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*** UNCHECKED BOXES AND LINED THRU ORDERS ARE NOT APPLICABLE |
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| ALLERGIES: | |
| ADMITTING DIAGNOSIS: | Thyroid
Storm Intrauterine Pregnancy |
| ADMIT TO: | [ ] ICU |
| ACTIVITY: | [
]Bedrest
with bathroom privileges with assistance [ ]Other:__________________________________________________________________ |
| MONITORING: | Vital Signs every
hour . Continuous Fetal Monitoring. [ ]Cooling blanket if T > 101 and fever nonresponsive to Acetaminophen |
| LABS: | CBC with differential
daily Chem 12 daily Free T4 and free T3 daily [ ] ABG if pulse ox < 90%, respiratory distress or altered consciousness. |
| RADIOLOGY: | [ ] OB Ultrasound for fetal weight and AFI [ ] CXR [ ] Echocardiogram |
| IV THERAPY: | [
] Saline lock with 0.9% NaCL, 3 mL flush every 8 hours and before and after medications
Lactated Ringers 1000 mL to run at 150 mL/hour |
| MEDICATIONS: |
1.) O2 @ [ ] 2 [ ] 4 [ ]
6 Liters/min via [ ] NC or [ ] FM. 2.) Tylenol 500 mg 1-2 PO Q 4-6 hr PRN pain or T > 101°F. 3.) Propylthiouracil (PTU) 300 mg orally (PO) or nasogastric tube (NG); every 6 hours . 4.) One to two hours after the administration of PTU give: Potassium Iodide, saturated solution (SSKI) 5 drops PO / NG every 8 hours . If SSKI not available may give sodium iodide 1 gram PO /NG every 12 hours. If SSKI and sodium iodide not available may give Lugol's solution 10 drops every 8 hours IF ALLERGIC TO IODINE MAY GIVE lithium carbonate 300 mg PO / NG every 6 hours 5.) Propranolol (Inderal) ___ mg (40–80 mg) PO / NG every 6 hours . [ ] Propranolol (Inderal) 1 mg/min IV every 5 minutes for a total of 6 mg. IF HISTORY OF SEVERE BRONCHOSPASM MAY GIVE Reserpine (Serpasil) 2.5 mg IM every 4 hours 6. Dexamethasone (Decadron) 2 mg IV or IM every 6 hours X 4 doses If dexamethasone is not available may give Hydrocortisone (Solu-Cortef) 100 mg IV every 8 hours [ ] Ceftriaxone (Rocephin) 1 gram IVPB every 24 hours. [ ] MOM 30 mL PO every 12 hours PRN constipation [ ] Aluminum Hydroxide / Magnesium Hydroxide (Maalox) 30 mL PO every 4 hours PRN indigestion [ ] Zaleplon (Sonata) 5 mG PO HS PRN insomnia [ ] Acetaminophen 650 mG PO every 4 hours PRN mild-mod pain (level 1 6) [ ] Other: ______________________________________________________________ |
| DIET: | NPO until stable, then regular diet [ ] Clear liquid diet [ ] Other: ______________________________________________________________ |
| CALL PHYSICIAN FOR COMPLAINTS OF: | |
| Respiratory rate less than 12
or greater than 25 per minute Complaint of sore throat Rash Temperature >100.4 °F Chest pain 02 Sat less than 90% on room air Decreased loss of consciousness Respiratory distress |
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Date:____________ Time:_____________ Physician Signature:_________________________
[ ] RBO Date:____________ Time:_____________ Noted: _______________________________________ |
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| PATIENT I.D. LABEL |
THYROID STORM IN PREGNANCY PHYSICIAN ORDERS |