Originally Posted by docB
JCAHO is getting crappier and crappier about orders so check with your seniors about what's allowed at your house but here are some good starters:
FSBS q 6 hours or qac and qhs
if glucose < 70 give 1/2 amp D50 po or iv and recheck FSBS in 30 min
if glu 70 - 150 do nothing
if glu 151 - 200 give 2 units reg insulin SQ
" 201 - 250 " 4 "
" 251 - 300 " 6 "
" 301 - 350 " 8 "
" 351 - 400 " 10 "
" >400 " 12 " and call MD
If K < 3.0 call MD
If K 3.0 - 3.2 give K riders x 40 meq iv over 4 hours or KDur 40 meg po
If K 3.2 - 3.3 " x 30 meq
If K 3.3 - 3.5 " x 20 meq
If K > 6.0 call MD
Tylenol 650 mg po/pr q 4 hours PRN pain/fever
*only do the fever part if you expect the patient to have a fever and you don't need to work it up
*remember to provide alternate routes. If the pt can't take it po it's gotta go pr. This goes for other stuff too. You don't want a call a 0200 to ask if the IV ativen could be given PO.
If Temp > 100.6 obtain blood cx x 2, urine cx, sputum cx, CXR.
Morphine 1-5 mg IV q 4 hours PRN pain
Dilaudid 1-2 mg IV q 4 hours PRN pain
Phenergan 12.5 - 25 mg IV q 6 hours PRN nausea
*write it as nausea because they technically can only give it after the patient pukes if you write "vomiting."
Albuterol 2.5 mg Neb q 4 hours PRN wheezing
Atrovent 0.5 mg neb q 8 hours PRN wheezing
*write wheezing instead of SOB or they may keep giving Nebs to your worsening CHF patient.
Restoril 15 mg po qhs PRN sleeplessness
*every oldster expects a sleeper. Your covering colleagues or night float will love you if you write for the sleepers.
Ativan 1 mg IV/IM/PO q 6 hours PRN agitation
Haldol 2.5 mg IV/IM/PO q 6 hours PRN agitation
*be stingy on this one. The idea is to deal with the demented sundowner patients without over sedating a patient with unrecognized delerium.
ABG PRN vent changes
You don't want a call at 0200 asking if it's OK to get the gas just so you can get called 30 min later with the results.
Disclaimer: I'm sure there are those who want to debate dosages and so on and maybe even the use of slides and PRN altogether. Instead of doing that I'll just say that you have to use judgement and know your patients. You have to base these things on your particular patient and your labs norms.
Yes again, thank you docB so much for taking the time to post that long post.
Anyone else with some more tips. Cause right about now I'm