Admission Orders Flashcards
definition of inpatient
someone expected to stay more than 2 midnights
definition of outpatient
occurs within 1 day, no overnight stay
- usually occurs in a surgery center, eye center, or special procedures
define observation admissions
needs hospital care but expected to stay only 1 midnight, can transition to inpatient admission if meets criteria
defined skilled nursing care
occurs in a nursing home but particular beds are set aside for “post-acute care”
when should you transfer a patient to a skilled nursing facility (SNiF)
when they have surgeries or illnesses that cause significant debilitation where they are not ready to go home within 3-4 days
compare hospice care and home health
hospice care: denotes palliative care w/ hospice at end of life
home health: needs skilled care at home
what is the ADC VANDALISMM pneumonic (used to write complete admit orders for patients)
Admit Diagnosis Condition Vitals Activity Nursing Diet Allergies Lab and Diagnostics IV fluids Specialists/Consultants Medications Monitoring
What parts of the ADC VANDALISM pneumonic correlate with “conditions for admission” of a patient
(ADCAM) Admit Diagnosis Condition Allergies Medications
What parts of the ADC VANDALISM pneumonic correlate with “diagnostic processes” of a patient
(VANDLISM) Vitals Activity Nursing Diet Lab and Diagnostics IV Fluids Specialists and Consultants Mediations
What parts of the ADC VANDALISM pneumonic correlate with “safety” of a patient
(MM)
Medications
Monitoring
what must you specify in an admission order
- the service (ex: medicine)
- the attending (ex: Dr. Snow)
- a particular unit (ex: medical, step-down)
- whether this patient will need cardiac monitoring (telemetry)
what patients should be admitted to the ICU
Those who:
- requiring advanced respiratory support
- requiring support of 2+ organs
- chronic impairment of 1+ organ systems who also require support for acute reversible failure of another organ
define “support” when talking about admission to the ICU
care that cannot be addresses on another unit due to:
1) medication intensity
2) need for close monitoring
3) high risk of decline in condition
how to document a diagnosis on an admission order
1) list primary diagnosis (do NOT list signs and sx)
2) list in order of priority
3) break them into two groups (acute and chronic - first acute, then chronic)
define “stable” when referring to a patient
implies patient has stable vita signs and is in no life-threatening duress
(“good” denotes the same)
define “fair” when referring to a patient
implies pt is experiencing a condition whereby they are not doing well and will need monitoring
- may be due to pain issues or other mild circumstances w/ minimal impairment of pt safety
(“ill-appearing” denotes the same)
define “guarded” when referring to a patient
pts that need to be monitored closely
- vital signs possibly labile
- mentation could be altered
- they could be in a category of “toxic” as in sepsis
- multiple injuries from trauma
define “critical” when referring to a patient
pts going to intensive care as they are potentially unstable or have been unstable prior to admission
- pt is stabilized enough to be transferred
define “expectant” when referring to a patient
pts that have been placed on palliative care or are pending hospice consultation
- presentation prior to admission deems them likely to die within 72 hours
- pt likely needs inpatient palliative care
(“poor prognosis” or “poor” denotes the same)
- sx of impeding death such as low BP, bradycardia, agonal respirations, hypoxia, comatose state
what should you document regarding vitals on an admission order
frequency of vital signs you prefer
what is the usual frequency of vital signs on an admitted pt
every 4-8 hours
- sometimes you want them every 2 hours for 8 hours (4x), then move to every 4 hours
vital signs parameters that require notifying a physician on an admitted pt
SBP: <90 or >150
HR: <60
RR: <10
T: >38.3 (100.9F)
define “up ad lib” as a direction for admitted patients
patient can get up when they want to usually w/o help
define “bedrest w/ assistance” as a direction for admitted patients
patient stays in bed and only gets up with help
define “bathroom privileges” as a direction for admitted patients
patient can get up and go to the bathroom unassisted
- “with help” can be added
define “bedrest” as a direction for admitted patients
pt should not get up at all
orders like “turn, cough, deep breathe exercises every 2 hours”, “routine oral care”, and “routine hygiene” that are not completed by the physician are referred to as what
nursing orders
list examples of respiratory nursing orders
- updrafts (nebulizer tx)
- endotracheal suctioning
- spirometry
- incentive spirometer
list examples of wound care nursing orders
- dressing changes
- DVT stockings
list examples of precautionary measure nursing orders
- aspiration precautions
- fall prevention
- seizure precautions
list examples of general health nursing orders
- strict inputs/outputs
- daily weights
- foley to gravity
- O2 requirement
- 1:1 observation
list examples of neurological nursing orders
neurocheck q4h
list examples of nursing order protocols
- hypoglycemia protocol
- bedsore prevention
- incentive spirometer
define “carbohydrate consistent” diet for an admitted pt and what pts are normally prescribed it
usually done for diabetics
- can specify calories per day and the nutrition center will calculate the carbs for you, eg 1600, 1800, 2000/day
define “clear liquid” diet for an admitted pt and what pts are normally prescribed it
done for pre-procedure patients or in the face of persistent nausea and vomiting
- pts only get broth, jello, coffee, water
define “full liquid” diet for an admitted pt and what pts are normally prescribed it
used for a slow advance to regular diet after surgery or other illnesses causing decreased oral intake
- ice cream, milk, cream of “whatever” soup, certain juices
define “NPO” diet for an admitted pt and what pts are normally prescribed it
means “nil per os” which means “nothing by mouth”
- pre-operative order that goes into place at midnight before date of surgery or at least 6 hours before a procedure
- or if there is persistent nausea and vomiting
- or if they have dx of acute pancreatitis or bowel obstruction –> NPO will facilitate “bowel rest”
most important feature of admission orders
medications
