_01028_std_postheartcath

_01028_std_postheartcath - SCANNED TO PHARMACY STAT...

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Unformatted text preview: SCANNED TO PHARMACY STAT MEDICATION Date: ______________________ Time: ________________________ 1. Disposition: Discharge to home when discharge criteria met. Status of Admission: Outpatient with Extended Recovery Observation Level of Care: Telemetry CVIU ICU/CICU 2. Remove sheath(s) per protocol for hemostasis at ________ (time). If sheath(s) cannot be removed at ordered time, notify physician and obtain further orders. Premedicate x 1 with _________________________________________________________________________ Treat hypertension >160 systolic or >90 diastolic with _______________________________________________ IV. Normal Saline IV 250-500 mL for symptomatic hypotension PRN. 3. Activity: Bedrest for ______ hours with affected leg straight. May elevated head of bed 30-60 degrees one hour after sheath removal. Out of bed/dangle ______ hours after hemostasis obtained. 4. Diet: Cardiac diet. Encourage PO fluids. Other ___________________________________________ 5. IV: ________________________________ at _______ mL per hour for ______ hours. 6. Vital Signs: Assess and document vital signs, arterial access site, and peripheral pulses Q 15 minutes X 4, Q 30 minutes X 2, Q 1 Hour X 2, then Q 4 Hours per unit routine. Notify cardiologist for loss of pulses, excessive bleeding and/or expanding hematoma. 7. Medications: If patient was taking Metformin, restart in 48 hours after serum creatinine is obtained. Acetylcysteine (Mucomyst) 600 mg PO Q 12 hours x 2 doses if calculated creatinine clearance is less than 50mL/min and/or serum creatinine is greater than 1.3. Check to see if one dose has already been given. Patient should receive total of 2 doses. Sodium Bicarbonate Infusion (154 mEq / L D5W) to infuse at 1 mL/kg/hour for a total of six (6) hours (from the time of the patient’s arrival to the unit) if the calculated creatinine clearance is less than 50 mL/min and/or serum creatinine is greater than 1.3. Do not discharge patient until after the post-procedure 6 hours of sodium bicarbonate is completed. Aspirin_______mg PO daily Water soluble Enteric Coated Atropine 0.5-2 mg IV for symptomatic bradycardia. Nitroglycerine 0.4 mg SL every 5 minutes times three PRN angina / chest pain. Notify MD. Acetaminophen (Tylenol) 325 mg PO every 4 hours PRN discomfort. (No more than 4 gms/24 hour period.) PRN pain/sedation, may give: ___________________________________________________________ x 48 hours. Discontinue heparin. Discontinue low molecular weight heparin. Beta blocker: _______________________________________________________________________________ ACE / ARB: _______________________________________________________________________________ Statin: ____________________________________________________________________________________ 8. Treatments: May insert Foley Catheter if unable to void. May use Lidocaine jelly. Physician Signature ________________________________________________ Physician # __________________ Authorization for therapeutic substitution is given unless checked here Patient Identification Sutter Medical Center, Sacramento A Sutter Health Affiliate Heart Cath Orders Post Procedure 01028 (7/9/09) ORDERS ...
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This note was uploaded on 12/26/2009 for the course PHYS 341 taught by Professor Mavromatis during the Spring '09 term at American University of Beirut.

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