Name
Item
Name of attending physician
text
Phone
Item
Phone number of attending physician
integer
Admitting Diagnosis
Item
Diabetic Ketoacidosis Contributing Diagnoses
text
Diet
Item
NPO for 12 hrs, then CL as tolerated; progress to 2,000 calorie ADA as tolerated
boolean
Activity
Item
Bed rest with bathroom privileges ad lib, beginning tomorrow if stable
boolean
Nursing
Item
Pulse and respiratory every 1 hr X6, every 2 hrs X3, then every 4 hrs if stable
boolean
Nursing
Item
T every 4 hrs
boolean
Nursing
Item
I&O every 1 X6, every 4 hrs X3, then daily
boolean
Nursing
Item
Notify MD for: T > 39 C; P < 60 or > 130; BP < 90/60 or > 170/110; all lab results
boolean
Medications
Item
Regular insulin (0.1 units/kg)___ units IV bolus, then regular insulin infusion (0.1 units/kg/hr)__units/hr
boolean
Specification of regular insulin
Item
If regular insulin, please specify amount of units
integer
Specification of regular insulin infusion
Item
If regular insulin, please specify amount of regular insulin infusion units
integer
Medications
Item
Lantus insulin if takes @home___units SQ at bedtime
boolean
Specification of Lantus
Item
If Lantus insulin, please specify amount of units
integer
IV
Item
1000mL normal saline at 1000ml/hr
boolean
IV
Item
1000mL normal saline with 20 mEq KCl at 500 mL/hr (add KCl after patient voids)
boolean
IV
Item
1000mL normal saline with 20 mEq KCl at 500 mL/hr
boolean
IV
Item
1000mL 1/2 normal saline with 20 mEq KCl at 250 mL/hr
boolean
IV
Item
Change IVF to 1000mL Dextrose 5% in 1/2 normal saline with 20 mEq KCl at 250 mL/hr when glucose < 250 mg/dl
boolean
Lab
Item
Basal metabolic profile on admission and 4,8, and 12 hrs after admission
boolean
Lab
Item
Serum ketones with first, second and third blood draw
boolean
Lab
Item
Hemogram, UA, urine C&S
boolean
Lab
Item
ABGs on admission
boolean
Lab
Item
Serum osmolality, PO4, Mg and Ca at admission
boolean
Magnesium
Item
If Mg 1.4-1.8 mg/gl, apply 1g MgSO4 with IV Piggyback over 30 minutes
boolean
Magnesium
Item
If Mg < 1.4 mg/dl apply 2 g MgSO4 with IV Piggyback Over 30-60 minutes
boolean
PO4
Item
With all IV PO4 supplementation, check calcium every 4 hrs
boolean
PO4
Item
After all infusions, complete immediately, check PO4 level
boolean
PO4
Item
If calcium supplementation necessary, do not give in same IV line as PO4
boolean
Other
Item
If pH < 7.1, then add 1 amp (44mEq) of NA bicarbonate to bag
boolean
Other
Item
Normal saline every 2 hrs until pH > 7.1 ABG every 4 hrs (if treating with bicarbonate)
boolean
Other
Item
Consider DVT prophylaxis with Lovenox 40 mg sq daily
boolean
Other
Item
If PO4 1.0-1.8 mg/dl supply orally, if possible with milk or neutral-phos
boolean
Specification of PO4 1.0-1.8 mg/dl
Item
If 1.0-1.8 mg/dl please specify solution
text
Specification of PO4 1.0-1.8 mg/dl
Item
If 1.0-1.8 mg/dl please specify duration
integer
Other
Item
If PO4 0.5-1.0 mg/dl supply IV with 0.08 mM/Kg KPO4 in 250 cc NS for 4 hrs
boolean
Other
Item
If PO4 < 0.5 mg/dl supply IV with 0.16 mM/Kg KPO4 in 250 cc NS for 4 hrs
boolean
Signature
Item
Signature
text
Print Name
Item
Print Name
text
Date and Time
Item
Date and Time
datetime
