HM BARIATRIC INFUSION		version 12/15/2023		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☐	Referral to IV Infusion Room	Once	S	1 treatment	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine		
	☐	Nursing communication	Every visit	S	Until discont'd	
		Please continue to schedule subsequent infusion appointments manually as appropriate.		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Saline lock IV	PRN	S	Until discont'd	
		Clinic Performed, Normal		
	☐	sodium chloride 0.9% flush 10 mL	PRN	S	Until discont'd	
		10 mL, intravenous, PRN, line care, Starting when released, for 10 doses		
	☐	sodium chloride 0.9% infusion 250 mL	PRN	S	Until discont'd	
		250 mL, intravenous, at 30 mL/hr, PRN, Flush bag, Starting when released, Until Discontinued		
	☐	Vital signs - T/P/R/BP Per Unit Protocol	PRN	S	Until discont'd	
		No details available for preview		
	☐	Call doctor	PRN	S	Until discont'd	
		Clinic Performed, Normal
	Call MD for:
	• Temperature greater than 101o F
	• Pulse greater than 120 or less than 50 beats per minute
	• Respiratory rate greater than 24 or less than 10 per minute
	• Systolic BP greater than 150 or less than 100
	• Diastolic BP greater than 100 or less than 50		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	Basic metabolic panel	PRN	S	Until discont'd	
		Normal, Lab Collect		
	☐	Comprehensive metabolic panel	PRN	S	Until discont'd	
		Normal, Lab Collect		
	☐	CBC hemogram	PRN	S	Until discont'd	
		Normal, Lab Collect		
	☐	Magnesium level	PRN	S	Until discont'd	
		Normal, Lab Collect		
	☐	Phosphorus level	PRN	S	Until discont'd	
		Normal, Lab Collect		
	☐	Potassium level	PRN	S	Until discont'd	
		Normal, Lab Collect		

IV Fluids 	

	
	Interval	Defer Until	Duration	
	☐	thiamine (B-1) 500 mg in sodium chloride 0.9% 50 mL IVPB	PRN	S	Until discont'd	
		500 mg, intravenous, Administer over: 30 Minutes, every 24 hours, Starting when released		
	☐	sodium chloride 0.9% 1,000 mL with mvi, adult 10 mL, thiamine 500 mg, folic acid 1 mg infusion	PRN	S	Until discont'd	
		intravenous, once, Starting when released		
	☐	sodium chloride 0.9 % bolus 1,000 mL	PRN	S	Until discont'd	
		1,000 mL, intravenous, once, Starting when released
	After above infused.		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	ondansetron (ZOFRAN) IV 4 mg	PRN	S	Until discont'd	
		4 mg, intravenous, every 8 hours PRN, nausea, vomiting, Starting when released, Until Discontinued
	May cause QTc prolongation.		
	☐	ketorolac (TORADOL) injection 15 mg	PRN	S	Until discont'd	
		15 mg, intravenous, every 6 hours PRN, mild pain (score 1-3), Starting when released, for 5 days		
	☐	ketorolac (TORADOL) injection 30 mg	PRN	S	Until discont'd	
		30 mg, intravenous, once PRN, severe pain (score 7-10), Starting when released, for 5 days		
	☐	cyanocobalamin injection 1,000 mcg	PRN	S	Until discont'd	
		1,000 mcg, intramuscular, once, Starting when released		
	☐	cyanocobalamin-cobamamide 5,000-100 mcg lozenge	PRN	S	Until discont'd	
		sublingual, Starting when released