171-1319supportivecare.ofm

PHYSICIAN'S ORDERS
Mark in for desired orders. If is blank, order is inactive.
SUPPORTIVE CARE ORDERS
Agitation/ Anxiety/ Confusion/ Delirium
LORazepam (ATIVAN) 1 mg every 2 hours PO, IV or sublingual as needed for anxiety or agitation. Do not exceed 6 mg in 24 hours.
haloperidol (HALDOL) 2 - 4 mg PO or IM every 4 hours as needed for confusion or delirium; not to exceed 20 mg per 24 hours. traZODONE HCL (DESYREL) 50 mg PO every night as needed for sleeplessness For severe agitation use:
haloperidol (HALDOL) 5 mg PO or IM every 1 hour as needed for severe agitation; not to exceed 20 mg per 24 hours.
Constipation
docusate sodium (COLACE) 100 mg PO twice a day as needed for constipation
If on opioids: add docusate-senna (SENOKOT-S) 50mg/8.6 mg (1 tablet) PO three times daily for constipation.
If no bowel movement in 2 days: add magnesium hydroxide (MILK OF MAGNESIA) 30 mL PO daily as needed for constipation.
If no bowel movement in 3 days: check for impaction.
If no impaction, administer: bisacodyl (DULCOLAX) 10 mg suppository times 1 for constipation.
If no results: sodium biphosphate-sodium phosphate (FLEET ENEMA) times 2 for constipation.
morphine 5 mg PO or sublingual OR 2 mg IV or subcutaneous every 1 hour as needed for dyspnea.
Hold if respiratory rate less than 8.
Supplemental oxygen as needed to maintain comfort. Start with 2 liters per minute per cannula. Titrate up to 4 liters per minute to achieve target respiratory rate of less than 25.
If bronchospasm audible: start albuterol (PROVENTIL) 2.5 mg nebulizer every 4 hours as needed for wheezing.
If no relief: ADD ipratropium (ATROVENT) 0.5 mg nebulizer every 4 hours as needed for wheezing.
Mouth / Throat Soreness
Use green swizzle sticks and/or glycerine swabs for mouth comfort.
Magic Mouthwash: (equal parts aluminum hydroxide/magesium hydroxide (MAALOX), diphenhydrAMINE (BENADRYL), lidocaine (XYLOCAINE)) 10 mL PO swish / expectorate three times a day before meals as needed for mouth pain.
Nausea and Vomiting
NPO until vomiting stops, then clear liquids. Advance as tolerated.
haloperidol (HALDOL) 0.5 - 1 mg PO/IV/SQ every 4 hours as needed for nausea and vomiting.
If no relief: administer ondansetron (ZOFRAN) 8 mg IV every 8 hours as needed for nausea and vomiting.
If no results: call physician.
Terminal Secretions
atropine ophthalmic (ISOPTO-ATROPINE) 1% 2 - 4 drops sublingual every 2 hours as needed for mild secretions.
If atropine given, apply scopolamine (TRANSDERM-SCOP) 1.5 mg transdermally; change every 72 hours.
glycopyrrolate (ROBINUL) 0.4 mg subcutaneous or IV every 4 hours as needed for severe secretions.
For Thick Secretions
guaiFENesin (ROBITUSSIN) 20 mL (100 mg/ 5 mL) PO every 4 hours for 48 hours as needed for thick secretions.
Suction as needed for thick secretions.
If no relief from above interventions , nebulized normal saline 2 - 3 mL every 4 hours as needed for thick secretions.
Date:____________ Time:_______________ _______________________________________
(Required) (Required) Prescriber's Signature
Cell/Pager:__________________________ _______________________________________ Printed Name Scanned to pharmacy / entered into TDS by: Orders verified by:_______________________Date_____________Time______ _______________________Date_____________Time______ PHYSICIAN ORDERS
SUPPORTIVE CARE ORDERS

Source: http://carenet.tmfhs.info/Forms/Supportive%20Care.pdf