Unique Plan Description: Gen Adm Subarachnoid Hemorrhage (MH)
Plan Selection Display: Gen Adm Subarachnoid Hemorrhage (MH)
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2013-12-11 16:07:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-10-03 11:48:33
Available at all facilities: No

Gen Adm Subarachnoid Hemorrhage (MH)
Admit/Discharge/Transfer
	Admit to Critical Care Inpatient Status (MH)
		T;N, Anticipated LOS 2 midnight or more
Vital Signs
	Vital Signs
		T;N, Q1H
	Weight
		T;N, DAILY
Activity
	Bedrest
		T;N, Elevate head of bed 30 degrees
	Activity-As Tolerated
		T;N
Diet
	NPO
		T;N, Until nursing swallow completed. If fails nurse swallow screen, keep NPO until speech therapy evaluation. If no dysphagia, advance diet to general
Laboratory
	CBC with Diff
		T;N, Stat, spec type = Blood
		T+1;0400, Routine, Q24H, 3 Day(s), spec type = Blood
	Basic Metabolic Panel
		T+1;0400, Routine, Q24H, 3 Day(s), spec type = Blood
	CMP
		T;N, Stat, spec type = Blood
	INR - MH/WH/JE
		T;N, Stat, spec type = Blood
		T+1;0400, Routine, Q24H, 3 Day(s), spec type = Blood
	PTT - MH/WH/JE
		T;N, Stat, spec type = Blood
		T+1;0400, Routine, Q24H, 3 Day(s), spec type = Blood
	Glucose POC - RN
		T;N, Stat
		T;N, Q6H
	Hemoglobin A1C
		T;N, Stat, spec type = Blood
	Toxicology Screen DAU - MH/WH/JE
		T;N, Stat, Stat, Urine Random, spec type = Urine
	Ethanol Level
		T;N, Stat, spec type = Blood
	UA (Culture Pos)
		T;N, Routine, Routine, spec type = Urine
Diagnostic Tests
	CT Head w/o Contrast
		T+1;0600, Routine, Hemorrhage
			Comment: subarachnoid hemorrhage
	CT Head w Contrast
		T;N, Routine, Subarachnoid Hemorrhage
	CTA Head
		T;N, Routine, Hemorrhage
			Comment: subarachnoid hemorrhage
	CTA Neck
		T;N, Routine, Abnormal Findings
			Comment: subarachnoid hemorrhage
	MRI Brain w & w/o Contrast
		T;N, Routine, Cerebrovascular Accident/Stroke
	MRA Head w Contrast
		T;N, Routine, Stroke/CVA
	MRA Head w/o Contrast
		T;N, Routine, Stroke/CVA
	MRA Neck w/o Contrast
		T;N, Routine, Cerebrovascular Accident/Stroke
	Chest 2 View
		Stroke, T;N, Routine, Findings/Abnormal
IV Solutions
	Cardene 20mg/NS 200mL
		200 mL, IV, STAT, Start: T;N, Duration: 1 Dose(s)/Time(s), 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. Reduce by 2.5mg/hr every 15 minutes.   If the dose has been titrated twice within the specified timeframe and goal parameter is not achieved, the titration dose can be doubled until the ordered parameter is achieved or maximum dose is reached.  IV may be re-initiated after weaning within 12hours, re-initiate at the last dosing rate that maintained Goal parameter. Discontinue order after 12hr if patient does not require IV re-initiation.
		20 mg, EVERY BAG, 5 mg/hr, T;N
	Cardene 25 mg/NS 250 mL
		25 mg, EVERY BAG, 5 mg/hr, T;N+240
		250 mL, IV, Routine, Start: T;N+240, 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. Reduce by 2.5mg/hr every 15 minutes.   If the dose has been titrated twice within the specified timeframe and goal parameter is not achieved, the titration dose can be doubled until the ordered parameter is achieved or maximum dose is reached.  IV may be re-initiated after weaning within 12hours, re-initiate at the last dosing rate that maintained Goal parameter. Discontinue order after 12hr if patient does not require IV re-initiation.
	IV-Restart
		T;N, Q12H
			Comment: if peripheral site is used while on nicardipine
	Sodium Chloride 0.9% with KCl 20mEq
		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
	Keppra
		500 mg, Tab, By Mouth, BID, 3 Day(s)
	Dilantin IVPB
		15 mg/kg, Injection, IV, Once
		100 mg, INT, IVPB, Q8H, T;N+480, duration: 7 Day(s)
	Dilantin
		100 mg, Capsule-Extended-Release, By Mouth, Q8H, T;N+480, duration: 7 Day(s)
	hydrALAZINE
		10 mg, Injection, IV Push, Q1H, PRN
			Comment: BP Above Target >140mmHg
	Zofran
		4 mg, Injection, IV Push, Q6H, PRN, nausea
	niMODipine
		60 mg, By Mouth, Q4H, 21 Day(s)
			Comment: Notify pharmacy for NG dosing
	Tylenol
		650 mg, Tab, By Mouth, Q6H, PRN, fever
			Comment: >100.4
		650 mg, Suppository, RECTALLY, Q6H, PRN
			Comment: >100.4 and unable to take oral
	Pepcid
		20 mg, Injection, IV Push, BID
			Comment: convert to PO when taking PO
		20 mg, Tab, By Mouth, BID
	aluminum hydroxide/magnesium hydroxide/simethicone 200 mg-200 mg-20 mg/5 mL oral susp
		10 mL, Suspension-Oral, By Mouth, Q12H, indigestion
Patient Care
	Resuscitation Status
		T;N, Full Code
		T;N, No Code
	Neurological Assessment-Focused
		T;N, Q1H
	Intake and Output
		T;N
			Comment: strict I&O
	Elevate head of bed
		T;N, Elevate head of bed 30 degrees
	Foley Catheter
		T;N, Foley, Insert, Acute urinary retention | Critically ill-requires accurate output
			Comment: strict I&O
	Cardiac Telemetry Monitoring
		T;N, Telemetry Indications: Stroke/TIA
	Notify MD
		if SBP >160mmHg
		if temp >100.4
	Cough, Deep Breathe
		Q1HAWAKE
	Incentive Spirometer
		Q1HAWAKE
	Notify MD
		T;N, if no BM in 72 hours
		T;N, if o2 sat <92%
	Fall Precautions
		T;N
	Aspiration Precautions
		T;N
	Complete NIH Stroke Scale Form
		T;N, Now
	Complete Nurse Swallow Screen
		T;N, Now
			Comment: on admission
	Enteral Tube
		T;N, Per Nasogastric Tube (NG), Insert, X Ray
	Seizure Precautions
		T;N
	No Anticoagulants/antiplatelets/thrombolytics
		T;N
	Vital Signs/Hemodynamic Monitoring
		T;N, SBP goal<160mmHg unless otherwise directed by MD
	Sequential Compression Device
		T;N, Apply, Once
			Comment: knee high
Therapies
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID
	Consult Occupational Therapy, Evaluate and Treat
		T+1;0600, Order Dx: Stroke, Reason to See: Evaluate and Treat
			Comment: within 24 hours
	Consult Physical Therapy, Evaluate and Treat
		T+1;0600, For: Stroke, Order Dx: Stroke
			Comment: within 24 hours
	Consult Speech Language (MH), Evaluate and Treat
		T+1;0600, Stroke
			Comment: within 24 hours. MBS if appropriate. Order diet as recommended. Methodist Speech Therapy, call 402-354-4461 and leave a message for consult.
Consults/Follow-up
	Consult Dietitian
		Regarding: Nutrition Assessment
	Smoking Cessation Consult
		T;N
	Smoking Cessation Education RT (FH)
		T;N
	Consult Social Work
		T;N, Evaluation
	Consult Neurologist
		Reason for Referral: Stroke
	Consult Neurosurgery
		Reason for Referral: Stroke
	Consult Physical Medicine (Rehab)
		Reason for Referral: Stroke associated sequelae
			Comment: Place the patient on Dr. Rini Desai's list and notify Administrative Coordinator of Rehab at 402-354-4408 and leave a message.
	Consult Intensivist
		Reason for Referral: Stroke

Pain Constipation Nausea Protocol EKM
Medications
		Select only one medication in each category(NOTE)*
Mild Pain
	Tylenol
		650 mg, Tab, By Mouth, Q4H, PRN, see comment
			Comment: discomfort and/or pain-mild (pain rating 1-3) in opiate intolerant patient
		650 mg, Suppository, RECTALLY, Q6H, PRN, see comment
			Comment: discomfort and/or pain-mild (pain rating 1-3) in opiate intolerant patient
	ibuprofen
		600 mg, Tab, By Mouth, Q6H, PRN, pain-mild
			Comment: pain rating 1-3
		800 mg, Tab, By Mouth, Q8H, PRN, pain-mild
			Comment: pain rating 1-3
	Norco 5/325
		1 TAB, Tab, By Mouth, Q4H, PRN, pain-mild
			Comment: pain rating 1-3
	Percocet 5 mg-325 mg oral tablet
		1 TAB, Tab, By Mouth, Q4H, PRN, pain-mild
			Comment: pain rating 1-3
	Dilaudid Injectable
		0.2 mg, Injection, IV Push, Q2H, PRN, pain-mild
			Comment: for pain rating 1-3 and if NPO
	morphine  IV
		2 mg, Syringe, IV Push, Q2H, PRN, pain-mild
			Comment: for pain rating 1-3 and if NPO
Moderate Pain
	Norco 5/325
		1 TAB, Tab, By Mouth, Q4H, PRN, pain-moderate
			Comment: For pain rating 4-6. If inadequate relief after 1 hour, may repeat dose if pain level moderate (pain rating 4-6) to severe (pain rating 7-10).  If repeat dose given, administer next dose at 4hr minimum unless otherwise prescribed.
	Norco 7.5/325
		1 TAB, Tab, By Mouth, Q4H, PRN, pain-moderate
			Comment: For pain rating 4-6. If inadequate relief after 1 hour, may repeat dose if pain level moderate (pain rating 4-6) to severe (pain rating 7-10).  If repeat dose given, administer next dose at 4hr minimum unless otherwise prescribed.
	Norco 10/325
		1 TAB, Tab, By Mouth, Q4H, PRN, pain-moderate
			Comment: For pain rating 4-6. If inadequate relief after 1 hour, may repeat dose if pain level moderate (pain rating 4-6) to severe (pain rating 7-10).  If repeat dose given, administer next dose at 4hr minimum unless otherwise prescribed.
	Percocet 5 mg-325 mg oral tablet
		1 TAB, Tab, By Mouth, Q4H, PRN, pain-moderate
			Comment: For pain rating 4-6. If inadequate relief after 1 hour, may repeat dose if pain level moderate (pain rating 4-6) to severe (pain rating 7-10).  If repeat dose given, administer next dose at 4hr minimum unless otherwise prescribed.
	Percocet 7.5 mg-325 mg oral tablet
		1 TAB, Tab, By Mouth, Q4H, PRN, pain-moderate
			Comment: For pain rating 4-6. If inadequate relief after 1 hour, may repeat dose if pain level moderate (pain rating 4-6) to severe (pain rating 7-10).  If repeat dose given, administer next dose at 4hr minimum unless otherwise prescribed.
	Percocet 10 mg-325 mg oral tablet
		1 TAB, Tab, By Mouth, Q4H, PRN, pain-moderate
			Comment: For pain rating 4-6. If inadequate relief after 1 hour, may repeat dose if pain level moderate (pain rating 4-6) to severe (pain rating 7-10).  If repeat dose given, administer next dose at 4hr minimum unless otherwise prescribed.
	Roxicodone
		5 mg, Tab, By Mouth, Q4H, PRN, pain-moderate
			Comment: For pain rating 4-6. If inadequate relief after 1 hour, may repeat dose if pain level moderate (pain rating 4-6) to severe (pain rating 7-10).  If repeat dose given, administer next dose at 4hr minimum unless otherwise prescribed.
	morphine  oral immediate release
		15 mg, Tab, By Mouth, Q4H, PRN, pain-moderate
			Comment: Pain rating 4-6
	Dilaudid Injectable
		0.2 mg, Injection, IV Push, Q2H, PRN, pain-moderate
			Comment: For pain rating 4-6; may give if NPO or for breakthrough pain if on oral analgesics
		0.4 mg, Injection, IV Push, Q2H, PRN, pain-moderate
			Comment: For pain rating 4-6; may give if NPO or for breakthrough pain if on oral analgesics
	morphine  IV
		2 mg, Syringe, IV Push, Q2H, PRN, pain-moderate
			Comment: For pain rating 4-6; may give if NPO or for breakthrough pain if on oral analgesics
		4 mg, Syringe, IV Push, Q2H, PRN, pain-moderate
			Comment: For pain rating 4-6; may give if NPO or for breakthrough pain if on oral analgesics
	ketorolac injectable
		15 mg, Injection, IV Push, Q6H, PRN, pain-moderate, 48 hr
			Comment: For pain rating 4-6.
Severe Pain
	Norco 5/325
		2 TAB, Tab, By Mouth, Q4H, PRN, pain-severe
			Comment: Pain rating 7-10
	Norco 7.5/325
		2 TAB, Tab, By Mouth, Q4H, PRN, pain-severe
			Comment: Pain rating 7-10
	Percocet 5 mg-325 mg oral tablet
		2 TAB, Tab, By Mouth, Q4H, PRN, pain-severe
			Comment: Pain rating 7-10
	Percocet 7.5 mg-325 mg oral tablet
		2 TAB, Tab, By Mouth, Q4H, PRN, pain-severe
			Comment: Pain rating 7-10
	Percocet 10 mg-325 mg oral tablet
		2 TAB, Tab, By Mouth, Q4H, PRN, pain-severe
			Comment: Pain rating 7-10
	Roxicodone
		10 mg, Tab, By Mouth, Q4H, PRN, pain-severe
			Comment: Pain rating 7-10
	morphine  oral immediate release
		30 mg, Tab, By Mouth, Q4H, PRN, pain-severe
			Comment: Pain rating 7-10
	Dilaudid Injectable
		0.4 mg, Injection, IV Push, Q2H, PRN for pain-severe
			Comment: For pain rating 7-10 if NPO or for breakthrough pain if on oral analgesics. Use 0.4mg if over age 70.
		0.5 mg, Injection, IV Push, Q2H, PRN, pain-severe
			Comment: For pain rating 7-10 if NPO or for breakthrough pain if on oral analgesics. Use 0.4mg if over age 70.
		0.6 mg, Injection, IV Push, Q2H, PRN, pain-severe
			Comment: For pain rating 7-10 if NPO
		0.8 mg, Injection, IV Push, Q2H, PRN, pain-severe
			Comment: For pain rating 7-10 if NPO
		1 mg, Injection, IV Push, Q2H, PRN, pain-severe
			Comment: For pain rating 7-10 if NPO
	morphine  IV
		4 mg, Syringe, IV Push, Q2H, PRN, pain-severe
			Comment: For pain rating 7-10; may give if NPO or for breakthrough pain if on oral analgesics.
		6 mg, Syringe, IV Push, Q2H, PRN, pain-severe
			Comment: For pain rating 7-10; may give if NPO or for breakthrough pain if on oral analgesics.
		Opiate Reversal(NOTE)*
	Narcan
		0.2 mg, Injection, IV Push, Q2MIN, PRN for see comment
			Comment: if patient has received opiate agents in the past 24 hours and/or if patient becomes somnolent with minimal or no response to stimuli or respiratory rate is 10 or less per minute.  RN may administer naloxone prior to contacting MD.  Notify MD immediately upon administration of naloxone.  May give 0.2mg every 2 min up to 1mg total dose.
Constipation
	docusate
		100 mg, Capsule, By Mouth, DAILY
			Comment: Hold for diarrhea
	Senokot S 50 mg-8.6 mg oral tablet
		2 TAB, Tab, By Mouth, QHS
	MiraLax oral powder for reconstitution
		17 gm, Packet, By Mouth, Q12H, PRN, constipation
			Comment: Mix in 6 oz juice or water
		17 gm, Packet, By Mouth, DAILY, PRN, constipation
			Comment: Mix in 6 oz juice or water
	Milk of Magnesia 8% oral suspension
		30 mL, Suspension, By Mouth, DAILY, PRN for constipation
			Comment: If Miralax not effective; do not use if creatinine clearance or GFR < 30mL/min
		30 mL, Suspension, By Mouth, Q12H, PRN for constipation
			Comment: If Miralax not effective; do not use if creatinine clearance or GFR < 30mL/min
	Dulcolax
		10 mg, Suppository, RECTALLY, DAILY, PRN, constipation
			Comment: If MOM ineffective or if patient NPO
		10 mg, Suppository, RECTALLY, Q12H, PRN, constipation
			Comment: If MOM ineffective or if patient NPO
	Fleet Enema 19 gm-7 gm rectal enema
		1 EA, Enema, RECTALLY, Q12H, PRN, constipation
			Comment: If bisacodyl ineffective
	Enema-Administer
		Tap water, Q1H, constipation
			Comment: if suppository ineffective
Nausea Vomiting
	Zofran
		4 mg, Injection, IV Push, Q6H, PRN for nausea and/or vomiting
			Comment: Administer for nausea if not previously administered by anesthesia, PACU, or ED
		4 mg, Tablet-Disintegrating, By Mouth, Q6H, PRN for nausea and/or vomiting
			Comment: Administer for nausea if not previously administered by anesthesia, PACU, or ED
		Select either promethazine or prochlorperazine orders(NOTE)*
	prochlorperazine
		10 mg, Injection, IV Push, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures.
		25 mg, Suppository, RECTALLY, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures, give if IV access not available.
	Phenergan (MH/WH)
		25 mg, Tab, By Mouth, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures.
		25 mg, Suppository, RECTALLY, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
		6.25 mg, Injection, IV Push, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
	Phenergan (FH)
		12.5 mg, INT, IVPB, Once, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
		25 mg, INT, IVPB, Once, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
	Phenergan (JE)
		25 mg, Tab, By Mouth, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures
		25 mg, Suppository, RECTALLY, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
	Reglan
		10 mg, Injection, IV Push, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron and phenothiazine ineffective; avoid in patients > 65 y/o.
		10 mg, Injection, IM-Intramuscular, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron and phenothiazine ineffective; avoid in patients > 65 y/o.
Patient Care

	Notify MD
		If patient develops itching
		if no results from enema.

hs Troponin T - MH/WH/JE
Laboratory
	hs Troponin T - MH/WH/JE
		Stat, spec type = Blood
		T;N+120, Timed, spec type = Blood
		T;N+360, Timed, spec type = Blood

Insulin Drip (IV Infusion) Protocol
	Glucose POC - RN
		T;N, Q1H
		T;N, As needed for signs and symptoms of hypoglycemia
IV Solutions
		Discontinue any previous insulin and/or oral diabetic medication orders when starting insulin drip(NOTE)*
	insulin regular 50 units/NS 50 mL
		50 units, EVERY BAG, 2 units/hr
		50 mL, IV, Routine, Total Volume = 50
			Comment: concentration: 1 unit/mL, Initial rate based on initial glucose:  181-300: 2 units/hr;  301-400:  3 units/hr; 401 or greater: 4 units/hr;   Titrate infusion to target glucose of 120-180:  If glucose is:1) Less than 100 discontinue infusion,continue blood glucose monitoring and follow Insulin IV infusion hypoglycemia treatment parameters if necessary; restart drip at 1/2 previous rate when glucose >120.2) 100-120, decrease infusion by 1 unit/hr.3) 121-180, no change.4) 181-249, and is greater than or equal to the previous glucose, increase infusion by 0.5 unit/hr.5) 181-249, and is less than the previous glucose, maintain same rate.6) 250-350, increase infusion by 1 unit/hr.7) > 351, increase infusion by 2 unit/hr.  Contact MD if rate >10 unit/hr.  If the glucose decreases >75mg/dl from the last glucose check, decrease insulin rate by 50% and check blood glucose in 30 minutes. If enteral and/or parenteral nutrition support is stopped or held, decrease infusion to 0.5 unit/hour and notify physician
	Dextrose 5% with 0.45% NaCl
		1,000 mL, IV, Routine, 50 ml/hr, Total Volume = 1,000
			Comment: Begin if patient not currently on dextrose containing IV or TPN when glucose is 200 or less.  If patient has a current IV order that doesn't contain dextrose, add dextrose to that IV and do not start this D5/45 Order.
Medications
	insulin regular
		5 units, Solution-Injection, IV Push, Once, PRN, see comment
			Comment: Prior to starting insulin drip if initial blood glucose 301 or greater
	Dextrose 50% injection
		25 mL, Injection, IV Push, Q15MIN, PRN, blood glucose < ...., Routine
			Comment: For blood glucose <60mg/dL or 60-70mg/dL and patient unable to tolerate oral intake. Notify provider if given with corresponding POC glucose re-check value
		50 mL, Injection, IV Push, Q15MIN, PRN, blood glucose < ...., Routine
			Comment: For blood glucose <60mg/dL or 60-70mg/dL and patient unable to tolerate oral intake. Notify provider if given with corresponding POC glucose re-check value
	glucagon
		1 mg, Injection, IM-Intramuscular, Q15MIN, PRN for low blood sugar, Routine, T;N
			Comment: May give SQ or IV; give if glucose < 70mg/dL, patient unresponsive and does not have IV access, or if dextrose 50% injectable unavailable. Notify provider if given with corresponding POC glucose re-check value.
Patient Care
	Notify MD
		T;N, for instructions if dietary change: abrupt change in oral intake, change to NPO status, tube feedings are held or discontinued, TPN held or discontinued.  (caloric intake necessary to prevent hypoglycemia)
		T;N, If insulin requirements > 10units/hr for further instruction
	Notify MD of Lab results
		T;N, if blood glucose is not less than 180 after 6 hours on the Insulin IV Infusion protocol.
	IV Insulin Parameters
		T;N, Decrease infusion to 0.5 units/hour if enteral and/or parenteral nutrition support is stopped or held and notify physician.
		T;N, If the glucose decreases >75mg/dl from the last glucose check, decrease insulin rate by 50% and check blood glucose in 30 minutes.
		T;N, If initial glucose < 180, do not start infusion.  Enter order for blood glucose Q4H and start infusion if necessary based on parameters.
		T;N, When glucose </= 200, and patient not on a dextrose containing IV/TPN: add D5W to current IV.  Continue same IV base, electrolytes and rate.  If patient not currently on IV or TPN, initiate D5W/0.45% sodium chloride.
	Order Lab
		When glucose is in target range (121-180) for 6 hours, cancel glucose Q1H order and enter new glucose order Q2H.  If glucose falls out of target range, change glucose checks back to Q1H until in range again for 6 hours.
	Hypoglycemia Treatment Parameters
		T;N, If glucose </=60 mg/dL, discontinue infusion and give 25 mL of Dextrose 50%, and call MD. Repeat glucose 15 min after treatment. May repeat dextrose if blood glucose still < 55 or give juice as per protocol.
		T;N, If glucose 56-70 mg/dL, discontinue infusion and administer 120mL apple juice.  If patient NPO or unable to tolerate oral intake, may give Dextrose 50%, 25mL.  Repeat glucose in 15 minutes after treatment.    If repeat glucose is 56-70, give another
			Comment: 120mL apple juice or 25mL Dextrose 50% if NPO and call MD, repeat glucose in 15 minutes.  If repeat glucose is 71-120, do not restart infusion, continue to check blood glucose and monitor for hypoglycemia symptoms Q1H.
		T;N, When blood glucose is greater than 120 mg/dL, restart infusion at 1/2 previous rate and change glucose checks to every hour until glucose is in the target range (121-180) for 6 hours, then may change to Q2H glucose checks.
		T;N, When blood glucose is greater than 120mg/dl, restart infusion by ½ previous rate and change glucose checks to every hour until glucose is in the target range (121-180) for 6 hours, then may change to Q2H glucose checks
		T;N, Hypoglycemia protocol initiated for patients with glucose <70mg/dl.  Patient should have an IV while on insulin protocol.
		T;N, glucose <60 mg/dL, discontinue infusion and treat with Dextrose 50% 25 mL OR glucagon 1mg as per medication orders. Notify provider as per critical result protocol.
			Comment: Repeat treatment as outlined in hypoglycemia parameters. Notify provider of all treatments given and POC glucose recheck values. When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy
		T;N, T;N, glucose 60-70 mg/dL, discontinue infusion, and administer 4 oz apple juice, 4 oz non-diet soda, or glucose gel.  If patient NPO or unable to tolerate oral intake, give Dextrose 50% 25 mL OR glucagon 1mg as per medication orders.
			Comment: Repeat treatment as outlined in hypoglycemia parameters. Notify provider of all treatments given and POC glucose recheck values. When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy.
		T;N, After initial treatment of any glucose value </= 70 mg/dL, repeat POC glucose in 15 min; if result </= 70mg/dL continue treating as per protocol and rechecking glucose 15 min after treatment until glucose >70mg/dL.
			Comment: Notify provider of all treatments given and corresponding POC glucose recheck values. When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy.
		T;N, Once glucose is within normal limits, give 1 complex carb and 1 protein source (such as ½ sandwich OR 1 individual container of peanut butter and 3 packs of crackers) or patient meal if patient able to take orals to prevent recurrent hypoglycemia.
			Comment: When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy.

*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