HEART FAILURE ADMISSION ORDERS ATTENDING PHYSICIAN: Harper…

HEART FAILURE ADMISSION ORDERS ATTENDING PHYSICIAN: Harper… HEART FAILURE ADMISSION ORDERSATTENDING PHYSICIAN: Harper DATE:4/5/20ORDER:XTIME:1000Admit to        ?  CCU    X  Telemetry  ____   ?  General Med ____  SERVICE: Diagnosis:Exacerbation Heart FailureCONDITION?   Good    X   Fair   ?   GuardedVITAL SIGNSX   Per Unit Routine   ? Other: ____________________________________________X   Call HO for a SBP > 150 SBP < 80 mmHg, HR > 100, HR < 50 RR > 24 or RR < 8.ALLERGIESX   NKDA     ?  Allergy:ACTIVITYX   Bed rest?   Bed rest with commode privileges?   Out of bed with assistance?   Ambulation   ?   Physical Therapy ConsultationDIETX   2 gram Na Diet with 2000 ml (2 quarts) PO fluid restriction?   2 gram Na Diet with 1500 ml PO fluid restriction?   2 gram Na; Carbohydrate controlled Diet with _____ cc PO fluid restriction?   Other: _________________________________________________________IV'SX    Saline Lock with 3ml normal saline flush q 12 hours (document on flow sheet 0800H and 2000H)Other: ___________________________________ I/O and WEIGHTX     Strict recording of Ins and Outs Daily weights FOLEYX   If patient is unable to void, place Foley catheter.MONITORINGX   Cardiac monitoringX   Pulse oximetryRESPIRATORYPLEASE COMPLETE RESPIRATORY THERAPY FORMLABORATORY NowCBC with differential and plateletsElectrolytes, BUN, Creatinine, Glucose  ?  Mg  ? Ca ?   PO4   ? Uric AcidCPK total and MB NOW and Q8 hours x 3 Cardiac troponin NOW and 6 hours PT/INR and  ? PTT BNP (if indicated)Liver function tests (if indicated) ______________________________________________Cardiovascular lipid panel (nonfasting) Digoxin level (if patient receiving digoxin)Thyroid Function Tests _____________________________________________________Others:__________________________________________________________________In AMX    Electrolytes, BUN, Creatinine  ? Glucose ?  Mg  ? Ca ?   PO4   ? Uric AcidX    CBC with differential and platelets ?  PT/INR   ? PTT BNP (if indicated)?   Others: _________________________________________________________________TESTSEKG-PLEASE COMPLETE REQUISITIONChest X-ray (PA and lateral) PLEASE COMPLETE REQUISITIONEchocardiogram - if not performed in prior 12 months or prior EF cannot be documented      PLEASE COMPLETE REQUISITION MD Signature: ___________________________________  MEDICAL CENTER ADMISSION ORDERS 1.   DATE AND TIME ORDERS2.   CHECK ALL APPROPRIATE ORDERS.PAGE 2 of 2Patient Addressograph   HEART FAILURE ADMISSION ORDERS (cont)MEDICATIONS(X Indicated in Bold)IV MedicationsDiureticsX  Furosemide 40 mg IV BIDOther ________________________________________     (Consider using diuretic protocol)  Potassium ChloridePotassium Chloride ___ mEq IVPB  in _____ D5W IVPB over ___  hrs X 1X     Potassium Chloride 40 mEq tab ONE PO BIDPotassium Chloride ___ mEq elixir PO x1Magnesium Sulfate ___ mEq in ______ D5W over_________hrs X 1Oral MedicationsX   ACE Inhibitor: Lisinopril 5 mg PO daily (hold for SBP < 90, notify HO)X   Beta Blocker: Metoprolol 25 mg PO BID (hold for SBP < 90 or HR < 60, notify HO) (should not be newly initiated for HF until patient is stable and no longer significantly volumeoverloaded, continue current dose unless shock) (start with low HF doses for initiation)Spironolactone: ______ mg PO qd. (use with caution if Cr > 2.5, contraindicated if hyperkalemia; use very low doses, closely monitor renal function and K+)Digoxin ___________________mg PO ____  (keep level < 1.1 ng/ml) Nitrate  X    Enteric Coated Aspirin ____ mg PO QD (if CAD, CVD, PVD, Diabetes) Clopidogrel  75 mg PO QD (if indicated) X   Statin: simvastatin 40  mg PO dailty (if CAD, CVD, PVD, Diabetes) Warfarin _______mg PO _____  (if paroxysmal or chronic afib, LV thrombus, or heart valve)Docusate (Colace) 100mg PO BID_____________________________________   ?  ______________________________________________________________________   ?  ______________________________________________________________________   ?  ______________________________________________________________________   ?  ______________________________________________________________________   ?  ______________________________________________________________________   ?  _________________________________ DVT Prophylaxis or AnticoagulationHeparin 5000 units SQ bid    ?  IV Heparin ProtocolEnoxaparin 40 mg SQ qd (reserve for pts at increased risk of bleeding, caution in renal failure)X     Intermittent compression stockings   ?   Elastic Stockings (thigh high) PRN Medications?    Acetaminophen 650 mg PO Q 4H prn pain, HA or fever T > 38.5.?    Lorazepam (Ativan) ____ mg PO Q8 prn for anxiety.?    Mylanta II  15 ml PO Q6 hrs prn dyspepsia or GI upset.Temazepam 15 mg PO Q hs prn insomnia.  May repeat x 1 prn. ?   _____________________________________________________________________PROTOCOLSX  Provide and Document HF Instructions for 1) diet, fluid restriction, 2) activity, 3) medications, 4) daily weight, 5) worsening symptoms, and 6) follow-up.Provide and Document “HF Patient Education”: print out from web and give to patient/familyNutrition Consultation and Counseling       Smoking Status  ?  current or past 1 year   ?  former   ?  nonsmoker  ?  unknown Smoking Cessation Counseling and Patient Education MaterialsCardiac Rehabilitation Assessment and Referral   HF Admission OrdersPrioritization Activity Carl Shapiro is being admitted to your cardiac step-down unit from the ED. It is 0930. You know Carl’s history (MI, DM, COPD).  Labs and CXR were completed in the ED. His BNP is 986, potassium is 3.3mEq/dl. Currently his BP is 108/61, HR 109, RR 28, temp 98.3, O2sat 93% on 4L NC. Lungs with crackles bilaterally. HRR, sinus tachycardia with occasional PVC’s. Pulses are weak, color is pale. He received Lasix 40 mg in the ED at 0700 and his U.O was 500 mL. He had a #18G SL in his right forearm but he accidently pulled it out moving from the stretcher to the bed. He has a patent Foley catheter that was put in by the ED nurse. He took his home medications of lisinopril, metoprolol , ASA, Lasix and KCL at 2100 last night. His admission orders are attached. Medications have been verified by pharmacy and are available. List in order of priority the first 10 interventions and the rationale. THINK ABC PriorityInterventionRationale1   2   3   4   5   6   7   8   9   10     Health Science Science NursingNURE 231Share QuestionEmailCopy link Comments (0)

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