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Impella Device Post Procedure [30400924] Impella Device Post Procedure [30400924] Height_____________________ Weight_____________________ Allergies____________________ General Vital Signs [X] Frequent vital signs Indication: Q15 minutes x (# of occurrences): 4 Q30 minutes x (# of occurrences): 4 Q1 hour x (# of occurrences): Q2 hours x (# of occurrences): Q4 hours x (# of occurrences): Then: Q1h Until discontinued, Starting today [X] Check temperature Routine, Every 2 hours, Starting today, If temperature greater than 38.5 C initiate Evaluation for Possible Sepsis Physician Order #829 [X] Asses Arterial access and distal pulses Indication: Q15 minutes x (# of occurrences): 4 Q30 minutes x (# of occurrences): 4 Q1 hour x (# of occurrences): Q2 hours x (# of occurrences): Q4 hours x (# of occurrences): Then: Q1h Until discontinued, Starting today Monitoring [X] Document Device Monitoring Per Impella Flow Sheet Routine, Until discontinued, Starting today [X] Hemodynamic monitoring Routine, Until discontinued, Starting today, Per protocol Notify Physician [X] For Impella flow less than *** L/Minute, for greater than 10 Routine, Until discontinued, Starting today, For Impella flow less than minutes, or if flow state unresolved *** L/Minute, for greater than 10 minutes, or if flow state unresolved [X] For signs of hemolysis or hematuria. Impella may need to be Routine, Until discontinued, Starting today, For signs of hemolysis or repositioned. hematuria. Impella may need to be repositioned. Provider Initial:______________ Page 1 of 5 PATIENT INFORMATION Impella Device Post Procedure [30400924] 924 PHYSICIAN ORDERS [X] If improper Impella positioning is suspected. Follow Routine, Until discontinued, Starting today, If improper Impella troubleshooting guidelines per operator manual positioning is suspected. Follow troubleshooting guidelines per operator manua [X] Notify attending Cardiologist for any signs of active bleeding or Routine, Until discontinued, Starting today, Notify attending if unable to obtain blood sample Cardiologist for any signs of active bleeding or if unable to obtain blood sample Activity [X] Strict Bed rest Routine, Until discontinued, Starting today, Patient may be rolled from side to side. Leg with pump insertion site must be kept straight. [X] Knee Immobilizer Routine, As needed, Starting today [X] Elevate HOB Routine, Until discontinued, Starting today Elevate HOB: Less than 30 degrees SAH, SCH, SFH, SJMC Nursing Interventions [X] 1:1 Nursing Required While on Impella Device Routine, Until discontinued, Starting today [X] Apply Dressing Routine, Until discontinued, Starting today, Dry, sterile dressing to site [X] Continue to check ACT every hour, goal range = 160-180/sec Routine, Until discontinued, Starting today, Use ACT for heparin dose while on heparin adjustments per Attending Cardiologist. [X] Check aPTT every 6 hours, begin 6 hours after initiation of Routine, Until discontinued, Starting today, Use ACT to adjust heparin heparin infusion (ideal goal range for aPTT = 60-90 seconds) Harrison Nursing Interventions [X] 1:1 Nursing Required While on Impella Device Routine, Until discontinued, Starting today [X] Apply Dressing Routine, Until discontinued, Starting today, Dry, sterile dressing to site [X] Check aPTT every 6 hours, begin 6 hours after initiation of Routine, Until discontinued, Starting today, Use ACT to adjust heparin heparin infusion (ideal goal range for aPTT = 60-90 seconds) Resuscitation [X] Nursing communication Routine, Until discontinued, Starting today, 1) Initiate CPR per ACLS guidelines as indicated 2) Obtain portable chest x-ray or echocardiogram per physician discretion 3) Decrease performance level to P2 as soon as possible 4) Impella does not have to be stopped or unplugged to defibrillate Labs SAH, SCH, SFH, SJMC Chemistry [ ] CK total and CKMB Every 2 hours, Starting today with First Occurrence Include Now For 4 Occurrences [ ] Troponin I Every 2 hours, Starting today with First Occurrence Include Now For 4 Occurrences [ ] B-type natriuretic peptide Start now, Starting today For 1 Occurrences [ ] B-type natriuretic peptide Morning draw, Starting tomorrow For 3 Occurrences Provider Initial:______________ Page 2 of 5 PATIENT INFORMATION Impella Device Post Procedure [30400924] 924 PHYSICIAN ORDERS [ ] Basic metabolic panel Start now, Starting today For 1 Occurrences [ ] Basic metabolic panel Morning draw, Starting tomorrow For 3 Occurrences Harrison Chemistry [ ] CK total and CKMB Now then every 6 hours, Starting today For 3 Occurrences [ ] Troponin I Now then every 6 hours, Starting today For 3 Occurrences [ ] Pro Brain Natriuretic Peptide Start now, Starting today For 1 Occurrences [ ] Pro Brain Natriuretic Peptide Morning draw, Starting tomorrow For 3 Occurrences [ ] Basic metabolic panel Start now, Starting today For 1 Occurrences [ ] Basic metabolic panel Morning draw, Starting tomorrow For 3 Occurrences SAH, SCH, SFH, SJMC Hematology [ ] CBC, no diff (hemogram) As needed, Starting today Per Protocol Harrison Hematolgy [ ] CBC, no diff (hemogram) Morning draw, Starting today For 1 Occurrences [ ] Haptoglobin Morning draw, Starting today For 1 Occurrences SAH, SCH, SFH, SJMC Coagulation [ ] POCT activated clotting time Routine, As needed, Starting today For Until specified, Per protocol [ ] Protime-INR As needed, Starting today For Until specified Per protocol [ ] Activated partial thromboplastin time As needed, Starting today Per Protocol [ ] Fibrinogen As needed, Starting today Per Protocol [ ] POCT occult blood stool Routine, As needed, Starting today, While on heparin Harrison Coagulation [ ] Protime-INR As needed, Starting today For Until specified Per protocol [ ] Activated partial thromboplastin time Once, Starting today For 1 Occurrences Upon arrival to unit [ ] Activated partial thromboplastin time As needed, Starting today Per Protocol [ ] Fibrinogen As needed, Starting today Per Protocol [ ] POCT occult blood stool Routine, As needed, Starting today, While on heparin Microbiology [X] Blood culture As needed, Starting today For temperatures greater than 38.5 C (oral temperature or equivalent) [X] Wound culture and gram stain As needed, Starting today Specimen Source: _______________________________ Required For temperatures greater than 38.5 C (oral temperature or equivalent) Provider Initial:______________ Page 3 of 5 PATIENT INFORMATION Impella Device Post Procedure [30400924] 924 PHYSICIAN ORDERS [X] Respiratory culture and gram stain As needed, Starting today For temperatures greater than 38.5 C (oral temperature or equivalent). [X] Urine culture As needed, Starting today For Until specified For temperatures greater than 38.5 C (oral temperature or equivalent) Imaging Imaging [X] X-ray chest AP portable STAT, Daily imaging, Starting today For 1 On arrival to unit Reason for Exam: _______________________________ Required Is the patient pregnant? __________________________ Required Reason for Exam (USE SIGNS AND SYMPTOMS): Transport Mode: Transport Mode: Bed [ ] X-ray chest AP portable Routine, Daily imaging, Starting tomorrow For 3 Occurrences Every AM Reason for Exam: _______________________________ Required Is the patient pregnant? __________________________ Required Reason for Exam (USE SIGNS AND SYMPTOMS): Transport Mode: Transport Mode: Bed Cardiac Studies Cardiac Studies [ ] ECG 12 lead Routine, Daily, Starting today Reason for Exam (Signs & Symptoms): ______________________________________________ Required ECG every am while on device support [ ] ECG 12 lead Routine, As needed, Starting today Reason for Exam (Signs & Symptoms): ______________________________________________ Required For chest pain [ ] Echocardiogram Routine, Once, Starting today For 1 Occurrences Portable: Yes Portable Echocardiogram on arrival to unit for LVAD placement assessment Device Maintenance Device Maintenance [ ] Change Cassette every 72 hours Routine, Until discontinued, Starting today, Change Cassette every 72 hours [ ] heparin 25,000 units in D20W 500 ml 4-20 mL/hr, Other, Continuous PRN, other Purge solution, infusion tubing change every 24 hours Routine [ ] Dextrose 20% infusion 10-15 ml/hr, Intravenous, Continuous, Starting Today at 1300 For impella device. Rat is 10 – 15 /hr auto adjusted by the Impella Routine Provider Initial:______________ Page 4 of 5 PATIENT INFORMATION Impella Device Post Procedure [30400924] 924 PHYSICIAN ORDERS Medications Anticoagulation [ ] heparin infusion 50 units/mL in 0.45% NaCl 12 Units/kg/hr, IntraVENous, Continuous Use standard heparin infusion concentration of 50 units/mL and infusion pump. Routine [X] Hold Heparin infusion Routine, Until discontinued, Starting today, Hold Heparin infusion for active, life-threatening bleeding or per Attending Cardiologist [X] Heparin hold or dose adjustment Routine, Until discontinued, Starting today, Heparin hold or dose adjustment must be reassessed at least every 4 hours by the Attending Cardiologist Date:_______ Time:________ Printed Name of Ordering Provider:____________________________________________________________________ Provider Signature:_______________________________________________________________________________ Date:_______ Time:_______ RN Acknowledged: _______________________________________________________________________________ Provider Initial:______________ Page 5 of 5 PATIENT INFORMATION Impella Device Post Procedure [30400924] 924 PHYSICIAN ORDERS .
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