Atrial Fibrillation Admission Orders

Date and time: Name: Age: Allergies: DOB:

1. Admit to: [ X ] Acute Care [ ] Day Bed [ ] SCUnit [ X ] Telemetry 2. Attending Dr: Younger 3. Admitting Dx: atrial fibrillation with an uncontrolled ventricular rate. 4. Contributing Dx:

5. Condition: [ X ] Stable [ ] Fair [ ] Serious [ ] Critical 6. VS: qid with blood pressure sitting and standing. Weight on admission and each AM. 7. Activity: Up with assistance. 8. Nursing: I/O Q shift. 9. Diet: DASH diet. 10. IV: Saline lock plus the cardizem drip. 11. Meds: Tylenol 1000 mg PO Q 4 hr prn pain. Milk of Magnesia, 30 ml by mouth at bedtime as needed for constipation. Ambien 5 mg, one tablet by mouth at bedtime and may repeat X 1 if needed for sleep. 12. Other Meds: Cardizem 20 mg IV bolus given in the ER, and should be followed by a 5 mg/hour constant infusion. If the heart rate is still > 100/min in 4 hours, then the infusion should be increased to 10 mg/hour. Amiodarone 200 mg, 2 tablets by mouth tonight, and then tomorrow, start 200 mg by mouth 3 times a day. Lovenox 1 mg/kg sub cu every 12 hours. No ASA or Plavix, until the patient has been in a normal sinus rhythm for 12 hous. Then, the Lovenox can be stopped and aspirin 325 mg can be restarted at one tablet by mouth daily. NTG 1/150th grain, one tablet dissolved under the tongue every 3 to 5 minutes for up to 3 doses as needed for chest pain. If the pain isn’t relieved in 15 minutes do an EKG, troponin I, CPK level, CK-MB band and call the physician. 13. Labs: CBC, chem 7, LFTs, cardiac enzymes, and TSH today. EKG on admission and if he converts to Normal Sinus Rhythm- may do the following AM if after 5 PM; Chest x-ray portable. Tomorrow, do cardiac enzymes, EKG, CBC and a chem. 14. Other: Call MD if: altered mental status, T 101F or higher, chest pain, pulse < 40 or >150. 15. H&P: Type up the dictated H&P. 16. Consultants: None. 17. Respiratory Please keep the patient on oxygen at 2 liters per minute by nasal Therapy: cannula overnight, and then try daily to titrate to room air as long as the SpO2 level stays above 90%.

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