Cholelithiasis


 

 

 

Admission Orders

1. Admit to:

2. Diagnosis: Bacterial cholangitis

3. Condition:

4. Vital Signs: q4h. Call physician if BP systolic >160, <90; diastolic. >90, <60; P >120, <50; R>25, <10; T >38.5°C.

5. Activity: Bed rest

6. Nursing: Inputs and outputs

7. Diet: NPO

8. IV Fluids: 0.5-1 L LR over 1h, then D5 ½ NS with 20 mEq KCL/L at 125 cc/h. NG tube at low constant suction. Foley to closed drainage.

9. Special Medications:

-Ticarcillin or piperacillin 3 gm IV q4-6h (single agent) OR

-Imipenem/cilastatin (Primaxin) 1.0 gm IV q6h (single agent) OR

-Ampicillin/sulbactam (Unasyn) 1.5-3.0 gm IV q6h (single agent).

 

10. Symptomatic Medications:

-Hydroxyzine (Vistaril) 25-50 mg IV/IM q4-6h prn MS, nausea.

-Omeprazole (Prilosec) 20 mg PO bid OR

-Famotidine (Pepcid) 20 mg IV/PO q12h.

-Heparin 5000 U SQ q12h OR

-Enoxaparin (Lovenox) 30 mg SQ q12h.
 

11. Extras: CXR, ECG, RUQ ultrasound, HIDA scan, acute abdomen series. GI consult, surgical consult.

12. Labs: CBC, CMP, GGT, amylase, lipase, blood C&S x 2. UA, INR/PTT

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