admission/tranfer orders

Introduction

Admit to <service>

Diagnosis: <myocardial infarction, pneumonia, etc.>

Condition: (guarded, stable)

Allergies: <i.e. NKDA>

Diet: (<i.e. NPO>

Activity: <i.e. bedrest, as tolerated>

Nursing:

• call MD for 35.5 C < Temp < 38.5, 90 < SBP < 180
• Teds/SCD or heparin SC BID
• NG tube for meds {if needed}
• IV: {i.e. heplock}
• Ventilator settings (if needed):
  • i.e. AC @ 14/min, TV 650, PEEP 5, 35% O2
• Incentive spirometer

Medications:

• ASA 81 mg QD (CAD)
• Tylenol 650 mg PO every 4-6 hours PRN (pain)
• ranitidine (Zantac) 50 mg IV every 8 hours (MICU, GI stress)
• Colace 100 mg PO BID (constipation)

Laboratory:

• basic metabolic panel CBC, urinalysis, other

EKG if indicated

Chest X-ray