Admission Orders Flashcards
Identify considerations in admitting a patient to the ICU for care.
Patients requiring, or likely to require, advanced respiratory support
Patients requiring support of two or more organ systems
Patients with chronic impairment of one or more organ systems who also require support for an acute reversible failure of another organ.
Support = care that cannot be addressed on another unit due to medication intensity, need for close monitoring, high risk of decline in condition
What is the difference between an inpatient and outpatient?
Inpatient: Someone expected to stay more than 2 midnights due to their clinical presentation.
Outpatient: Occurs within one day, no overnight stay, usually occurs in a surgery center, eye center, or special procedures
Observation admissions: Needs hospital care but expected to stay only 1 midnight to observe progress. Can transition to an inpatient admission if meets criteria.
What kind of patients are in skilled nursing care?
Skilled Nursing Care:
Occurs in a nursing home but particular beds are set aside for “post-acute care”.
Often patients have surgery or illnesses that cause significant debilitation where they are not ready to go home within 3-4 days, so they are transitioned to a Skilled Nursing Facility (“SNiF”) until such time as they can safely go home.
What is the difference between hospice and home care?
Hospice care
Denotes palliative care with hospice at end of life
Home Health
Needs skilled care at home
What is the common pneumonic used to incorporate all the information needed into an admissions order?
Admit Diagnosis Condition Vitals Activity Nursing Diet Allergies Lab and Diagnostics IV fluids Specialists/Consultations Medication Monitoring
What is the purpose of the “admit” section?
Specifies the service (Medicine) and the attending (Dr. Snow)
Should likewise specify a particular unit (medical, step-down, etc) and whether this patient will need cardiac monitoring (telemetry)
What is the purpose of the “diagnosis” section?
List Primary Diagnosis.
It may only be a working diagnosis, but this is the biggest concern you have for the patient.
Do not list signs and symptoms as a diagnosis!
List in order of priority if you mention more than just the primary Dx.
Break them into two groups.
First, New/Acute Problems.
Second, Chronic Problems.
This may be helpful to let those processing the orders to know chronic conditions that contribute to the admission like diabetes, CAD, HTN, major depressive disorder.
In terms of the “condition” section, what does “stable” refer to?
“Stable”- Implies the patient has stable vital signs and is in no life-threatening duress. Some may use the term “good” to denote the same.
In terms of the “condition” section, what does “fair” refer to?
“Fair”- implies the patient is experiencing a condition whereby they are not doing well and will need monitoring. It may be due to pain issues or other mild circumstances with minimal impairment of patient safety. Some would use “Ill-appearing” as an equivalent.
In terms of the “condition” section, what does “guarded” refer to?
“Guarded”- implies a level that portends to a patient with a need to be monitored closely. Vital signs are possible labile, their mentation could be altered, or they could be in a category that could be termed “Toxic” as in sepsis, or multiple injuries from trauma.
In terms of the “condition” section, what does “critical” refer to?
“Critical”- these patients typically are going to intensive care as they are either potentially unstable or have been unstable prior to the admission and effectively stabilized enough to be transitioned to a medical unit that is appropriate for their diagnosis and care.
In terms of the “condition” section, what does “expectant” refer to?
“Expectant”- Most of these patients have been placed on palliative care or are pending hospice consultation as their presentation prior to admission deems them likely to die within 72 hours. The patient likely needs inpatient palliative care in order to achieve symptom control which cannot be done within the home. Some may call this “Poor Prognosis”, or just “Poor”. Some patients qualify for the term “Actively dying” or “expectant”, which denotes signs of impending death such as low blood pressure, bradycardia, agonal respirations, hypoxia, comatose state. Obviously, the patient is likely not going to need curative therapy, but intense therapy for comfort care.
Whar i s
Notes the frequency of vital signs you prefer
Usually this is every 4, or 8 hours. Sometimes you may want the patient to have vital signs every 2 hours for 8 hrs, then move to every 4 hrs.
Parameters for notifying physician can be placed here as well- e.g. SBP <90 or >150; HR < 60, RR <10, T > 38.3 degrees
What is the purpose of the vitals section? What goes in there?
Notes the frequency of vital signs you prefer
Usually this is every 4, or 8 hours. Sometimes you may want the patient to have vital signs every 2 hours for 8 hrs, then move to every 4 hrs.
Parameters for notifying physician can be placed here as well- e.g. SBP <90 or >150; HR < 60, RR <10, T > 38.3 degrees
what is the purpose of the activity section? what goes in here?
Up ad lib- as the patient wants to get up, usually without help
Bedrest with assistance- the patient stays in bed and only gets up with help
Bathroom privileges- the patient can get up to the bathroom unassisted. “with help” can be added.
Bedrest- should not get up at all
Often orthopedics will have special activities after surgery, eg, “no weight bearing to left lower extremity”, “toe touch only to left lower extremity”
