PLACE LABEL HERE
CARDIOVERSION
PRE and POST PROCEDURE
ORDERS
The following orders will be implemented. Orders with a “q” are choices and are NOT implemented unless checked.
Initial all handwritten order modifications and the bottom of each page when indicated (multipage).
DIAGNOSIS: _____________________________________________________________________________
PRE-PROCEDURE
1. Cardioversion: Day of Procedure: ________________________
2. NPO status:
q NPO now and confirm patient has been NPO after midnight (patient coming from home)
q NPO after midnight except medications for cardioversion tomorrow (patient in hospital)
q NPO now for cardioversion today (patient in hospital)
3. STAT Diagnostics: STAT Labs: q CBC, q Chem 7, q Magnesium level
q PT / INR q PTT q Anti Xa (Heparin level)
Notify physician if K+ < 3.7 or INR < 2.0
4. ECG 12-lead Reason: Pre Cardioversion, cardiac arrhythmia evaluation, Read by _________________
5. Urine hCG for any menstruating female ≥ 12 years of age
6. Blood glucose finger stick prior to procedure (Diabetic patient)
7. Venous Access: INT to right arm, if possible and no current IV access
8. Normal Saline IV at KVO rate, start immediately prior to procedure
9. O2 per protocol (# 34431)
10. q OUTPATIENT POST-PROCEDURE ORDERS
STAT ECG 12 lead Reason: Status Post Cardioversion, Read by: __________________
May go home when discharge criteria met:
· Able to tolerate PO fluids
· PAR score ≥ 9 or at pre-procedure level. If PAR ≤ 8 discharge by Physician orders.
· Ambulate with minimal assistance
11. q INPATIENT POST PROCEDURE ORDERS
STAT ECG 12 lead Reason: Status Post Cardioversion, Read by___________________
Resume previous diet when awake and alert
Return to floor when PAR score ≥ 9 or at pre-procedure level. If PAR ≤ 8, discharge by Physician orders.
Vital Signs upon returning to unit and per unit routine
Up with assist first time out of bed, then PRN
____________ ___________ ______________________________________ _____________
Date Time Physician Signature PID Number
Copy to pharmacy
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