Considerations for new admission patients

Considerations for a new admission patient

new admission

• why is the
  patient here?
  • they present the physician with complex
    diagnostic challenge that cannot be safely
    or efficiently performed in outpatient setting
    acutely ill, and require...
    • diagnostic tests
    • intervations
    • treatments
  decision making
  • optimal clinical service
    • medicine
    • urology
    • neurology
  • level of care
    • observation
    • general floor
    • telemetry
    • ICU
  • necesary consultantants
  communication the relavant
  information and outline the
  anticipated events in hospital to...
  • patient
  • family
  • other caregivers
  types of errors we
  may be concerned with
  • error of commission
  • error of ommission
  care for multiple medical conditions
  prevention of possible
  nosocomial complications
  • DVT
  • Peptic ulcers
  • line infections
  • pressure ulcers
  consistance in approach
  • helps in clearifying orders and saving time
  • good nmenonic to remember
  systematic approach
  • + ADMIT VITALS AND PHYSICAL EXAM

ADMIT VITALS AND PHYSICAL EXAM pnemonic

admission orders

• ADMIT VITALS AND PHYSICAL EXAM
• Admit to-
  • medicine
  • oncology
  • ICU
  • provide status
    • acute
    • observation
• Diagnosis
• MD
  • attending
  • resident
  • intern
  • student
  • primary care MD
  • consultants
• Isolation requirements
  • state respiratory / contact isolation
  • reason for order
• Telemetry
  • indications for telemetry
  • monitor parameters
• Vital Signs
  • breathing rate
  • pulse rate
  • BP
  • temperature
  • pulse oximetry Y/N
  • orthostatic VS Y/N
• IV access and IV fluid / TPN
• Therapists
• Allergies
• Labs
  • blood count
  • chemistries
  • coagulation tests
  • type and screen
  • UA
  • Special tests
• Activity
  • weight bearing
  • ambulating
  • fall / seizure precautions
  • restraints
• Studies
  • CT
  • US
  • Angiograms
  • Endoscopies
• Nursing orders
  • call inturn if...
  • order I/Os
  • daily weights
  • blood glucose
• Diet
  • NPO?
  • tube feeding?
• Peptic ulcer prevention
  • PPi
  • Misoprostol
• Heparin / other modality
  • warfarin
  • compression boots
  • support hose
• Yank all foley cath. and nonessential lines
  • to prevent iatrogenic infections
• skin care
  • pressure sore precaution
  • air mattresses
  • RN wound care
• incentive spirometry
  • prevent atelecctasis
  • Hospital Acquired Pneumonia
• calcium, vit-D, and biphosphonates
  • if steroid use,
  • bone fracture
  • osteoporotic
• ACE-I and Aspirin
  • nearly all ptn with CHD / DM
• Lipid panel
  • assess and treat all cardiac and vascular ptn for HYperlipidaemia
• ECG
  • nearly every patienr >50 at time of admin
• X-rays
  • chest
  • abdomen
  • evaluate Central lines
  • endotracheal tubes
• Advanced directives
  • full code
  • DNR
• Medications
• Stat DRIP
  • Stat
  • Daily
  • Round-the-clock
  • IV
  • PRN
• be specific

both were adapted from Harrison:s Manual of Medicine 16th ed.