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&D Page &p of &P Hemorrhagic Stroke General Admit patients to a stroke unit
Vital signs Every 30 minutes for 3 hours, every hour for 24 hours, then every 4 hours Neuro Status Monitoring, Order Every 30 minutes for 3 hours, every hour for 24 hours, then every 4 hours Glasgow Coma Scale Order Every 30 minutes for 3 hours, every hour for 24 hours, then every 4 hours every 4 hours NIH Stroke Scale Order On admission to unit once a day with morning assessment Other
Diet NPO until dysphagia screening completed PUREED DIET Other
Medications Antidotes and Rescue Agents phytonadione 2.5 milligram intravenously once 2.5 milligram orally once 5 milligram orally once Antiepileptics diazepam 5 milligram intravenously every 5 minutes for maximum dose of 15 milligrams LORazepam 2 milligram intravenously every 5 minutes for a maximum dose of 6 milligrams fosphenytoin 1 gram intravenously once loading dose 100 milligram intravenously every 8 hours maintenance dose levETIRAcetam 500 milligram intravenously once loading dose 500 milligram intravenously every 12 hours maintenance dose Antihypertensives enalaprilat 0.625 milligram intravenously NOW test dose 1.25 milligram intravenously EVERY 6 HOURS AS NEEDED labetalol intravenously TITRATE DOSE PER PROTOCOL 10 milligram intravenously every 20 minutes maximum of 4 doses, (maximum bolus dose is 300 milligram/24 hours) niCARdipine intravenously TITRATE DOSE PER PROTOCOL Physician/Date/Time: _________________________ Nurse/Date/Time: _______________________ Secretary/Date/Time: ________________________ Full page of orders requires only one physician, one nurse and one clerical signature Original to Patient's Chart
Original: 10/2013
Revised:
Reviewed:
Fax to Pharmacy
Form #: 6.5­001
&D Page &p of &P nitroglycerin intravenously TITRATE DOSE PER PROTOCOL Antipyretics acetaminophen 650 milligram by feeding tube EVERY 6 HOURS AS NEEDED for temp greater than 99.6F/37.5C 650 milligram rectally EVERY 6 HOURS AS NEEDED for temp greater than 99.6F/37.5C, if patient is NPO Stress Ulcer Prophylaxis Agents: Histamine­2 Receptor Antagonists famotidine 20 milligram intravenously every 12 hours Other
Respiratory Stroke­Maintain O2>92% 72 hrs Blood gas, arterial Blood gas, venous Biphasic positive airway pressure (BIPAP) Mode:___________ I­PAP(cm H2O):_____ E­PAP(cm H2O):_____ FIO2:_____ Other
Laboratory Blood Bank FRESH FROZEN PLASMA , reason wanted: PLATELETS PRODUCT , platelet product wanted: pheresed and reason wanted: Cardiac Markers Troponin­I Chemistry Calcium level, serum, total Ethanol (EtOH) level Magnesium (Mg) level, serum Phosphorus level, serum Thyroid stimulating hormone (TSH) Thyroxine (T4), free Panels Electrolyte panel Hepatic function panel Lipid panel Renal function panel Therapeutic Drug Levels/Toxicology Phenytoin level, total Urine Studies Toxicology drug screen, urine Urinalysis (UA) with microscopy Other
Radiology Either CT or MRI should be used as the initial imaging modality
Physician/Date/Time: _________________________ Nurse/Date/Time: _______________________ Secretary/Date/Time: ________________________ Full page of orders requires only one physician, one nurse and one clerical signature Original to Patient's Chart
Original: 10/2013
Revised:
Reviewed:
Fax to Pharmacy
Form #: 6.5­001
&D Page &p of &P Computed Tomography CT angiography, head CT, head or brain, with and without contrast CT, head or brain, without contrast on day 2 General Radiography XR,MODIFIED BA SWALLOW
Magnetic Resonance Studies MRA, head, with contrast MRA, head, without contrast MRI, brain, with and without contrast MRI, brain, without contrast Other
Diagnostic Tests Neurology Electroencephalogram (EEG) Other
Consults Consult to neurology Consult to neurosurgery Consult to Inpt Rehab (CIRU)
Consult to Home Care Eval Consult to dietitian OCCUPATIONAL THERAPY PT. ORDER PHYSICAL THERAPY PT. ORDER SPEECH THERAPY PT. ORDER ­ speech therapist to write orders for diet consistencies, altered diets and modified barium swallows as per their recommendations Other
Nursing Orders Assessments Dysphagia screening Order
Cardiac monitor Accuchek Order ACCUCHEK 6­12­6­12 for 48 hours if NPO Contingency Notify provider if blood glucose is less than 80 or greater than 140 milligram/deciliter Interventions IPC with graduated compression stockings should be used to prevent VTE
Elevate head of bed 30 degrees Nasogastric/orogastric tube insertion/management Other
Patient/Caregiver Education Education, alcohol intake Physician/Date/Time: _________________________ Nurse/Date/Time: _______________________ Secretary/Date/Time: ________________________ Full page of orders requires only one physician, one nurse and one clerical signature Original to Patient's Chart
Original: 10/2013
Revised:
Reviewed:
Fax to Pharmacy
Form #: 6.5­001
&D Page &p of &P Education, diet Education, exercise Education, weight reduction Education, stroke/TIA Order ­ give the "Let's Talk Stroke and TIA" booklet Other
Physician/Date/Time: _________________________ Nurse/Date/Time: _______________________ Secretary/Date/Time: ________________________ Full page of orders requires only one physician, one nurse and one clerical signature Original to Patient's Chart
Original: 10/2013
Revised:
Reviewed:
Fax to Pharmacy
Form #: 6.5­001
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