Community acquired pneumonia care plan: medical admission orders James Campbell MD This order set provides guideline-based guidance for writing of admission orders to the medical ward for an adult patient (age 18 and older) with pneumonia contracted outside the hospital setting. Admission order set for adult with community acquired pneumonia Demonstrate to HL7 workgroups Admission / Discharge / Transfer Admit to hospital Admission status: Urgent Admitting physician: James Campbell James Campbell Referring physician: Craig Parker Craig Parker Prognosis: Admitting diagnosis: community acquired pneumonia Code status: Consults Bedside Nicotine Program Respiratory therapy consult Infectious disease consult P:ulmonary medicine consult Social service consult Vital signs and Assessments Vital signs per unit protocol Weigh patient daily for two days Intake and output daily for two days Electrocardiographic telemetry continuously Pulse oximetry continuously Monitor and record Relative perceived dyspnea Diet Encourage oral fluid intake Goal: body weight at prescribed weight by discharge Laboratory and Testing Arterial blood gases, one time, STAT Compehensive metabolic panel; one time; routine Basic metabolic panel; one time; routine Liver function panel; one time; routine Protime and PTT; one time; routine Blood culture aerobic and anaerobic; one time; STAT prior to antibiotic Treatments Oxygen by nasal cannula to maintain saturations above 90% Oxygen by mask to maintain saturations above 90% Turn cough and deep breathe per protocol Medications Administer antibiotics within four hours of admission Fluoroquinolone OR (Extended cephalosporin or beta lactam) plus a macrolide for uncomplicated case Moxifloxacin 400mg IV daily Extended cephalosporin or beta lactam Ceftriaxone 1 gram IV daily Ampicillin Sulbactam 3 grams IVPB q6h Macrolide Clarithromycin 500mg PO BID for 10 days Azithromycin 500mg IV for 3 days Suspected aspiration: Fuoroquinolone plus Clindamycin or Flagyl OR Penicillin beta lactam inhibitor Piperacillin / tazobactam 4.5 grams IV q4hours Moxifloxacin 400mg IV daily Anaerobic coverage: Clindamycin or Flagyl Clindamycin 300mg IV q6hours Metronidazole 7.5 mg/kg IV q6hours