Introduction to Admission Orders

Question 1

ADC VANDALISM Here

Answer 1

A: Admit
D: Diagnosis
C: Condition

V: Vitals
A: Allergies
N: Nursing
D: Diet
A: Activity
L: Labs
I: IV
S: Special
M: Medications
H: House Order

Question 2

Admit

Answer 2

• WHERE ARE YOU ADMITTING the Patient?
  a) General Medical Floor )GMF)
  b) General Surgical Floor
  c) Med/ Surg
  d) ICU (Cardiac, Medical, Surgical, Neuro?)
  e) Acute Telemetry
• WHO ARE ADMITTING the Patient to?
  a) Attending Name
  b) Service Name

Question 3

Diagnosis

Answer 3

• What is the REASON the Person is being admitted?
  a) List in the Order of Priority
  b) NOT the place to PUT Differential Diagnosis

Question 4

Condition

Answer 4

• HOW is YOUR Patient?
  a) Stable
  b) Guarded
  c) Poor
  d) Critical

Question 5

Vitals

Answer 5

• HOW OFTEN would you like Vitals Taken? (Q2 hours, Q shift, Q 1 hour x 4 then Q 4 hours)

a) Typical (BP, HR, Temp, RR)
b) DO you need other?
- O2 Sat?
- Daily Weights

Question 6

Allergies

Answer 6

• WHAT is YOUR ALLERGIC to?
  a) MOST IMPORTANT here is MEDICATION ALLERGIES!!!
• Put Reaction to it as well
• This is where TOLERANCES go as well!!!
• FOOD ALLERGIES can be PERTINENT
  a) For Diet Restrictions
  b) Cross Reactivity (Shellfish Allergy —> IV Contrast)

Examples:

• NKDA
• Penicillin: Anaphylaxis
• NSAID: CI due to Renal Failure

Question 7

Nursing Orders

Answer 7

• Monitor INS and OUTS (Strict, Routine)
• Dressing Changes (Wound Care)
• Place Foley Catheter
• Place Sequential COMPRESSION DEVICE (SCD) for DVT Prophylaxis
• Place NASOGASTRIC TUBE (NGT)
  a) TO intermittent Suction or Clamped
• Turn patient Q 2 Hours (Bedrest/ ICU)
  a) Prevent Bed Sores
• Head of Bed (HOB) at 30 Degrees (Prevent Aspiration)

Question 8

Diet

Answer 8

What Will you patient be eating? If so, then what kind of diet?

• Regular Diet (Anything they want)
• ADA Diabetic Diet
• Cardiac Diet (Low Sodium Diet)
• NPO (Nothing By Mouth)
• Sips of Water
• Ice Chips
• Clear Liquids
• Mechanical Soft
• Dysphagia Diet

Question 9

Activity

Answer 9

Are you going to let your Patient Move Around?

• UP AD LIB (Can Walk around as much as they like)
• Up with ASSISTANCE
• Bedside Commode
• Up to Chair TID
• FALL PRECAUTIONS
• BEDREST
• AMBULATE (Move About) THREE TIMES A DAY

Question 10

Labs

Answer 10

What kind of Laboratory Work do you need?

• Best to order the Individual Test you want at your state until you know what comes in “Panels”!!!!
  a) Hemoglobin
  b) Platelets
  c) AST/ALT
• Complete Blood Count
• Comprehensive Metabolic Panel
• Fasting Lipid Panel
• Hemoglobin A1C
• TSH
• ABG

WHEN DO YOU NEED THESE?

• Now (Get done Today)
• STAT (Get done ASAP
• In AM (Tomorrow morning early around 4am)

Question 11

IV

Answer 11

Intravenous FLUIDS/ MEDICATIONS:
- Normal Saline (NS)

• Lactated Ringers
• D5 1/2 NS

What RATE do you Want it Running At?
- 125 cc/hr

• 1 liter bolus
• 200 cc/hr x 2 hours then SL
• Saline Lock
• Heparin Lock
• Keep Vein Open (KVO)

Question 12

Special

Answer 12

CATCH ALL AREA!!!!!!!

Radiology/Diagnostics:

• CT/ X Ray/ MRI
• EKG
• Echo
• Doppler

CONSULT:

• Wound Care
• Respiratory Therapy
• PT/OT
• Surgery/ Cardiology/ GI/ Etc

Question 13

Medications

Answer 13

RECONCILE HOME MEDICATIONS:
- Which need to be Discontinued?

• Which need to be HELD, then RESTARTED?

What NEW MEDICATIONS are Needed?

• Anticoagulation
• Blood Pressure
• Antibiotics
• PRN Medications

Question 14

House Officer

Answer 14

NOTIFY House Officer (This is you during Residency- Specifically PGY1)

• If Systolic Blood Pressure LESS THAN 90 or GREATER THAN 160!!!!
• Temperature GREATER THAN 101F
• Blood Sugar LESS THAN 70 or GREATER THAN 400
  a) Usually Protocol of Insulin for number in between this