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Ephratahospital.org

Provider Orders
General Medical Admission 
  
General Medical Admission 
General  
Nursing  
Assessments / Interventions  
c Weigh daily  Fingerstick glucose ac & h.s.   Patient Care Instructions  
Activity  
Select one diet only! If combination diet is required, please use other field.  
Provider Signature_______________________________________ 
Date/Time_______________________ 
Provider Orders
General Medical Admission 
c Diet, 2gm Na low fat/low cholesterol  g Consults  
c P/T Eval & Treat (Reason:____________________)  g c OT Eval & Treat (Reason:____________________)  g c Dietary consult (Reason: Assess and educate)  g c Social Service consult (Reason:____________________)  g Labs on Admission  
c Glycohemoglobin/HGBA1C (If not done in last 3 months)  g Labs in A.M.  
c Basic metabolic panel (Daily x _______)  g c B-type natriuretic peptide (Daily x__________)  g Provider Signature_______________________________________ 
Date/Time_______________________ 
Provider Orders
General Medical Admission 
Diagnostic Tests  
c EKG (Daily x __________days)  XR chest 2 views (Reason for exam ____________________)   XR chest portable (Reason for exam ____________________)   Respiratory  
IV Fluids  
✔ 2 milliliter IV PUSH every 8 hours if no fluids   c @__________ milliliter/hour intravenously   c @__________ milliliter/hour intravenously   c @__________ milliliter/hour intravenously   c @__________ milliliter/hour intravenously   Medications  
Do not exceed 4 grams of acetaminophen in 24 hours  
Provider Signature_______________________________________ 
Date/Time_______________________ 
Provider Orders
General Medical Admission 
Analgesics  
c 650 milligram orally every 4 hours as needed for headache , mild pain or fever of 101.4 F or greater   oxyCODONE-acetaminophen 5 mg-325 mg tab (Percocet)   c 1 tablet every 4 hours as needed for moderate pain   c 2 milligram intravenously every 4 hours as needed for chest pain or severe pain   c 1 milligram intravenously every 2 hours as needed for severe pain   Anti Anxiety  
c 0.5 milligram orally every 6 hours as needed for anxiety   Antiemetics  
c 4 milligram intravenously every 6 hours as needed for nausea/vomiting   Anti-ulcer Agents  
c 15 milliliter orally every 6 hours as needed for epigatric distress   c 40 milligram intravenously once a day   Antitussive Agents  
c 10 milliliter orally every 4 hours as needed for cough   Bronchodilators  
albuterol 2.5 mg/3 mL (0.083%) neb solution   c 2.5 milligram inhaled 4 times a day  g c 2.5 milligram inhaled every 2 hours as needed for shortness of breath   albuterol-ipratropium 2.5 mg-0.5 mg/3 mL soln for inhalation (DUONEB)   c 1 ampule inhaled every 2 hours as needed for shortness of breath   Laxatives  
c 100 milligram orally 2 times a day (Hold if having diarrhea)   magnesium hydroxide (Milk of Magnesia Concentrate)   c 10 milliliter orally once a day as needed for constipation   Provider Signature_______________________________________ 
Date/Time_______________________ 
Provider Orders
General Medical Admission 
c 1-2 tablet orally once a day as needed for constipation   c 1 enema rectally once a day as needed for constipation   Nitrates  
c 0.4 milligram sublingually every 5 minutes as needed for chest pain x 3 doses. Hold if Sys BP less than ✔ Notify provider unrelieved CP (After nitroglycerin)   Sleep Aids  
c 5 milligram orally once a day, at bedtime as needed for sleep   DVT Prophylaxis  
MUST select one. If not ordered please enter reason.  
c No DVT prophylaxis (Reason:____________________)  g c Early ambulation  TED hose (Remove TEDs to inspect skin b.i.d.)   c Alternating Pressure Device (SCDs)  heparin   c 5000 unit subcutaneously every 12 hours  g c 5000 unit subcutaneously every 8 hours   c 2.5 milligram subcutaneously every 24 hours   c 40 milligram subcutaneously every 24 hours   Smoking Cessation Medications  
✔ Initiate Smoking Cessation Protocol   Provider Signature_______________________________________ 
Date/Time_______________________ 

Source: http://www.ephratahospital.org/Portals/0/docs/POS%20September%2012/General%20Medical%20Admission_V4_09_2012.pdf