HEMORRHAGIC STROKE ADMISSION ORDERS
Allergies: _____________________________________________________________________
PHYSICIANS: Orders with boxes must be checked to activate
FOCUS
INTERVENTION
AREA
Level of
 Outpatient / Observation
Care
Admit Inpatient to:
 5A with continuous cardiac monitoring for 24 hours
 4A Telemetry
 Critical Care
Diagnosis
Hemorrhagic Stroke
Unit
Secretary
Select Routine Orders for Hemorrhagic Stroke Orders 1 & 2
Condition
 Stable
Vital signs
 Vital Signs every___________________________________________
 Guarded  Serious
 Call MD with Temp
 Critical  Other __________________
>_______Heart Rate
>________ <________
Systolic BP >________ <_______Diastolic BP >________ <________
Nursing
orders
 Finger stick glucose test every _______ hours and record
Notify MD for blood glucose > __________ or < __________
 Foley Catheter
Activity:  Out of Bed TID
 Ambulate with Assistance
 Ad lib
 Bed Rest
Oxygen Protocol (CD 0093)
Stroke Education [CORE MEASURE]
Sequential Compression Device [CORE MEASURE]
Intake & Output Monitoring and Daily Weights
Aspiration precautions if swallow screen positive or if indicated by Speech Therapy
Neuro Checks (Glasgow Coma Scale) every 4 hours for 72 hours then every shift until
discharge (minimum required). Call MD to report decline in neurological status
Educate Patient on Venous Thromboembolism Prevention
Diet
Keep patient NPO until Swallow Screen complete (Refer to Form # 5319)
IF SWALLOW SCREEN POSITIVE:
1. Keep patient NPO (including meds) until evaluated by Speech Therapy
2. Consult Speech Therapy for swallow evaluation and follow their
recommendations for diet consistency or for continued NPO status
3. Consult Nutrition Services for evaluation the day following the swallow
evaluation by Speech Therapy
IF SWALLOW SCREEN NEGATIVE:
1. Order prudent diet
Nutrition Consult to assess appropriateness of diet order and begin teaching if indicated
Hemorrhagic Stroke Admission Orders
Southern Regional Medical Center
Riverdale, GA 30274
Developed 11/07, Revised 5/10, 1/12
CD 0707
Page 1 of 3
IV fluids
 IV fluids: _______________________________________________________
 INT (rinse with 2.5ml saline every 12 hours and after IV meds)
Medications
**No anticoagulants or anti-thrombotics for example Aspirin, Fondaparinux
(Arixtra), Prasugrel (Effient), Clopidogrel (Plavix) , Dabigitran (Pradaxa),
Enoxaparin (Lovenox), Heparin or Warfarin (Coumadin) **
BP CONTROL: Goal is to maintain Systolic BP between 160-185 mm Hg. Call
neurologist if systolic BP>185 mm HG in acute care

Labetalol (Normodyne) 10 mg IV every 15 minutes to target BP of 160/90 mm Hg.
Maximum 300 mg cumulative dose)

niCARdipine (Cardene) drip: Initiate at 5 mg per hour and titrate every 15 minutes by
2.5 mg per hour (maximum dose of 15 mg per hour) to target BP of 160/90 mm Hg or
MAP of 110

hydrALAZINE (Apresoline) 5 – 10 mg IV every 6 hours as needed to target BP range
above.
SEIZURE PROPHYLAXIS AND TREATMENT:

Lorazepam (Ativan) 1-2 mg IV every 4 hours as needed for seizures

Fosphenytoin (Cerebyx) 20 mg PE/kg IV loading dose followed by Fosphenytoin
(Cerebyx) 5 mg PE/kg IV daily
□
Levetiracetam (Keppra) 500 mg IV or by mouth twice daily
TREATMENT FOR INCREASED INTRACRANIAL PRESSURE:
1. Maintain Head of Bed position at 30 degree angle
2. Hyperventilate (if on mech. ventilator) to target pCO2 levels of 30-35 mm Hg.

Mannitol 1 Gm/kg IV bolus and continue with 0.25 Gm/kg IV every 6 hours.

3% Saline at 50 mL/hr. Sodium level prior to starting and every 6 hr – hold 3% saline if
sodium ≥ 155 mEq/L

Serum osmolality every 6 hours; Call MD for serum osmolality >315 mOsm/L.

Replace hourly urine output with same volume of IV fluids.

Consult Neurosurgery.
 Fomotidine (Pepcid) 20 mg PO or IV twice daily
ANALGESIA AND SEDATION:

Morphine 2-4 mg IV every 4 hours as needed for pain.

If Morphine allergy give Hydromorphone 0.5 mg IV every 4 hours as needed for pain.

Lorazepam (Ativan) 1-2 mg IV every 4 hours as needed for agitation.
Acetaminophen (Tylenol) 650 mg by mouth or rectally every 4 hours as needed for pain
or temp >100 degrees F.
Aluminum-Magnesium Complex (Riopan) 30 mL by mouth every 4 hours as needed for
indigestion - Hold if NPO.
Magnesium Hydroxide (MOM) 30 mL by mouth daily as needed for constipation Hold if
NPO.
Docusate Sodium (Colace) 100 mg by mouth twice daily: Hold if NPO and/or for loose stools
Hemorrhagic Stroke Admission Orders
Southern Regional Medical Center
Riverdale, GA 30274
Developed 11/07, Revised 5/10, 1/12
CD 0707
Page 2 of 3
Laboratory
(Do Not Repeat if done in ED)
□
Urine drug screen (#2305) if not performed in the ED. Reason: __________
□
Complete U/A (#7000)
□
CKMB, Troponin (# 1864, # 2262)
□
EKG (#1) if not performed in the ED Reason For EKG: _______________
CBC with differential (#5511)
PT/PTT (#6008)
ESR (#5730)
CMP (#1574)
Lipid Profile - Fasting (#1932)
Diagnostic
Imaging
 Portable Chest X-ray (#6509) if not performed in the ED
 Routine Chest X-ray (#6510) ( PA and Lateral ) if not performed in the ED
Reason for X-Ray:________________________
 EEG (#6) (RE: subclinical epileptiform activity)
 Follow up non-contrast CT of head (#4558) on ______________(date)
 MRI of Brain withOUT Contrast (#1527) □ MRI of Brain WITH Contrast (#1525)
 MRA Head withOUT Contrast (#1512)
Consults
□ MRI of Brain withOUT contrast (#1527)
 Neurologist: __________________
 Neurosurgeon: ___________________________________
 Respiratory Therapy Assess and Treat Protocol
 Rehab Services assessed and not indicated at this time
 Occupational Therapy evaluate and treat
 Physical Therapy evaluate and treat
 Speech Therapy evaluate and treat:
 Swallowing  Speech/Language  Cognition
D/C planning and Case Management
Respiratory Therapy for Smoking Cessation Liaison if Patient Currently Smokes or has
Smoked in the Last 12 months. Diagnosis: Stroke
Additional
Orders
Time: __________ Date:___________ Physician Signature: __________________________________
TO: Time: ______ Date: _________ Dr. ____________ Nurse Signature: _______________________
 READ BACK AND VERIFIED
Hemorrhagic Stroke Admission Orders
Southern Regional Medical Center
Riverdale, GA 30274
Developed 11/07, Revised 5/10, 1/12
CD 0707
Page 3 of 3