Neurovascular Orders: Stroke
(check box Ö to activate orders)
ADMIT TO: TRANSFER TO: Stroke ward Neuro Step-down unit Neuro ICU Other ______
SERVICE: ______ATTENDING: ______RESIDENT: ______PAGER: ______
DIAGNOSIS: ischemic stroke hemorrhagic stroke TIA NIH Stroke Scale Score: ______
CONDITION: stable guarded critical
SPECIAL PRECAUTIONS: post-thrombolysis post-angiography
CODE STATUS: full code DNR other: ______ADVANCE DIRECTIVE: Yes No
ACTIVITY: bedrest x 24h then: OOB with assist other: ______
DIET: NPO x 24h then: diabetic ____cal. ADA low cholesterol/low fat regular
Other: ______
Place soft feeding tube: 20 mg Metoclopramide IV x 1; wait 20-30 minutes then pass feeding tube per protocol; obtain KUB for
confirmation of position; obtain nutritional consult and begin tube feeding per dietician recommendations.
VITAL SIGNS/NEURO SIGNS: q1h (Neuro ICU) q2h (Neuro ICU/Neuro Step-down unit) q4h other: q____h
Admission weight and height
Cardiac monitor x 24 hours then discontinue (if patient requires cardiac monitor > 24 hours, please write separate order)
patient may come off cardiac monitor to travel off-floor for tests and to participate in physical/occupational therapy
patient must stay on cardiac monitoring to travel off-floor for tests (requiring HO or critical care transport nurse to travel
with patient) and to participate in physical/occupational therapy
CALL HO FOR: change in neuro status T>38.5C P>______<______RR>______<______SBP>______<______
DBP>______<______SpO2 <______% with O2 UO>______cc/hr or <______cc/hr x 2h
IV Therapy: ______Normal Saline lock when taking PO
O2 Therapy to keep SpO2 ³ 94% Naso-tracheal suction PRN
See DVT Prophylaxis Order Form
Foley to gravity
Moderate Stroke – Remove foley 6 AM hospital day 2 and begin bladder training.
Severe Stroke – Remove foley 6 AM day 3 and begin bladder training if patient cognitively intact, able to discern
urge sensation, cognitively able to learn how to inhibit urge, able to go to the commode or toilet with assistance.
Straight catheterization PRN every 4 hours. Notify HO for bladder volume > 300 mL
Straight catheterization Q6h PRN no void
I&O
Occupational Therapy (requisition required)
Physical Therapy (requisition required)
Speech Therapy (requisition required)
RISK FACTOR MODIFICATION EDUCATION:
Exercise Counseling Your Health Matters/Information Sheet
Diet Counseling Your Health Matters/Information Sheet
Smoking Cessation Non-smoker Counseling Your Health Matters/Information SheetStroke warning signs Counseling Your Health Matters/Information Sheet
FLAG CHART Signature ______M.D. Beeper# ______M.D. # ______
TO INDICATE Print Name ______M.D
NEW ORDER Checked by ______R.N. Time ______Date ______
Neurovascular Orders: Stroke
(check box Ö to activate orders)
LABS: CBC, Electrolytes, BUN, Cr., Glucose daily Coagulation studies per Heparin protocol
Fasting Total Chol, HDL, LDL, TG on admission FBS four times daily x 24h; call HO for BS>150 mg/dL
UA on admission Other: ______
ALT, AST, ALK-P’TASE, Total Bilirubin on admission
DIAGNOSTIC STUDIES:
Head CT scan (requisition/scheduling required) CXR EKG
Head MRI/MRA (requisition/scheduling required) Carotid US (requisition required)
Schedule post t-PA patient for CT scan 24h after thrombolysis: Date due: ______
Other: ______
MEDICATIONS:
ALLERGIES: ______
Aspirin:
Enteric-coated Aspirin 325 mg PO daily or ASA 325 mg per feeding tube daily or if NPO ASA 300 mg PR daily
IV HEPARIN PER PROTOCOL – ADULT
Acetaminophen 650 mg PO/PR q4h PRN Temp >38.5 or pain
Colace 250 mg PO BID (hold for loose stool)
MOM 30cc PO/FT Once daily constipation
Dulcolax suppository 1 Tab PR BOD PRN Constipation
Fleets Enema once daily PR PRN Constipation
H2 Blocker (specify) ______
Anti-emetic (specify) ______
Other medication(s):
______
______
______
______
______
______
Other orders:
______
______
______
______
FLAG CHART Signature ______M.D. Beeper# ______M.D. # ______
TO INDICATE Print Name ______M.D
NEW ORDER Checked by ______R.N. Time ______Date ______
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