0Chest Pain-Presumed cardiac in nature

By Katherine Turner,2014-04-27 23:14
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0Chest Pain-Presumed cardiac in nature

Chest Pain-Presumed cardiac in nature Dyspnea in the absence of chest pain Abdominal pain and/or vomiting Extremity Injury ; ES Cardiac Panel ; CBC, CCP, Amylase, Lipase, BNP ; CBC, CCP ; Determine mechanism of injury and exact location of pain. Evaluate joint ; PT/PTT, Any applicable drug levels ; Any applicable drug levels ; Amylase, Lipase above and joint below the injury for ; Initiate ED GAP orders ; pCXR, EKG and show to ED MD ; BHCG on pre-menopausal tenderness. Order appropriate x-ray females of childbearing age ; EKG and show to ED MD ; O2 as appropriate ; Urinalysis with urine culture ; IV saline lock ; 2L via N/C for COPD pts o Right/Left(circle) ____________ ; Minicath on females ; pCXR ; Maintain pulse ox >92% for non-COPD pts ; IV saline lock ; O2 @ 2L via N/C, Cardiac monitor, ; IV saline lock o Right/Left(circle) ____________ pulse oximeter ; EKG for age >35 ; Stat Albuterol neb with peak flow before and after ; ASA 324mg PO chewed (if no allergy to ; Phenergan 6.25 mg IV every 30 ; Anticipate administration of diuretics, steroids, ; Immobilize / Elevate injured extremity ASA) minutes x 2 prn for and/or antibiotics ; Apply cold compress if injury is less nausea/vomiting ; NTG 0.4mg SubL every 5 min x 3 for than 48 hours old CP if SBP > 90mm Hg ; Consult ED MD for analgesic ; Saline lock for obviously displaced medication ; MSO4 5mg IV prn if no allergy to fractures MSO4…may be repeated X 2 prn ; Consider BHCG for pre-menopausal ; Notify physician for persistent pain females of childbearing age Pleuritic Chest Pain ; Consult ED MD for analgesic CXR, EKG and show to ED MD, medication Pulse oximetry Altered mental status Animal bites Asthma Patients on Coumadin with bleeding CBC, CCP, Urinalysis with culture ; Remove jewelry from affected extremity if ; O2 @ 2L via N/C ; PT/PTT pCXR applicable ; IV saline lock ; CBC, CCP EKG and show to ED MD ; Cleanse wound with Betadine or chlorhexidine ; Continuous pulse oximetry ; Pulse oximetry O2 @ 2L via N/C, cardiac monitor ; Use sterile 4x4 gauze pad to dry wound ; Stat Albuterol neb with peak flow ; IV saline lock IV saline lock, continuous pulse oximetry ; Anticipate suture by MD or PA before and after ; Anticipate administration of Stat One Touch ; Obtain tetanus immunization status ; Anticipate administration of IV intravenous crystalloid solutions and Head injury steroids blood products ; Administer 0.5cc Tetanus Toxoid if immunized >5 CT head (only if loss of consciousness, or on yrs ago or if it is unknown ; Notify ED MD of patient’s Coumadin, or subsequent altered mental presence and presentation ; Anticipate antibiotic administration status) ; Complete Animal Encounter Report form and fax to the number on the Animal Encounter Report Suspected ETOH intoxication Suspected foreign body in the eye Adult Fever Pediatric fever CBC, CCP, ETOH level, Magnesium level ; Obtain and document visual acuity in OD, OS, and ; 15mg/kg of acetaminophen with a ; Obtain weight (kg), height (cm) on Stat One Touch OU max dose of 1000mg orally OR children 12 yrs of age and younger IV saline lock ; Document tetanus immunization status If ; 15mg/kg or acetaminophen with a ; Obtain head circumference (cm) in EKG and show to ED MD longer than 5 years administer 0.5cc TD IM maximum dose of 650mg rectally children 2 yrs of age and younger Continuous cardiac monitor ; Instill 2 drops Alcaine every 30 minutes x 2 prn ; Reassess patient’s temperature ; Obtain rectal temp for children under 2 Continuous pulse oximetry unless allergic or suspicion of open globe injury within 60minutes and document years of age IV saline lock ; Notify physician for further orders ; Obtain rectal temp on other children ; Consult ED MD for analgesic medication ; Anticipate administration of IV fluids if fever persists who do not tolerate oral temps containing MVI, Folate,, Thiamine, and ; Verify and document antipyretic MgSO4 administration prior to arrival ; Administer Children’s Motrin 10mg/kg for temp greater than or equal to 100F. ; If Motrin was administered prior to arrival, administer Tylenol 20mg/kg orally or rectally ; Reassess and document temperature within 30-60 minutes Suspected GI bleed Immunocompromised/Oncology patients with Suspected kidney stones or enal Lacerations fever/weakness colic CBC, CCP, PT/PTT, Type & Screen ; CBC, CCP ; CBC, CCP ; Cleanse wound with normal saline BHCG on pre-menopausal females of ; PT/PTT ; Urinalysis with urine cultures ; X-ray injured area if indicated to rule childbearing age out foreign body or a suspected ; Blood Cultures x 2 ; Minicath on females ; Urinalysis fracture ; Urinalysis and urine culture ; BHCG on pre-menopausal Minicath on females ; Consider BHCG for pre-females of childbearing age ; pCXR ; Foley catheter for active bleeding menopausal females of ; IV Normal saline at 250cc/hr ; Pulse oximetry on males and females childbearing age ; Consult ED MD for analgesic ; Maintain patient in private room ; IV saline lock ; Document tetanus immunization status medication ; Anticipate antibiotic administration ; Cardiac monitor, continuous pulse ; If longer than 5 years administer ; Anticipate CT scan with kidney ; Administer Acetaminophen 1 gm PO oximetry 0.5cc TD IM stone protocol ; Orthostatic vitals as tolerated by pt ; Suture set-up at bedside ; Anticipate nasogastric tube placement ; Anticipate post-suture clean up and and gastric lavage dressing administration ; Anticipate administration of intravenous crystalloid solutions and blood products

Suspected meningitis Traumatic injury to musculoskeletal Suspected overdose Active or subjective seizure System CBC, CCP ; Assess and document pain quality and ; CBC, CCP, Urinalysis with culture, ; Continuous cardiac monitoring IV saline lock quantity on “0-10” pain scale UDS ; Pad siderails, siderails up, bed low Blood cultures x 2 ; Consult MD or PA for analgesia prior to ; Acetaminophen level position Maintain patient in private room obtaining radiological studies ; Salicylate level ; Administer oxygen as appropriate Anticipate lumbar puncture…have lumbar ; Place pt in wheelchair or stretcher ; ETOH level ; IV Saline Lock or Normal Saline at puncture kit at bedside ; Elevate/Immobilize affected extremity/area KVO rate ; pCXR, EKG Anticipate antibiotic administration as applicable ; Obtain CBC, CCP, any applicable ; BHCG on pre-menopausal females of Consult ED MD for analgesic medication ; Apply ice to affected extremity/area for 20 drug levels, blood cultures x 2, childbearing age ; Maintain dimmed lights in patients room minutes Urinalysis ; EKG, Stat One Touch as much as possible ; Order plain X-ray of the affected ; Notify ED MD of patient’s presence ; Cardiac monitor, continuous pulse extremity/area noting the location of the pain ; Anticipate CT scan oximetry ; Anticipate anti-convulsants and/or ; IV saline lock antipyretics ; Anticipate gastric lavage and administration of antidotes R/O sepsis; fever greater than 100.5F Sickle Cell Crisis Syncope in the absence of chest pain Stroke or TIA symptoms age 50 or older (Non-Stroke Alert) ; CBC, CCP, Urinalysis with culture ; Notify physician of patient’s presence and ; CBC, CCP, AMI ; Notify ED MD of patient’s presence presentation and presentation ; Blood cultures x 2 ; Any applicable drug levels ; Initiate IV access ; Expedite to treatment area ; BHCG on pre-menopausal females of ; EKG and show to ED MD childbearing age ; Obtain CBC, Reticulocyte count ; Continuous cardiac monitoring ; pCXR ; pCXR, cardiac monitor, continuous ; Administer 1 liter Normal Saline bolus ; Administer oxygen as appropriate ; IV saline lock pulse oximetry ; Administer Dilaudid 1mg IV, Phenergan ; IV access ; O2 @ 2L via N/C ; IV saline lock, O2 @ 2L via N/C 12.5mg IV, & Toradol 30mg IV if no ; Obtain CBC, CCP, AMI, PT/PTT, ; Stat One Touch allergies are present ; Acetaminophen 1 gm PO or 650 mg Portable CXR ; Orthostatic vitals if tolerated by pt rectally prn for temp > 100.5F ; Notify ED MD if further analgesia is ; Stat 12-lead EKG and show to ED MD ; Anticipate CT scan of head required ; Anticipate antibiotic administration ; Keep HOB elevated 30 degrees o Goal for Community Acquired ; If febrile, also obtain CCP, Blood cultures x ; Frequent neuro checks no less than Pneumonia is 4hrs from arrival 2, Urinalysis with culture, CXR, and notify every 60 minutes ED MD for prompt antibiotic selection & ; Anticipate head CT administration ; Anticipate hospital admission Transplant Patients Unconscious patient Suspected UTI Wound Recheck and Suture Removal Without fever ; Determine which medical facility ; Assess Airway, Breathing, and Circulation ; Ensure the sutures were placed at Urinalysis with urine cultures and treat deficiencies aggressively SMMC ; performed the transplant and document Minicat,h on females on the chart ; Notify ED MD of patient’s presence and ; Ensure no signs of infection BHCG on pre-menopausal females of presentation ; Notify the ED physician of the patient’s ; Ensure there is no drain in place childbearing age presence and symptoms ; Obtain IV access ; Ensure the patient is afebrile With fever of 100.5F or > ; CBC, CCP ; Continuous cardiac monitor ; Ensure the patient has presented Same as above ; PT/PTT ; Administer oxygen as appropriate according to previous instructions CBC, CCP, Blood cultures x 2 ; Blood Cultures x 2 ; Stat EKG and One Touch ; If all these are ensured, then the nurse BHCG on pre-menopausal females of may perform the wound check and/or ; Urinalysis and urine culture ; Obtain CBC, CCP, AMI, Urinalysis with childbearing age remove the sutures from the wound culture, Urine Drug Screen, Acetaminophen ; pCXR Acetaminophen 1gm PO and document the appearance of the and Salicylate levels, ETOH level, ; Pulse oximetry Saline lock wound before and after the suture ; Portable CXR ; Maintain patient in private room Anticipate antibiotic administration removal ; Anticipate transfer to transplant facility Consult ED MD for analgesic medication ; If any of these are not met, then the patient must be seen by the ED MD or PA for further evaluation Additional Orders Additional Orders Additional Orders Signatures RN Signature Date:_______________Time:__________

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