Admission Orders Template
Primary Diagnosis:
Status/Condition (Critical, Guarded, Stable, etc.) :
Code Status:
Allergies:
Admit to Unit:
Activity Level:
Diet:
IV Fluids:
· Critical Drips (If ordered, include type and rate. Do not defer to ICU protocol.) :
Respiratory: Oxygen (If ordered, include type and rate.), pulmonary toilet needs, ventilator settings :
Medications (include ALL, tx of primary condition, underlying conditions, pain, comfort needs, etc., dose and route) :
Nursing Orders (vital signs, skin care, toileting, ambulation, etc.) :
Follow-Up Lab Tests:
· Diagnostic testing (CXR, US, 2D Echo, etc.) :
Consults:
NOTE: (Do not defer management to a specialist. As an ACNP, you must manage the patient’s acute needs for at least a 24-hour period]. Include indication for consult. For example: “Cardiology consult for evaluation of new-onset atrial fibrillation,” or “Nutrition consult for TPN recommendations.”
Patient Education and Health Promotion (address age-appropriate patient education. if applicable) :
Discharge Planning and Required Follow-Up Care:
References (minimum of three timely references that prove this plan follows current standards of care) :
