Neurovascular Orders: Stroke

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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