Chest Pain – R/O MI Orders
Chest Pain – R/O MI Orders
| |
|Date and time: |Name: |
| |Age: |
|Allergies: |DOB: |
|1. Admit to monitored bed: acute care |
|2. Attending Dr: Younger |
|3. Admitting Dx: Chest Pain – R/O MI |
|4. Contributing Dx: |
|5. Condition: |[ ] Stable [ ] Fair [ ] Serious [ ] Critical |
|6. VS: |Q 1 hr until stable for 4 hr, then Q 4 hr. Continuous cardiac monitoring. |
| |Call MD if: P < 50 or > 110, BP < 90/60 or > 150/90, R > 25, chest pain unrelieved with 3 NTG or CP with EKG |
| |changes. |
|7. Activity: |Bed rest with bathroom privileges with assistance. May go to activity ad lib after 2 sets of EKGs and cardiac |
| |enzymes have been negative. |
|8. Nursing: |I/O Q shift; weight on arrival and each am; STAT EKG for significant chest pain or arrhythmia; arrhythmia |
| |protocol (record a rhythm strip every 6 hours). |
|9. Diet: |Clear liquid diet until 4 hours without chest pain and then a DASH diet without caffeine. |
|10. IV: |Normal Saline IV at 80 ml per hour. |
|11. Meds: |Nitropaste one inch applied topically Q 6 hr. |
| |ASA Enteric Coated 325 mg PO now (if not given in the ER) and Q am. |
| |NTG 1/150 SL prn CP, may repeat Q 5 min until pain free or max = 3 tabs/episode or the blood pressure drops |
| |below 100 systolic. If the pain is unrelieved after 3 doses, then repeat the cardiac enzymes and EKG and call |
| |the physician. |
| |MSO4 2-4 mg Slow IVP Q 10 min prn severe chest pain. |
| |Tylenol 500 mg 2 PO Q 4 hr prn HA or pain. |
| |Ambien 10 mg PO QHS prn insomnia. |
| |MOM 30 cc PO Q am prn constipation. |
| |Maalox 30 cc PO QID prn indigestion. |
| |Lopressor 5 mg IV q 5 minutes x 3 doses (unless the systolic blood pressure drops below 100), and then start |
| |on 50 mg, one tablet by mouth every 12 hours. |
| |Lisinopril 10 mg, one tablet by mouth every day (unless contraindicated). |
| |Magnesium oxide 400 mg, one tablet by mouth every 12 hours for low magnesium level and to prevent heart rhythm|
| |problems. |
|12. Other Meds: | |
|13. Respiratory therapy: |Oxygen at 2 liters per minute by nasal cannula (maintain SpO2 level > 92%) for 12 hours after the last episode|
| |of chest pain. Recheck a SpO2 level after removal of the O2 to ensure the SpO2 is > 90%. If it is < than 90%, |
| |then reapply oxygen to maintain a SpO2 level > 90% and daily try to retitrate the oxygen requirements of the |
| |patient on room air. |
|14. Consultants: | |
|15. Labs: |Total CK, monoclonal CK-MB, troponin I on admission (if not done in ER) and 8 hr later X 2 for total of 3 |
| |times. Call if abnormal. |
| |CBC and magnesium level if not done in ER. |
| |Chem 8 and LFTs, if not done in ER. |
| |Lipid profile fasting in am. |
| |CXR (portable) if not done in ER. |
| |EKG on admission (if not done in ER) and with each cardiac enzyme panel. |
|16. H&P: |Please type up the H&P. |
| | |
| |________________________________________________ |
| |Signature |
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