Admissions Orders

Question 1

Purpose of admission orders:

Answer 1

outline an intitial treatment plan for patients that enter a medical facility for specialized care as a means to communicate

Question 2

–Someone expected to stay more than 2 midnights due to their clinical presentation.

Answer 2

Inpatient

Question 3

Occurs within one day, no overnight stay, usually occurs in a surgery center, eye center, or special procedures

Answer 3

Outpatient

Question 4

–Needs hospital care but expected to stay only 1 midnight to observe progress. Can transition to an inpatient admission if meets criteria.

Answer 4

Observation admissions

Question 5

What is Skilled Nursing Care?

Where does it occur?

Answer 5

•Often patients have surgery or illnesses that cause significant debilitation where they are not ready to go home within 3-4 days, so they are transitioned to a Skilled Nursing Facility (“SNiF”) until such time as they can safely go home.

• occurs in a nursing home, where some beds are set-aside for “post-acute care”

Question 6

what are the 2 types of home environment?

Answer 6

• 1. Hospice care: palliative care at a hospice for end- of life patients
• 2. Home health: needs skilled care at home

Question 7

What is the structure of admission orders?

Answer 7

1. Written

2. Template

3. Electronic

Question 8

How do we write admissions orders?

Answer 8

ADC VANDALISMM

• Admit
• diagnosis
• condition
• Vitals
• Activity
• Nursing
• Diet
• Allergies
• Labs and diagnostics
• IV fluids
• Specialists/consulations
• Medication
• Monitoring

Question 9

What should we write under “admit”

Answer 9

Specifies the service (ICU, med, PCU) and the attending.

Should also specifiy a particular unit and whether the patient will need cardiac monitoring (telemetry)

Question 10

Who is admitted into the ICU?

Answer 10

Patients

• 1. that need, or will need advanced respiratory support
• 2. that need support of 2 or more organ systems
• 3. that have chronic impariment of 1 more organ systems + also need support for an acute reversible failure of another organ
• 4. Support/care that cannot be addressed on another unit due to medication intensensity, need for close motnitoring or high risk of decline in condition

Question 11

What should your write under dianogisis?

What should you not write?

How can you organize them?

Answer 11

• Primary diagnosis (biggest concern), even if working diagnosis.
• NOT signs and symptoms.
• In order of priority and break into 2 groups (acute – main concer– vs chronic)

Question 12

Which is breaking down a diagnosis into 2 groups helpful?

Answer 12

Can let those processing orders to know chronic conditions that contribute to admission, like DB, CAD, HTN, MDD.

Question 13

what do we write for condition?

Answer 13

1. stable/ “good”

2. Fair

3. Guarded

4. Critical

5. Expectant

Question 14

“Stable”/good

Answer 14

-stable vital signs and no life-threatening duress

Question 15

fair= _______.

What is it?

Answer 15

ill-appearing

• Pt is not doing well and needs to be monitored d.t pain or mild circum, but there is minimal impairment of the patients safety.

Question 16

guarded

Answer 16

patient needs to be monitored closely bc change in vital signs, mentation is altered.

Ex. “toxic” due to sepsis or trauma that caused multiple injuries

Question 17

patients are going to intensive care bc fear they could become unstable or were unstable before being admitted, but stable enough to go to a medical unit aprop for diagnosis and care

Answer 17

critical

Question 18

expectant= _______

Answer 18

poor/poor prognosis or actively dying/expantant

• patients who are admitted and seem like they are most likely to die within 72 hours
• Often on palliative care or waiting to be put on.

Question 19

Expectant patients likely needs ________ palliative care, in order to do what?

Answer 19

inpatient.

control symptoms that cannot be done at home

Question 20

What symptoms are experienced in actively dying or expectant patients?

Answer 20

Signs that they’re going to die

1. low BP
2. bradycardia
3. agonal respiration
4. Hypoxia
5. comatose states

Question 21

Expectant patients do not need _____ therapy, they need _________.

Answer 21

• curative
• need: intense therapy for comfort

Question 22

how often do you take vitals, usually?

Answer 22

• every 4 or 8 hours.
• if pt is in bad condition, take every 2 hours for 8 hours and then move to 4.
• make sure you note frequency.

Question 23

what do you write for activity?

Answer 23

the activity that the patient is allowed to do; bed-rest w, water ad-lib (water as desired),

Question 24

What are Nursing orders?

Answer 24

Orders for nurses “turn, cough, breather exercises ever 2 hrs, wound care” but usually not needed any longer bc they develop are plans for patients.

Question 25

Diet is assigned based on the patients situation.

Describe the type of patients often assigned

• -regular
• -carb consistent
• -clear liquid
• -full liquid
• -NPO

Answer 25

• Regular: pt can w/e
• Carb consistent: DB pts
• Clear liquid: pre-procedure pts or who face persistent N/V
• Full liquid: slow advance to regular diets after surgery or other illness (creams)
• NPO: nothing by mouth assx to midnnight b4 surgery or at least 6 hours b4 proecedure. often assx with bedrest
  
  • persis N/V
  • acute pancreatitis
  • Bowel obstruction

Question 26

What does Dr. Tyler think is the MOST IMPORTANT FEATURES of admission orders?

Answer 26

• Medications
  
  • write all meds and doses, those for reconcilation
  • specific to admission

Question 27

how do you write medications?

Answer 27

name, dose, route and schedule

– Docusate Na 100 mg PO BID

Question 28

what do we write under monitoring

Answer 28

• safety,
• discharge plan,
• patient education