Unique Plan Description: PMR Hemiplegia Admission (MH)
Plan Selection Display: PMR Hemiplegia Admission (MH)
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2023-12-12 08:08:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-07-29 08:10:35
Available at all facilities: Yes

PMR Hemiplegia Admission (MH)
Vital Signs
	Vital Signs
		QID, 1, week(s)
Medications
	sertraline
		50 mg, Tab, By Mouth, DAILY
Patient Care
	Prevalon Boot
		T;N, Apply bilaterally while in bed or recliner
	Patient Education
		T;N, Instructions: Initiate patient education and/or family education regarding foley management, ROM exercises, sling, limb care, limb neglect interventions, skin monitoring
	Activity-Position
		T;N, Elevate affected extremity
	Anti Embolism Stockings
		T;N, TED hose, knee high
		T;N, Juzo 20-30mmHG
			Comment: Discontinue if patient is hypertensive and not orthostatic.
	Compression Glove
		T;N, apply to affected hand
	Edema Wear-apply
		T;N, Location: Bilateral legs
	Turn patient
		T;N, Q2H-Sch
			Comment: While awake and during sleep. TAPS if needed. Seated Position System if needed.
	Rehab PHQ-2 to 9
		T;N, Q1WK
			Comment: Notify provider of result.
	Sleep Pattern Assessment
		T;N, 3, Day(s)
			Comment: initiate sleep log
	Day/Night Orientation
		T;N
			Comment: Encourage healthy day/night sleep cycle. Open shades during the day, encourage nighttime rest.
	Passive Range of Motion
		T;N, BID
			Comment: Affected extremities
Therapies
	IRF Physical Therapy Evaluation and Treatment
		T;N
			Comment: Consider early implementation of: neuromuscular electrical stimulation (Bioness, FES), robotic assisted therapies (exoskeleton), body weight supported gait training, neuromuscular re-education (forced use, weight bearing, overflow), lower extremity support (brace, Bioness, tape).Family/Patient Ed: ROM exercises, Sling/Brace, Neglect
	IRF Occupational Therapy Evaluation and Treatment
		T;N
			Comment: Consider early implementation of: neuromuscular electrical stimulation (FES), neuromuscular re-education (forced use, weight bearing, overflow), upper extremity support (sling, tape, brace), vision therapy.If spasticity is present, consider early implementation of splints (research proves improved outcomes compared to PROM exercises for reduction in spasticity)Notify provider of vision impairment to prompt consult for Neuro OphthalmologyFamily/Patient Ed: ROM exercises, Sling/Brace, Neglect
	IRF SLP Evaluation and Treatment
		T;N
			Comment: Consider early implementation of interventions for breathing, voice and swallowing interventions (electrical stimulation, Frazier Free Water Protocol, respiratory muscle training device)Consider early implementation of familiar items from home (labeled family photos)Family/Patient Ed: Swallow strategies, modified diet/liquid
	IRF Therapeutic Recreation Evaluation and Treatment
		T;N
			Comment: Consider Stroke Chat and peer support visit.
	Extended Rehab Therapy Schedule
		T;N
Consults/Follow-up
	Consult Diabetes Educator
		T;N, Needs Diabetic Assessment
			Comment: High Hgb A1C
	Consult Dietitian
		T;N, Regarding: Diet instructions, Dietitian Assess and Treat
		T;N, Regarding: Initiate oral supplements, Dietitian Assess and Treat
	Consult Behavioral Health
		Reason for Referral: Stroke, depression
	Consult Chaplain
		
	Consult Neuro Ophthalmologist
		Reason for Referral: neglect

PMR Hydration and Free Water Protocol
Diet
	Rehab Hydration Diet
		T;N
			Comment: When on thickened liquids, tray will include 120ml appropriately thickened water.
Medications
	chlorhexidine 0.12% oral rinse
		15 mL, Mouthwash, Q1H, PRN for see comment
			Comment: only unadulterated water ad lib with other applicable safe swallow strategies.
Patient Care
	Fluids-Increase
		
	Offer Fluids
		T;N, BID, Offer 60ml BID with medication administration. Document volume in I&O
		T;1500, Q24H, Offer 240ml daily at 3pm, Document volume in I&O
	Free Water Protocol
		
Therapies
	IRF Physical Therapy Evaluation and Treatment
		T;N
			Comment: Patient on Hydration Protocol
	IRF Occupational Therapy Evaluation and Treatment
		T;N
			Comment: Patient on Hydration Protocol
	IRF Speech Language Pathology Evaluation and Treatment
		T;N
			Comment: Patient on Hydration Protocol
	IRF Therapeutic Recreation Evaluation and Treatment
		T;N
			Comment: Patient on Hydration Protocol

*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