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Critical Care Cardiothoracic Surgery Atrial Fibrillation Management [30400733] Height_____________________ Weight_____________________ Allergies____________________ Note to Physician Discontinue previous amiodarone, diltiazem and metoprolol orders General Notify Provider [X] Notify provider Routine, Until discontinued, Starting today Pulse greater than: 120 __________________________________ Respiratory rate less than: ________________________________ Respiratory rate greater than: ______________________________ Temperature greater than (celsius): _________________________ Urine output less than (mL/hr): _____________________________ Systolic BP greater than: _________________________________ Systolic BP less than: 90 _________________________________ Diastolic BP greater than: _________________________________ Diastolic BP less than: ___________________________________ Other: Pulse less than 60 - If Temporary Pacing Wires not present, notify surgeon - Prior to administering medications for atrial fibrillation management, Notify surgeon or physician asistant. Temporary pacing is required. Diltiazem infusion at maximum dose of 15mg/hour. Respiratory status change requiring increased oxygen supply. Hemodynamic instability not covered above [ ] Other Nursing Interventions [X] Nursing Communication Routine, Until discontinued, Starting today Systolic BP greater than: 90 ______________________________ Pulse less than: 120 _____________________________________ Pulse greater than: 70 ___________________________________ A-fib status: __________________________________(Required) Prior to administering medications for atrial fibrillation management, connect temporary pacemaker and target vital signs parameters. Prior to administering medications for atrial fibrillation management, ensure external defibrillator/pacemaker immediately available. [ ] Other Date/Time ___________________Provider Initial:______________ PATIENT INFORMATION Page 1 of 3 Critical Care Cardiothoracic Surgery Atrial Fibrillation Management [30400733] PROVIDER ORDERS Medications Amiodarone [ ] Amiodarone [ ] Administer initial amiodarone bolus [ ] amiodarone (CORDARONE) infusion [ ] amiodarone (PACERONE) tablet [ ] Administer second amiodarone bolus Dose: 150 mg _______________________________________ Route: IntraVENous ___________________________________ Frequency: Once _____________________________ Duration: for 10 Minutes, Administer over 20 minutes if systolic blood pressure less than 100 mmHg Routine Dose: 1 mg/min ______________________________________ Route: IntraVENous ___________________________________ Frequency: Titrated ___________________________________ Duration: 1 mg/minute for 6 hours, then decrease to 0.5 mg/minute. Discontinue 2 hours after first amiodarone oral dose Routine Dose: 400 mg ________________________________________ Route: Oral _____________________________________ Frequency: 2 times daily PRN PRN Comment: change to BID scheduled if patient converts to Normal Sinus Rhythm. If patient converts to normal sinus rhythm - Nurse to send Rx message - Reason = Adjust Times - requesting pharmacist to change frequency to BID [not PRN]. Stop amiodarone infusion 2 hours after first oral dose. Routine Dose: 150 mg ______________________________________ Route: IntraVENous ___________________________________ Frequency: As needed ________________________________ Duration: for 10 Minutes, PRN comment: If patient returns to atrial fibrillation after converting to sinus rhythm, administer second amiodarone bolus and continue amiodarone PO Administer over 20 minutes if systolic blood pressure less than 100 mmHg Routine [ ] Other Diltiazem (Cardizem) 4 hours after initiation of amiodarone infusion, if heart rate remains greater than 120 beats per minute and systolic blood pressure greater than 90 mmHg, initiate diltiazem [ ] Diltiazem (Cardizem) [ ] Administer initial diltiazem bolus Dose: 0.25 mg/kg _____________________________________ Route: IntraVENous ___________________________________ Frequency: Once ___________________________________ Admin Instructions: Maximum dose 15 mg Requires Cardiac Monitor Routine Date/Time ___________________Provider Initial:______________ PATIENT INFORMATION Page 2 of 3 Critical Care Cardiothoracic Surgery Atrial Fibrillation Management [30400733] PROVIDER ORDERS [ ] Diltiazem infusion at 5 mg/hour (maximum rate is 15 mg/hour) [ ] Administer second diltiazem bolus [ ] diltiazem infusion 1 mg/mL Dose: 5 mg/hr _______________________________________ Route: IntraVENous ___________________________________ Frequency: Titrated _____________________________ Admin Inst: Increase by 5 mg/hour every 15 minutes to achieve target parameters. Requires cardiac monitor. Routine Dose: 0.35 mg/kg _____________________________________ Route: IntraVENous ___________________________________ Frequency: Once ___________________________________ Admin Instructions: Maximum dose 20 mg Administer if heart rate remains greater than 120 and systolic blood pressure greater than 90 mmHg 15 minutes after initiation of first diltiazem IV loading dose. Requires Cardiac Monitor Routine Dose: 2-10 mg/hr _____________________________________ Route: IntraVENous ___________________________________ Frequency: Titrated _____________________________ Admin Inst: Continue titrating diltiazem infusion to target parameters and/or maximum rate of 15 mg/hour. Routine [ ] Other Metoprolol (Lopressor) If patient tolerating diltiazem infusion and within target parameters, initiate metoprolol. [ ] Metoprolol (Lopressor) [ ] Start metoprolol Dose: 25 mg ________________________________________ Route: Oral _________________________________________ Frequency: Every 6 hours _____________________________ If patient tolerating diltiazem infusion and within target parameters. Hold if HR < 70 or SBP < 90 mmHg. Routine [ ] Begin tapering diltiazem infusion off two hours after first PO Priority: Routine, dose Frequency: Until discontinued, Starting today Decrease dose by 2 mg/hour every 15 minutes while maintaining heart rate and blood pressure within the target parameters until infusion off. [ ] Hold metoprolol if heart rate less than 70 beats per minute or Routine, Until discontinued, systolic blood pressure less than 90 mmHg Starting today [ ] Other Date/Time:__________________________ Printed Name of Ordering Provider:_______________________________________________ Provider Signature: ______________________________________________________ Date/Time:_________________ RN Acknowledged: ___________________________________________________________ Date/Time ___________________Provider Initial:______________ PATIENT INFORMATION Page 3 of 3 Critical Care Cardiothoracic Surgery Atrial Fibrillation Management [30400733] PROVIDER ORDERS
