Name
Item
Name of attending physician
text
Phone
Item
Phone number of attending physician
integer
Admitting Diagnosis
Item
Hypokalemia Associated Diagnoses
text
Activity
Item
Bed rest with bedside commode
boolean
Activity
Item
Bathroom privileges
boolean
Activity
Item
Up ad lib
boolean
Nursing
Item
Vital signs with neuro checks every 4 hrs for 24 hrs then every shift
boolean
Nursing
Item
Continuous cardiac monitoring; arrhythmia orders
boolean
Nursing
Item
Notify MD for: T > 101.5; P > 120; BP < 90/60 or > 180/110; presence of any muscle weakness, hyporeflexes, paresthesias or arrhythmias
boolean
Nursing
Item
Daily weight
boolean
IV/Medications: If serum K+ > 2.5 and ECG changes are absent
Item
Potassium chloride 10 mEq in 100 mL normal saline IVPB over 1 hr, times___doses
boolean
IV/Medications: If serum K+ > 2.5 and ECG changes are absent
Item
If Potassium chloride, please specify: times__doses
integer
IV/Medications: If serum K+ > 2.5 and ECG changes are absent
Item
IV fluids__with 40 mEq KCl/L @___mL/hr
boolean
IV/Medications: If serum K+ > 2.5 and ECG changes are absent
Item
if IV fluide, please specify IV fluids___with mEq KCl/L
text
IV/Medications: If serum K+ > 2.5 and ECG changes are absent
Item
If IV fluids, please specify KCl/L @___mL/hr
integer
IV/Medications: If serum K+ < 2.5 and/or ECG changes are present
Item
Potassium chloride 20 mEq in 100 mL NSS IVPB over on hr, times___doses
boolean
IV/Medications: If serum K+ < 2.5 and/or ECG changes are present
Item
Please specify times__doses
integer
IV/Medications: If serum K+ < 2.5 and/or ECG changes are present
Item
IV fluids___with 40 mEq KCl/L @___mL/hr
boolean
IV/Medications: If serum K+ < 2.5 and/or ECG changes are present
Item
If IV fluids, please specify
text
IV/Medications: If serum K+ < 2.5 and/or ECG changes are present
Item
If IV fluids, please specify KCl/L @___mL/hr
integer
IV/Medications: If serum K+ < 2.5 and/or ECG changes are present
Item
Potassium chloride 40 mEq every __ hrs
boolean
IV/Medications: If serum K+ < 2.5 and/or ECG changes are present
Item
If Potassium chloride, please specify frequency
integer
IV/Medications: If serum K+ < 2.5 and/or ECG changes are present
Item
Maalox 30 mL PO every 4 hrs prn indigestion
boolean
IV/Medications: If serum K+ < 2.5 and/or ECG changes are present
Item
MOM 30 mL PO every 12 hrs prn constipation
boolean
IV/Medications: If serum K+ < 2.5 and/or ECG changes are present
Item
Tylenol PO every 4 hrs prn pain/fever
boolean
IV/Medications: If serum K+ < 2.5 and/or ECG changes are present
Item
Ambien 10 mg PO at bedtime prn insomnia
boolean
IV/Medications: If serum K+ < 2.5 and/or ECG changes are present
Item
Consider Lovenox 40 mg sc daily
boolean
Lab
Item
Admission: hemagram, comp med profile, Mg, calcium, TSH, urinalysis, urine osmo, Na,K+, Cl, bicarb
boolean
Lab
Item
Serum potassium every __ hrs
boolean
Lab
Item
If serum potassium, please specify frequency
integer
Lab
Item
Consider: serum cortisol, renin, aldosterone, urine myoglobin, 24 hrs urine K+, Na, creat, protein, cortisol
boolean
Signature
Item
Signature
text
Print Name
Item
Print Name
text
Date and Time
Item
Date and Time
datetime
