Outpatient Preop Cardiac Cath Plan printable pdf download

Patient Label Here

PRE-OP CARDIAC CATHERIZATION

AND INTERVENTION ORDERS

Date: ____________________________________________________

 NKDA

 Allergic to: ___________________________________________________________________

1. Allergies:

 Cardiac Outpatient Surgery

 Observation:

2. Admit to:

Nursing Unit___________________________

3. Attending Physician:_________________________________________ Resident/Fellow_______________________________

 Consult: _____________________________________________________________________________________________

_____________________________________________________________________________________________

4. Diagnosis:______________________________________________________________________________________________

5. Co-Morbidities: __________________________________________________________________________________________

__________________________________________________________________________________________

 Full Code

 DNR/DNI

 Comfort Care

 Other ______________________________________

6. Code Status:

7. Condition:  Stable

 Fair

 Serious

 Critical

General Orders:

1. Notify Dr.______________________ of admission(or PA/NP if applicable)

2. Obtain H&P and place on chart. Notify physician if H&P not on chart or not dictated

3. Weigh patient, record height and weight on chart

4. Notify Cardiologist of dye allergies

5. Check and mark pulses

6. Complete pre-cath checklist

7. Skin prep according to site of procedure:

 Femoral

 Brachial

 Subclavian

 Other________________________________

 Foley catheter PRN for inability to void

8. Have patient void prior to pre-medicating

Ensure that consents for procedure are on chart for:

 Left Heart Catheterization and coronary angiography

 Right Heart Cath

 PTCA/Coronary Stent

 Permanent Pacemaker

 Possible emergency coronary artery bypass surgery

 Arch and Carotid

 Abdominals with run offs

 Renal

 Other_________________________________________________________________________________________

Routine Pre-Procedure Teaching

 Pre-Cath/Pre-intervention teaching as appropriate

 Obtain lab from physician’s office

Diagnostic Tests:

 Basic Metabolic Panel, CBC, PT, PTT, FT4, or place results on chart if within 72 hours (CALL ABNORMAL RESULTS)

 Thyroid Panel

 HCG:  Serum  Urine (all females of child bearing years unless sterile or known pregnancy)

 Urinalysis

 EKG within 24 hours for inpatient, within 1 week for outpatient

 Other_____________________________________________________________________________________________

 TO  Read back

Order taken by Signature: ________________________________________Date/Time: _____________________________

Physician Signature

Date/Time

__________________________________________

_____________________________

Page 1 of 2- Pre-Op Cardiac Catheterization & Intervention Orders 10/10/2014 (#971 R-3)

Outpatient Preop Cardiac Cath Plan

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