Pneumonia Admission Orders (All Forms) Page 4
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4Name:______________________________
DOB:______________________________
Generic equivalents are utilized unless checked.
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CORE MEASURE REQUIREMENTS
PRN
Adult Insulin Sliding Scale Protocol
Low
High
Pain
Severe ( 7 - 10 )
Morphine Sulphate 2 mg IV push every 2 hours PRN severe pain
Moderate ( 4 - 6 )
HYDROcodone / APAP 5 / 325 mg 2 tabs PO every 6 hours PRN moderate pain
Mild ( 1 - 3 )
HYDROcodone / APAP 5 / 325 mg 1 tab PO every 4 hours PRN mild pain
PRN
Tylenol (Acetaminophen) 650 mg PO every 4 hours PRN temperature over 101.3
Temperature
degrees Fahrenheit
Constipation
Colace (Ducosate Sodium) 100 mg PO two times per day PRN constipation
Milk of Magnesia (magnesium hydroxide) 30 mL PO daily PRN constipation
Nausea
Zofran (ondansetron) 4 mg IV every 3 hours PRN Nausea / Vomiting
Diagnostics
Lab
In AM
Basic Metabolic Panel
Magnesium
Complete Blood Count with differential
Comprehensive Metabolic Panel
Radiology
Chest X-ray _________________________________________
Other
_______________________________________________________________
Consults
Other:
Speech Therapy
Notify Physician
Temperature greater than ____________
Heart Rate greater than ___________ or less than _________
Oxygen Saturation less than ____________________________%
Systolic Blood Pressure less than _______________________
Diastolic Blood Pressure greater than _____________________
Change of patient condition
Transcribed
Noted / Acknowledged
Signature
Date / Time
Signature
Date / Time
Telephone Order(TOR)
PHYSICIAN SIGNATURE
DATE / TIME
Originated 2010
rev Pneumonia Admission Orders Pg 4 of 4 public
Revised 5/12/11
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