Pancreatitis CDU Admission Order Sheet
Diagnosis: Pancreatitis
1. Admit: CDU
2. Private MD: None Time contacted
3. Consult Dr. Reason: Pancreatitis
4. Laboratory: CBC, CMP, Amylase, Lipase, and Mg if not done in ER
Repeat CBC, Amylase, Lipase in 12 Hrs
Repeat Chem 7 every 6 Hrs
Other______
5. Radiology:
Abdominal series: Clinical indication: pancreatitis, rule out small bowel obstruction
CT abdomen/pelvis: Clinical indication: pancreatitis, rule out pseudo cyst
Abdominal U/S: Clinical indication: pancreatitis, rule out pseudo cyst, biliary tract disease
6. Vital Signs: Per routine Every ____Hrs
7. I & O recorded every 8 Hours
8. NG tube to low intermittent suction (if persistent vomiting, obstruction, severe ileus)
9. Notify MD for fever >101, WBC >16,000, Calcium <8mg/dl, unstable vital signs or worsening condition
10. Diet: NPO until vomiting resolves and NGT discontinued, then advance to clear liquid diet
11. Activity: Bedrest BSC BRP Up ad lib Up with assistance
12. IVF______ml/Hr
Scheduled Medications:
13. Pepcid 20 mg IVP every 12 Hrs
14. Other
15. Patient may take own home medications:
Home Medication / Dose / Route / Frequency / IndicationPRN Medications:
16. Severe pain: (Choose one if needed)
Morphine 1-4 mg IV every 3 Hrs prn
Dilaudid 0.5-1 mg IV every 3 Hrs prn
Other: ______
17. Moderate pain: (Choose one if needed)
Lortab 5 mg, 1-2 tablets po every 4 Hrs prn
Percocet 5 mg, 1-2 tablets po every 4 Hrs prn
Toradol 30 mg IV (or IM if no IV access) every 6 Hrs prn (if pt >65 years old, give 15 mg)
Other: ______
Orders continued on next page
18. Mild pain/temp
>100.5°F/HA: Tylenol 650 mg po every 4 Hrs
Other______
19. Nausea: (Choose one if needed)
Phenergan 6.25 – 25 mg IV every 4 Hrs prn, may use
IM if no IV access
Zofran 4 mg IV every 8 Hrs prn
Other______
20. Sleep: (Choose one if needed)
Restoril 30 mg po at bedtime prn (7.5 mg if greater than 65 years old, may repeat x 1 dose)
Ambien 10 mg po at bedtime prn (5 mg if greater than 65 years old, may repeat x 1 dose)
Other: ______
21. Indigestion: Maalox XS 30 ml po four times daily prn
Other: ______
22. Stool softener: Colace (docusate) 100 mg po two times daily prn; if no bowel movement.
Other: ______
23. Constipation: Milk of Magnesia (MOM) 30 ml po daily prn
Other______
25. Anxiety: (Choose one if needed)
Ativan 0.5-1 mg po every 8 Hrs prn
Xanax 0.25-0.5 mg po every 6 Hrs prn
Other: ______
______