Unique Plan Description: TNK (tenecteplase) for STEMI (MH/FH)
Plan Selection Display: TNK (tenecteplase) for STEMI (MH/FH)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-02-10 13:26:31
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-10-10 18:38:05
Available at all facilities: Yes

TNK (tenecteplase) for STEMI (MH/FH)
Vital Signs
	Vital Signs
		q15min x 4, q30 min x12, q1h x16,
Activity
	Bedrest
		T;N
Laboratory
	CBC with Diff
		T+1;0400, Routine, spec type = Blood
Medications
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	TNKase:
		30 mg, Solution, Injection, IV Push, Once, NOW, 1 Dose(s)/Time(s)
			Comment: Weight less than 60 kg.  TNK IS NOT COMPATIBLE WITH DEXTROSE.
		35 mg, Solution, Injection, IV Push, Once, NOW, 1 Dose(s)/Time(s)
			Comment: Weight 60-69  kg.  TNK IS NOT COMPATIBLE WITH DEXTROSE.
		40 mg, Solution, Injection, IV Push, Once, NOW, 1 Dose(s)/Time(s)
			Comment: Weight 70- 79 kg.  TNK IS NOT COMPATIBLE WITH DEXTROSE.
		45 mg, Solution, Injection, IV Push, Once, NOW, 1 Dose(s)/Time(s)
			Comment: Weight 80- 89 kg.  TNK IS NOT COMPATIBLE WITH DEXTROSE.
		50 mg, Solution, Injection, IV Push, Once, NOW, 1 Dose(s)/Time(s)
			Comment: Weight > or equal to 90 kg.  TNK IS NOT COMPATIBLE WITH DEXTROSE.
Patient Care
	Notify MD
		T;N, See comment.
			Comment: If any of the following develop: Signs of bleeding, severe headache or neurological changes, nausea, vomiting, temp > 101.5, SBP <90 or > / =180, DBP > / = 110, chest pain or its equivalent, low back or abdominal pain, ecg changes, or blood in urine or stool.
	Neurological Assessment-Focused
		T;N, Once
		T;N+15, Q15MIN, 4, Dose(s)/Time(s)
		T;N+60, Q30MIN, 2, Dose(s)/Time(s)
		T;N+135, Q1H, 4, Dose(s)/Time(s)
	Cardiac Telemetry Monitoring
		T;N, Telemetry Indications: Cardiologist Recommendation
			Comment: Continuously  Monitor for and document reperfusion arrhythmias, resolution of ST elevation, abrupt cessation of chest pain
	Order ECG
		T;N
			Comment: to be done 30 minutes post TNK
		T;N
			Comment: to be done 1 hour post TNK
		T;N
			Comment: for chest pain or chest pain equivalent.
	No IM Injections
		T;N
			Comment: Do not give IM injections or insert access devices into non compressible arterial or venous sites.  Avoid needle sticks for 24 hours after TNK.  Draw blood from saline lock if possible

*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