CARD ELECTROPHYSIOLOGY STUDY PLAN · CARD ELECTROPHYSIOLOGY STUDY PLAN PHYSICIAN ORDERS Weight _ Allergies _ Place an "X" in the Orders column to designate orders of choice

UMC Health System Patient Label Here

CARD ELECTROPHYSIOLOGY STUDY PLAN

PHYSICIAN ORDERS

Weight ____________________________________________ Allergies ________________________________________________________

Place an "X" in the Orders column to designate orders of choice AND an "x" in the specific order detail box(es) where applicable.

ORDER ORDER DETAILS

Patient Care

Vital Signs Per Unit Standards, Vital Signs every 15 minutes x 4; then every 30 minutes x 2; then repeat in 1 hour x 4; then q4 hour.

Post Procedure Site Assessment See Special Instructions, Every 15 minutes x 4; then every 30 minutes x 2; then repeat in 1 hour x 4; then q4 hour.

Perform Neurovascular Checks To: Operative Extremity, See Special Instructions, Every 15 minutes x 4; then every 30 minutes x 2; then repeat in 1 hour x 4; then q4 hour.

Daily Weight

Patient Activity Bedrest, Bed Position: HOB Greater Than or Equal to 30 degrees, Bedrest for 2 hrs post sheath removal.

Strict Intake and Output Per Unit Standards

Continuous Telemetry (Intermediate Care)

Intermittent Telemetry

Insert Urinary Catheter Foley, To: Dependent Drainage Bag, Insert foley if patient unable to void while on bedrest.

Discontinue Urinary Catheter DC Foley, when bedrest complete

Discontinue Venous Sheath Pull venous sheath(s) on arrival if NO Heparin given. If Heparin given then, ACT every 1 hr until ACT less than 170 and then pull sheath(s).

Discontinue Arterial Sheath Pull areterial sheath(s) on arrival if NO Heparin given. If Heparin given then, ACT every 1 hr until ACT less than 150 then pull sheath(s).

Convert IV to INT

Communication

TO Read Back Scanned Powerchart Scanned PharmScan

Order Taken by Signature: _________________________________________________________________________ Date ____________________________ Time ____________________________

Physician Signature: ___________________________________________________________________________ Date ____________________________ Time ____________________________

Page: 1 Card Electrophysiology Study Plan Version: 4 Effective on: 04/13/15

1201

Page 1 of 13

tphillip3

Typewritten Text

tphillip3

Typewritten Text

Diagnosis _______________________________

tphillip3

Typewritten Text

tphillip3

Typewritten Text

tphillip3

Typewritten Text



PHYSICIAN ORDERS


ORDER ORDER DETAILS

Code Status Code Status: Full Code Code Status: DNR - Do Not Resuscitate Code Status: DNI - Do Not Intubate Code Status: DNR/DNI - Do Not Resuscitate or Intubate Code Status: Partial Resuscitative Effort

Dietary

Oral Diet Regular Diet AHA Diet Clear Liquid Diet Full Liquid Diet Clear Liquid Diet, Advance as tolerated to Regular Clear Liquid Diet, Advance as tolerated to AHA

ADA Diet 1800 Calories, AHA 1600 Calories, AHA 1800 Calories 1600 Calories

NPO Diet

IV Solutions

1/2 NS IV, 75 mL/hr IV, 125 mL/hr IV, 150 mL/hr IV, 200 mL/hr

D5 1/2 NS IV, 75 mL/hr IV, 125 mL/hr IV, 150 mL/hr IV, 200 mL/hr

D5NS IV, 75 mL/hr IV, 125 mL/hr IV, 175 mL/hr IV, 200 mL/hr

NS IV, 75 mL/hr IV, 125 mL/hr IV, 150 mL/hr IV, 200 mL/hr

MedicationsMedication sentences are per dose. You will need to calculate a total daily dose if needed.





1201

Page 2 of 13



PHYSICIAN ORDERS


ORDER ORDER DETAILS

warfarin 1 mg, PO, tab, QPM 2 mg, PO, tab, QPM 2.5 mg, PO, tab, QPM 3 mg, PO, tab, QPM 4 mg, PO, tab, QPM 5 mg, PO, tab, QPM 6 mg, PO, tab, QPM 7.5 mg, PO, tab, QPM 10 mg, PO, tab, QPM

dabigatran 150 mg, PO, cap, BID 75 mg, PO, cap, BID

furosemide 40 mg, IVPush, inj, ONE TIME

Laboratory

CBC with Differential Routine, T;N Routine, T+1;0300

Basic Metabolic Panel Routine, T;N Routine, T+1;0300

Diagnostic Tests

EKG-12 Lead STAT, Atrial Fibrillation (427.31) STAT, Atrial Flutter (427.32)

EKG-12 Lead Routine, Atrial Fibrillation (427.31), Every AM for 2 days Routine, Atrial Flutter (427.32), Every AM for 2 days

Respiratory

Respiratory Care Plan Protocol

Oxygen Therapy Via: Nasal cannula, Keep sats greater than: 92% Via: Simple mask, Keep sats greater than: 92% Via: Nonrebreather mask, Keep sats greater than: 92%

...Additional Orders





1201

Page 3 of 13

tphillip3

Typewritten Text


SLIDING SCALE INSULIN PROTOCOL PLAN

PHYSICIAN ORDERS


ORDER ORDER DETAILS

Patient Care

POC Blood Sugar Check Per Sliding Scale Insulin Frequency AC & HS AC & HS 3 days TID BID q12h q6h q6h 24 hr q4h q2h

Sliding Scale Insulin Protocol Follow SSI Reference Text


insulin regular (Low Dose Insulin Sliding Scale) 0-10 units, subcut, inj, AC & nightly, PRN glucose levels - see parameters Low Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician

70-110 - 0 units; 111-150 - 0 units; 151-200 - 2 units subQ; 201-250 - 3 units subQ; 251-300 - 4 units subQ; 301-350 - 6 units subQ; 351-400 - 8 units subQ; Greater than 400 - 10 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physician. 0-10 units, subcut, inj, q6h, PRN glucose levels - see parameters Low Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician

70-110 - 0 units; 111-150 - 0 units; 151-200 - 2 units subQ; 201-250 - 3 units subQ; 251-300 - 4 units subQ; 301-350 - 6 units subQ; 351-400 - 8 units subQ; Greater than 400 - 10 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physician. 0-10 units, subcut, inj, q4h, PRN glucose levels - see parameters Low Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician

70-110 - 0 units; 111-150 - 0 units; 151-200 - 2 units subQ; 201-250 - 3 units subQ; 251-300 - 4 units subQ; 301-350 - 6 units subQ; 351-400 - 8 units subQ; Greater than 400 - 10 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physician.Continued on next page....TO Read Back Scanned Powerchart Scanned PharmScan




1201

Page 4 of 13



PHYSICIAN ORDERS


ORDER ORDER DETAILS

0-10 units, subcut, inj, q2h, PRN glucose levels - see parameters Low Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician

70-110 - 0 units; 111-150 - 0 units; 151-200 - 2 units subQ; 201-250 - 3 units subQ; 251-300 - 4 units subQ; 301-350 - 6 units subQ; 351-400 - 8 units subQ; Greater than 400 - 10 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physician. 0-10 units, subcut, inj, TID, PRN glucose levels - see parameters Low Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician

70-110 - 0 units; 111-150 - 0 units; 151-200 - 2 units subQ; 201-250 - 3 units subQ; 251-300 - 4 units subQ; 301-350 - 6 units subQ; 351-400 - 8 units subQ; Greater than 400 - 10 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physician. 0-10 units, subcut, inj, BID, PRN glucose levels - see parameters Low Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician

70-110 - 0 units; 111-150 - 0 units; 151-200 - 2 units subQ; 201-250 - 3 units subQ; 251-300 - 4 units subQ; 301-350 - 6 units subQ; 351-400 - 8 units subQ; Greater than 400 - 10 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physician.





1201

Page 5 of 13



PHYSICIAN ORDERS


ORDER ORDER DETAILS

insulin regular (Moderate Dose Insulin Sliding Scale) 0-12 units, subcut, inj, AC & nightly, PRN glucose levels - see parameters Moderate Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician

70-110 - 0 units; 111-150 - 2 units subQ; 151-200 - 3 units subQ; 201-250 - 4 units subQ; 251-300 - 6 units subQ; 301-350 - 8 units subQ; 351-400 - 10 units subQ; Greater than 400 - 12 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300; then resume normal accucheck and sliding scale routine. Call physician. 0-12 units, subcut, inj, q6h, PRN glucose levels - see parameters Moderate Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician



70-110 - 0 units; 111-150 - 2 units subQ; 151-200 - 3 units subQ; 201-250 - 4 units subQ; 251-300 - 6 units subQ; 301-350 - 8 units subQ; 351-400 - 10 units subQ; Greater than 400 - 12 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300; then resume normal accucheck and sliding scale routine. Call physician.Continued on next page....





1201

Page 6 of 13



PHYSICIAN ORDERS


ORDER ORDER DETAILS

0-12 units, subcut, inj, TID, PRN glucose levels - see parameters Moderate Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician

70-110 - 0 units; 111-150 - 2 units subQ; 151-200 - 3 units subQ; 201-250 - 4 units subQ; 251-300 - 6 units subQ; 301-350 - 8 units subQ; 351-400 - 10 units subQ; Greater than 400 - 12 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300; then resume normal accucheck and sliding scale routine. Call physician. 0-12 units, subcut, inj, BID, PRN glucose levels - see parameters Moderate Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician

70-110 - 0 units; 111-150 - 2 units subQ; 151-200 - 3 units subQ; 201-250 - 4 units subQ; 251-300 - 6 units subQ; 301-350 - 8 units subQ; 351-400 - 10 units subQ; Greater than 400 - 12 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300; then resume normal accucheck and sliding scale routine. Call physician.

insulin regular (High Dose Insulin Sliding Scale) 0-14 units, subcut, inj, AC & nightly, PRN glucose levels - see parameters High Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician

70-110 - 0 units; 111-150 - 3 units subQ; 151-200 - 4 units subQ; 201-250 - 6 units subQ; 251-300 - 8 units subQ; 301-350 - 10 units subQ; 351-400 - 12 units subQ; Greater than 400 - 14 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physician 0-14 units, subcut, inj, q6h, PRN glucose levels - see parameters High Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician;

70-110 - 0 units; 111-150 - 3 units subQ; 151-200 - 4 units subQ; 201-250 - 6 units subQ; 251-300 - 8 units subQ; 301-350 - 10 units subQ; 351-400 - 12 units subQ; Greater than 400 - 14 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physicianContinued on next page....





1201

Page 7 of 13



PHYSICIAN ORDERS


ORDER ORDER DETAILS

0-14 units, subcut, inj, q4h, PRN glucose levels - see parameters High Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician;

70-110 - 0 units; 111-150 - 3 units subQ; 151-200 - 4 units subQ; 201-250 - 6 units subQ; 251-300 - 8 units subQ; 301-350 - 10 units subQ; 351-400 - 12 units subQ; Greater than 400 - 14 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physician 0-14 units, subcut, inj, q2h, PRN glucose levels - see parameters High Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician;

70-110 - 0 units; 111-150 - 3 units subQ; 151-200 - 4 units subQ; 201-250 - 6 units subQ; 251-300 - 8 units subQ; 301-350 - 10 units subQ; 351-400 - 12 units subQ; Greater than 400 - 14 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physician 0-14 units, subcut, inj, TID, PRN glucose levels - see parameters High Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician;

70-110 - 0 units; 111-150 - 3 units subQ; 151-200 - 4 units subQ; 201-250 - 6 units subQ; 251-300 - 8 units subQ; 301-350 - 10 units subQ; 351-400 - 12 units subQ; Greater than 400 - 14 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physician 0-14 units, subcut, inj, BID, PRN glucose levels - see parameters High Dose Insulin Sliding Scale Blood glucose is less than 70 and patient is symptomatic; Initiate hypoglycemic protocol and Call physician;

70-110 - 0 units; 111-150 - 3 units subQ; 151-200 - 4 units subQ; 201-250 - 6 units subQ; 251-300 - 8 units subQ; 301-350 - 10 units subQ; 351-400 - 12 units subQ; Greater than 400 - 14 units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG is less than 300, then resume normal accucheck and sliding scale routine. Call physicianContinued on next page....TO Read Back Scanned Powerchart Scanned PharmScan




1201

Page 8 of 13



PHYSICIAN ORDERS


ORDER ORDER DETAILS

insulin regular (Blank Insulin Sliding Scale) See Comments, subcut, inj, PRN glucose levels - see parameters Blood glucose is less than ___; Initiate hypoglycemic protocol and Call physician; 70-110 - __ units; 111-150 - __ units subQ; 151-200 - __ units subQ; 201-250 - __ units subQ; 251-300 - __ units subQ; 301-350 - __ units subQ; 351-400 - __ units subQ; Greater than 400 - __ units IV now, repeat accucheck in 30 minutes; continue to repeat 10 units IV and accuchecks every 30 minutes until BG less than ___, then resume normal accucheck and sliding scale routine. Call physician

HYPOglycemia Protocol

HYPOglycemia Protocol If BS is less than 70 mg/dL, and patient SYMPTOMATIC, give 6 oz. of juice PO (if applicable) and/or follow HYPOglycemia Protocol meds.

glucose (D50) 25 g, IVP, syringe, as needed, PRN glucose levels - see parameters Patient unable to swallow / NPO WITH IV access. Dextrose 50% 50 mL IV. Recheck BG in 15 -20 minutes. Repeat treatment until blood glucose greater than 100 mg/dL. If not NPO provide additional snack once able to swallow.

glucose 15 g, PO, gel, as needed, PRN glucose levels - see parameters

glucagon 1 mg, IM, inj, as needed, PRN glucose levels - see parameters Patient UNABLE to swallow / NPO WITHOUT IV access. Administer Glucagon 1 mg IM or SubQ. Contact physician for further orders. Establish IV access with saline lock. Recheck BG every 15 to 20 minutes. Use aspiration precautions as glucagon may cause nausea and vomiting.





1201

Page 9 of 13


DISCOMFORT MED PLAN

PHYSICIAN ORDERS


ORDER ORDER DETAILS

Patient Care

Perform Bladder Scan Scan PRN, If more than 250, Then: Call MD, Perform as needed for patients complaining of urinary discomfort and/or bladder distention present OR 6 hrs post Foley removal and patient has not voided.


phenol-menthol topical (phenol-menthol 2.9%-0.12% (Cepastat) lozenge) 1 lozenge, PO, lozenge, q4h, PRN sore throat Do not exceed 6 lozenges in 24 hours

dextromethorphan-guaiFENesin (dextromethorphan-guaiFENesin 20 mg-200 mg/10 mL oral liquid) 10 mL, PO, liq, q4h, PRN cough

dexamethasone-diphenhydrAMIN-nystatin-NS (Fred’s Brew) 15 mL, swish & spit, liq, q2h, PRN mucositis While awake

lidocaine topical (Lidocaine Viscous 2% mucous membrane solution) 15 mL, swish & spit, liq, q4h, PRN mucositis

Analgesics

acetaminophen 500 mg, PO, tab, q6h, PRN pain-mild (scale 1-3) ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF acetaminophen ineffective/contraindicated, USE ibuprofen if ordered:***** 1,000 mg, PO, tab, q4h, PRN pain-mild (scale 1-3) ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF acetaminophen ineffective/contraindicated, USE ibuprofen if ordered:*****

acetaminophen 650 mg, rectally, supp, q4h, PRN pain-mild (scale 1-3) ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****If acetaminophen ineffective/contraindicated, USE ibuprofen if ordered:*****

ibuprofen 400 mg, PO, tab, q6h, PRN pain-mild (scale 1-3) ***Do not exceed 3,200 mg of ibuprofen from all sources in 24 hours*** Give with food. Use if acetaminophen ineffective or contraindicated.

HYDROcodone-acetaminophen (HYDROcodone-acetaminophen 5 mg-325 mg oral tablet) 1 tab, PO, tab, q4h, PRN pain-moderate (scale 4-7) ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF HYDROcodone-acetaminophen ineffective/contraindicated or NPO, USE ketorolac if ordered***** 2 tab, PO, tab, q4h, PRN pain-moderate (scale 4-7) ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF HYDROcodone-acetaminophen ineffective/contraindicated or NPO, USE ketorolac if ordered*****





1201

Page 10 of 13


DISCOMFORT MED PLAN

PHYSICIAN ORDERS


ORDER ORDER DETAILS

acetaminophen-codeine (acetaminophen-codeine #3) 1 tab, PO, q4h, PRN pain-moderate (scale 4-7) ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF acetaminophen-codeine #3 ineffective/contraindicated or NPO, USE ketorolac if ordered***** 2 tab, PO, q4h, PRN pain-moderate (scale 4-7) ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF acetaminophen-codeine #3 ineffective/contraindicated or NPO, USE ketorolac if ordered*****

ketorolac 15 mg, IVPush, inj, q6h, PRN pain-moderate (scale 4-7), x 48 hr ***May give IM if no IV access*** Use if HYDROcodone-acetaminophen ineffective or contraindicated. 30 mg, IVPush, inj, q6h, PRN pain-moderate (scale 4-7), x 48 hr ***May give IM if no IV access*** Use if HYDROcodone-acetaminophen ineffective or contraindicated.

morphine 2 mg, IVPush, inj, q4h, PRN pain-severe (scale 8-10) ***Slow IV Push*** *****IF morphine is ineffective/contraindicated, USE HYDROmorphone if ordered***** 4 mg, IVPush, inj, q4h, PRN pain-severe (scale 8-10) ***Slow IV Push*** *****IF morphine is ineffective/contraindicated, USE HYDROmorphone if ordered*****

HYDROmorphone 1 mg, IVPush, inj, q4h, PRN pain-severe (scale 8-10) ***Slow IV Push*** Use if morphine ineffective or contraindicated.

Antiemetics

promethazine 25 mg, PO, tab, q4h, PRN nausea/vomiting *****IF promethazine is ineffective/contraindicated or patient is NPO, USE ondansetron if ordered*****

ondansetron 4 mg, IVPush, soln, q8h, PRN nausea/vomiting Use if promethazine ineffective or contraindicated.

Gastrointestinal Agents

docusate 100 mg, PO, cap, Nightly, PRN constipation *****IF docusate is contraindicated or ineffective after 12 hours, USE bisacodyl if ordered*****

bisacodyl 10 mg, rectally, supp, Daily, PRN constipation *****IF bisacodyl is contraindicated or ineffective after 6 hours, USE Fleet Enema if ordered*****





1201

Page 11 of 13


DISCOMFORT MED PLAN

PHYSICIAN ORDERS


ORDER ORDER DETAILS

sodium biphosphate-sodium phosphate (Fleet Enema) 132 mL, rectally, enema, Daily, PRN constipation

loperamide 4 mg, PO, cap, ONE TIME, PRN diarrhea Initial dose after first loose stool 4 mg, PO, liq, ONE TIME, PRN diarrhea Initial dose after first loose stool

loperamide 2 mg, PO, cap, as needed, PRN diarrhea 2 mg after each loose stool, up to 16 mg per day 2 mg, PO, liq, as needed, PRN diarrhea 2 mg after each loose stool, up to 16 mg per day

Antacids

Al hydroxide-Mg hydroxide-simethicone (aluminum hydroxide-magnesium hydroxide-simethicone 200 mg-200 mg-20 mg/5 mL oral suspension) 30 mL, PO, susp, q4h, PRN indigestion Administer 1 hour before meals and nightly.

simethicone 80 mg, PO, tab chew, q4h, PRN gas 160 mg, PO, tab chew, q4h, PRN gas

Sedatives

ALPRAZolam 0.25 mg, PO, tab, TID, PRN anxiety *****IF ALPRAZolam is ineffective/contraindicated or patient is NPO, USE LORazepam if ordered*****

LORazepam 1 mg, IVPush, inj, q6h, PRN anxiety 0.5 mg, IVPush, inj, q6h, PRN anxiety

zolpidem 5 mg, PO, tab, Nightly, PRN insomnia may repeat x1 in one hour if ineffective

Antihistamines

diphenhydrAMINE 25 mg, PO, cap, q4h, PRN itching *****IF diphenhydrAMINE PO is ineffective or patient is NPO, USE diphenhydrAMINE inj if ordered*****

diphenhydrAMINE 25 mg, IVPush, inj, q4h, PRN itching Use if oral dose is ineffective or patient is NPO

Anti-pyretics





1201

Page 12 of 13


DISCOMFORT MED PLAN

PHYSICIAN ORDERS


ORDER ORDER DETAILS

acetaminophen 500 mg, PO, tab, q4h, PRN fever ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF acetminophen is ineffective/contraindicated, USE ibuprofen if ordered***** 1,000 mg, PO, tab, q4h, PRN fever ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF acetminophen is ineffective/contraindicated, USE ibuprofen if ordered*****

ibuprofen 200 mg, PO, tab, q4h, PRN fever Do not exceed 3,200 mg in 24 hours. Give with food. Use if acetaminophen is ineffective or contraindicated. 400 mg, PO, tab, q4h, PRN fever Do not exceed 3,200 mg in 24 hours. Give with food. Use if acetaminophen is ineffective or contraindicated.

Anorectal Preparations

witch hazel-glycerin topical (witch hazel-glycerin 50% topical pad) 1 app, topical, pad, as needed, PRN hemorrhoid care Wipe affected area *****IF witch hazel-glycerin or phenylephrine ointment ineffective/contraindicated, USE hydrocortisone-pramoxine foam if ordered*****

phenylephrine topical (phenylephrine 0.25%-3% rectal ointment) 1 app, rectally, oint, q6h, PRN hemorrhoid care Apply to affected area *****IF witch hazel-glycerin or phenylephrine ointment ineffective/contraindicated, USE hydrocortisone-pramoxine foam if ordered*****

hydrocortisone-pramoxine topical (hydrocortisone-pramoxine 1%-1% rectal foam) 1 app, rectally, foam, q8h, PRN hemorrhoid care apply to affected area





1201

Page 13 of 13

Documents

CARD ELECTROPHYSIOLOGY STUDY PLAN · CARD ELECTROPHYSIOLOGY STUDY PLAN PHYSICIAN ORDERS Weight _____ Allergies _____ Place an "X" in the Orders column to designate orders of choice

CARD ELECTROPHYSIOLOGY STUDY PLAN · CARD ELECTROPHYSIOLOGY STUDY PLAN PHYSICIAN ORDERS Weight _ Allergies _ Place an "X" in the Orders column to designate orders of choice