Master of Science Nursing, Walden University
NRNP 6550
Admission Orders Template
Primary Diagnosis: Pulmonary Embolism secondary to deep vein thrombosis
Status/Condition (Critical, Guarded, Stable, etc.): Guarded
Code Status: Full
Code Allergies: NKDA
Admit to Unit: ICU
Activity Level: Bed rest
Diet: Consistent Carbohydrate 1800 calorie
, IV Fluids: NS 500cc bolus, followed by NS @ 100cc/hr IV
• Critical Drips (If ordered, include type and rate. Do not defer to ICU protocol.):
1. Heparin drip PE/DVT protocol- initiate at 80 units/kg bolus, followed by an infusion of 18
units/kg/hr (Prucnal et al., 2019)
Respiratory: Oxygen (If ordered, include type and rate.), pulmonary toilet needs, ventilator settings:
Oxygen via nasal cannula, titrate to achieve O2 saturation ≥ 92%, notify provider if greater than 6 lpm
required
Medications (include ALL, tx of primary condition, underlying conditions, pain, comfort needs, etc., dose
and route):
1. Hold blood pressure medications due to borderline blood pressure
2. Zofran 4mg IV every 4 hours PRN nausea
3. Nicotine patch 21mg transdermal daily
4. Acetaminophen 650 mg every 4 hours PRN mild pain or temp > 100.4 F
5. Hydrocodone/APAP 5/325 mg PO every 4 hours severe pain
6. Colace 100mg PO BID with 8 ounces of water
7. D50 25gm IV PRN for blood sugar < 50
8. Regular insulin sliding scale SC AC and HS
9. Potassium replacement protocol
10. Magnesium replacement protocol
Nursing Orders (vital signs, skin care, toileting, ambulation, etc.):
1. Continuous cardiac monitoring
2. Continuous pulse oximetry
NRNP 6550
Admission Orders Template
Primary Diagnosis: Pulmonary Embolism secondary to deep vein thrombosis
Status/Condition (Critical, Guarded, Stable, etc.): Guarded
Code Status: Full
Code Allergies: NKDA
Admit to Unit: ICU
Activity Level: Bed rest
Diet: Consistent Carbohydrate 1800 calorie
, IV Fluids: NS 500cc bolus, followed by NS @ 100cc/hr IV
• Critical Drips (If ordered, include type and rate. Do not defer to ICU protocol.):
1. Heparin drip PE/DVT protocol- initiate at 80 units/kg bolus, followed by an infusion of 18
units/kg/hr (Prucnal et al., 2019)
Respiratory: Oxygen (If ordered, include type and rate.), pulmonary toilet needs, ventilator settings:
Oxygen via nasal cannula, titrate to achieve O2 saturation ≥ 92%, notify provider if greater than 6 lpm
required
Medications (include ALL, tx of primary condition, underlying conditions, pain, comfort needs, etc., dose
and route):
1. Hold blood pressure medications due to borderline blood pressure
2. Zofran 4mg IV every 4 hours PRN nausea
3. Nicotine patch 21mg transdermal daily
4. Acetaminophen 650 mg every 4 hours PRN mild pain or temp > 100.4 F
5. Hydrocodone/APAP 5/325 mg PO every 4 hours severe pain
6. Colace 100mg PO BID with 8 ounces of water
7. D50 25gm IV PRN for blood sugar < 50
8. Regular insulin sliding scale SC AC and HS
9. Potassium replacement protocol
10. Magnesium replacement protocol
Nursing Orders (vital signs, skin care, toileting, ambulation, etc.):
1. Continuous cardiac monitoring
2. Continuous pulse oximetry
