Unique Plan Description: PMR Inpatient Rehab Admission
Plan Selection Display: PMR Inpatient Rehab Admission
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2011-12-09 14:10:30
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-01-10 15:04:48
Available at all facilities: Yes

PMR Inpatient Rehab Admission
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
Vital Signs
	Vital Signs
		TID
		Q4H-Sch, 48, hr
		T;N+2880, TID
	Weight
		T;N, DAILY
Activity
	Up in Chair
		T;N
			Comment: PRN as desired, progress length of time in chair as appropriate.
		TIDWM
			Comment: Notify PMR MD if refusing
	Weight Bearing
		T;N
			Comment: per orthopedic service.
	Hip Dislocation Precautions
		
	Activity-Restrictions
		T;N
		T;N, No twisting
		T;N, No bending or stooping
		T;N, No lifting over 10 pounds
		T;N, No lifting over 15 pounds
		T;N, No lifting over 20 pounds
		T;N, No lifting over 25 pounds
	Weight Bearing
		T;N
Diet
	Regular Diet
		T;N
	Diabetic Diet
		T;N
	Cardiac Diet
		T;N
	Pureed 4 Diet
		T;N
	Minced and Moist 5  Diet
		T;N
	Easy to chew 7 Diet
		T;N
	Soft and Bite Sized 6 Diet
		T;N
	Renal Diet
		T;N
Laboratory
Today's Lab
	Basic Metabolic Panel
		T;N, Routine, spec type = Blood
	CBC with Diff
		T;N, Routine, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Routine, spec type = Blood
	Magnesium Level
		T;N, Routine, spec type = Blood
Tomorrow's Lab
	Basic Metabolic Panel
		T+1;0600, Routine, spec type = Blood
	CBC with Diff
		T+1;0600, Routine, spec type = Blood
	Comprehensive Metabolic Panel
		T+1;0600, Routine, spec type = Blood
	Magnesium Level
		T+1;0600, Routine, spec type = Blood
Medications

	Tylenol
		325 mg, Tab, BY MOUTH, Q4H, PRN, pain-mild
		650 mg, Tab, BY MOUTH, Q4H, PRN, pain-mild
		1,000 mg, Tab, By Mouth, TID, PRN for pain-mild
	traZODone
		25 mg, Tab, BY MOUTH, QHS, PRN for insomnia
			Comment: Not to be given after 1am
	melatonin
		5 mg, Tab, By Mouth, QHS, PRN for insomnia
			Comment: give 30min prior to bedtime
	ondansetron
		4 mg, Tablet-Disintegrating, By Mouth, Q6H, PRN for nausea and/or vomiting
	Tums E-X
		750 mg, Tablet-Chew, By Mouth, TID, PRN for indigestion
	traMADol
		50 mg, Tab, By Mouth, Q6H-Sch, PRN for pain-moderate
	MiraLax oral powder for reconstitution
		17 gm, Packet, BY MOUTH, DAILY, PRN for constipation
			Comment: Mix in 6 oz of juice or water
	Milk of Magnesia 8% oral suspension
		30 mL, Suspension, BY MOUTH, DAILY, PRN for constipation
			Comment: If MiraLax ineffective
	docusate sodium
		100 mg, Tab, By Mouth, BID
			Comment: Hold for loose stools
	Senna
		17.2 mg, Tab, By Mouth, QHS
			Comment: Hold for loose stools
Patient Care
	Resuscitation Status
		
	May Shower
		
	Shower
		T;N
			Comment: Verify with surgeon if okay to shower.
	Sitter
		
	Cardiac Telemetry Monitoring
		
	Incentive Spirometer
		T;N, Q1HAWAKE
	Juzo Stockings
		
	Intake and Output
		T;N, Q6H-Sch minus Q12 End of Shift
	Aspiration Precautions
		T;N
	Seizure Precautions
		T;N
	Notify MD
		T;N, Notify Primary Rehab Physician if no bm in 72 hours
	Enema-Administer
		T;N, Fleets, constipation
			Comment: PRN
	GI Assessment-Focused
		T;N, Q48H, constipation
			Comment: Assess for presence of/remove impaction
Therapies
	IRF Therapeutic Recreation Evaluation and Treatment
		T;N
	IRF Physical Therapy Evaluation and Treatment
		T+1;0600
	IRF Occupational Therapy Evaluation and Treatment
		T+1;0600
	IRF SLP Evaluation and Treatment
		T+1;0600
		T+1;0600
			Comment: Respiratory Muscle Training Device "The Rebreather"
Consults/Follow-up
	Consult Hospitalist
		Reason for Referral: medical co-management
	Consult PCP
		
	Consult Diabetes Educator
		Needs Diabetic Assessment
	Consult Dietitian
		T;N+1, Regarding: Nutrition Assessment, Dietitian Assess and Treat
		T;N+1, Regarding: Calorie Count, Dietitian Assess and Treat
	Pharmacy Consult
		
	Consult Social Work
		Evaluation
	Consult Behavioral Health
		
	Consult Chaplain
		
	Consult Wound Care
		Reason for Referral: Wound, evaluate and treat wound
		Reason for Referral: wound nurse to see for nail care

PMR Inpatient Neurogenic Bladder Management
Activity
	Toilet patient
		T;N, Q6HAWAKE
			Comment: Timed void
		T;N, Q4HAWAKE
			Comment: Timed void q4h while awake. Encourage double void PRN if small volume.
Medications
	oxyBUTYnin
		5 mg, Tab, By Mouth, TID
	Flomax
		0.4 mg, Capsule, By Mouth, DAILY
		0.8 mg, Capsule, By Mouth, DAILY
Patient Care
	Bladder Scan
		T;N
			Comment: after each void attempt or if no void in > 6hours. Ok to discontinue after 3 normal consecutive PVRs < 100.
	Urinary Assessment-Focused
		T;N, Q6H-Sch
			Comment: assess for urinary complaints.
	Straight Catheter
		T;N, Straight
			Comment: >250ml
	Notify MD
		T;N, Notify Primary Rehab Provider if Urine output < 180 ml/6 hr.

PMR Inpatient Neurogenic Bowel Management
Activity
	Toilet patient
		T;N
			Comment: Bowel program DAILY, Bisacodyl suppository in shower commode chair with digital stimulation every 5-10 minutes until BM complete. Manual disempaction after BM if needed.
Medications
	Dulcolax
		20 mg, Tablet, Enteric-Coated, By Mouth, DAILY, PRN for if no BM, duration: 3 Day(s)
			Comment: for 3 days in a row
		10 mg, Suppository, RECTALLY, DAILY, PRN for if no BM
			Comment: Give 8 hours after tabs if no results.  If no results 1 hour after suppository, transfer patient to commode and begin digital stimulation per neurogenic bowel program
	Enemeez Mini Enema
		283 mg, Enema, RECTALLY, Q3D, PRN, if no BM
			Comment:  give 8 hours after tabs if no BM per neurogenic bowel program
	Dulcolax
		10 mg, Suppository, RECTALLY, QPM
	docusate sodium
		100 mg, Tab, By Mouth, TID
			Comment: Hold for loose stools
	Senna
		17.2 mg, Tab, By Mouth, QHS
			Comment: Hold for loose stools
Patient Care
	Digital Stimulation
		T;1800, Q24H
			Comment: Neurogenic Bowel protocol: repeat digital stimulation every 5-10 minutes until the BM is complete.
	Notify MD
		T;N, Notify Rehab physician if no regular BM in 48 hours, if increased incontinence or changes in bowel movements
			Comment: per neurogenic bowel program or constipation program.

VTE Prophylaxis
Medications
	Lovenox
		40 mg, Syringe, SUBCUTANEOUS, DAILY, T;N
			Comment: (CrCl>30) Pharmacy to adjust dose based on pt weight. VTE Prophylaxis
		40 mg, Syringe, SUBCUTANEOUS, DAILY, T;N+480
			Comment: (CrCl>30) Start 8 hours after admission. Pharmacy to adjust dose based on pt weight. VTE Prophylaxis
		40 mg, Syringe, SUBCUTANEOUS, DAILY, T+1;0900
			Comment: (CrCl>30) Pharmacy to adjust dose based on pt weight. VTE Prophylaxis
	HEParin 5000 units/mL SUBCUTANEOUS
		5,000 units, Injection, SUBCUTANEOUS, Q8H-Sch, T;N
			Comment: VTE Prophylaxis
		5,000 units, Injection, SUBCUTANEOUS, Q8H-Sch, T;N+480
			Comment: Start 8 hours after admission. VTE Prophylaxis
		5,000 units, Injection, SUBCUTANEOUS, Q8H-Sch, T+1;0600
			Comment: VTE Prophylaxis
Patient Care
		Sequential Compression Device and Anti Embolism Device orders will not suppress the VTE Advisor(NOTE)*
	Sequential Compression Device
		T;N, Apply, Once
	Anti Embolism Stockings
		T;N, Apply, Once
			Comment: knee high
	VTE Prophylaxis Contraindication
		High Risk of Bleeding
		Procedure Planned
		ASA order meets prophylaxis requirement
		If patient is low risk or further evaluation needed, complete advisor:(NOTE)*
	VTE Advisor
		Medical

PMR Hydration and Free Water Protocol
Diet
	Rehab Hydration Diet
		T;N
			Comment: When on thickened liquids, tray will include 120ml appropriately thickened water.
Medications
	chlorhexidine 0.12% oral rinse
		15 mL, Mouthwash, Q1H, PRN for see comment
			Comment: only unadulterated water ad lib with other applicable safe swallow strategies.
Patient Care
	Fluids-Increase
		
	Offer Fluids
		T;N, BID, Offer 60ml BID with medication administration. Document volume in I&O
		T;1500, Q24H, Offer 240ml daily at 3pm, Document volume in I&O
	Free Water Protocol
		
Therapies
	IRF Physical Therapy Evaluation and Treatment
		T;N
			Comment: Patient on Hydration Protocol
	IRF Occupational Therapy Evaluation and Treatment
		T;N
			Comment: Patient on Hydration Protocol
	IRF Speech Language Pathology Evaluation and Treatment
		T;N
			Comment: Patient on Hydration Protocol
	IRF Therapeutic Recreation Evaluation and Treatment
		T;N
			Comment: Patient on Hydration Protocol

*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