Chronic Daily Headache Detoxification Admission Orders
Date and time:
Allergies:
Name:
Age:
DOB:
1. Admit to: [ X ] Acute Care [ ] Day Bed [ ] SCUnit
2. Attending Dr: Younger
3. Admitting Dx: Incapacitating Chronic Daily Headaches
4. Contributing Dx:
5. Condition:
6. VS:
7. Activity:
8. Nursing:
9. Diet:
10. IV:
11. Meds:
12. Other Meds:
[ ] Telemetry
[ X ] Stable
[ ] Fair
[ ] Serious
[ ] Critical
qid with blood pressure sitting and standing.
Weight on admission and each AM.
Up with assistance.
I/O Q shift.
Regular diet.
IV of LR at 80 ML/hour.
Tylenol 1000 mg PO Q 4 hr prn pain.
Milk of Magnesia, 30 ml by mouth at bedtime as needed for
constipation.
Ambien 5 mg, one tablet by mouth at bedtime and may repeat
X 1 if needed for sleep.
Dihydroergotamine (DHE) protocol:
DHE mesylate 0.5 mg, IV over two to three minutes every eight
hours for three days.
Zofran (Ondansetron) 4 mg, IV every eight hours for three
days, administered just prior to the DHE dose.
The following two drugs (Toradol and Norflex) may be
alternated for relief of pain.
Toradol (Ketorolac) 30 mg, IM/or IV every six hours as needed
for pain.
Norflex Injection, 30Mg/Ml, 30 mg IM/or IV every 12 hours as
needed for cervical muscles pain.
If the patient's headache becomes severe, the following drug
may be used as a onetime dose:
Depacon (Valproate sodium) 1000 mg IV times one dose.
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If the patient complains of a very severe headache and the
Depacon, Toradol, and Norflex are not effective in relieving the
pain, then Medrol (methylprednisolone) 80 mg may be given
IM times one dose only.
13. Labs:
14. Other:
15. H&P:
16. Consultants:
For relief of extremely severe pain, Methadone 10 mg IV in
combination with Phenergan 50 mg IV may be given every six
hours.
CBC, chem 7, LFTs, TSH;
EKG on admission.
Call MD if: altered mental status, T 102F or higher, chest pain,
pulse < 40 or >130, or if the Depacon, Medrol, or
Methadone/Phenergan are required to manage the patient's pain.
Type up the dictated H&P.
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