Admission Orders - Diabetic
Date/Time
- Admit to reg nsg floor per Dr. MD / Dr. POD
- Dx: cellulitis R foot secondary to infected ulcer
- Condition: stable
- Vitals: q shift
- Activity: CBR c bedpan, strict NWB right foot
- Nsg: Keep dsg C,D,I, podiatry service to change. Bolster dsg as necessary. Accu check q Q 6h/Q 4h if NPO
- Diet: High/ Medium or Low CCC Diet
-
I/O:
- IVF to heplock
- If dehydrated, orthostatic start NSS @100cc/h unless renal compromise, Then 80cc/h is safe.
-
Labs:
- CBC-D
- CMP
- CRP
- ESR
- HgA1C
- cultures
- blood Cx
- PVR's
- TCOM's - all longstanding wounds, chronic infections, all DM patients over 50 y/o and all patients with DM >10 years.
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-
- written as - Consult respritory Therapy for Transcutaneous oxygen measurements
- Specify where you want measurments taken. Keep in mind the plantar foot is not a good location due to thickness of skin.
- PT/PTT/INR
- UA
- CXR and EKG - if to go to OR
-
Meds:
- all home meds - confirm with admitting MD
- IV Abx = confirm with attending / ID if already involved
- Lovenox 40mg SQ daily
- Ambien 5mg po qhs prn insomnia
- Multivitamins, arginate, zinc if nutritional status is low.
-
X-rays:
3 views
- MRI, bone scan when indicated.
-
Consult:
- Infectious Disease consult
- Medical clearance, Cardiology clearance if to OR
- Vascular consult if needed
- Dietary consult if needed.
- Social services for SNF placement if anticipated or Medicaid pending number if no insurance.
Admission Orders - Trauma
Date/Time
- Admit to reg nsg floor per Dr. MD/ Dr. POD
- Dx: ankle fracture right
- Condition: stable
- Vitals: q shift
- Activity: CBR c bedpan, strict NWB right foot
-
Nsg:
- Keep dsg C,D,I. Bolster dsg as necessary (call resident if strikethrough)
- Accu check q Q 6h if diabetic (q 4h if NPO)
- Elevate left foot on foam elevator with popliteal support
- Ice to posterior knee 2o min of every hour, or maintain polar care unit
- Incentive spirometry to bedside with instruction
- SCD's in place and functioning at all times
- Diet: 2,000 calorie, adjust dep. on patient. Dinner tray to bedside now if late.
-
I/O:
- Continue IVF @ 100cc/hr until PO tolerant then heplock
- Monitor I/O's
- Monitor drain output, stripping, etc if drain in place.
-
Labs:
- CBC-D
- CMP in am, monitor H&H if big case
- Check PT/PTT/INR if medicine admit b/c everyone is on heparin!
- EKG
- UA
- CXR
- tox screens, ETOH dep. On Patient
- Hep profile
- HIV when indicated
- HCG when indicated
-
Meds:
- all home meds = if needed
- IV Abx = open fracture, etc
- Lovenox 40mg SQ daily, Fragmin if long-term anticoagulation
- Morphine 2-10mg prn severe pain
- Vicodin or Percocet 5mg po q 4-6h prn mod pain
- Prednisone taper (60-50-40-30-20-10)vs Motrin for swelling
- Flexeril 10mg tid if tendon injury
- Toradol 30 mg IV q6 unless contraindicated, only x 5 days
- Phenergan 12.5mg IV q6-8h prn
- Ambien 5mg po qhs prn insomnia
- Reg. insulin sliding scale if diabetic
- NPO orders if to OR in am
- Medical, cardiology clearance if to OR
Admission Orders - Post-OP
Date/Time
- Extended recovery per Dr. podiatry attending Or readmit the pt to RNF per Dr. (pt's primary doctor, if the doctor is not a SVCH staff we usually ask Drs. Wardega, Tahir, and Tcaciuc)/Dr. podiatry attending
- Dx: s/p name of the procedure R/L foot/leg
- Condition: stable
- Vitals: Per shift (consider q4 hours if febrile)
- Activity: CBR with bedpan or bedside commode, strict NWB
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NSG:
Keep DSG C/D/I, call resident if strikethrough.
- Incentive spirometry to bedside with instruction.
- Please make sure that SCD is properly placed and working
- *Polar care unit, (recirculate q3 hours if Cryo/Cuff)
- Elevate R/L foot with a foam elevator with popliteal support
- Diet: Regular/Low,Medium or High CCC diet depending on the pt advance as tolerated. Dinner tray to bedside now if late.
-
I/O:
Continue IVF (NSS) @100cc/hr (depending on the current rate) to heplock when pt is p.o. tolerant
- D/C Foley catheter (if the pt has one)
- Record I/Os
- Empty the J/P drain when halfway filled and record the amount (if drain placed), strip drain q 2 hours.
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Labs:
CBC with Diff, BMP in a.m.
- H&H now (if pt lost a large volume of blood)
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Meds
: Already prescribed home meds +
- Ancef 1g q8 hours x 3 doses
- Morphine 2-10mg IV q4-6 hours PRN breakthrough pain
- Vicodin 5mg T-TT p.o. q4-6 hours PRN moderate to severe pain (or Percocet)
- Toradol (be careful with PUD) 30mg IV q6 hours x 5 days
- Phenergan 12.5mg IV q4-6 hours PRN N/V (again this can mask constitutional symptoms)
- Ambien 5mg T p.o. qhs PRN insomnia
- Flexeril 10mg T p.o. TID (if tendon work has been done)
- Lovenox 40mg SC daily
- Multivitamins, Zinc, any nutritional deficit should be covered
- Cepacol Lozenges to bedside PRN sore throat
- Xrays: 3 views R/L ankle/foot with specific post-op diagnosis
- Consults: Physical therapy consult in a.m. for evaluation and training NWB R/L. dx: s/p procedure
* Be sure to culture all drain tips in a dry, sterile specimen cup when pulled*
Date/Time
- NPO after midnight
- Pt may take am meds with a sip of water
- Hold all am po hyploglycemics
- Begin D5 & 1/2NS @ 80-100 cc/hr at midnight.
- Accu check q4h while NPO.
- PT / PTT / INR if on heparin, coumadin
- EKG - done?
- Medical clearance? Cardiology Clearance?