Admission Orders Template

Admission Orders Template

Under Week 2, go to the required readings and review the Admission Orders Template. You will need it to complete this assignment.

The Assignment:

• Using the required admission orders template attached
• Develop a set of orders as the admitting provider.
• Be sure to address each aspect of the order template
• Write the orders as you would in the patient’s chart. Be specific. Do not leave room for the nurse to interpret your orders.
• Do not assume anything has already been done/ordered. Use the information given. Example: If the case does not mention fluids being given, the patient did not receive fluids. You may have to start from scratch as if working in the ER. You must also provide orders if the patient needs to be admitted.
• Make sure the order is complete and applicable to the patient. Admission Orders Template
• Provide rationales for your labs and diagnostics and anything else you need to explain. This should be done at the end of the order set—it is not included with the order.
• Please do not write per protocol. We do not know your protocol, and you need to demonstrate the appropriate standard of care for this patient.
• At least five current (within the last five years) evidenced-based references are required.

Under this assignment, the result of the Branching Exercise (attached as JPEG) shows that I have already completed all its components. You are now ready to utilize the information below.

PLACE YOUR ORDER HERE NOW

• Review the information provided in the case (patient presentation, vital signs, PMH, home meds, lab results, and diagnostics). Then, critically consider what is happening with the patient.
• Use your critical thinking skills and current guidelines to develop orders. Include additional labs/diagnostics and what needs to be repeated and followed up on. Medications that need to be ordered or changed.

This week’s assignment is the branching exercise. You can go through the exercise as much as you want until it is submitted. You can only submit the assignment once for grading. At the end of the exercise, you are to write orders that reflect your treatment plan for this patient. The template for your order set is located in the required reading. Please be sure that you are writing specific orders exactly as you would in a patient’s chart.

Here is some additional information you need to complete your order set.

63-year-old female

VS:  BP  108/68   Temp  99 degrees F,  RR 18/min,  SpO2 95%  Wt   155 lbs,   Ht 5’4″

Past Medical History:  Hypertension, Diabetes, TIA

Allergic to Penicillin

Curents Meds:  Lisinopril, METFORMIN

Exam:    alert and oriented

S1 S2  no murmur, rubs, or gallops heard.  No JVD or carotic bruits

Lungs clear

Abdomen soft, non-tender, positive bowel sounds in all 4 quadrants  Admission Orders Template

 

Primary Diagnosis: Atrial Fibrillation with rapid Ventricular Response

 

Status/Condition (Critical, Guarded, Stable, etc.): Stable

 

Code Status: Full Code

 

Allergies: Penicillin

 

Admit to Unit: Cardiac Unit

 

Activity Level: Bed rest initially, up as tolerated

 

Diet: Cardiac diet

IV Fluids:

• Critical Drips (If ordered, include type and rate. Do not defer to ICU protocol.): 

Normal saline at maintenance rate

Metoprolol IV bolus 2.5 mg to 5 mg infused over 2 minutes (Hendricks et al., 2020). Monitor for bradycardia. Recheck heart rate after 15 minutes, and if >100 bpm, repeat bolus up to 15 mg at 5-minute intervals. If the patient converts to sinus rhythm (SR), convert to oral Metoprolol and discontinue IV 30 minutes after administration.

Had the patient presented with a medical history of heart failure or pulmonary disease, an intravenous bolus of Diltiazem 0.25 mg/kg administered over 2 minutes would have been prescribed. If the heart rate exceeds 100 beats per minute after 15 minutes, repeat the bolus at 0.35 mg/kg for an additional 2 minutes. Subsequently, the infusion should be maintained at 5 mg to 15 mg per hour until SR is achieved, which should occur within 5 minutes (Joglar et al., 2023). Additionally, these patients may exhibit dyspnea; therefore, supplemental oxygen may be required.

Respiratory: Oxygen (If ordered, include type and rate.), pulmonary toilet needs, ventilator settings:

• Oxygen via nasal cannula at 2 L/min to maintain SpO2 > 95%
• Encourage coughing and deep breathing exercises every 2 hours while awake

Medications (include ALL, tx of primary condition, underlying conditions, pain, comfort needs, etc., dose and route):

• Diltiazem 0.25 mg/kg IV bolus over 2 minutes, then 5-15 mg/hour continuous infusion for rate control of atrial fibrillation
• Metoprolol tartrate 2.5 mg IV bolus over 2 minutes for rate control, repeat every 5 minutes for up to 3 doses as needed (Hindsholm et al., 2023).
• Anticoagulation therapy (e.g., heparin drip) per cardiology consultation
• Acetaminophen 650 mg orally every 6 hours as needed for fever control

Nursing Orders (vital signs, skin care, toileting, ambulation, etc.): Admission Orders Template

• Continuous cardiac monitoring
• Vital signs every 2 hours
• Monitor oxygen saturation continuously
• Strict bed rest initially, with gradual mobilization as tolerated
• Provide oral care every 4 hours

Follow-Up Lab Tests:

• 12 lead EKG
• Thyroid-stimulating hormone (TSH)
• Complete blood count with differentials and platelets (CBC w/ diff & plt)
• Comprehensive metabolic panel (CMP)
• International normalized ratio (INR)

Diagnostic testing (CXR, US, 2D Echo, etc.):

Transthoracic echocardiogram (TTE) to evaluate for structural heart disease

Chest X-ray (CXR)

Consults:

• Cardiology consult for further management of atrial fibrillation, rate control, and anticoagulation therapy
• Anticoagulation service for initiation and monitoring of anticoagulation therapy

NOTE: (Do not defer management to a specialist. As an ACNP, you must manage the patient’s acute needs for at least a 24-hour period]. Include indication for consult. For example: “Cardiology consult for evaluation of new-onset atrial fibrillation” or “Nutrition consult for TPN recommendations.”

Patient Education and Health Promotion (address age-appropriate patient education. if applicable):

• Provide the patient with information regarding the adverse effects of medications on the gastrointestinal system, the anticholinergic effects of medications should they be continued, and the need for ongoing monitoring for arrhythmia (Nesheiwat et al., 2022).
• Educate the patient on the importance of adherence to anticoagulation therapy and rate-control medications (Kleindorfer et al., 2021) Admission Orders Template
• Review signs and symptoms of worsening atrial fibrillation and when to seek medical attention.
• Emphasize the importance of lifestyle modifications, including smoking cessation and limiting alcohol and caffeine intake.

Discharge Planning and Required Follow-Up Care:

• Discharge the patient on anticoagulation drug therapy
• Arrange outpatient cardiology follow-up within one week post-discharge for further evaluation and management
• Provide resources for cardiac rehabilitation program enrollment if indicated
• The patient should return in the event of palpitations, increased heart rate and shortness of breath without exertion.

 

 

 

References (minimum of three timely references that prove this plan follows current standards of care):

References

Hindricks, G., Potpara, T., Dagres, N., Arbelo, E., Bax, J. J., Blomström-Lundqvist, C., Boriani, G., Castella, M., Dan, G.-A., Dilaveris, P. E., Fauchier, L., Filippatos, G., Kalman, J. M., La Meir, M., Lane, D. A., Lebeau, J.-P., Lettino, M., Lip, G. Y. H., Pinto, F. J., & Thomas, G. N. (2020). 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-thoracic Surgery (EACTS). European Heart Journal, 42(5). https://doi.org/10.1093/eurheartj/ehaa612

Hindsholm, M. F., Damgaard, D., Gurol, M. E., Gaist, D., & Simonsen, C. Z. (2023). Management and prognosis of acute stroke in atrial fibrillation. Journal of Clinical Medicine, 12(17), 5752. https://doi.org/10.3390/jcm12175752

Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., Gorenek, B., Hess, P. L., Hlatky, M., Hogan, G., Ibeh, C., Indik, J. H., Kido, K., Kusumoto, F., Link, M. S., & Linta, K. T. (2023). 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: A report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation, 149(1). https://doi.org/10.1161/CIR.0000000000001193

Kleindorfer, D. O., Towfighi, A., Chaturvedi, S., Cockroft, K. M., Gutierrez, J., Lombardi-Hill, D., Kamel, H., Kernan, W. N., Kittner, S. J., Leira, E. C., Lennon, O., Meschia, J. F., Nguyen, T. N., Pollak, P. M., Santangeli, P., Sharrief, A. Z., Smith, S. C., Turan, T. N., & Williams, L. S. (2021). 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline from the American Heart Association/American Stroke Association. Stroke, 52(7). https://doi.org/10.1161/str.0000000000000375

Nesheiwat, Z., Goyal, A., & Jagtap, M. (2022). Atrial Fibrillation. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526072/#:~:text=On%20ECG%2C%20atrial%20fibrillation%20presents Admission Orders Template