Name
Item
Name of attending physician
text
Phone
Item
Phone number of attending physician
integer
Admitting Diagnosis
Item
Partial Small Bowel Obstruction Contributing Diagnoses
text
Activity
Item
Bed rest with bathroom privileges with assistance
boolean
Nursing
Item
Vital signs: every 4 hrs for 24 hrs then every shift
boolean
Nursing
Item
Notify MD for: T > 101.5, P > 120, BP < 90/60 or > 180/110
boolean
Nursing
Item
NG tube to low continuous suction
boolean
Medications
Item
Demerol 25-50mg slow IVP every 3-4 hrs prn pain
boolean
Medications
Item
Phenergan 12.5 mg slow IVP every 3-4 hrs
boolean
IV
Item
Dextrose 5% normal saline with 20 mEq KCl @125 mL/hr
boolean
IV
Item
Bolus_____
boolean
IV
Item
If Bolus, please specify
text
IV
Item
Replace NG output mL per mL with___normal saline every 12 hrs
boolean
IV
Item
Please specify amount of normal saline if NG output is replaced by saline
integer
Lab
Item
Daily hemogram, basal metabolic profile in a.m.
boolean
Other
Item
X-ray: acute abdominal series if not done in ER/clinic
boolean
Other
Item
Surgical consult as indicated (complete obstruction)
boolean
Other
Item
Consider DVT prophylaxis with Lovenox 40 mg sq daily
boolean
Others
Item
Consider gastrografin UGI with small bowel follow-through after 24-26 hrs of NG suction
boolean
Signature
Item
Signature
text
Print Name
Item
Print Name
text
Date and Time
Item
Date and Time
datetime