PLACE LABEL HERE
HYPERTENSIVE URGENCY
OBSERVATION 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 pate when indicated (multipage).
1. Status: q Place in Observation for: _____________________________________
2. Level of Care: Acute Care Location/Specialty Unit Preference 5 South
3. q Telemetry: If patient Medical/Surgical, must complete form # 36084
4. q Isolation: q Contact q Droplet q Airborne For: _________________
5. Consults: ______________________________________________ q Notified by physician
______________________________________________ q Notified by physician
6. Diagnostics: STAT Labs: q CBC q Chem 7 q UA
AM Labs: q CBC q Chem 7
q Other: __________________________________________
q STAT EKG, Reason: Hypertension, Read by _______________
q AM EKG, Reason: Hypertension, Read by _______________
7. Vital signs per unit routine or q ____ hrs
8. Pulse oximetry spot check q 6 h by RT x 24 hrs (do not order if telemetry with pulse ox selected)
9. Neuro checks q 4 hrs
10. Notify physician for:
Diastolic BP > 115 mmHg or Systolic BP > 180 mmHg
Blood pressure not responding to treatment
Chest pain
SOB
Changes in neurologic status
11. Diet: q Regular q Cardiac q Diabetic ______ calorie q Renal q Other: _________
12. Activity: q Bed Rest q Bedside commode q Bathroom privileges
q Up ad lib q Up with assistance
SCHEDULED MEDICATIONS:
13. IVF: q NS q LR q D5NS q D5 ½ NS with 20 KCl at ___________ ml/hr
14. VTE prophylaxis, Initiate Venous Thromboembolism (VTE) Prophylaxis Orders (form # 33058)
q Low risk: No pharmacologic or mechanical prophylaxis, ambulate 3 times daily
q Heparin 5,000 units SQ q 8 hrs (q 12 hrs if wt < 50 kg or age > 75)
or q Lovenox (enoxaparin) 40 mg SQ daily at 1700 (30 mg if CrCl < 30 ml/min)
and/or q Mechanical devices: SCDs
15. Antihypertensive:
q Lopressor (metoprolol) 25 mg po twice daily (Hold for SBP < 90 or HR < 60)
q Trandate (labetalol) 200 mg po twice daily (Hold for SBP < 90 or HR < 60)
and/or q Trandate (labetalol) 20 mg IV x 1 STAT
q Vasotec (enalapril) 20 mg po daily (Hold for SBP < 90)
q Losartan 100 mg po daily (Hold for SBP < 90)
q Catapres (clonidine) 0.1 mg po q 6 hrs (Hold for SBP < 90)
q Hydralazine 50 mg po four times daily (Hold for SBP < 90)
q Other: _______________________________________________________________________
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 pate when indicated (multipage).
PRN MEDICATIONS (See policy 520-06 for range orders and pain intensity guidelines)
16. Antihypertensive as needed for SBP > 180 mmHg or DBP > 100 mmHg
q Catapres (clonidine) 0.1 mg or q 0.2 mg po q 4 hrs prn
q Vasotec (enalaprilat) 1.25 mg IV q 6 hrs prn
q Trandate (labetalol) 40-80 mg IV q 10 min (max 300 mg) prn
q Hydralazine 10 mg IV q 4 hrs prn
q Other: _______________________________________________________________________
17. q Electrolyte Replacement Protocol (form # 21340)
18. Mild Pain, Temp >100.5°F, HA: q Tylenol (acetaminophen) 650 mg po or PR q 4 hrs prn
19. Moderate Pain:
q Norco (HYDROcodone/acetaminophen) 5/325 mg or 10/325mg 1 tab po q 4 hrs prn. DC if Percocet ordered.
or q If patient can not take tablet, Hycet elixir (HYDROcodone/acetaminophen 7.5/325 mg/15 ml) 15 ml po q 4 hrs prn intead of Norco. DC if Percocet ordered.
or q Percocet (oxyCODONE/acetaminophen) 5/325 mg or 10/325 mg 1 tab po q 4 hrs prn. DC if Norco ordered.
and/or q Toradol (ketorolac) 30 mg IV (or IM if no IV access) q 6 hrs prn (15 mg if CrCl 31-50, > 65 y/o old or < 50 kg) or 10 mg po q 6 hrs prn (max combined duration of IV and po ketorolac is 5 days). DC if CrCl < 30.
20. Severe Pain (Begin when Epidural or PCA has been discontinued)
q Morphine 1-2 mg IV q 3 hrs prn, DC if CrCl < 30. Hold for excessive sedation. DC if Dilaudid ordered.
or q Dilaudid (HYDROmorphone) 0.25-0.5 mg IV q 3 hrs prn. If CrCl < 30, dose at 0.25 mg. Hold for excessive sedation. DC if Morphine ordered.
21. Nausea/Vomiting: q Zofran (ondansetron) 4 mg IV or po q 6 hrs prn
q If N/V persists, add Reglan (metoclopramide) 10 mg IV q 6 hrs prn (5 mg if > 65 y/o)
22. Sleep: q Ambien (zolpidem) 5 mg (female or males ≥ 65 y/o) or 5-10 mg (male < 65 y/o) po at HS prn
23. Indigestion: q Maalox XS (aluminum/magnesium/simethicone) 30 ml po four times daily prn
24. Stool Softener: q Colace (docusate) 100 mg po bid prn; if patient has not had a bowel movement
25. Constipation: q Milk of Magnesia (MOM) 30 ml po daily prn
If no BM after 48 hrs q Dulcolax (biscodyl) 10 mg per rectum daily prn
and/or q Senokot-S (docusate/senna) 2 tablets po at bedtime nightly
26. Cough: q Robitussin (guaifenesin) 15 ml po q 4 hrs prn
27. Sore Throat: q Chloraseptic (phenol/sodium phenolate) throat spray q 2 hrs prn
ADDITIONAL ORDERS:
_______________________________________________________________________________________
_______________________________________________________________________________________
______________ _______________ _________________________________ ___________
Date Time Physician Signature PID Number
Copy to pharmacy
FORM 3-37198 REV. 12/2014 Page 2 of 2