Stroke Admission Orders

Stroke Admission Orders: Ischemic Stroke, NO tPA

Weight: lbs

Height: ft in

(If you fill in weight and height you will get a BMI value)

Initial Management:

Standard Vital Signs with Neuro checks: Q 30 minutes x 2 hrs, then Q 1 hr x 4 hrs, then Q 2 hrs x 4 hrs, then Q 4 hrs
if No will need to handwrite
Yes
No

Bedside Cardiac Monitor
Yes
No

Oximetry - if < 93%, start oxygen at 2L/min, titrate to ≥ 93%
Yes
No

IV Type:

None
D5W
D5+0.45% NaCl
D5+0.9% NaCl
0.9% NaCl

IV rate:

KVO
50mL/hr
80mL/hr
100mL/hr
Other - will need to write in value

Diet:
for all categories except NPO,
follow Bedside Swallow Screen

NPO
Regular
Regular NCS
Mechanical soft, nectar liquids
Will handwrite

Therapies, Rehab, Discharge Planning

Speech Therapy - bedside swallow eval only
Speech Therapy - swallow eval, VFSS or FEES as needed
Speech Therapy - eval and Rx speech/cognition
Physical Therapy - eval and Rx
Occupational Therapy - eval and Rx
Rehab Admission nurse to see
Discharge Planner to see

Risk Factor and Other Testing

Fasting lipid profile
Carotid duplex sonography
2D echocardiogram
EKG
EEG
Daily protime, INR
Daily protime, INR, PTT
HgbA1c

Blood Pressure Management

Keep SBP < 220 mmHg and DBP < 120 mmHg

Drugs for BP Mgmt:

None
Labetolol 10mg IV over 1-2 minutes, repeat dose every 10 minutes to total = 150 mg. Titrate to target
Cardene drip 5mg/hr; increase by 2.5mg every 5 min to max of 15mg/hr. Titrate to target

Anticoagulation

None
Coumadin 5mg po daily, start tomorrow
Coumadin (handwrite dose)

Antiplatelet Therapy

None
Aspirin 81mg po daily
Aspirin 325mg po daily
Clopidogrel 75mg po daily
Aggrenox 25/200 po daily x 5 days, then BID

The use of aspirin and clopidogrel together is not advised, but may be accomplished by a handwritten order.
Similarly, since Aggrenox contains aspirin, the use of aspirin with Aggrenox would generally not make sense.

Parenteral:

None
IV heparin 25,000 units/250mL to perfuse per coronary low dose, no bolus
Enoxaparin 1mg/kg SQ every 12 hrs
Enoxaparin 40mg SQ daily

Antihyperlipidemia Drugs
Atorvastatin (Lipitor) 10mg po daily
Atorvastatin (Lipitor) 20mg po daily
Simvastatin (Zocor) 20mg po daily
Simvastatin (Zocor) 40mg po daily
None of these
Other Drugs
Laxative of choice prn constipation
Acetaminophen 650mg po every 4 hrs prn temp > 101 degrees F
Famotidine (Pepcid) 20mg po BID
Docusate sodium (Colace) 100mg po BID
Senokot S, 1-2 po BID as needed for bowel program

Please carefully read the orders after clicking to make sure they are correct