[Lecture] Admission Orders and IV Fluids (Tyler) Flashcards
A patient needing admission for more than 2 midnights would be admitted ____
Inpatient
A patient needing admission for 1 midnight would be admitted to ____
Observation
What is an outpatient facility?
Treatment occurs w/in 1 day without overnight stay (i.e. surgery centers, eye centers, special procedures)
When are patients admitted to a skilled nursing facility?
Patients w/ surgery/illnesses that cause significant debilitation and can’t go home w/in 3-4 days
What is the difference between home health and hospice?
Hospice: end of life palliative care
Home health: skilled care at home
What is the ADC VANDALISM mnemonic for admission orders?
Admit
Diagnosis
Condition
Vitals
Activity
Nursing
Diet
Allergies
Lab and diagnostics
IV fluids
Specialists/Consults
Medications/Monitoring
What parts of Dr. Tyler’s framework for admission do Admit, Diagnosis, Condition, Allergies, and Medication fall under?
Conditions for admission
What parts of Dr. Tyler’s framework for admission do Vitals, Activity, Nursing, Diet, Lab/Diagnostics, IV fluids, Specialists and Consultations, Medications fall under?
Diagnostic processes
What parts of Dr. Tyler’s framework for admission do Medication and Monitoring fall under?
Safety
What kinds of patients are admitted to the ICU?
Requring advanced resp support
Support of 2 or more organ systems
Chronic impairment of one or more organ systems with acute reversible failure of another organ
What order should diagnoses be listed on admission orders?
First - New/Acute problems
2nd - Chronic problems that contribute to admission (i.e. DM, HTN, CAD, major depressive disorder)
A patient with a “fair” or “Ill-appearing” condition would be admitted where?
Medical floor
(pt is experiencing a condition where they are not doing well and need monitoring, mild circumstances with minimal impairment of safety)
A patient with a “guarded” or “critical” condition would be admitted where?
ICU
(pt needs to be monitored closely, vitals are labile, altered mental status, may be toxic, traumatic)
Patients requring admission for palliative care with likelihood of dying withing 72 hours can be considered what condition?
Expectant/Poor
How often are vitals usually obtained with admission orders?
Every 4-8 hours
What would an admission order stating “up ad lib” mean?
Pt has free control of activity without help
“up at liberty”
If you see “foley to gravity”, “Dressing changes”, “Fall precaution” on an admission order, what are they?
Nursing orders
Diabetics will usually have what diet on their admission orders?
Carbohydrate consistent
Clear liquid diets are for what types of patients?
Pre-procedural
Persistent N/V
Patients who need to be slowly advanced to a regular diet after surgery or illness w/ decreased oral intake would be put on what diet?
Full liquid (milk, ice cream, soup)
NPO diet is usually what kind of order?
Pre-operative at least 6 hours before a procedure
Persistent nausea/vomiting
Acute pancreatitis
Bowel obstruction
What does Dr. Tyler consider the most important feature of admission orders?
MEDICATIONS
- Reconciliation
- ID all meds and doses
- Delete/Add
- Specific to admission
What does the “monitoring” part of admission consist of?
Safety
Parameters for monitoring
Pt education
Discharge planning
5 Rs of fluid replacement
Resuscitation
Replacement
Redistribution
Routine maintenance
oRal/enteRal maintenance
What is the composition of an isotonic crystalloid?
Normal Saline
Lactated Ringer’s
D5W (+/-) (5% dextrose in water)
What is the composition of a hypotonic crystalloid?
1/2 normal saline
D5W (+/-) (5% dextrose in water)
What is the composition of a hypertonic crystalloid?
3% NaCl
D10W (10% dextrose in water)
D5 1/2 normal saline
D5 NS
D5 Lactated Ringers
What is the Holliday-Segar method of calculating maintenance fluid volume in pediatric pts?
1st 10 kg = 100 ml/kg in 24 hrs
2nd 10 kg = 50 ml/kg in 24 hours
Remaining kg = 20 ml/kg in 24 hrs
24kg child: 1000ml + 500ml + 80 ml = 1580 ml/24 hrs = 66 ml/hr
Fast and dirty way of calculating volume loss?
Compare normal weight with current weight
1 kg = 1L
How do you administer fluid replacement in children?
Replace half of fluid volume replacement dose in 8 hrs, the rest over the next 16 hours w/ monitoring
Deficit + Maintenance (Holliday-Segars #) = Total fluids for the first 24 hours
What is the rate of fluid replacement in adults?
Depends on severity - rate of replacement must be greater than rate of fluid loss, usually 50-100 mL/hr greater than loss
Severly hypovolemic: 1-2L isotonic saline as rapidly as possible to restore perfusion (not necessary for mild to moderate)
When would you not administer Lactated Ringer’s solution?
Pts with rhabdomyolysis, blood transfusions
Can increase emboli formation
Why might D5W cause significant electrolyte shift?
D5W, while isotonic, may be hypotonic in relation to the patient during the initial response phase