Transcript PHILHEALTH CLINICAL PATHWAYS CLINICAL GUIDELINES

PHILHEALTH
CLINICAL PATHWAYS
CLINICAL GUIDELINES
DENGUE CLINICAL PATHWAY
Assessment
Diagnostics
Treatments
Teaching
1st 30 min
2nd 30 min
Ascertained with fever of 2-7
days duration with any of the
following:

skin flushing

rashes

headache

retro-orbital pain

myalgia/arthralgia,
CBC taken
Risk factors for hemorrhagic
tendency assessed.
3rd 30 min
Platelet ct less than 100,000,
do PTT and blood typing
Platelet ct greater than 100,000
discharge and advised to do

serial CBC daily
Admit if:
platelet count is less than
100,000
OR
if with any of the ff. regardless
of the platelet count

spontaneous bleeding

persistent abdominal pain

persistent vomiting

changes in mental status

restlessness

weak rapid pulse

cold clammy skin

circumoral cyanosis

difficulty of breathing

seizures

hypotension

narrowing of pulse
pressure.
Give information on Dengue
fever and measures to control
infection at home
ADMITTING
ORDERS
Admitting Impression: Dengue Fever
Concomitant diagnosis:
____________________________
Please admit to room of choice under the service of Dr. ________________
Diet: __________________________________
Vital signs:
Lab:
–
–
–
–
–
–
–
–
–
every 4 hours
every _____________
CBC
blood typing
PTT
SGPT
Urinalysis
Chest x-ray PA and lateral
Na, K
BUN, Creatinine
Others: __________________________
__________________________
ADMITTING ORDERS
•
IVF:
__________________________
Other medications:
_________________________________________________
_________________________________________________
•
Ancillary Therapy:
_________________________________________________
_________________________________________________
_________________________________________________
•
•
•
Referral to other services:
Hematology _________________________________________________
Others
_________________________________________________
•
•
•
•
•
•
Inform attending physician(s) and resident-on-duty of patient’s room number
Refer for any undue development.
______________________
Signature over printed name
Attending Physician
URINARY TRACT
INFECTION
Assessment
Diagnostics
1st 30 min
2nd 30 min
Ascertained with 1 or
more of the ff: dysuria,
frequency, hematuria,
fever, flank pain, lower
abdominal pain AND
no vaginal discharge,
absent vaginal irritation
Routine urinalysis
ordered
Risk factors assessed:

DM

pregnancy
3rd 30 min
4th 30 min
Urine culture and
sensitivity for the ff:
Schedule for renal
ultrasound if with any
of the ff:

gross hematuria

obstructive
symptoms

persistent
infection

history or
symptoms
suggestive of
urolithiasis
Blood culture if with
sepsis
May be sent home with
oral antibiotic OR
Admit if:

uncomplicated
pyelonephritis in
women and unable
to take oral
antibiotics

pregnant women
with acute
pyelonephritis

complicated UTI




Management
worsening signs
and symptoms
pregnant women
acute
uncomplicated
pyelonephritis
suspected
complicated UTI.
ADMITTING ORDERS
•
•
•
•
•
•
Admitting Impression: Urinary Tract Infection
Concomitant diagnosis: ____________________________
•
Lab:
Please admit to room of choice under the service of Dr. ________________
Diet: __________________________
Vital signs: __ every 4 hours __every hour
every _____________
–
–
–
–
–
•
•
•
Urinalysis
CBC
Urine culture
Chest x-ray PA and lateral
BUN, Creatinine
Na, K
Urine culture
Others: __________________________
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
ADMITTING ORDERS
Antibiotics:
Cefuroxime 1.5 gms. IV infusion for 30 minutes every 8 hours
Co-amoxiclav 1.2 gms. IV infusion for 30 minutes every 8 hours
Ampicillin/sulbactam 1.5 gms. IV infusion for 30 minutes every 8 hours
Piperacillin/tazobactam 4.5 gms. IV infusion for 30 min every 8 hours
Ticarcillin/clavulanate 3.2 gms. IV infusion for 30 min every 8 hours
Ertapenem 1 grm IV infusion for 30 min every 24 hours
Meropenem 1 gm. IV infusion for 30 min every 8 hours
Imipenem 500 mgs. IV infusion for 30 min every 6 hours
Ciprofloxacin 400 mgs. IV infusion for 30 min every 12 hours
Administer after negative skin test
Others: _________________________________________________
_________________________________________________
_________________________________________________
Other medications:
_________________________________________________
ADMITTING ORDERS
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Ancillary Therapy:
_________________________________________________
_________________________________________________
Referral to other services:
Infectious Disease
Nephrology
Others:
_________________________________________________
_________________________________________________
_________________________________________________
Inform attending physician(s) and resident-on-duty of patient’s room number
Refer for any undue development.
______________________
Signature over printed name
Attending Physician
COMMUNITY ACQUIRED
PNEUMONIA
CLINICAL DIAGNOSIS
•
•
•
•
•
Cough
Fever
Difficulty of breathing
Chills
Within the past 24 hours to less than 2 weeks
CLINICAL DIAGNOSIS
Associated with
• Tachypnea (RR > 20 breaths/min)
• Tachycardia (HR > 100/min)
• Fever (T > 37.8oC)
With at least one of the ff:
• Diminished breath sounds
• Rhonchi
• Crackles
• Wheeze
DIAGNOSTIC TESTS
• Chest Xray
• Gram stain and culture of appropriate
pulmonary secretions
• Pre-treatment Blood Cultures
ADMITTING ORDERS
•
•
•
•
•
•
•
Admitting Impression: Community-acquired pneumonia, moderate-risk
Concomitant diagnosis: ____________________________
Please admit to room of choice under the service of Dr. ___________________
Diet as tolerated
Vital signs: every 4 hours every _____________
Lab:
Chest x-ray PA and lateral
CBC
Sputum GS, C/S
Blood Culture
BUN, Creatinine
Serum Na+
Serum K+
Others: __________________________
ADMITTING ORDERS
• IVF: ________________________
• Antibiotics:
Co-amoxiclav 1.2 gm IV infusion for 30 minutes every 8 hours
Ampicillin/sulbactam 1.5 g IV infusion for 30 minutes every 8
hours
Azithromycin 500 mg IV infusion for 2-3 hours every 24 hrs
1 tablet 2x a day
Cefuroxime 750 mg IV every 8 hours
Clarithromycin 500 mg IV infusion for 2-3 hours q 12 o
Others:
_________________________________________________
ADMITTING ORDERS
• Other medications:
• Pneumococcal vaccine prior discharge
• Influenza vaccine prior to discharge
________________________________________________
_________________________________________________
• Ancillary Therapy:
• O2 inhalation ____________________________________
• Others:
_________________________________________________
ADMITTING ORDERS
•
•
•
•
•
Referral to other services:
Infectious Disease____________________________________________
Pulmonary
____________________________________________
Others:
____________________________________________
Inform attending physician(s) and resident-on-duty of patient’s room
number
• Refer for any undue development.
•
•
=
• _____________________
• Signature over printed name
•
Attending Physician
•
CAP
SEVERE
ADMITTING ORDERS
•
•
•
•
•
•
•
Admitting Impression: Community-acquired pneumonia, high risk
Concomitant diagnosis: ____________________________
Please admit to ICU under the service of Dr. ___________________
Diet as tolerated
Vital signs: every 1 hour
every _____________
Lab:
Chest x-ray PA and lateral
CBC
Sputum GS, C/S
Blood Culture
BUN, Creatinine
Serum Na+
Serum K+
Others: __________________________
ADMITTING ORDERS
• IVF: ___________________________
• Antibiotics:
• * Pls modify dose if creatinine is elevated
•
Piperacillin/tazobactam 4.5 g IV infusion for 30 min every 8 hours *
•
Ticarcillin/clavulanate 3.2 g IV infusion for 30 min every 8 hours *
•
Meropenem 1 g IV infusion for 30 min every 8 hours *
•
Imipenem 500 mg IV infusion for 30 min every 6 hours*
•
Amikacin 500 mg IV infusion for 30 min every 24 hours*
•
Levofloxacin 500 mg IV infusion for 30 minutes every 24 hours*
•
Azithromycin 500 mg IV infusion for 2 hours every 24 hours*
•
Clarithromycin 500 mg IV infusion for 2 hours every 12 hours o
•
Others:
_________________________________________________
•
_________________________________________________
ADMITTING ORDERS
• Other medications:
• Pneumococcal vaccine prior discharge
• Influenza vaccine prior to discharge
________________________________________________
_________________________________________________
• Ancillary Therapy:
• O2 inhalation ____________________________________
• Others:
_________________________________________________
ADMITTING ORDERS
•
•
•
•
•
Referral to other services:
Infectious Disease____________________________________________
Pulmonary
____________________________________________
Others:
____________________________________________
Inform attending physician(s) and resident-on-duty of patient’s room
number
• Refer for any undue development.
•
•
=
• _____________________
• Signature over printed name
•
Attending Physician
•