Hospital Admission Orders Flashcards
what word should not be in your orders
“Unknown”
How to list medications in orders?
one medication per
what does AADC VAAN DISSLS stand for?
Admit
Attending
Diagnosis
Condition/Code
Vitals
Activity
Allergies
Nursing Procedures
Diet
Ins/outs
Specific meds
Symptomatic meds
Labs/imaging/consults
Special
What features should be part of the admit and attending
admit service
attending physician
floor/room
Special needs (telemetry, bed near nursing)
POA
what does POA stand for?
power of attorney
if a diagnosis has not been established, how should it be written
list the cheif complaint and condition that is most likely as a R/O (rule out)
How specific should you be when writing the diagnosis
very!
Include: side of body, exact location
What are the 4 types of condition?
- good
- fair (satisfactory or stable)
- serious (poor or gaurded)
- critical
what does good condition mean
VS are stable and within normal limits
pt is conscious and comfortable
what does fair condition mean
VS are stable and within normal limits
patient is conscious but may be uncomfortable
what does serious condition mean
VS may be unstable and not within normal limts
indicators/outlook is questionable
what does critical condition mean
VS are unstable and not within normal limits
pt may be unconcious
indicators/outlook is unfavorable
DNR stands for
do not resuscitate
DNI stands for
do not intubate
what 2 things do you need to list for vital signs
- frequency
- criterira for when to alert/who to call
What does “activity” indicate
- bedrest, OOB, Up ad lib, ambulate QID, bathroom privilages
- fall risk?
- alarms for bed or chair?
- sitter?
Dont forget to document this when documenting allergies
the reaction
List the 4 types of nursing procedures
- Bed position
- Preps
- dressing changes/ wound care
- toileting
what does bed position mean?
head of the bed @ ____
when should preps be ordered in nursing procedures
for planned procedures or surgeries
what types of things can be ordered for preps?
- enemas
- scrubs
- showers
How should dressing changes be documented
change, location, time, who to call if something is abnormal
what should be ordered for toileting
bathroom privileges
ex. OOB to bedside commode
ex. bedpan
What 3 things should be considered for diet
- does the diet fit patients condition/preference
- does the patient need to be fed
- daily fluid goals
Can diet orders be combined?
yes!
ex. clear liquid diet for 24 hrs and advances as tolerated
NPO
nothing by mouth
IVF
intravenous fluids
what are the names of normal saline?
0.9% Normal saline
0.9% NS
0.9% NaCl
ns
3 types of isotonic fluids
- normal saline
- Lactated ringer’s solution
- 5% dextrose in Water
what does lactated ringer’s solution contain?
LR
- water
- sodium
- potassium
- calcium
- chloride
- lactate
What does D5W start as and then turn into
starts as isotonic and then changes to hypotonic when dextrose is metabolized
what are the two types of hypotonic fluids
- 0.45% normal saline
- D5W after its metabolized
what are the three names of hypotonic normal saline
- 0.45% ns
- 0.45% NaCl
- 1/2 NS
what are the 4 types of hypertonic fluids
- 3% normal saline
- 5% Dextrose + 0.45% NS
- 5% dextrose and lactated ringer
- 10% dextrose in water
names for 5% dextrose + 0.45% normal saline
- D5 0.45% NS
- D5 0.45% NaCl
- D5 1/2 NS
D5LR
5% dextrose and lactated ringer
D10W
10% dextrose with water
How is a bolus IV given
rapidly
wide open line
over 15 minutes or less
when is a bolus IV indicated
- dehydration
- hypotension
- shock
- active bleeding + unstable vitals
for what comorbidities should be caution be taken when giving bolus IV
- heart failure
- chronic renal failure
standard adult dosing IVF bolus
500-1000 ml NS
how to dose IV bolus in pedatric patients
weight based dosing
20ml/kg
what is the dosage for typical maintenance dosage of IVF
30ml/kg/24 hrs
for what pts is maintenance IVF administered?
NPO, restricted oral intake, vomiting, hypotension requiring fluid resus.
what is the maintenance dosage for obese patients
24ml/kg/24 hours
when should a maintenance dose of 20-25ml/kg/24hrs be considered
- elderly
- renal impairment
- cardiac Failure
- malnourished pts
IV NS at KVO
IV normal saline keep vein open
* IVF given at minimal drip rate to maintain access.
IV SL
IV saline lock
IV catheter in place in pt but not hooked up
Record In’s
volume of any fluids fluids given to Pt IV or orally
record out’s
record volume of urine output measured in a hat, urinal, foley cath
Drain types
list 3
- NG tube
- Foley to gravity
- JP drain
what is a JP drain
jackson pratt drain
Medication list order
name, dose, route, frequency
what three types of medication lists should be included
- meds to treat diagnosis
- meds to continue from home
- PRN meds for the admission
what should be included in lab/imaging orders
- study to be done
- time of day
- reason
what should be included in a consultatino request?
- name of consult
- reason for consultation
what are three types of special tests could be ordered
- DVT prophylaxis
- respiratory therapy
- oxygen
how should DVT prophylaxis be ordered?
name, dose, route, frequency
how should respiratory therapy be ordered?
name, dose, frequency of neb trx
how should oxygen be ordered?
- specific amount of O2
- method of delivery
- instructions for titration
