[Lecture] Admission Orders and IV Fluids (Tyler)

Question 1

A patient needing admission for more than 2 midnights would be admitted ____

Answer 1

Inpatient

Question 2

A patient needing admission for 1 midnight would be admitted to ____

Answer 2

Observation

Question 3

What is an outpatient facility?

Answer 3

Treatment occurs w/in 1 day without overnight stay (i.e. surgery centers, eye centers, special procedures)

Question 4

When are patients admitted to a skilled nursing facility?

Answer 4

Patients w/ surgery/illnesses that cause significant debilitation and can’t go home w/in 3-4 days

Question 5

What is the difference between home health and hospice?

Answer 5

Hospice: end of life palliative care

Home health: skilled care at home

Question 6

What is the ADC VANDALISM mnemonic for admission orders?

Answer 6

Admit

Diagnosis

Condition

Vitals

Activity

Nursing

Diet

Allergies

Lab and diagnostics

IV fluids

Specialists/Consults

Medications/Monitoring

Question 7

What parts of Dr. Tyler’s framework for admission do Admit, Diagnosis, Condition, Allergies, and Medication fall under?

Answer 7

Conditions for admission

Question 8

What parts of Dr. Tyler’s framework for admission do Vitals, Activity, Nursing, Diet, Lab/Diagnostics, IV fluids, Specialists and Consultations, Medications fall under?

Answer 8

Diagnostic processes

Question 9

What parts of Dr. Tyler’s framework for admission do Medication and Monitoring fall under?

Answer 9

Safety

Question 10

What kinds of patients are admitted to the ICU?

Answer 10

Requring advanced resp support

Support of 2 or more organ systems

Chronic impairment of one or more organ systems with acute reversible failure of another organ

Question 11

What order should diagnoses be listed on admission orders?

Answer 11

First - New/Acute problems

2nd - Chronic problems that contribute to admission (i.e. DM, HTN, CAD, major depressive disorder)

Question 12

A patient with a “fair” or “Ill-appearing” condition would be admitted where?

Answer 12

Medical floor

(pt is experiencing a condition where they are not doing well and need monitoring, mild circumstances with minimal impairment of safety)

Question 13

A patient with a “guarded” or “critical” condition would be admitted where?

Answer 13

ICU

(pt needs to be monitored closely, vitals are labile, altered mental status, may be toxic, traumatic)

Question 14

Patients requring admission for palliative care with likelihood of dying withing 72 hours can be considered what condition?

Answer 14

Expectant/Poor

Question 15

How often are vitals usually obtained with admission orders?

Answer 15

Every 4-8 hours

Question 16

What would an admission order stating “up ad lib” mean?

Answer 16

Pt has free control of activity without help

“up at liberty”

Question 17

If you see “foley to gravity”, “Dressing changes”, “Fall precaution” on an admission order, what are they?

Answer 17

Nursing orders

Question 18

Diabetics will usually have what diet on their admission orders?

Answer 18

Carbohydrate consistent

Question 19

Clear liquid diets are for what types of patients?

Answer 19

Pre-procedural

Persistent N/V

Question 20

Patients who need to be slowly advanced to a regular diet after surgery or illness w/ decreased oral intake would be put on what diet?

Answer 20

Full liquid (milk, ice cream, soup)

Question 21

NPO diet is usually what kind of order?

Answer 21

Pre-operative at least 6 hours before a procedure

Persistent nausea/vomiting

Acute pancreatitis

Bowel obstruction

Question 22

What does Dr. Tyler consider the most important feature of admission orders?

Answer 22

MEDICATIONS

• Reconciliation
• ID all meds and doses
• Delete/Add
• Specific to admission

Question 23

What does the “monitoring” part of admission consist of?

Answer 23

Safety

Parameters for monitoring

Pt education

Discharge planning

Question 24

5 Rs of fluid replacement

Answer 24

Resuscitation

Replacement

Redistribution

Routine maintenance

oRal/enteRal maintenance

Question 25

What is the composition of an isotonic crystalloid?

Answer 25

Normal Saline Lactated Ringer's D5W (+/-) (5% dextrose in water)

Question 26

What is the composition of a hypotonic crystalloid?

Answer 26

1/2 normal saline D5W (+/-) (5% dextrose in water)

Question 27

What is the composition of a hypertonic crystalloid?

Answer 27

3% NaCl D10W (10% dextrose in water) D5 1/2 normal saline D5 NS D5 Lactated Ringers

Question 28

What is the Holliday-Segar method of calculating maintenance fluid volume in pediatric pts?

Answer 28

1st 10 kg = 100 ml/kg in 24 hrs 2nd 10 kg = 50 ml/kg in 24 hours Remaining kg = 20 ml/kg in 24 hrs *24kg child: 1000ml + 500ml + 80 ml = 1580 ml/24 hrs = 66 ml/hr*

Question 29

Fast and dirty way of calculating volume loss?

Answer 29

Compare normal weight with current weight 1 kg = 1L

Question 30

How do you administer fluid replacement in children?

Answer 30

Replace half of fluid volume replacement dose in 8 hrs, the rest over the next 16 hours w/ monitoring Deficit + **Maintenance** (Holliday-Segars #) = Total fluids for the first 24 hours

Question 31

What is the rate of fluid replacement in adults?

Answer 31

Depends on severity - rate of replacement must be greater than rate of fluid loss, usually 50-100 mL/hr greater than loss Severly hypovolemic: 1-2L isotonic saline as rapidly as possible to restore perfusion (not necessary for mild to moderate)

Question 32

When would you not administer Lactated Ringer's solution?

Answer 32

Pts with rhabdomyolysis, blood transfusions Can increase emboli formation

Question 33

Why might D5W cause significant electrolyte shift?

Answer 33

D5W, while isotonic, may be hypotonic in relation to the patient during the initial response phase