Unique Plan Description: Hospitalist Heart Failure Admission
Plan Selection Display: Hospitalist Heart Failure Admission
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2025-12-18 16:06:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-12-18 16:06:00
Available at all facilities: Yes

Hospitalist Heart Failure Admission
Vital Signs
	BP and Pulse, Orthostatic
		T; N, Once
		T;N, DAILY
		T;N, BID
Diet
	Sodium Restricted Diet
		T;N, 2000 mg (2 gm) Sodium (Low Sodium)
	Fluid Restriction
		2000 ml/per day
Laboratory
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	Iron Panel - MH/WH/JE
		T+1;0400, Routine, spec type = Blood
	Ferritin
		T+1;0400, Routine, spec type = Blood
Diagnostic Tests
	Echo w Doppler resting
		Indication: Congestive heart failure
Medications
Diuretic
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	furosemide injection
		40 mg, Injection, IV Push, Once
			Comment: administer over 1-2 min
		40 mg, Injection, IV Push, Once, PRN see comment, T;N +360
			Comment: 6 hours after initial dose may give 40 mg once if urine output 500-1000 mL 6 hr after first diuretic dose; administer over 2-3 min (give either 40 mg or 80 mg once based on urine output, do not give both)
		80 mg, Injection, IV Push, Once, PRN see comment, T;N +360
			Comment: Comment: 6 hours after initial dose may give 80 mg once give if urine output <500 mL 6 hr after first diuretic dose; administer over 3-5 min (give either 40 mg or 80 mg once based on urine output, do not give both)
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		100 mg, Injection, IV Push, Once
			Comment: administer over 2-3 minutes
		100 mg, Injection, IV Push, Once, PRN see comment, T;N +360
			Comment: 6 hours after initial dose may give 100 mg once if urine output 500-1000 mL 6 hr after first diuretic dose; administer over 2-3 min (give either 100 mg or 200 mg once based on urine output, do not give both)
		200 mg, Injection, IVPB, Once, PRN see comment, T;N +360
			Comment: 6 hours after initial dose may give 200 mg once if urine output 500-1000 mL 6 hr after first diuretic dose; administer over 2-3 min (give either 100 mg or 200 mg once based on urine output, do not give both)
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		200 mg, IVPB, Once
			Comment: administer over 60 minutes
		200 mg, IVPB, Once, PRN see comment, T;N +360
			Comment: 6 hours after initial dose may give if urine output < 1000 mL, administer over 60 min
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	bumetanide
		2.5 mg, Injection, IV Push, Once
			Comment: Administer over 3 minutes.
		2.5 mg, Injection, IV Push, Once, PRN see comment, T;N +360
			Comment: 6 hours after initial dose may give if urine output 500-1000 mL; administer over 3 min (give either 2.5 mg or 5 mg once based on urine output, do not give both)
		5 mg, Injection, IV Push, Once, PRN see comment, T;N +360
			Comment: 6 hours after initial dose may give if urine output < 500 mL; administer over 5 min (give either 2.5 mg or 5 mg once based on urine output, do not give both)
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		5 mg, Injection, IV Push, Once
			Comment: Administer over 3 minutes.
		5 mg, Injection, IV Push, Once, PRN see comment, T;N +360
			Comment: 6 hours after initial dose may give if urine output 500-1000 mL; administer over 3 min (give either 5 mg or 7.5 mg once based on urine output, do not give both)
		7.5 mg, Injection, IV Push, Once, PRN see comment, T;N +360
			Comment: 6 hours after initial dose may give if urine output < 500 mL; administer over 5 min (give either 5 mg or 7.5 mg once based on urine output, do not give both)
Scheduled Medications
	furosemide injection
		40 mg, IVPB, BID
		80 mg, IVPB, BID
		100 mg, IVPB, BID
		120 mg, IVPB, BID
	furosemide 200mg/NS 100mL
		100 mL, IV, 5 ml/hr
		200 mg, EVERY BAG, 10 mg/hr
Potassium Supplement
	potassium chloride Oral
		20 mEq, Tablet-Extended-Release, By Mouth, DAILY
		40 mEq, Tablet-Extended-Release, By Mouth, DAILY
		20 mEq, Tablet-Extended-Release, By Mouth, Q6H, duration: 2 Dose(s)/Time(s)
		40 mEq, Tablet-Extended-Release, By Mouth, Q6H, duration: 2 Dose(s)/Time(s)
Patient Care

	Intake and Output
		Q6H-Sch, 24, hr
	Patient Education
		Instructions: Provide the "Heart Failure Zone Log" Calendar
	Cardiac Telemetry Monitoring
		Telemetry Indications: Acute Decompensated HF
	Notify MD
		If Urine Output <500 mL in first 6 hours of admission
		if any of the following: no improvement in dyspnea, c/o dyspnea at rest, pt cannot lay flat secondary to dyspnea.
Therapies
	Oxygen Therapy
		T;N, Titrate/wean to keep: > or = to 90%
	Pulse Oximetry Spot Check RT
		T;N, BID
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID
	Smoking Cessation Education
		
Consults/Follow-up
	Consult Cardiologist
		Reason for Referral: CHF, Refer to/Consult with: Heart Consultants, Special Instructions No provider notified.
	Consult Social Work
		Discharge Planning
			Comment: Assess for patient resources including medication barriers, food insecurities, and transportation to appointments.
	Consult Dietitian
		Regarding: Nutrition Assessment
	Consult Cardiac Rehab: Inpatient
		Indications Heart Failure
	Consult Cardiac Rehab: Outpatient
		Indications Heart Failure
	Consult Care Navigator
		Education
	Consult APRN
		T;N, Consult Heart Failure Clinic APRN Call Heart Consultants at 402-391-5055 to schedule an appointment in the next 3-5 days.
	Consult Inpatient Palliative Care
		Reason for Consult Goals of care
	Consult Outpatient Palliative Care
		Goals of care

*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