PLACE LABEL HERE

CELLULITIS ORDERS

Emergency Department

The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.

Initial all handwritten order modifications and the bottom of each page when indicated (multipage).

1. Diagnosis & Status: Place in Observation for Cellulitis

2. Consult: Dr.______Time contacted: ______

3. Home care: Social Services Consult Coordinated Care Consult

4. Laboratory: CBC q 8 hrs

Blood Culture prior to antibiotic administration Wound Culture MRSA

5 Finger stick blood glucose before meals and at bedtime if patient is diabetic

6. Vital signs:  q 4 hrs  q ______hrs

7. Mark edges of cellulites with indelible marker when placed in observation status

8. Notify ED physician for fever > 102.5F, WBC > 20,000, systolic <100, heart rate >130, increasing area of cellulitis or toxic appearance of patient

9. Diet:  Regular Clear liquids  ______Consistent Carb diet _____gram Sodium

10. Activity (advance as tolerated):BedrestBedside Commode Bathroom Privileges

Up ad libUp with assistance

SCHEDULED MEDICATIONS:

11. IVF: ______at ______ml/hr IV

12. Antibiotic: Unasyn (ampicillin/sulbactam) 3 gm IV q 6 hrs or______

 Ancef (cefazolin) 1 gm IV q 8 hrs or ______

 Vancomycin ______gm IV x 1 dose or ______

 Bactrim DS (sulfamethoxazole 800mg/trimethoprin 160 mg) 2 tabs po NOW

and q 12 hrs or ______

HOME MEDICATION ORDERS: to be administered while in observation:

______

______

______

______

______

The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.

Initial all handwritten order modifications and the bottom of each page when indicated (multipage).

PRN MEDICATIONS (If > one drug is ordered for the same indication, clinical assessment will be used per policy 520-06)

13.Severe Pain: Morphine 1-4 mg IV q 3 hrs prn

Dilaudid (HYDROmorphone) 0.5-1 mg IV q 3 hrs prn

14.Moderate Pain: Lortab (HYDROcodone/acetaminophen) 5/500 mg -10/500 mg po q 4 hrs prn

Percocet (oxyCODONE/acetaminophen) 5/325 mg-10/325 mg po q 4 hrs prn

Motrin (ibuprofen) 600 mg po q 6 hrs prn

15.Mild Pain, Temp>100.5F, HA: Tylenol (acetaminophen) 650 mg po q 4 hrs prn

16.Nausea/Vomiting: Zofran (ondansetron) 4 mg IV or po q 6 hrs prn

Reglan (metoclopramide) 10 mg IV or po q 6 hrs prn (5 mg if > 65 y/o)

Phenergan (promethazine) 12.5-25 mg po or per rectum q 4 hrs prn

17.Sleep: Ambien (zolpidem)5-10mg po at HS prn. If 5 mg given, may repeat x 1 dose after 2 hrs

If > 65 years old, begin with 5 mgpo at HS,mayrepeat x 1 dose after 2 hrs

Other: ______

18.Indigestion: Maalox XS (aluminum/magnesium/simethicone) 30 ml po four times daily prn

19.Stool Softener: Colace (docusate) 100 mg po bid prn; if patient has not had a bowel movement

20. Constipation: Milk of Magnesia (MOM) 30 ml po daily prn

21.Anxiety:Ativan(lorazepam)0.5 - 1 mg po q 8 hrs prn

 Xanax (alprazolam) 0.25 - 0.5 mg po q 6 hrs prn

22.Cough: Robitussin (guaifenesin) 15 ml po q 4 hrs prn

If cough unrelieved by guaifenesin, Hycodan (HYDROcodone/homatropine) 5 ml po q 4 hrs prn

ADDITIONAL ORDERS:

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DateTimePhysician SignaturePID Number

Send copy to pharmacy

FORM 3-16340 REV. 07/2012 Page 2 of 2