VS Q4

BG AC, HS & PRN for s/s of hypo/hyperglycemia

Weight Daily

Strict I/Os

Cardiac diet with fluid restriction of 1500 mL

Bladder scan Q8H & PRN & straight cath > 400mL

Continuous telemetry for 48 hours

SPC dressing & cap change Q4D

Parameters: Call MD for SBP >160 or < 90, DBP > 90 or < 50, T > 100.4⁰F, HR >120

O₂ 2-4L PRN to Keep SpO₂ > 92%

Hypoglycemia protocol- call MD for BG <70 or >300

Lab: BMP daily @ 0500

Lab: CBC daily @ 0500

Consult heart failure team

Na 139

K 3.4

Mg 2.0

Ca 8.9

Glucose 109

Albumin 1.8

WBC 3.8

LDH 182

Cr 1.0

BUN 20

RBCs 5

Hgb 14

Hct 38

PLT 191

proBNP 3875

T: 97.9⁰F

BP: 158/89

HR: 112

RR: 22

SpO₂: 93% on 2L NC

Admit weight 85 kg. Home weight 82.5 kg

0900 Furosemide 40 mg IVP BID

0900 Aspirin 81 mg daily

0900 Metoprolol 50 mg PO BID

0900 Amlodipine 10 mg PO BID

0900 Simvastatin 40 mg PO BID Human

0900 Albumin 100 mL IVPB over 1 hour x1 dose

0900 KCl 20 mEq PO once

0800, 1200, 1700, 2100 Insulin Novolog

Per sliding scale: Before meals and HS

< 120 0 units

121-150 2 units

151-200 4 units

201-250 6 units

251-300 8 units

>300 8 units and call provider

IVFs:   

0.9NaCl @ 100 mL/hr

0.9% NaCl flush 2 mL Q12 & PRN

PRN:  

Hydralazine 10mg PO PRN for SBP >165 Q6 hrs

Acetaminophen 650 mg PO Q4H for mild pain or fever

Senna 8.6 mg PO BID

Miralax 17 g PO daily

Albuterol inhaler 2 puffs Q4 for SOB

Electrolyte replacement per protocol