Community acquired pneumonia care plan: medical admission orders
JamesCampbellMDJamesCampbellMDJamesCampbellMDJamesCampbellMDThis 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 pneumoniaDemonstrate to HL7 workgroupsAdmission / Discharge / TransferAdmit to hospitalAdmission status: UrgentAdmitting physician: James CampbellJames CampbellReferring physician: Craig ParkerCraig ParkerPrognosis:Admitting diagnosis: community acquired pneumoniaCode status:ConsultsBedside Nicotine ProgramRespiratory therapy consultInfectious disease consultP:ulmonary medicine consultSocial service consultVital signs and AssessmentsVital signs per unit protocolWeigh patient daily for two daysIntake and output daily for two daysElectrocardiographic telemetry continuouslyPulse oximetry continuouslyMonitor and record Relative perceived dyspneaDietEncourage oral fluid intakeGoal: body weight at prescribed weight by dischargeLaboratory and TestingArterial blood gases, one time, STATCompehensive metabolic panel; one time; routineBasic metabolic panel; one time; routineLiver function panel; one time; routineProtime and PTT; one time; routineBlood culture aerobic and anaerobic; one time; STAT prior to antibioticTreatmentsOxygen by nasal cannula to maintain saturations above 90%Oxygen by mask to maintain saturations above 90%Turn cough and deep breathe per protocolMedicationsAdminister antibiotics within four hours of admissionFluoroquinolone OR (Extended cephalosporin or beta lactam) plus a macrolide for uncomplicated caseMoxifloxacin 400mg IV dailyExtended cephalosporin or beta lactamCeftriaxone 1 gram IV dailyAmpicillin Sulbactam 3 grams IVPB q6h MacrolideClarithromycin 500mg PO BID for 10 daysAzithromycin 500mg IV for 3 daysSuspected aspiration: Fuoroquinolone plus Clindamycin or Flagyl OR Penicillin beta lactam inhibitorPiperacillin / tazobactam 4.5 grams IV q4hoursMoxifloxacin 400mg IV dailyAnaerobic coverage: Clindamycin or FlagylClindamycin 300mg IV q6hoursMetronidazole 7.5 mg/kg IV q6hours