NSTEMI standing orders

STANDING ORDERS

ADMIT ? Unstable Angina/Non?ST-Elevation MI (NSTEMI) ACC/AHA Class I Recommendations* in Bold

Patient ___________________________ ______________________ _______

(LAST NAME)

(FIRST NAME)

(MI)

Age: ___________ years Weight: __________ kg

Male Female

Admit to: Cardiology Condition:_______________________________________________________ Diagnosis: Unstable angina NSTEMI

Check/Initial/Date

_____/_____ Allergies: ________________________________________

________________________________________________

_____/_____

EARLY RISK STRATIFICATION High risk Intermediate risk Low risk

High risk: elevated cardiac biomarkers, ST depression, transient ST elevation, >20 min of rest pain, hemodynamic instability, signs of CHF EARLY INVASIVE STRATEGY

Intermediate risk: no high-risk features, prior MI, prior CABG, T-wave inversions, rest angina 70 years EITHER EARLY INVASIVE OR EARLY CONSERVATIVE STRATEGY

Low risk: No high- or moderate-risk features, progressive angina without prolonged rest pain, normal cardiac markers, normal ECG with pain EARLY CONSERVATIVE STRATEGY

ACC/AHA Class I A rapid clinical determination of the likelihood risk of Recommendation obstructive CAD (ie, high, intermediate, or low) should

be made in all patients with chest discomfort or other symptoms suggestive of an ACS and considered in patient management [Level of Evidence: C]. Patients who present with chest discomfort or other ischemic symptoms should undergo early risk stratification for the risk of cardiovascular events (eg, death or [re]MI) that focuses on history, including anginal symptoms, physical findings, ECG findings, and biomarkers of cardiac injury, and results should be considered in patient management [Level of Evidence: C].

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STANDING ORDERS

ADMIT ? Unstable Angina/Non?ST-Elevation MI (NSTEMI) ACC/AHA Class I Recommendations* in Bold

Check/Initial/Date NURSING

_____/_____ Activity ? Bed rest _____/_____ Cardiac monitor

ACC/AHA Class I Bed/chair rest with continuous ECG monitoring is Recommendation recommended for all patients during the early hospital

phase [Level of Evidence: C].

_____/_____ Vital signs q4h x 24 h then q8h

_____/_____ Diet: house/no added salt/low saturated fat; low cholesterol

_____/_____

Call house officer for T >101?, SBP >190 mm Hg or SBP 120 bpm or HR 30 or RR ................
................

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