Unique Plan Description: Ketamine Low Dose Infusion
Plan Selection Display: Ketamine Low Dose Infusion
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2025-06-10 13:14:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-06-10 13:14:00
Available at all facilities: Yes

Ketamine Low Dose Infusion
Vital Signs
	Vital Signs
		T;N, (heart rate, blood pressure, respiratory rate, oxygen saturation, and ETC02)
			Comment: Prior to Initiation, and then every 15 minutes x 4 after a bolus dose or initiation of infusion x4, then hourly and prn any dose adjustments (per provider order) while on continuous infusion
Laboratory
	Blood Gases Arterial (ABG) - MH/WH/JE
		T+1;0400, Routine, Q24H, spec type = Blood
		T+1;0400, Routine, spec type = Blood
	Blood Gases Arterial (ABG) - FH
		T+1;0400, Routine, Q24H, spec type = Blood
		T+1;0400, Routine, spec type = Blood
	Blood Gases VENOUS (VBG)
		T+1;0400, Routine, Q24H, spec type = Blood
		T+1;0400, Routine, spec type = Blood
IV Solutions
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	ketamine IVPB
		0.3 mg/kg, INT, IVPB, Once, STAT
			Comment: Loading dose (max 50mg). Dose using ideal body weight (IBW)
	ketamine 200mg/NS 250mL Premix IV
		250 mL, IV, Routine, T;N
			Comment: Max dose 10mg/hr. Dose using ideal body weight (IBW). Provider directed increase or decrease in dose - no nurse titration. Stop infusion if HR< 50 or >120, or SBP <90mmhg, or for CNS effects (Hallucinations, paranoia, tremors, diplopia, confusion and notify Provider for further direction. Notify provider for excessive oral and/or airway secretions.
		200 mg, EVERY BAG, 0.05 mg/kg/hr
Medications
	glycopyrrolate
		0.2 mg, Injection, IV Push, Q6H, PRN secretions
			Comment: as needed for hyper-salivation or excessive secretions
	LORazepam Injectable
		1 mg, Injection, IV Push, Q3H, PRN see comment, duration: 2 Dose(s)/Time(s)
			Comment: psychotomimetic effects (Hallucinations, paranoia, tremors, diplopia, confusion)
Patient Care
	Assess RASS
		T;N, Q15MIN, 4, Dose(s)/Time(s)
		T;N+60, Q1H
			Comment: While on continuous infusion and PRN for any dosage adjustments as directed by provider
	Pain Assessment
		T;N, Q15MIN, 4, Dose(s)/Time(s)
		T;N+60, Q1H
			Comment: While on continuous infusion and PRN for any dosage adjustments as directed by provider
	Notify MD
		If SBP <90 or >180 mmHg, MAP < 65, HR< 50bpm or >120bpm, RASS < -2.
		For excessive oral and/or airway secretions or other CNS effects (Hallucinations, paranoia, tremors, diplopia, nystagmus and confusion).
	Monitor for CNS effects
		T;N, Q15MIN, 4, Dose(s)/Time(s), Monitor for Hallucinations, paranoia, tremors, diplopia, nystagmus and confusion
			Comment: while on continuous infusion and prn any dosage adjustments. If symptoms noted, Stop infusion and notify provider for further direction
		T;N+60, Q1H, Monitor for Hallucinations, paranoia, tremors, diplopia, nystagmus and confusion
			Comment: while on continuous infusion and prn any dosage adjustments. If symptoms noted, Stop infusion and notify provider for further direction
Therapies
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID
	End Tidal CO2 (ETCO2) Monitoring
		T;N
			Comment: Continuous while medication infusing.
Consults/Follow-up
	Pharmacy Consult
		Ketamine ordered.  Review opioids/pain medications for potential dose reduction and discuss with ordering provider.

*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