Initial Management:
None D5W D5+0.45% NaCl D5+0.9% NaCl 0.9% NaCl
KVO 50mL/hr 80mL/hr 100mL/hr Other - will need to write in value
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 less than 220 mmHg and DBP less than 120 mmHg
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
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 greater than 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