Chronic Obstructive Pulmonary Disease
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PHYSICIAN'S ORDER SHEET Chronic Obstructive Pulmonary Disease Another brand of a generically equivalent product identical in dosage form and content of active ingredient may be administered unless indicated.
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patient imprint
Chronic Obstructive Pulmonary Disease Admit Location c Admit to location __________________ d e f g Admission Status c Admit to inpatient to Dr. ______service. d e f g c Admit to observation to Dr. _________ service. d e f g Code Status c Resuscitation status Full Code d e f g c Resuscitation status Do Not Resuscitate / Do Not d e f g Intubate (allow natural death) c Resuscitation status Partial Code d e f g
c Blood gas, venous now if not done and ________. d e f g Source c Ventilator settings Evidence d e f g c Please record autopeep on vent. d e f g
Diet
g NPO / NPO except po meds with sips. c d e f c Clear liquids d e f g c Regular diet d e f g c Therapeutic diet ____________. d e f g There is inconclusive evidence to support the use of nutritional supplementation in patients with chronic Vital Signs obstructive pulmonary disease Evidence c Vitals per unit protocol d e f g IV Fluids c Vital signs every_____hour and then d e f g c Dextrose 5% with 0.9% NaCl @ _____mL/hr for 24 d e f g every_____________ hours. Pulse oximetry c Dextrose 5% with 0.45% NaCl @ _____mL/hr for 24 d e f g Continuous c d e f g hours. c Spot every shift and prn d e f g c Sodium Chloride 0.9% @ ______mL/hr for 24 hours. d e f g Activity c Additives ______________________ d e f g c Ambulate with assistance every 8 hours. d e f g c Saline lock. d e f g c Bed rest with bedside commode d e f g Medications c Bed rest d e f g Antibacterial Agents Evidence c Up ad lib to ______. d e f g Consider the administration of antimicrobial therapy Nursing Orders Evidence Assessments c cefTRIAXone /ROCEPHIN 1 gram intravenously once a d e f g c Glucose, blood, fingerstick. _______ One Time. Other d e f g day Frequency _______________ c azithromycin /ZITHROMAX 500 milligram d e f g intravenously once a day c Measure and document intake and output Total for d e f g every 8 hours c clarithromycin /BIAXIN 500 milligram orally every 12 d e f g hours with food. c Measure weight d e f g Contingency c levofloxacin /LEVAQUIN 500 milligram intravenously d e f g once a day c Notify provider specify parameters temp > 101; HR < d e f g 60 or > 120, RR < 8 or > 30, SBP < 90 or > 180; UO c levofloxacin /LEVAQUIN 750 milligram intravenously d e f g once a day < 120 in 4 hours Bronchodilators Interventions Spiriva and Atrovent should not be used concurrently c Elevate head of bed to ______ degrees. d e f g c albuterol /PROVENTIL 2.5/5 milligram by nebulizer d e f g c Urinary catheter initiation/management d e f g every ____hours c Urinary straight catheterization d e f g c ipratropium /ATROVENT 500 microgram by nebulizer d e f g Respiratory every ___hours c Oxygen via __________@ _____ to maintain O2 sat at d e f g Magnesium sulfate 2 g IVPB over 20 minutes Source c d e f g 90% or greater. Evidence Corticosteroids c Biphasic positive airway pressure (BIPAP) Evidence d e f g c Inhaled steroid d e f g c Biphasic positive airway pressure (BIPAP) Biphasic d e f g budesonide 0.5 mg/2 ml neb solution /PULMICORT positive airway pressure (BIPAP) with heliox bleedin every 12 hours Source Systemic Corticosteroids Evidence Continuous positive airway pressure (CPAP) Evidence c d e f g Consider the administration of a systemic c Blood gas, arterial now if not done and ________. d e f g corticosteroid Evidence
Order Initiated By: _________________________ Date/Time: _______________ Physician Signature: ________________________ Date/Time: _______________ Telephone/Verbal Orders: g c Read Back g d e f c Confirmed d e f
Released: April 2, 2009 Page &p of &P
PHYSICIAN'S ORDER SHEET
patient imprint
Another brand of a generically equivalent product identical in dosage form and content of active ingredient may be administered unless indicated. Consider renal impairment when deciding on doses of c dexamethasone/DECADRON ___ mg IVP every ___ d e f g LMWH, the direct thrombin inhibitors, and other hours antithrombotic drugs that are cleared by the kidneys, c methylPREDNISolone /SOLUMEDROL ____ milligram d e f g particularly in elderly patients and those who are at high intravenously every ____hours risk for bleeding. c predniSONE /STERAPRED ____ milligram orally d e f g In acutely ill medical patients who have been admitted once a day to the hospital with CHF or severe respiratory disease, Analgesics or who are confined to bed and have one or more Opioids Evidence adtioanla risk factors, inclujding active CA, previous c morphine 2 milligram intravenously every 4 hours d e f g VTE, sepsis, acute neurologic disease, or inflammatory as needed for shortness of breath or wheezing bowel disease, prophylaxis with LDUH or LMWH is c morphine 15 milligram capsule, sustained release d e f g recommended. In meidcal patients with risk factors for orally 2 times a day as needed for shortness of VTE in whom there is a contraindication to anticoagulant breath or wheezing prophylaxis, GCS or IPC is recommended. Antipyretics Early and persistant mobilization c d e f g c acetaminophen /TYLENOL 650 milligram orally or d e f g Graded compression stockings (1530 mm Hg of c d e f g rectally every 4 hours as needed for fever >100.4 pressure at the ankle) c acetaminophen /TYLENOL 650 milligram orally or d e f g c Sequential Compression Device d e f g rectally every 6 hours as needed for fever greater c CBC every other day starting on day 4 of heparin d e f g than 100.4 therapy thru day 14 or until Unfractionated Laxatives heparin/LMWH is discontinued. c magnesium hydroxide /MILK OF MAGNESIA 30 d e f g milliliter orally once a day as needed for constipation LowDose Unfractionated Heparin c docusate sodium /COLACE 100 milligram orally 2 d e f g c heparin 5,000 unit subcutaneously every 8 hours d e f g times a day LowMolecularWeight Heparins c bisacodyl /DULCOLAX 5 milligram orally once a day as d e f g c enoxaparin /LOVENOX 40 milligram subcutaneously d e f g needed for constipation once a day c bisacodyl /DULCOLAX 10 milligram suppository d e f g Reminders rectally once a day as needed for constipation Avoid the routine use of parenteral betaagonists in Sedatives Evidence patients with acute exacerbation of chronic obstructive c LORazepam /ATIVAN 1 milligram intravenously every d e f g pulmonary disease Evidence 6 hours as needed for sedation Stress Ulcer Prophylaxis c LORazepam /ATIVAN 1 milligram orally 2 times a day d e f g c Initiate Stress Ulcer Prophylaxis Protocol d e f g as needed for sedation Diagnostic Tests c zolpidem /AMBIEN 5 milligram orally once a day, at d e f g c 12lead ECG Evidence d e f g bedtime as needed for insomnia c Radiograph, chest, 1 view Evidence d e f g zolpidem /AMBIEN 10 milligram orally once a day, at c d e f g Laboratory bedtime as needed for insomnia Smoking Cessation Medications Evidence c Complete blood cell count with automated white blood d e f g cell differential Evidence c nicotine 7 mg/24 hr transdermal film, extended d e f g release 1 patch transdermally once a day c Complete blood cell count with manual differential. d e f g c Basic metabolic panel d e f g c nicotine 14 mg/24 hr transdermal film, extended d e f g release 1 patch transdermally once a day c Comprehensive metabolic panel d e f g c nicotine 21 mg/24 hr transdermal film, extended d e f g c Magnesium (Mg) level, serum d e f g release 1 patch transdermally once a day c Phosphorus level, serum d e f g DVT Prophylaxis c Eosinophil count d e f g Mechanical methods of prophylaxis should be used Physician Consults primarily in patients who are at high risk of bleeding or c Consult to pulmonology d e f g as an adjunct to anticoagulantbased prophylaxis. c Consult to cardiology d e f g Consults c Consult to pulmonary rehabilitation Evidence d e f g Order Initiated By: _________________________ Date/Time: _______________ Physician Signature: ________________________ Date/Time: _______________ Telephone/Verbal Orders: g c Read Back g d e f c Confirmed d e f
Released: April 2, 2009 Page &p of &P
PHYSICIAN'S ORDER SHEET Another brand of a generically equivalent product identical in dosage form and content of active ingredient may be administered unless indicated.
patient imprint
Other:________________________________ c Consult to Palliative Care d e f g
Order Initiated By: _________________________ Date/Time: _______________ Physician Signature: ________________________ Date/Time: _______________ Telephone/Verbal Orders: g c Read Back g d e f c Confirmed d e f
Released: April 2, 2009 Page &p of &P
Print Only Selected Items
Print All
PHYSICIAN'S ORDER SHEET Chronic Obstructive Pulmonary Disease Another brand of a generically equivalent product identical in dosage form and content of active ingredient may be administered unless indicated.
Print All
patient imprint
Chronic Obstructive Pulmonary Disease Admit Location c Admit to location __________________ d e f g Admission Status c Admit to inpatient to Dr. ______service. d e f g c Admit to observation to Dr. _________ service. d e f g Code Status c Resuscitation status Full Code d e f g c Resuscitation status Do Not Resuscitate / Do Not d e f g Intubate (allow natural death) c Resuscitation status Partial Code d e f g
c Blood gas, venous now if not done and ________. d e f g Source c Ventilator settings Evidence d e f g c Please record autopeep on vent. d e f g
Diet
g NPO / NPO except po meds with sips. c d e f c Clear liquids d e f g c Regular diet d e f g c Therapeutic diet ____________. d e f g There is inconclusive evidence to support the use of nutritional supplementation in patients with chronic Vital Signs obstructive pulmonary disease Evidence c Vitals per unit protocol d e f g IV Fluids c Vital signs every_____hour and then d e f g c Dextrose 5% with 0.9% NaCl @ _____mL/hr for 24 d e f g every_____________ hours. Pulse oximetry c Dextrose 5% with 0.45% NaCl @ _____mL/hr for 24 d e f g Continuous c d e f g hours. c Spot every shift and prn d e f g c Sodium Chloride 0.9% @ ______mL/hr for 24 hours. d e f g Activity c Additives ______________________ d e f g c Ambulate with assistance every 8 hours. d e f g c Saline lock. d e f g c Bed rest with bedside commode d e f g Medications c Bed rest d e f g Antibacterial Agents Evidence c Up ad lib to ______. d e f g Consider the administration of antimicrobial therapy Nursing Orders Evidence Assessments c cefTRIAXone /ROCEPHIN 1 gram intravenously once a d e f g c Glucose, blood, fingerstick. _______ One Time. Other d e f g day Frequency _______________ c azithromycin /ZITHROMAX 500 milligram d e f g intravenously once a day c Measure and document intake and output Total for d e f g every 8 hours c clarithromycin /BIAXIN 500 milligram orally every 12 d e f g hours with food. c Measure weight d e f g Contingency c levofloxacin /LEVAQUIN 500 milligram intravenously d e f g once a day c Notify provider specify parameters temp > 101; HR < d e f g 60 or > 120, RR < 8 or > 30, SBP < 90 or > 180; UO c levofloxacin /LEVAQUIN 750 milligram intravenously d e f g once a day < 120 in 4 hours Bronchodilators Interventions Spiriva and Atrovent should not be used concurrently c Elevate head of bed to ______ degrees. d e f g c albuterol /PROVENTIL 2.5/5 milligram by nebulizer d e f g c Urinary catheter initiation/management d e f g every ____hours c Urinary straight catheterization d e f g c ipratropium /ATROVENT 500 microgram by nebulizer d e f g Respiratory every ___hours c Oxygen via __________@ _____ to maintain O2 sat at d e f g Magnesium sulfate 2 g IVPB over 20 minutes Source c d e f g 90% or greater. Evidence Corticosteroids c Biphasic positive airway pressure (BIPAP) Evidence d e f g c Inhaled steroid d e f g c Biphasic positive airway pressure (BIPAP) Biphasic d e f g budesonide 0.5 mg/2 ml neb solution /PULMICORT positive airway pressure (BIPAP) with heliox bleedin every 12 hours Source Systemic Corticosteroids Evidence Continuous positive airway pressure (CPAP) Evidence c d e f g Consider the administration of a systemic c Blood gas, arterial now if not done and ________. d e f g corticosteroid Evidence
Order Initiated By: _________________________ Date/Time: _______________ Physician Signature: ________________________ Date/Time: _______________ Telephone/Verbal Orders: g c Read Back g d e f c Confirmed d e f
Released: April 2, 2009 Page &p of &P
PHYSICIAN'S ORDER SHEET
patient imprint
Another brand of a generically equivalent product identical in dosage form and content of active ingredient may be administered unless indicated. Consider renal impairment when deciding on doses of c dexamethasone/DECADRON ___ mg IVP every ___ d e f g LMWH, the direct thrombin inhibitors, and other hours antithrombotic drugs that are cleared by the kidneys, c methylPREDNISolone /SOLUMEDROL ____ milligram d e f g particularly in elderly patients and those who are at high intravenously every ____hours risk for bleeding. c predniSONE /STERAPRED ____ milligram orally d e f g In acutely ill medical patients who have been admitted once a day to the hospital with CHF or severe respiratory disease, Analgesics or who are confined to bed and have one or more Opioids Evidence adtioanla risk factors, inclujding active CA, previous c morphine 2 milligram intravenously every 4 hours d e f g VTE, sepsis, acute neurologic disease, or inflammatory as needed for shortness of breath or wheezing bowel disease, prophylaxis with LDUH or LMWH is c morphine 15 milligram capsule, sustained release d e f g recommended. In meidcal patients with risk factors for orally 2 times a day as needed for shortness of VTE in whom there is a contraindication to anticoagulant breath or wheezing prophylaxis, GCS or IPC is recommended. Antipyretics Early and persistant mobilization c d e f g c acetaminophen /TYLENOL 650 milligram orally or d e f g Graded compression stockings (1530 mm Hg of c d e f g rectally every 4 hours as needed for fever >100.4 pressure at the ankle) c acetaminophen /TYLENOL 650 milligram orally or d e f g c Sequential Compression Device d e f g rectally every 6 hours as needed for fever greater c CBC every other day starting on day 4 of heparin d e f g than 100.4 therapy thru day 14 or until Unfractionated Laxatives heparin/LMWH is discontinued. c magnesium hydroxide /MILK OF MAGNESIA 30 d e f g milliliter orally once a day as needed for constipation LowDose Unfractionated Heparin c docusate sodium /COLACE 100 milligram orally 2 d e f g c heparin 5,000 unit subcutaneously every 8 hours d e f g times a day LowMolecularWeight Heparins c bisacodyl /DULCOLAX 5 milligram orally once a day as d e f g c enoxaparin /LOVENOX 40 milligram subcutaneously d e f g needed for constipation once a day c bisacodyl /DULCOLAX 10 milligram suppository d e f g Reminders rectally once a day as needed for constipation Avoid the routine use of parenteral betaagonists in Sedatives Evidence patients with acute exacerbation of chronic obstructive c LORazepam /ATIVAN 1 milligram intravenously every d e f g pulmonary disease Evidence 6 hours as needed for sedation Stress Ulcer Prophylaxis c LORazepam /ATIVAN 1 milligram orally 2 times a day d e f g c Initiate Stress Ulcer Prophylaxis Protocol d e f g as needed for sedation Diagnostic Tests c zolpidem /AMBIEN 5 milligram orally once a day, at d e f g c 12lead ECG Evidence d e f g bedtime as needed for insomnia c Radiograph, chest, 1 view Evidence d e f g zolpidem /AMBIEN 10 milligram orally once a day, at c d e f g Laboratory bedtime as needed for insomnia Smoking Cessation Medications Evidence c Complete blood cell count with automated white blood d e f g cell differential Evidence c nicotine 7 mg/24 hr transdermal film, extended d e f g release 1 patch transdermally once a day c Complete blood cell count with manual differential. d e f g c Basic metabolic panel d e f g c nicotine 14 mg/24 hr transdermal film, extended d e f g release 1 patch transdermally once a day c Comprehensive metabolic panel d e f g c nicotine 21 mg/24 hr transdermal film, extended d e f g c Magnesium (Mg) level, serum d e f g release 1 patch transdermally once a day c Phosphorus level, serum d e f g DVT Prophylaxis c Eosinophil count d e f g Mechanical methods of prophylaxis should be used Physician Consults primarily in patients who are at high risk of bleeding or c Consult to pulmonology d e f g as an adjunct to anticoagulantbased prophylaxis. c Consult to cardiology d e f g Consults c Consult to pulmonary rehabilitation Evidence d e f g Order Initiated By: _________________________ Date/Time: _______________ Physician Signature: ________________________ Date/Time: _______________ Telephone/Verbal Orders: g c Read Back g d e f c Confirmed d e f
Released: April 2, 2009 Page &p of &P
PHYSICIAN'S ORDER SHEET Another brand of a generically equivalent product identical in dosage form and content of active ingredient may be administered unless indicated.
patient imprint
Other:________________________________ c Consult to Palliative Care d e f g
Order Initiated By: _________________________ Date/Time: _______________ Physician Signature: ________________________ Date/Time: _______________ Telephone/Verbal Orders: g c Read Back g d e f c Confirmed d e f
Released: April 2, 2009 Page &p of &P
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Print All
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