PLACE LABEL HERE

SICKLE CELL (Adult)

ORDERS

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. Do you expect that the patient’s condition will require a hospital stay that will cross two midnights (includes the time spent in outpatient- ED, surgery, OBS) and the patient has medical necessity for an inpatient admission?

Yes, admit as inpatient, proceed to # 2No, place in observation

2.If admitted as inpatient, Inpatient Physician Certification:

Diagnosis: ______

Level of Care:  Critical  Intermediate  Acute Care Location/Specialty Unit Preference_____

  1. Telemetry: If patient Medical/Surgical, must complete form # 36084
  2. Isolation: Contact  Droplet Airborne For: ______
  1. Consults: ______
  • Consider Pain Clinic Consult if not converted to oral medications after 24-48 hrs hospitalization or patient on daily high dose narcotics at home prior to admission
  • Consider Hematology consult if chest crisis, stroke, DVT, or exchange transfusion warranted
  1. Diagnostics (if not done in ED):

CBC with differential Reticulocyte Count CMP LFTs UA

 Serum Ferritin (if history of multiple transfusions)

CXR PA/lateral EKG ______to read

  1. Intake and output q shift
  2. Foley Catheter Removal and Voiding Assessment/Interventions Standing Orders (form # 31620)
  3. Vital signs per unit routine or  q ______hrs
  4. O2 per protocol (form # 34431)
  5. Diet:  Regular CardiacDiabetic: ______calories Renal

If at any time the patient is unable to tolerate po meds, change diet to NPO.

  1. Oral Nutrition Supplement Standing Order (form # 31417), initiate if patient meets criteria
  2. Activity (advance as tolerated):

Bed rest Bedside commode Bathroom privileges Up ad lib Up with assistance

  1. CBC and reticulocyte count in am, notify physician for:
  2. Reticulocyte count > 10%
  3. Today’s Hb has fallen by more than 1.5 g/dl from yesterday’s value

SCHEDULED MEDICATIONS:

  1. IV Fluids: ______@______ml/hr IV

Initial narcotic loading dose (if pain not controlled after ED): Consider half the total 4 hr dose given in the ED as a single dose. Patient to be monitored in ED for 30 min prior to moving to floor bed.

Morphine______mg IV x 1 dose

Dilaudid (HYDROmorphone)______mg IV x 1 dose

Other: ______

  1. PCA: See PCA orders, # 2119  See Sleep Apnea PCA orders, # 21261

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. Patients who have intact GI function: consider starting long acting oral narcotic in the following dosages or double the usual home dose of long acting narcotics, if applicable. Administer at the same time they are given other breakthrough meds.

Patients without intact GI function: should be made NPO.

Oxycontin (oxyCODONE sustained release)______mg po q 8 hrs (Consider: 20 - 40 mg)

OR

MS Contin (morphine controlled release) ______mg po q 8 hrs (Consider: 30-60 mg)

  1. Ibuprofen 800 mg po q 6 hrs

OR

Toradol (ketorolac) 30 mg IV (or IM if no IV access) q 6 hrs (15 mg if > 65 y/o, CrCl 31-50 or < 50 kg), DC if CrCl < 30.

  1. Adjuvant Antidepressant:Amitriptyline______mg po q _____hr (Consider: 25 – 50 mg qHS)

Other: ______

  1. Multivitamin 1 tablet po daily
  2. Folic Acid 1 mg po daily
  3. Senokot-S (docusate/senna), 2 tablets po at bedtime nightly until patient has BM

PRN MEDICATIONSSee policy 520-06 for range orders and pain intensity guidelines.

  1. Severe Pain:

Morphine 4-10 mg IV q 2 hrs prn over 5 min (slow IV push)x 48 hrs, then DC unless reordered by physician or patient is NPO

or

Dilaudid (HYDROmorphone) 2-4 mg IV q3hrs prn over 5 min (slow IV push)x 48 hrs, then DC unless reordered by physician or patient is NPO

24.Moderate Pain:Percocet (oxyCODONE/acetaminophen) 10/325 mg, 1-2 tabs po q 4 hrs prn

Morphine sulfate (Immediate Release) 15 – 30 mg po q 4 hrs prn

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

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

 If N/V persists, add Reglan (metoclopramide) 10 mg IV q 6 hrs prn (5 mg if > 65 y/o)x 7 days only

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

If > 65 year old, begin with 5 mg po at HS, may repeat x 1 dose after 2 hrs.

 Other:______

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

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

or  DC Ativan if ordered. Xanax (alprazolam) 0.25 - 0.5 mg po q 6 hrs prn

30.Itching: Benadryl (diphenhydramine) 25 mg po or 12.5-25 mg slow IV push q 4 hrs prn

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DateTimePhysician SignaturePID Number

Copy to pharmacy

FORM 3-3020 REV. 11/2014 Page 1 of 2