DATE _________________________________________________ Time _____________________________________ 1. Admit to Service of ______________________________________________________________
2. Allergies: ____________________________________________________________________________________
3. Admit to:
4. Diagnosis:
Additional Diagnoses: ___________________________________________________________________________
5. Condition:
6. Code Status:
7. Nursing Documentation:
Other______________________________________
Daily Weights (kg) / I&O and record on admission and daily.
Saline lock or IV fluids: ____________________________________________________________________
9. Activity:
10. Diet:
11. Fluids:
Fluid Restriction _________________ml/day
12. Medication Choices:
Pharmacy to dose all medication for creatinine clearance.
Ceftriaxone (Rocephin) 1 gram IV every 24 hours and Doxycycline 100mg every 12 hours
Other ________________________________________________________________
Other ________________________________________________________________
Acetaminophen 650 mg orally every 4 hours prn temp greater than 100.5 F or mild pain / headache not to
Other______________________________________________________________________
Milk of Magnesia 1-4 tablespoons orally every day – titrate to soft stools
Other__________________________________________________________
Other_________________________________________
Other_________________________________________
Continued on page 2
8761-EH03 (12-16-08)
PATIENT LABEL PNEUMONIA ORDERS Page 2 of 2
Other : _______________________________________________________________________________________
Other : _______________________________________________________________________________________
Other : _______________________________________________________________________________________
Other : _______________________________________________________________________________________
Other : _______________________________________________________________________________________
Other : ________________________________________________________________________________-______ 14. Diagnostic Studies:
15. Admit Lab:
Blood Cultures x2, 15 minutes apart from different sites, prior to antibiotics
Sputum gram stain and culture. If patient not able to provide sample within 15 minutes, RT to induce with
2.5 mg Albuterol in 2.5cc normal saline. If patient cannot provide a sample within 30 minutes, consider nasal
Other ____________________________________________________________________________
16. Lab in AM: _______________________________________________________________________________________
17. Respiratory:
O2 __________________________________________________________
SVN with Albuterol + 2.5 mg QID / PRN or
SVN with/2.5 mg Albuterol + 0.5 mg Atrovent QID / PRN
Advair 100/50 1 click every am or
Other: ________________________________________________________________________________________
18. Assessments/Consultations:
Other ___________________________________________
Smoking cessation counseling/education if patient smoked in last year
19. Discharge planning:
_______________________________________________________________________________________ Physician’s Signature
PATIENT LABEL
Amaryllis´ Blooming Words by DI Isabella Burtscher-Pap JÄNNER: Steinbock-Saturn Was macht den Steinbock so anmutig in seinem Pflichtbewusstsein, was so klassisch in seiner Disziplin? Eine Antwort darauf gibt Freund Saturn, zugehöriger Planet zu diesem Tierkreiszeichen des Jahresbeginns. Saturn ist der weise alte Mann im Planetenreigen, auch der verhärtete Widersacher. S
PNEUMONIA ORDERS 
PNEUMONIA ORDERS