ED Abdominal Pain Female-02505-QM-0808 ver2 by acm31250

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                                                           Physician Orders
                                                           Care Set: ED Abdominal Pain Female Orders
                              ADULT                         [X or R] = will be ordered unless marked out.
                                                           T= Today; N = Now (date and time ordered)
Height: ___________cm Weight: __________kg
Allergies:                                            [ ] No known allergies
[ ]Medication allergy(s):_____________________________________________________________________
[ ] Latex allergy    [ ]Other:__________________________________________________________________
                                                Admission/Transfer/Discharge
  [ ] Admit Patient to Dr. ________________________________________
       Admit Status: [ ] Inpatient [ ] Routine Post Procedure <24hrs [ ] 23 hour OBS
         NOTE to MD: Admit as Inpatient: POST PCI (PTCA) care to cardiac monitored bed (Medicare requirement);
         severity of signs and symptoms, adverse medical event, patient does not respond to treatment.
         Post Procedure: routine recovery < 8 hours same day stay; extended recovery 8 -24 hours
         expected overnight stay, complexity of procedure or pt. condition, i.e., laparoscopy, HNP.
         23 Hour Observation: additional time needed to evaluate for inpatient admission, i.e. r/o MI, syncope,
         abdominal pain; patient will respond rapidly to treatment, i.e. dehydration.
      Bed Type: [ ] Med/Surg [ ] Critical Care [ ] Stepdown [ ] Telemetry; Specific Unit Location: ___________
 [ ] Notify physician once                            T;N, of room number on arrival to unit
Primary Diagnosis: _____________________________________________________
Secondary Diagnosis: __________________________________________________
                                                        Initial Orders
 [ ] Intermittent Needle Therapy Insert/Site (INT     T;N,q4day
      Insert/Site Care)
      NOTE: If patient is known diabetic, place Bedside Glucose order below:
 [ ] Whole Blood Glucose Nsg (Bedside Glucose         T;N, Stat, once, PRN
      Nsg)
 [ ] CBC                                              T;N, STAT, once, Type: Blood, Nurse Collect
 [ ] Comprehensive Metabolic Panel (CMP)              T;N,STAT,once,Type: Blood,Nurse Collect
 [ ] Amylase Level                                    T;N,STAT,once,Type: Blood,Nurse Collect
 [ ] Lipase Level                                     T;N,STAT,once,Type: Blood,Nurse Collect
 [ ] Urinalysis                                       T;N,STAT,once,Type: Urine,Nurse Collect
 [ ] Urinalysis w/Reflex Microscopic Exam             T;N, STAT, once, Type: Urine, Nurse Collect
      NOTE: If possibility of pregnancy, place one of the orders below:
 [ ] Pregnancy Screen Urine                           T;N,STAT,once,Type: Urine,Nurse Collect
 [X] Pregnancy Screen Urine Point of Care             T;N, Stat, once
 [ ] Pregnancy Screen Serum                           T;N,STAT,once,Type: Blood,Nurse Collect
 [ ] HCG Quantitative (Quantitative HCG)              STAT, T;N, once, Type: Blood, Nurse Collect
 [ ] Wet Prep                                         STAT, T;N, once, Specimen Source: Discharge Vagina, Nurse Collect
      NOTE: If positive pregnancy test, order US Pelvic Non OB Comp. If current pregnancy known, do not order US.

 [ ]     US Pelvic Non OB Comp                        T;N, Reason for Exam: Other, Enter in Comments, Stat, Stretcher
                                                          Vital Signs
                                                            Activity
                                                        Food/Nutrition
 [ ]     NPO                                          Start at: T;N
                                                         Patient Care
 [ ]     O2 Sat Spot Check-NSG                        T;N, Stat
 [ ]     O2 Sat Monitoring NSG                        T;N, Stat
 [ ]     Telemetry (Cardiac Monitoring)               T;N, Stat
                                                       Respiratory Care
 [ ]     Nasal Cannula (O2-BNC)                       T;N, 2 L/min, Special Instructions: titrate to keep O2 sat =/> 92%
                                                    Continuous Infusions
 [   ]   Sodium Chloride 0.9%                         500 mL, IV, STAT, ( 1 dose ), 1,000 mL/hr, Bolus
 [   ]   Sodium Chloride 0.9%                         1,000 mL, IV, STAT, 2,000 mL/hr, 2 dose, BOLUS
 [   ]   Sodium Chloride 0.9%                         1,000 mL, IV, STAT, 150 mL/hr
 [   ]   Sodium Chloride 0.45%                        1,000 mL, IV, STAT, 150 mL/hr
 [   ]   Dextrose 5% with 0.45% NaCl (Sodium chloride 1,000 mL, IV, STAT, 150 mL/hr
         0.45% with D5W)

ED Abdominal Pain Female-20505-QM-0808 ver2                                                                       *111*
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                                                                                                          attach patient label here

                                                       Physician Orders
                                                       Care Set: ED Abdominal Pain Female Orders
                              ADULT                     [X or R] = will be ordered unless marked out.
                                                       T= Today; N = Now (date and time ordered)
                                                          Medications
 [   ]   azithromycin                                  500 mg, Injection, IV Piggyback, once, STAT
 [   ]   clindamycin                                   900 mg,IV Piggyback,IV Piggyback,once,STAT,T;N
 [   ]   metronidazole                                 500 mg,IV Piggyback,IV Piggyback,once,STAT,T;N
 [   ]   gentamicin                                    100 mg,IV Piggyback,IV Piggyback,once,STAT,T;N
 [   ]   ceftriaxone                                   1 g, IV Piggyback, IV Piggyback, once, STAT
 [   ]   piperacillin-tazobactam                       3.375 g, IV Piggyback, IV Piggyback, once, STAT
 [   ]   HYDROmorphone                                 1 mg,Injection,IV Push,once,STAT,T;N
 [   ]   morPHINE                                      2 mg,Injection,IV Push,once,STAT,T;N
 [   ]   ketorolac                                     15 mg, Injection, IV Push, once, STAT
 [   ]   ketorolac                                     30 mg, Injection, IV Push, once, STAT
 [   ]   promethazine                                  12.5 mg,Injection,IV Push,once,STAT,T;N
 [   ]   metoclopramide                                10 mg,Injection,IV Push,once,STAT,T;N
 [   ]   ondansetron                                   4 mg,Injection,IV Push,once,STAT,T;N
                                                           Laboratory
 [   ]   Chem 8 Profile POC                            T;N, Stat
 [   ]   Prothrombin Time (PT/INR)                     T;N, STAT, once, Type: Blood, Nurse Collect
 [   ]   Partial Thromboplastin Time (PTT)             T;N,STAT,once,Type: Blood,Nurse Collect
 [   ]   Type and Screen                               T;N, STAT, to Hold, Type: Blood, Nurse Collect
 [   ]   Blood Culture                                 Time Study, q5min x 2 occurrence, Nurse Collect
 [   ]   Urine Culture                                 T;N, STAT, Specimen Source: Urine, Nurse Collect
 [   ]   Chlamydia DNA Probe                           T;N, STAT, Type: Genprobe Swab (cervical or urethral), Nurse Collect
 [   ]   GC DNA Probe                                  T;N, Routine, once, Type: Genprobe Swab (cervical or urethral), Nurse
                                                       Collect
 [ ]     Occult Blood, Stool                           T;N,Routine,once,Type: Stool,Nurse Collect
 [ ]     Occult Blood-Stool x 3 Specimens Orders
 [ ]     Rh Profile                                    STAT, T;N, once, Type: Blood, Nurse Collect
                                                        Diagnostic Tests
 [ ]     Abd Sing AP VW                                T;N, Reason for Exam: Abdominal Pain, Other reason: Abdominal Pain,
                                                       Stat, Stretcher
 [ ]     Abd Comp W Decubitus/Erect VW                 T;N, Reason for Exam: Abdominal Pain, Other reason: Abdominal Pain,
                                                       Stat, Stretcher
 [   ]   Chest 1VW Frontal                             T;N, Stat, Portable
 [   ]   Chest 2VW Frontal & Lat                       T;N, Stat, Stretcher
 [   ]   CT Abdomen W Cont Orders
 [   ]   CT Pelvis W Cont Orders
 [   ]   CT Abdomen WO Cont                           T;N, Reason for Exam: Abdominal Pain, Stat, Stretcher
 [   ]   CT Pelvis WO Cont                            T;N, Reason for Exam: Other, Enter in Comments, Stat, Stretcher
 [   ]   US Abd Comp                                  T;N, Reason for Exam: Abdominal Pain, Stat, Stretcher
 [   ]   US Abd Ltd Sing Organ/FU                     T;N, Reason for Exam: Abdominal Pain, Stat, Stretcher
 [   ]   US Non OB Transvaginal                       T;N, Reason for Exam: Other, Enter in Comments, Stat, Stretcher
 [   ]   Electrocardiogram (EKG)                      Start at: T;N, Priority: Stat, Reason: Other, specify, Abdominal Pain
                                                     Consults/Notifications
 [ ]     Physician Consult (Consult MD)               T;N, Reason for Consult: general surgery
 [ ]     Physician Consult (Consult MD)               T;N, Reason for Consult: GYN

__________________      __________________    _________________________________________________    __________________
Date                     Time                  Physician's Signature                                MD Number

ED Abdominal Pain Female-20505-QM-0808 ver2




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