DRAFT
COMMUNITY ACQUIRED PNEUMONIA ADMISSION ORDERS
(excludes HIV, Nursing Home or Long Term Care, and/ or recent readmit – within 2 weeks)
Date Time Medication and IV Orders
Allergies: Symptom/Reaction___________
IV fluids
❏ D5 ½ NS @ ___/hr. x___liters
❏ Vital Signs & System Assessment per protocol
❏ Additives ____ Meq KCL
ANTIBIOTIC FOR CAP
1st dose to be administered in ED
(Gatifloxacin-preferred agent)
❏ *Gatifloxacin 400mg. qd X ___days ❏IV ❏ PO
OR
❏ Ceftriaxone 1 gm. IV qd X ___ days Plus
Azithromycin 500mg qd X ___days ❏IV ❏ PO
❏ Other:__________
• If Cr Cl < 40 ml/min or patients on HD/CAPD
(dose after HD) give Gatifloxacin 400mg x1, then OOB as tolerated, ambulate TID beginning
200 mg qd.
❏ Other _______________________________
AUTOMATIC IV TO PO SWITCH PER
PHARMACY AND THERAPEUTIC
COMMITTEE GUIDELINES
Past History of Pneumococcal Vaccine
❏ yes ❏ Year_________ ❏ no
DAY OF DISCHARGE ADMINISTER:
❏ Influenza Vaccine (Oct. thru Mar.)
❏ Pneumococcal Polyvalent Vaccine
Dose: 0.5ml sc (repeat in 5 yrs as indicated)
OR
Outpatient appointment in ___ weeks for:
❏ vaccine, flu and or pneumococcal vaccine
❏ repeat Chest X-Ray _____ weeks
❏ Other:____________________________
MD Signature_____________________
CAP orders – CAP Team
Admit to _____________________ Service
Attending: ____________________
Resident: ______________________
Beeper #
Condition:
Pulse Oximetry upon admission
❏ O2 per NC @ 2 liters per minute, wean to
maintain pulse oximeter > ___%.
(Notify MD if O2 Saturation <__ %.)
❏ Other ____________________________
_________________________________
❏ Ventilator
Mode____ Rate____ FiO2 ______
Activity:
HOB > 30O , Encourage deep breathing
day 2.
Diet:
❏ as tolerated, encourage fluids
❏ Other____________________________
STANDING ORDERS (if not done in ED)
Blood Cultures x 2 (prior to abx)
* Sputum for Gm. stain and culture
* DC if not obtained 8hrs after antibiotic given
CBC w differential
Basic Metabolic Panel
LFT’s
Urinalysis
Chest X-Ray, PA & Lat
ADDITIONAL ORDERS
❏ ABG’s for pulse oximetry < 90%
❏ Legionella urinary antigen
❏ HIV antibodies (consent required)
❏ Sputum for AFB x 3 (requires isolation room)
❏ Lateral decubitis film (if pleural fluid present)
❏ Urine Culture
❏ Other:____________________________
❏ Other:____________________________
PATIENT EDUCATION:
• Information on Vaccines, (flu, Pneumovax)
• Smoking Cessation Video UMMS Channel 41
12:15pm,
• Micromedex “Smoking Cessation”
• ‘Risk Factors for respiratory infections”
(education sheet)
RN Signature______________________
11/10/08