# PIMC STANDARD ADMISSION ORDERS FOR PNEUMONIA IN ADULTS

1.  Admit to ward intermediate care ICU

2.  Dx: community-acquired pneumonia healthcare-associated pneumonia

> Other Dx:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3.  Condition: stable serious critical

4.  VS (if not in ICU): q4 hrs other:
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5.  Activity: ad lib commode fall precautions bed rest sitter

6.  Nursing: I&O call for O2 requirement over 4L/m, HR over 115, RR over
    32, SBP under 100

7.  Diet: NPO clear liquid soft mechical ADA \_\_\_\_\_\_\_\_\_\_\_cal
    regular

8.  IV: NS lock bolus NS \_\_\_\_\_\_\_\_\_\_ml maint rate
    \_\_\_\_\_\_\_\_\_\_\_ml per hour

> Maint fluid: NS D5NS ½NS D5½NS \_\_\_\_\_\_\_\_\_\_\_meq KCl per L

9.  Labs: blood culture x2 prior to antibiotics CXR PA+lat CBC+diff
    sputum GS+culture

CMP PPD HIV rapid ABG

other:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

10. Allergy: NKMA other:
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

11. Meds: pharmacy to adjust doses for estimated GFR:
    \_\_\_\_\_\_\_\_\_\_\_

NO high risk factors (NO significant chronic lung disease, NO recent
immunocompromise, NO abx for prior illness in past 3 months, NO recent
hospital/nursing facility stay, NO recent drug-resistant infection)

> ceftriaxone 1g IV q24hr (start date
> \_\_\_\_\_\_\_/\_\_\_\_\_\_\_/\_\_\_\_\_\_\_ at \_\_\_\_\_\_\_\_\_\_
> hrs)
>
> PLUS azithromycin 500mg IV q24hr (start date
> \_\_\_\_\_\_\_/\_\_\_\_\_\_\_/\_\_\_\_\_\_\_ at \_\_\_\_\_\_\_\_\_\_
> hrs)
>
> OR Unasyn 3g IV q6hr (start date
> \_\_\_\_\_\_\_/\_\_\_\_\_\_\_/\_\_\_\_\_\_\_ at \_\_\_\_\_\_\_\_\_\_
> hrs)
>
> PLUS azithromycin 500mg IV q24hr (start date
> \_\_\_\_\_\_\_/\_\_\_\_\_\_\_/\_\_\_\_\_\_\_ at \_\_\_\_\_\_\_\_\_\_
> hrs)
>
> ***(for suspected aspiration or superinfection of viral process)***
>
> OR levofloxacin 750mg IV q24hr (start date
> \_\_\_\_\_\_\_/\_\_\_\_\_\_\_/\_\_\_\_\_\_\_ at \_\_\_\_\_\_\_\_\_\_
> hrs)
>
> ***(for severe allergy to beta-lactam or macrolide)***
>
> PLUS clindamycin 900mg IV q8hr (start date
> \_\_\_\_\_\_\_/\_\_\_\_\_\_\_/\_\_\_\_\_\_\_ at \_\_\_\_\_\_\_\_\_\_
> hrs)
>
> ***(ONLY IF suspected aspiration or superinfection of viral
> process)***

HIGH RISK factors (significant chronic lung disease, or recent
immunocompromise, or abx used for prior illness in past 3 months, or
recent hospital/nursing facility stay, or recent drug-resistant
infection)

> ONE of these:
>
> cefepime 2g IV q12hr (start date
> \_\_\_\_\_\_\_/\_\_\_\_\_\_\_/\_\_\_\_\_\_\_ at \_\_\_\_\_\_\_\_\_\_
> hrs)
>
> Zosyn 3.375g IV q6hr (start date
> \_\_\_\_\_\_\_/\_\_\_\_\_\_\_/\_\_\_\_\_\_\_ at \_\_\_\_\_\_\_\_\_\_
> hrs)
>
> ***(for ceph allergy in PCN-tolerant pts, or suspected aspiration or
> superinfection of viral process)***
>
> aztreonam 2g IV q12hr (start date
> \_\_\_\_\_\_\_/\_\_\_\_\_\_\_/\_\_\_\_\_\_\_ at \_\_\_\_\_\_\_\_\_\_
> hrs)
>
> PLUS clindamycin 900mg IV q8hr (start date
> \_\_\_\_\_\_\_/\_\_\_\_\_\_\_/\_\_\_\_\_\_\_ at \_\_\_\_\_\_\_\_\_\_
> hrs)
>
> ***(for severe beta-lactam allergy, or suspected aspiration or
> superinfection of viral process)***

AND ONE of these:

ciprofloxacin 400mg IV q12hr (start date
\_\_\_\_\_\_\_/\_\_\_\_\_\_\_/\_\_\_\_\_\_\_ at \_\_\_\_\_\_\_\_\_\_
hrs)

gentamicin per pharmacy dosing protocol

PLUS azithromycin 500mg IV q24hr (start date
\_\_\_\_\_\_\_/\_\_\_\_\_\_\_/\_\_\_\_\_\_\_ at \_\_\_\_\_\_\_\_\_ hrs)

***(for quinolone allergy)***

AND ONE of these (unless only risk factor is significant lung disease or
immunocompromise):

vancomycin 1g IV q12hr (start date
\_\_\_\_\_\_\_/\_\_\_\_\_\_\_/\_\_\_\_\_\_\_ at \_\_\_\_\_\_\_\_\_\_
hrs)

linezolid 600mg IV q12hr (start date
\_\_\_\_\_\_\_/\_\_\_\_\_\_\_/\_\_\_\_\_\_\_ at \_\_\_\_\_\_\_\_\_\_
hrs)

***(for severe beta-lactam allergy)***

Vaccinate on (date) \_\_\_\_\_\_\_/\_\_\_\_\_\_\_/\_\_\_\_\_\_\_:
Pneumovax 0.5ml IM influenza 0.5ml IM

> promethazine12.5-25mg PO (IV if NPO) q4hr prn nausea or insomnia or
> excess cough
>
> albuterol MDI+spacer 2 puffs q2hr prn excess cough or SOB

APAP 650mg PO (PR if NPO) q4hr prn pain or chills

> O2 by NC prn to keep sats 89-92%
>
> additional meds listed on separate blank order sheet