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PNEUMONIA ORDERS
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DATE _________________________________________________
Time _____________________________________
1.
Admit to Service of ______________________________________________________________
2.
Allergies: ____________________________________________________________________________________
3.
Admit to:
4.
Diagnosis:
Additional Diagnoses: ___________________________________________________________________________
5.
Condition:
6.
Code Status:
7.
Nursing Documentation:
Other______________________________________
Daily Weights (kg) / I&O and record on admission and daily.
Saline lock or IV fluids: ____________________________________________________________________
9.
Activity:
10.
Diet:
11.
Fluids:
Fluid Restriction _________________ml/day
12.
Medication Choices:
Pharmacy to dose all medication for creatinine clearance.
Ceftriaxone (Rocephin) 1 gram IV every 24 hours
and Doxycycline 100mg every 12 hours
Other ________________________________________________________________
Other ________________________________________________________________
Acetaminophen 650 mg orally every 4 hours prn temp greater than 100.5 F or mild pain / headache not to
Other______________________________________________________________________
Milk of Magnesia 1-4 tablespoons orally every day – titrate to soft stools
Other__________________________________________________________
Other_________________________________________
Other_________________________________________
Continued on page 2
8761-EH03 (12-16-08)
PATIENT LABEL
PNEUMONIA ORDERS
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Other : _______________________________________________________________________________________
Other : _______________________________________________________________________________________
Other : _______________________________________________________________________________________
Other : _______________________________________________________________________________________
Other : _______________________________________________________________________________________
Other : ________________________________________________________________________________-______
14.
Diagnostic Studies:
15.
Admit Lab:
Blood Cultures x2, 15 minutes apart from different sites, prior to antibiotics
Sputum gram stain and culture. If patient not able to provide sample within 15 minutes, RT to induce with
2.5 mg Albuterol in 2.5cc normal saline. If patient cannot provide a sample within 30 minutes, consider nasal
Other ____________________________________________________________________________
16.
Lab in AM: _______________________________________________________________________________________
17.
Respiratory:
O2 __________________________________________________________
SVN with Albuterol + 2.5 mg QID / PRN
or
SVN with/2.5 mg Albuterol + 0.5 mg Atrovent QID / PRN
Advair 100/50 1 click every am
or
Other: ________________________________________________________________________________________
18.
Assessments/Consultations:
Other ___________________________________________
Smoking cessation counseling/education if patient smoked in last year
19.
Discharge planning:
_______________________________________________________________________________________ Physician’s Signature
PATIENT LABEL
Source: http://www.carsontahoe.com/imgUpload/PDF/8761-EH03PneumoniaOrders12-16-08.pdf
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