Name
Item
Name of attending physician
text
Phone
Item
Phone number of attending physician
integer
Admitting Diagnosis
Item
Hyponatremia Associated Diagnoses
text
Diet
Item
AHA step 2
boolean
Diet
Item
ADA__calories
boolean
Diet
Item
If Diet according to ADA, please specify amount of calories
integer
Diet
Item
If Other, please specify
text
Activity
Item
Bed rest with bathroom privileges with assistance
boolean
Nursing
Item
Orthostatic VS every 4 hrs until stable x4, then every shift
boolean
Nursing
Item
Notify MD for: T > 101, BP < 90/60 or > 190/100, neuro changes
boolean
IV: Hypovolemic
Item
___normal saline IV @500 mL/hr until orthostasis resolves, then
boolean
Item
following to the Item above
text
Code List
following to the Item above
CL Item
Dextrose 5% normal saline (if hyperosmolar) at __mL/hr OR (1)
CL Item
Dextrose 5%in 1/2 normal saline (if not hyperosmolar) at___mL/hr (2)
IV Hypovolmic
Item
If ___normal saline IV@ 500mL/hr, ,please specify
text
IV Hypovolemic
Item
If Dextrose 5% normal saline, please specify amount
integer
IV Hypovolemic
Item
If Dextrose 5% in 1/2 normal saline, please specify amount
integer
IV Hypervolemic
Item
Lasix 80 mg IV/PO daily
boolean
IV Hypervolemic
Item
Dextrose 5% in water @___mL/hr
boolean
IV Hypervolemic
Item
If Dextrose 5% in water, please specify amount
integer
Lab
Item
CMP, UA, urine Na+, TSH, urine OSM, plasma osmolality and CXR on arrival daily BMP
boolean
Consider
Item
DVT prophylaxis with Lovenox 40 mg SQ daily
boolean
Consider
Item
D/C medications that could contribute to hyponatremia (i.e., diuretics, tegratol, SSRI, amiodarone, theophylline)
boolean
Signature
Item
Signature
text
Print Name
Item
Print Name
text
Date and Time
Item
Date and Time
datetime