Stroke Hemorrhagic
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PHYSICIAN'S ORDER SHEET Stroke – hemorrhagic 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
Allergies: _______________ Admission Status g Admit to inpatient to Dr. ______service. c d e f c Admit to observation to Dr. _________ service. d e f g Admit Location c Admit to location __________________ d e f g
Code Status
c Blood gas, venous now if not done and ________. d e f g Source c Pulmonary Function Testing d e f g c FVC/negative inspiratory force every 6 hours d e f g c Ventilator settings 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 LINKED CONTENT: IV Fluids (medical) Vital Signs Medications c Vitals per unit protocol d e f g Reminders c Vital signs every_______hours and then d e f g Avoid sublingual NIFEdipine every_____________ Antihypertensives Pulse oximetry If SBP > 200 or MAP > 150 mm Hg consider aggressive c Continuous d e f g therapy with continuous infusion and BP monitoring q 5 c Spot q shift and prn d e f g min. If SBP > 180 or MAP > 130 mm Hg and there is Activity evidence of or suspicion of elevated ICP, then consider c Ambulate with assistance d e f g monitoring ICP and reducing BP using intermittent or continuous intravenous meds to keep CPP > 60 to 80 c Bed rest / bed rest with bedside commode d e f g mm Hg. If SBP > 180 or MAP > 130 mm Hg and there is c Up ad lib d e f g not evidence or suspicion of elevated ICP, then consider Nursing Orders modest reduction of BP using intermittent or continous Assessments meds and clinically rexamining the patient every 15 b Stand Dysphagia Protocol/Bedside swallowing c d e f g minutes. evaluation Evidence c labetalol /NORMODYNE 10 mg every 10 minutes (not d e f g c Glucose, blood, fingerstick. _______ One Time. Other d e f g to exceed 300 mg/day) until systolic BP is decreased Frequency _______________ If blood glucose greater by 15%. than or equal to ____, initiate glycemic control c labetalol /NORMODYNE 10 mg over 2 minutes followed d e f g protocol. by a 2 mg/min infusion (max 300 mg/day) c Measure and document intake and output Total for d e f g c niCARdipine /CARDENE 5mg/hr and titrate to a d e f g every 8 hours decreased BP of 15% not to exceed 15 mg/hr. c Measure weight d e f g c Esmolol /BREVIBLOC 250 microgram/kg IVP loading d e f g Contingency dose followed by 25 micrograms/kg/min increasing by 50 micrograms/kg every 5 minutes until BP has c Notify provider specify parameters temp > 101; HR < d e f g 60 or > 120, RR < 8 or > 30, SBP < 90 or > 180; UO decreased by 15% or a maximum of 300 < 120 in 4 hours, or neurologic deterioration micrograms/kg/min. Interventions c enalapril /VASOTEC 1.25 mg IVP every 6 hours. Hold d e f g for SBP < _____mm Hg. c Elevate head of bed to _________ degrees d e f g c Urinary catheter initiation/management d e f g c enalapril /VASOTEC 2.5 mg IVP every 6 hours. Hold d e f g for SBP < _____mm Hg. c Urinary straight catheterization d e f g c enalapril /VASOTEC 5 mg IVP every 6 hours. Hold for d e f g c Nasogastric/orogastric tube insertion/management d e f g SBP < _____mm Hg. Respiratory sodium nitroprusside /NIPRIDE 0.1 microgram/kg/min c d e f g c Oxygen via __________@ _____ to maintain O2 sat at d e f g and titrate up until BP has decreased by 15% or a 90% or greater. maximum of 10 micrograms/kg/min. c Biphasic positive airway pressure (BIPAP) d e f g c Continuous positive airway pressure (CPAP) d e f g c Blood gas, arterial now if not done and ________. d e f g g Resuscitation status Full Code b c d e f 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
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. Anticonvulsants c morphine ____mg intravenously every 5 minutes to d e f g a maximum of 10 mg/hr. b fosphenytoin /CEREBYX ___mg (15 to 20 mg c d e f g phenytoin equivalents/kg) IV/IM not to exceed 100 mg Antidotes and Rescue Agents PE/min once c naloxone /NARCAN ___ (0.42) milligram d e f g intravenously every ____min. (23) as needed for c phenytoin /DILANTIN ___mg 15 20 mg/kg IV not to d e f g exceed 50 mg/min once opiate reversal to improve mentation and RR > 10 and notify physician STAT c valproate/DEPACON 25 mg/kg at ___mg/ming 20 d e f g Antipyretics 100 mg/min once c acetaminophen /TYLENOL 650 milligram orally or d e f g c levetiracetam/KEPPRA 500 mg IV once d e f g rectally every 4 hours as needed for fever >100.4 Sedatives c acetaminophen /TYLENOL 650 milligram orally or d e f g c midazolam/VERSED 2 mg slow IVP once may repeat d e f g rectally every 6 hours as needed for fever greater once in 15 minutes than 100.4 c midazolam/VERSED 0.1 0.4 mg/kg/h continuous d e f g Laxatives infusion begin at 0.1 mg/kg/hr and titrate up by 0.1 mg/kg/hr every 15 minutes as needed for sedation to c magnesium hydroxide /MILK OF MAGNESIA 30 d e f g milliliter orally once a day as needed for constipation a max of 0.4 mg/kg/hr c docusate sodium /COLACE 100 milligram orally 2 d e f g c LORazepam /ATIVAN 2mg intravenously bolus, may d e f g times a day repeat x1 in 15 minutes Ophthalmic care c bisacodyl /DULCOLAX 5 milligram orally once a day as d e f g needed for constipation c hypromellose __ 0.3% gel __0.1% solution 1 d e f g application to each eye prn c bisacodyl /DULCOLAX 10 milligram suppository d e f g Warfarin reversal rectally once a day as needed for constipation DVT Prophylaxis c Vitamin K /MEPHYTON 10 mg __SC __IM __IV x 1 d e f g Mechanical methods of prophylaxis should be used dose primarily in patients who are at high risk of bleeding or c Fresh frozen plasma 15 units IVPB d e f g as an adjunct to anticoagulantbased prophylaxis. Analgesics Consider renal impairment when deciding on doses of Mild Pain (13) Evidence LMWH, the direct thrombin inhibitors, and other c acetaminophen /TYLENOL ____650 mg ____650 mg d e f g antithrombotic drugs that are cleared by the kidneys, orally or rectally _____every 4 hours ____every 6 particularly in elderly patients and those who are at high hours as needed for pain risk for bleeding. c ibuprofen /MOTRIN 400 milligram orally every 4 d e f g In acutely ill medical patients who have been admitted hours as needed for pain to the hospital with CHF or severe respiratory disease, (Contraindicated in pregnant women and children < 6 or who are confined to bed and have one or more mos. of age) adtioanla risk factors, inclujding active CA, previous Moderate Pain (46) VTE, sepsis, acute neurologic disease, or inflammatory c hydrocodone/APAP/LORTAB d e f g bowel disease, prophylaxis with LDUH or LMWH is ____5/500_____7.5/500 ______10/500 tablet orally recommended. In meidcal patients with risk factors for every ____4 hr._____6 hr. as needed for pain VTE in whom there is a contraindication to anticoagulant oxycodoneAPAP/PERCOCET c d e f g prophylaxis, GCS or IPC is recommended. ____5/325______7.5/325_____10/325 tablet orally c Early and persistant mobilization d e f g every _____4hr._____6hr. as needed for pain c Graded compression stockings (1530 mm Hg of d e f g c oxycodone _____mg tablet orally every d e f g pressure at the ankle) _____4hr._____6hr. as needed for pain Sequential Compression Device c d e f g Severe Pain (710) Evidence c CBC every other day starting on day 4 of heparin d e f g Consider the use of an opioid analgesic; morphine at therapy thru day 14 or until Unfractionated a dose of 0.1 mg/kg body weight has limited heparin/LMWH is discontinued. effectiveness Evidence c HYDROmorphone /DILAUDID 1 milligram SC/IV d e f g every __ 4 hrs. __ 6 hours as needed for pain c morphine ____ milligram intravenously every d e f g ____hours as needed for pain
LowDose Unfractionated Heparin c heparin 5,000 unit subcutaneously every 8 hours 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. LowMolecularWeight Heparins c enoxaparin /LOVENOX 40 milligram subcutaneously d e f g once a day Reminders Prophylaxis against deep venous thrombosis in patients with acute ICH should consist of mechanical means (elastic stocking, PCD)and mobilization when possible.
patient imprint
Other:_____________________ g Consult to neurology c d e f c Consult to occupational therapy d e f g c Consult to Palliative Care d e f g c Consult to physical therapy d e f g c Consult to speech therapy d e f g
Stress Ulcer Prophylaxis c Initiate Stress Ulcer Prophylaxis Protocol d e f g
Laboratory g Complete blood cell count with automated white blood b c d e f cell differential Evidence b Erythrocyte sedimentation rate (ESR) c d e f g b Partial thromboplastin time (PTT), activated c d e f g b Prothrombin time (PT) and international normalized ratio c d e f g (INR) Evidence c Basic metabolic panel d e f g c Comprehensive metabolic panel d e f g b Lipid panel c d e f g c Magnesium (Mg) Evidence d e f g c Phosphorus level Evidence d e f g c Creatine kinase, total (CKtotal) , CKMB isoenzyme, d e f g troponin c Rapid plasma reagin (RPR), qualitative d e f g b Urinalysis (UA) with microscopy c d e f g c Toxicology drug screen, urine d e f g
Diagnostic Tests g 12lead ECG b c d e f c Electroencephalogram (EEG) d e f g c Radiograph, chest, 1 view d e f g c Radiograph, chest, 2 views d e f g c CT, head or brain, without contrast on admission d e f g c CT angiography of the brain d e f g c CT angiography of the brain d e f g c CT angiography of the neck. d e f g c Radiograph, swallowing function, with cineradiography d e f g
and/or videoradiography (modified barium swallow) g MRI, brain, with contrast c d e f c MRI, brain, without contrast d e f g c MRA brain __with __without contrast d e f g c MRA neck ___with __without contrast. d e f g
Consults g Consult to neurosurgery c d e f c Consult to cardiology d e f g c Consult to dietitian, adult d e f g c Consult to internal medicine d e f g
c Consult to Acute inpatient rehabilitation 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 Stroke – hemorrhagic 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
Allergies: _______________ Admission Status g Admit to inpatient to Dr. ______service. c d e f c Admit to observation to Dr. _________ service. d e f g Admit Location c Admit to location __________________ d e f g
Code Status
c Blood gas, venous now if not done and ________. d e f g Source c Pulmonary Function Testing d e f g c FVC/negative inspiratory force every 6 hours d e f g c Ventilator settings 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 LINKED CONTENT: IV Fluids (medical) Vital Signs Medications c Vitals per unit protocol d e f g Reminders c Vital signs every_______hours and then d e f g Avoid sublingual NIFEdipine every_____________ Antihypertensives Pulse oximetry If SBP > 200 or MAP > 150 mm Hg consider aggressive c Continuous d e f g therapy with continuous infusion and BP monitoring q 5 c Spot q shift and prn d e f g min. If SBP > 180 or MAP > 130 mm Hg and there is Activity evidence of or suspicion of elevated ICP, then consider c Ambulate with assistance d e f g monitoring ICP and reducing BP using intermittent or continuous intravenous meds to keep CPP > 60 to 80 c Bed rest / bed rest with bedside commode d e f g mm Hg. If SBP > 180 or MAP > 130 mm Hg and there is c Up ad lib d e f g not evidence or suspicion of elevated ICP, then consider Nursing Orders modest reduction of BP using intermittent or continous Assessments meds and clinically rexamining the patient every 15 b Stand Dysphagia Protocol/Bedside swallowing c d e f g minutes. evaluation Evidence c labetalol /NORMODYNE 10 mg every 10 minutes (not d e f g c Glucose, blood, fingerstick. _______ One Time. Other d e f g to exceed 300 mg/day) until systolic BP is decreased Frequency _______________ If blood glucose greater by 15%. than or equal to ____, initiate glycemic control c labetalol /NORMODYNE 10 mg over 2 minutes followed d e f g protocol. by a 2 mg/min infusion (max 300 mg/day) c Measure and document intake and output Total for d e f g c niCARdipine /CARDENE 5mg/hr and titrate to a d e f g every 8 hours decreased BP of 15% not to exceed 15 mg/hr. c Measure weight d e f g c Esmolol /BREVIBLOC 250 microgram/kg IVP loading d e f g Contingency dose followed by 25 micrograms/kg/min increasing by 50 micrograms/kg every 5 minutes until BP has c Notify provider specify parameters temp > 101; HR < d e f g 60 or > 120, RR < 8 or > 30, SBP < 90 or > 180; UO decreased by 15% or a maximum of 300 < 120 in 4 hours, or neurologic deterioration micrograms/kg/min. Interventions c enalapril /VASOTEC 1.25 mg IVP every 6 hours. Hold d e f g for SBP < _____mm Hg. c Elevate head of bed to _________ degrees d e f g c Urinary catheter initiation/management d e f g c enalapril /VASOTEC 2.5 mg IVP every 6 hours. Hold d e f g for SBP < _____mm Hg. c Urinary straight catheterization d e f g c enalapril /VASOTEC 5 mg IVP every 6 hours. Hold for d e f g c Nasogastric/orogastric tube insertion/management d e f g SBP < _____mm Hg. Respiratory sodium nitroprusside /NIPRIDE 0.1 microgram/kg/min c d e f g c Oxygen via __________@ _____ to maintain O2 sat at d e f g and titrate up until BP has decreased by 15% or a 90% or greater. maximum of 10 micrograms/kg/min. c Biphasic positive airway pressure (BIPAP) d e f g c Continuous positive airway pressure (CPAP) d e f g c Blood gas, arterial now if not done and ________. d e f g g Resuscitation status Full Code b c d e f 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
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. Anticonvulsants c morphine ____mg intravenously every 5 minutes to d e f g a maximum of 10 mg/hr. b fosphenytoin /CEREBYX ___mg (15 to 20 mg c d e f g phenytoin equivalents/kg) IV/IM not to exceed 100 mg Antidotes and Rescue Agents PE/min once c naloxone /NARCAN ___ (0.42) milligram d e f g intravenously every ____min. (23) as needed for c phenytoin /DILANTIN ___mg 15 20 mg/kg IV not to d e f g exceed 50 mg/min once opiate reversal to improve mentation and RR > 10 and notify physician STAT c valproate/DEPACON 25 mg/kg at ___mg/ming 20 d e f g Antipyretics 100 mg/min once c acetaminophen /TYLENOL 650 milligram orally or d e f g c levetiracetam/KEPPRA 500 mg IV once d e f g rectally every 4 hours as needed for fever >100.4 Sedatives c acetaminophen /TYLENOL 650 milligram orally or d e f g c midazolam/VERSED 2 mg slow IVP once may repeat d e f g rectally every 6 hours as needed for fever greater once in 15 minutes than 100.4 c midazolam/VERSED 0.1 0.4 mg/kg/h continuous d e f g Laxatives infusion begin at 0.1 mg/kg/hr and titrate up by 0.1 mg/kg/hr every 15 minutes as needed for sedation to c magnesium hydroxide /MILK OF MAGNESIA 30 d e f g milliliter orally once a day as needed for constipation a max of 0.4 mg/kg/hr c docusate sodium /COLACE 100 milligram orally 2 d e f g c LORazepam /ATIVAN 2mg intravenously bolus, may d e f g times a day repeat x1 in 15 minutes Ophthalmic care c bisacodyl /DULCOLAX 5 milligram orally once a day as d e f g needed for constipation c hypromellose __ 0.3% gel __0.1% solution 1 d e f g application to each eye prn c bisacodyl /DULCOLAX 10 milligram suppository d e f g Warfarin reversal rectally once a day as needed for constipation DVT Prophylaxis c Vitamin K /MEPHYTON 10 mg __SC __IM __IV x 1 d e f g Mechanical methods of prophylaxis should be used dose primarily in patients who are at high risk of bleeding or c Fresh frozen plasma 15 units IVPB d e f g as an adjunct to anticoagulantbased prophylaxis. Analgesics Consider renal impairment when deciding on doses of Mild Pain (13) Evidence LMWH, the direct thrombin inhibitors, and other c acetaminophen /TYLENOL ____650 mg ____650 mg d e f g antithrombotic drugs that are cleared by the kidneys, orally or rectally _____every 4 hours ____every 6 particularly in elderly patients and those who are at high hours as needed for pain risk for bleeding. c ibuprofen /MOTRIN 400 milligram orally every 4 d e f g In acutely ill medical patients who have been admitted hours as needed for pain to the hospital with CHF or severe respiratory disease, (Contraindicated in pregnant women and children < 6 or who are confined to bed and have one or more mos. of age) adtioanla risk factors, inclujding active CA, previous Moderate Pain (46) VTE, sepsis, acute neurologic disease, or inflammatory c hydrocodone/APAP/LORTAB d e f g bowel disease, prophylaxis with LDUH or LMWH is ____5/500_____7.5/500 ______10/500 tablet orally recommended. In meidcal patients with risk factors for every ____4 hr._____6 hr. as needed for pain VTE in whom there is a contraindication to anticoagulant oxycodoneAPAP/PERCOCET c d e f g prophylaxis, GCS or IPC is recommended. ____5/325______7.5/325_____10/325 tablet orally c Early and persistant mobilization d e f g every _____4hr._____6hr. as needed for pain c Graded compression stockings (1530 mm Hg of d e f g c oxycodone _____mg tablet orally every d e f g pressure at the ankle) _____4hr._____6hr. as needed for pain Sequential Compression Device c d e f g Severe Pain (710) Evidence c CBC every other day starting on day 4 of heparin d e f g Consider the use of an opioid analgesic; morphine at therapy thru day 14 or until Unfractionated a dose of 0.1 mg/kg body weight has limited heparin/LMWH is discontinued. effectiveness Evidence c HYDROmorphone /DILAUDID 1 milligram SC/IV d e f g every __ 4 hrs. __ 6 hours as needed for pain c morphine ____ milligram intravenously every d e f g ____hours as needed for pain
LowDose Unfractionated Heparin c heparin 5,000 unit subcutaneously every 8 hours 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. LowMolecularWeight Heparins c enoxaparin /LOVENOX 40 milligram subcutaneously d e f g once a day Reminders Prophylaxis against deep venous thrombosis in patients with acute ICH should consist of mechanical means (elastic stocking, PCD)and mobilization when possible.
patient imprint
Other:_____________________ g Consult to neurology c d e f c Consult to occupational therapy d e f g c Consult to Palliative Care d e f g c Consult to physical therapy d e f g c Consult to speech therapy d e f g
Stress Ulcer Prophylaxis c Initiate Stress Ulcer Prophylaxis Protocol d e f g
Laboratory g Complete blood cell count with automated white blood b c d e f cell differential Evidence b Erythrocyte sedimentation rate (ESR) c d e f g b Partial thromboplastin time (PTT), activated c d e f g b Prothrombin time (PT) and international normalized ratio c d e f g (INR) Evidence c Basic metabolic panel d e f g c Comprehensive metabolic panel d e f g b Lipid panel c d e f g c Magnesium (Mg) Evidence d e f g c Phosphorus level Evidence d e f g c Creatine kinase, total (CKtotal) , CKMB isoenzyme, d e f g troponin c Rapid plasma reagin (RPR), qualitative d e f g b Urinalysis (UA) with microscopy c d e f g c Toxicology drug screen, urine d e f g
Diagnostic Tests g 12lead ECG b c d e f c Electroencephalogram (EEG) d e f g c Radiograph, chest, 1 view d e f g c Radiograph, chest, 2 views d e f g c CT, head or brain, without contrast on admission d e f g c CT angiography of the brain d e f g c CT angiography of the brain d e f g c CT angiography of the neck. d e f g c Radiograph, swallowing function, with cineradiography d e f g
and/or videoradiography (modified barium swallow) g MRI, brain, with contrast c d e f c MRI, brain, without contrast d e f g c MRA brain __with __without contrast d e f g c MRA neck ___with __without contrast. d e f g
Consults g Consult to neurosurgery c d e f c Consult to cardiology d e f g c Consult to dietitian, adult d e f g c Consult to internal medicine d e f g
c Consult to Acute inpatient rehabilitation 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
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