Acute Mi Care Map Standard Pre-Printed Orders
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4ACUTE MI CARE MAP
STANDARD PRE-PRINTED ORDERS:
Approved Initiative of the Winnipeg Regional Health Authority
These orders are to be used as a guideline and do not replace sound clinical judgement and professional practice standards.
Patient allergy, contraindications and clinical condition must be considered when completing these orders.
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Standard orders. If not in agreement with an order cross out and initial.
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ORDER
MEDICATION ORDERS
GENERAL ORDERS
TRANSCRIBED
Allergies:
Unknown
No
Yes
________________________________________________________________________________________________________
Activity:
Weight
kg
_______________
If early discharge anticipated progress activity as per
Diagnosis:
Physiotherapist directions
Weight on admission
Non STEMI
STEMI post fibrinolytics
Intravenous:
STEMI with NO fibrinolytics
IV of NS at TKO x 48 hours from admission
Additional orders for anticoagulant/antiplatelet per diagnosis
IV lock for bloodwork
Beta Blocker
Saline lock
______________________________________________________________________
Oxygen:
Nitroglycerin Spray 0.4 mg sublingual prn for chest pain
Oxygen prn to maintain SpO
greater than or equal
Acetaminophen
mg po (usual dose 325 - 650 mg)
2
________
to 90%
q4h prn for mild to moderate pain
(maximum dose 4 grams/24 hours)
Diagnostics:
Morphine
mg IV prn for chest pain
________
CK q8h x 24 hours (i.e. 3 sets are done)
(usual dose 2.5 mg IV prn)
HSTnT if not performed in Emergency Department
DimenhyDRINATE
mg po/IM/IV
________
aPTT 6 hours post start of heparin IV infusion
(usual dose 25 - 50 mg) q4h prn for nausea and vomiting
12 lead ECG day 2 and 3
Antacid 30 mL PO q2h prn for gastrointestinal upset
12 lead ECG if chest discomfort unrelieved by 2
Laxative of choice:
nitroglycerin sprays
Bisacodyl
mg po/PR (usual dose 5 - 10 mg)
________
CBC, platelets day 2, 3 and 4
HS prn for constipation
ALT/AST on day 1 (with admission sample from the ED)
__________________________________________________________________
Lipid profile with admission sample from the ED: HDL,
Lipid lowering agent:
(consider high dose statin if not contraindicated)
LDL, total cholesterol, triglycerides, TC-HDL ratio
_____________________________________________________________________
Chest x-ray in a.m. if not done in the ED
LORazepam
mg po/sublingual
________
Fasting bloodwork - electrolytes, urea, creatinine,
(usual dose 0.5 - 1 mg) HS prn for anxiety/insomnia
glucose, total CO
, in a.m. on day 2 and 4
ACE Inhibitor or angiotensin receptor blocker
2
CK day 3
______________________________________________________________________
Risk stratification ______________________________
Nitroglycerin patch:
_____________________________________________
Clinical Dietitian consult if serum lipid elevated and/or
Assess for signs/symptoms of nicotine withdrawal and
diabetic or unable to attend out patient class
consider therapy (anxiolytic and nicotine replacement
therapy)
Consult Physiotherapy
Consider completing order set for monitoring and
Consult Pharmacy
treatment for glycemic control
Diet:
__________________________________________________________________________
Sodium 100 mmol, modified fat
__________________________________________________________________________
Controlled carbohydrate
For patients with high risk of bleeding:
Controlled carbohydrate with snack
Ranitidine:
________________________________________________________
Proton Pump Inhibitor:
__________________________________________
Discharge patient when all clinical outcomes are met.
Signature and Designation
D
M
Y
Transcriber’s Signature
D
M
Y
PAGE 1 OF 3
01/16
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