergency Services Adult
Comments: Code Stroke
MRA Head w/o Contrast
Emergent, Emergency Services Adult
Comments: Code Stroke
MRA Head w/ Contrast
Emergent, Emergency Services Adult
Comments: Code Stroke
Diagnostic Tests
ED - EKG - 12 Lead
Emergent, Reason: Code Stroke
*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase