Critical Care Cardiothoracic Surgery Atrial Fibrillation Management [30400733]
Height______Weight______Allergies______
Note to Physician Discontinue previous amiodarone, diltiazem and metoprolol orders
General
Notify Provider [X] Notify provider Routine, Until discontinued, Starting today Pulse greater than: 120 ______Respiratory rate less than: ______Respiratory rate greater than: ______Temperature greater than (celsius): ______Urine output less than (mL/hr): ______Systolic BP greater than: ______Systolic BP less than: 90 ______Diastolic BP greater than: ______Diastolic BP less than: ______Other: Pulse less than 60 - If Temporary Pacing Wires not present, notify surgeon - Prior to administering medications for atrial fibrillation management, Notify surgeon or physician asistant. Temporary pacing is required. Diltiazem infusion at maximum dose of 15mg/hour. Respiratory status change requiring increased oxygen supply. Hemodynamic instability not covered above [ ] Other
Nursing Interventions [X] Nursing Communication Routine, Until discontinued, Starting today Systolic BP greater than: 90 ______Pulse less than: 120 ______Pulse greater than: 70 ______A-fib status: ______(Required) Prior to administering medications for atrial fibrillation management, connect temporary pacemaker and target vital signs parameters. Prior to administering medications for atrial fibrillation management, ensure external defibrillator/pacemaker immediately available. [ ] Other
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PROVIDER ORDERS
Medications Amiodarone [ ] Amiodarone [ ] Administer initial amiodarone bolus Dose: 150 mg ______Route: IntraVENous ______Frequency: Once ______Duration: for 10 Minutes, Administer over 20 minutes if systolic blood pressure less than 100 mmHg Routine [ ] amiodarone (CORDARONE) infusion Dose: 1 mg/min ______Route: IntraVENous ______Frequency: Titrated ______Duration: 1 mg/minute for 6 hours, then decrease to 0.5 mg/minute. Discontinue 2 hours after first amiodarone oral dose Routine [ ] amiodarone (PACERONE) tablet Dose: 400 mg ______Route: Oral ______Frequency: 2 times daily PRN PRN Comment: change to BID scheduled if patient converts to Normal Sinus Rhythm. If patient converts to normal sinus rhythm - Nurse to send Rx message - Reason = Adjust Times - requesting pharmacist to change frequency to BID [not PRN]. Stop amiodarone infusion 2 hours after first oral dose. Routine [ ] Administer second amiodarone bolus Dose: 150 mg ______Route: IntraVENous ______Frequency: As needed ______Duration: for 10 Minutes, PRN comment: If patient returns to atrial fibrillation after converting to sinus rhythm, administer second amiodarone bolus and continue amiodarone PO Administer over 20 minutes if systolic blood pressure less than 100 mmHg Routine
[ ] Other
Diltiazem (Cardizem) 4 hours after initiation of amiodarone infusion, if heart rate remains greater than 120 beats per minute and systolic blood pressure greater than 90 mmHg, initiate diltiazem [ ] Diltiazem (Cardizem) [ ] Administer initial diltiazem bolus Dose: 0.25 mg/kg ______Route: IntraVENous ______Frequency: Once ______Admin Instructions: Maximum dose 15 mg Requires Cardiac Monitor Routine
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PROVIDER ORDERS
[ ] Diltiazem infusion at 5 mg/hour (maximum rate is 15 mg/hour) Dose: 5 mg/hr ______Route: IntraVENous ______Frequency: Titrated ______Admin Inst: Increase by 5 mg/hour every 15 minutes to achieve target parameters. Requires cardiac monitor. Routine [ ] Administer second diltiazem bolus Dose: 0.35 mg/kg ______Route: IntraVENous ______Frequency: Once ______Admin Instructions: Maximum dose 20 mg Administer if heart rate remains greater than 120 and systolic blood pressure greater than 90 mmHg 15 minutes after initiation of first diltiazem IV loading dose. Requires Cardiac Monitor Routine [ ] diltiazem infusion 1 mg/mL Dose: 2-10 mg/hr ______Route: IntraVENous ______Frequency: Titrated ______Admin Inst: Continue titrating diltiazem infusion to target parameters and/or maximum rate of 15 mg/hour. Routine
[ ] Other
Metoprolol (Lopressor) If patient tolerating diltiazem infusion and within target parameters, initiate metoprolol. [ ] Metoprolol (Lopressor) [ ] Start metoprolol Dose: 25 mg ______Route: Oral ______Frequency: Every 6 hours ______If patient tolerating diltiazem infusion and within target parameters. Hold if HR < 70 or SBP < 90 mmHg. Routine [ ] Begin tapering diltiazem infusion off two hours after first PO Priority: Routine, dose Frequency: Until discontinued, Starting today Decrease dose by 2 mg/hour every 15 minutes while maintaining heart rate and blood pressure within the target parameters until infusion off. [ ] Hold metoprolol if heart rate less than 70 beats per minute or Routine, Until discontinued, systolic blood pressure less than 90 mmHg Starting today
[ ] Other
Date/Time:______Printed Name of Ordering Provider:______
Provider Signature: ______
Date/Time:______RN Acknowledged: ______
Date/Time ______Provider Initial:______Page 3 of 3 PATIENT INFORMATION Critical Care Cardiothoracic Surgery Atrial Fibrillation Management [30400733]
PROVIDER ORDERS