Unique Plan Description: ED Hyperglycemia
Plan Selection Display: ED Hyperglycemia
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-20 14:54:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-09-05 09:18:49
Available at all facilities: No

ED Hyperglycemia
Admit/Discharge/Transfer
	ED Request for Bed
		Diagnosis: DKA HHS
Laboratory
STAT Lab
	CBC with Diff
		T;N, Stat, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
	Amylase Level
		T;N, Stat, spec type = Blood
	Lipase Level
		T;N, Stat, spec type = Blood
	Beta-Hydroxybutyrate (Inpatient)
		T;N, Stat, spec type = Blood
	pH Blood
		T;N, Stat, spec type = Blood
	Blood Gases Arterial (ABG) - MH/WH/JE
		T;N, Stat, spec type = Blood
	Blood Gases Arterial (ABG) - FH
		T;N, Stat, spec type = Blood
	Potassium Level
		T;N, Stat, spec type = Blood
	Magnesium Level
		T;N, Stat, spec type = Blood
	Phosphorus
		T;N, Stat, spec type = Blood
	Glucose POC - RN
		T;N, Once
	Osmolality
		T;N, Stat, spec type = Blood
	Hemoglobin A1C
		T;N, Stat, spec type = Blood
	Basic Metabolic Panel
		T;N, Stat, spec type = Blood
	Urinalysis
		T;N, Stat, Stat, spec type = Urine
	Urinalysis (Culture if Pos)
		T;N, Stat, Stat, spec type = Urine
	Pregnancy Test Urine
		T;N, Stat, Stat, Urine Random, spec type = Urine
			Comment: For women of child bearing ability
	Beta-HCG Quantitative - Pregnancy
		T;N, Stat, spec type = Blood
Diagnostic Tests

	Chest 1 View
		Stat
	Abd & Upright w Chest
		Stat
	ECG in ED
		Stat, Indication: Electrolyte Abnormalities
IV Solutions
	Sodium Chloride 0.9%
		1,000 mL, IV, STAT, 1 Dose(s)/Time(s), 999 ml/hr
		1,000 mL, IV, 500 ml/hr
		1,000 mL, IV, 125 ml/hr
		1,000 mL, IV, 100 ml/hr
		1,000 mL, IV, 75 ml/hr
	insulin regular 100 units/NS 100 mL Premix
		100 mL, IV, Routine, Total Volume = 100
			Comment: concentration: 1 unit/mL, Initial rate based on initial glucose:  181-300: 2 units/hr;  301-400:  3 units/hr; 401 or greater: 4 units/hr;   Titrate infusion to target glucose of 120-180:  If glucose is:1) Less than 100 discontinue infusion,continue blood glucose monitoring and follow Insulin IV infusion hypoglycemia treatment parameters if necessary; restart drip at 1/2 previous rate when glucose >120.2) 100-120, decrease infusion by 1 unit/hr.3) 121-180, no change.4) 181-249, and is greater than or equal to the previous glucose, increase infusion by 0.5 unit/hr.5) 181-249, and is less than the previous glucose, maintain same rate.6) 250-350, increase infusion by 1 unit/hr.7) > 351, increase infusion by 2 unit/hr.  Contact MD if rate >10 unit/hr.  If the glucose decreases >75mg/dl from the last glucose check, decrease insulin rate by 50% and check blood glucose in 30 minutes. If enteral and/or parenteral nutrition support is stopped or held, decrease infusion to 0.5 unit/hour and notify physician
		100 units, EVERY BAG, 2 units/hr
	Dextrose 5% with 0.45% NaCl
		1,000 mL, IV, 50 ml/hr, 20 hr, Total Volume = 1,000
			Comment: start when glucose < 250
Medications
	ondansetron
		4 mg, Injection, IV Push, Once, STAT
	ondansetron (MH/WH)
		8 mg, Injection, IV Push, Once, STAT
	Reglan
		10 mg, Injection, IV Push, Once, STAT
	Phenergan (FH)
		6.25 mg, INT, IVPB, Once, STAT
	prochlorperazine
		5 mg, Injection, IV Push, Once, STAT
	insulin regular
		10 units, Solution-Injection, IV Push, Once, STAT
	potassium chloride IVPB - Peripheral line
		40 mEq, Injection-Premix, IVPB, Q6H, PRN for see comment, infuse over 4 hr, duration: 24 hr
			Comment: In NS 500 mL. for potassium <3.3. Enter order for stat potassium level after infusion complete.
		20 mEq, INT, IVPB, Q6H, PRN for see comment, infuse over 2 hr, duration: 24 hr
			Comment: In NS 250 mL for potassium 3.3-5. Enter order for stat potassium level after infusion complete.
	potassium chloride IVPB (FH)
		40 mEq, Injection-Premix, IVPB, Once, STAT, infuse over 4 hr
			Comment: For potassium <3.3. Enter order for stat potassium level after infusion complete.
		20 mEq, Injection-Premix, IVPB, Once, STAT, infuse over 2 hr
Patient Care
	ED Cardiac Telemetry Monitoring
		
	Oxygen Therapy, Nurse to Administer
		Via Nasal Cannula, Titrate->Keep Sats>/= to 90%
	Continuous Pulse Oximetry by Nurse
		
	Foley Catheter
		
	Straight Catheter
		Insert, Once
	Glucose POC - RN
		Once
		as needed
			Comment: for signs and symptoms of hyper or hypoglycemia.
	Notify MD of Lab results
		T;N, immediately if glucose <55.
	Glucose POC - RN
		T;N+120, Once
			Comment: if initial glucose 200-299, repeat glucose in 2 hours.
	Notify MD of Lab results
		T;N, immediately if initial glucose >300mg/dL. If no orders received, repeat glucose POC q1h. If insulin
	Notify MD
		T;N, if DKA patient and no orders for insulin drip received within 1 hour after insulin infusion.
	Glucose POC - RN
		Q1H
	Order Lab
		T;N, if initial ABG pH is less than 6.9, enter order for second ABG to be done in 2 hours
Consults/Follow-up
	Consult Endocrinologist
		Reason for Referral: Hyperglycemia
	Consult Hospitalist
		Reason for Referral: Hyperglycemia

ED Blood Culture with Lactate
Laboratory
	Lactate
		T;N, Stat, spec type = Blood
	.Culture Blood
		T;N, Stat, spec type = Blood
	.Blood Culture.
		T;N, Stat, spec type = Blood

ED Peripheral Lock Insert with Flush
Medications
	sodium chloride 0.9% flush injectable soln
		10 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush, 4 hr
Patient Care
	Peripheral Lock-Insert
		T;N, Once

ED Blood Culture Set
Laboratory
	.Blood Culture.
		T;N, Stat, spec type = Blood
		T;N, Routine, spec type = Blood
	.Blood Culture
		T;N, Stat, spec type = Blood
		T;N, Routine, spec type = Blood

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase