ORDERS - Adult Page 1 of 2
ADMIT TO DR:____________________ BED:_____ PRIMARY CARE PHYSICIAN ___________________ DIAGNOSIS: £ Possible gram negative pneumonia Aspiration Pneumonia £Other ________________
1. Consult Dr.
£ Palliative Care Consult - goal setting and symptom management
£ H & P to be done by H & P Service 2. £ Discharge planning referral
3. Laboratory studies: T Check to be sure all Emergency Dept. initial orders are complete and results are posted on the chart. T If any of these orders are not complete, do them now: CBC, Electrolytes, BUN/CR, Glucose,
Albumin, Sputum Gram Stain, Culture & Sensitivity. £ Blood Culture & Sensitivity STAT x 2 (draw from different sites) prior to first antibiotic if not done in ED
(if clinically indicated).
4. Ancillary orders:
T Two view Chest X-Ray if not done previously or prior X-Ray was portable (Reason: Pneumonia) T Pulse oximetry as needed for respiratory distress and notify physician
, titrate for O2 saturation greater than 92%. Re-evaluate need in 24 hours per protocol
T as tolerated
7. £ T £ T T T T
Miscellaneous: Obtain old medical records Vital Signs every 4 hours while awake I&O every shift Obtain and record: admission height and weight Nursing pneumococcal and influenza vaccine screen and administration per local protocol. If Serum Albumin less than 3.0, Dietary consult for nutritional intervention If signs/symptoms of aspiration or difficulty swallowing, consult Speech Therapy to evaluate for possible aspiration Smoking cessation counseling if positive history of smoking: Tips to stop smoking, Smoking resources and Quitting smoking video. Remove foley catheter in AM if in place, unless history of long term indwelling catheter or
obstructive disease. Monitor urine output and notify physician if no output in 8 hours.
Phone order taken by and read back by:
Prescriber's Printed Name:
Noting Nurse's Signature:
Pager Number/ID Number Date/Time:
P N E U M O N I A A D M I S S I O N O R D E R S A d u l t Form transmitted to pharmacy: Date/Time: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ B y : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Page 1 of 2 SO-019 10-6000-221 Page 1 of 2 REV 2/3/09 Original - Chart Copy - Fax or send to Pharmacy20