Unique Plan Description: ED Hemorrhagic Stroke
Plan Selection Display: ED Hemorrhagic Stroke
PlanType: Medical                                 
Version: 3          
Begin Effective Date: 2023-07-28 12:02:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-04-02 15:13:39
Available at all facilities: No

ED Hemorrhagic Stroke
Admit/Discharge/Transfer
	ED Request for Bed
		
	Transfer
		
Vital Signs
	Vital Signs
		T;N, Q15MIN, If stable may change to hourly
Activity
	Bedrest
		T;N, Elevate head of bed 30 degrees
Diet
	NPO
		T;N
IV Solutions
	niCARdipine 20mg/NS 200mL
		200 mL, IV, STAT, Start: T;N, Duration: 1 Dose(s)/Time(s), Maintain Parameter Goal: SBP< 160, Increment Increase: 2.5 mg/hr, Increment Decrease: 2.5 mg/hr, Increment Freq: 5 min(s), Max Dose: 15 mg/hr
			Comment: Begin to taper off nicardipine 1 hour after initiation of oral anti-hypertensive therapy.  If hypotension or tachycardia occurs, discontinue the infusion and notify provider.  IV may be re-initiated after weaning within 12hours, re-initiate at the dosing rate that maintained Goal parameter SBP < 160mmHG.. Discontinue order after 12hr if patient does not require IV re-initiation.
		20 mg, EVERY BAG, 5 mg/hr
	nicardipine 20mg/NS 200mL premix
		20 mg, EVERY BAG, 5 mg/hr
		200 mL, IV, Routine, Duration: 1 Dose(s)/Time(s), Maintain Parameter Goal: SBP< 160, Increment Increase: 2.5 mg/hr, Increment Decrease: 2.5 mg/hr, Increment Freq: 5 min(s), Max Dose: 15 mg/hr
			Comment: Begin to taper off nicardipine 1 hour after initiation of oral anti-hypertensive therapy.  If hypotension or tachycardia occurs, discontinue the infusion and notify provider.  IV may be re-initiated after weaning within 12hours, re-initiate at the dosing rate that maintained Goal parameter SBP < 160mmHG.. Discontinue order after 12hr if patient does not require IV re-initiation.
	Sodium Chloride 0.9%
		1,000 mL, IV, 50 ml/hr
		1,000 mL, IV, 75 ml/hr
		1,000 mL, IV, 100 ml/hr
		1,000 mL, IV, 125 ml/hr
		1,000 mL, IV, 150 ml/hr
Medications
	labetalol  injection
		10 mg = 2 mL, Injection, IV Push, Q10MIN, PRN, see comment, Duration: 2 Dose(s)/Time(s)
			Comment: To keep SBP < 160 mmHg, Give over 2 minutes.; Notify MD if labetalol 10mg, IV every 10 min PRN x2 doses is not effective
Patient Care
	Vital Signs/Hemodynamic Monitoring
		T;N, SBP goal 140-160 mmHg O2Sats >94% unless otherwise directed by MD
	ED Cardiac Telemetry Monitoring
		T;N
	Neurological Assessment-Focused
		T;N, Q15MIN
			Comment: if stable may change to hourly
	Notify MD
		if SBP >160mmHg
		if temp >100.4
		signs of neurological decline
	Seizure Precautions
		T;N
Consults/Follow-up
	Consult Neurologist
		Reason for Referral: Stroke
	Consult Neurosurgery
		Reason for Referral: Stroke
	Consult Tele Neurology (JEFH)
		Reason for Referral: Stroke
	Consult Hospitalist
		Reason for Referral: Stroke
	Consult Intensivist
		Reason for Referral: Stroke

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase