PHILHEALTHCLINICAL PATHWAYSCLINICAL GUIDELINES

DENGUE CLINICAL PATHWAY

1st 30 min 2nd 30 min 3rd 30 min

Assessment Ascertained with fever of 2-7 days duration with any of the following: skin flushingrashes headacheretro-orbital painmyalgia/arthralgia,

Risk factors for hemorrhagic tendency assessed.

Diagnostics CBC taken Platelet ct less than 100,000, do PTT and blood typing

Treatments Platelet ct greater than 100,000 discharge and advised to do serial CBC daily

Admit if:platelet count is less than 100,000

ORif with any of the ff. regardless of the platelet countspontaneous bleeding persistent abdominal pain persistent vomiting changes in mental statusrestlessnessweak rapid pulse cold clammy skincircumoral cyanosis difficulty of breathingseizures hypotension narrowing of pulse pressure.

Teaching Give information on Dengue fever and measures to control infection at home

ADMITTING ORDERSAdmitting Impression: Dengue FeverConcomitant diagnosis: ____________________________

Please admit to room of choice under the service of Dr. ________________Diet: __________________________________

Vital signs: every 4 hours every _____________Lab:

– 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 TRACTINFECTION

1st 30 min 2nd 30 min 3rd 30 min 4th 30 min

Assessment Ascertained with 1 or more of the ff: dysuria, frequency, hematuria, fever, flank pain, lower abdominal pain AND no vaginal discharge, absent vaginal irritation

Risk factors assessed:DMpregnancy

Diagnostics Routine urinalysis ordered

Urine culture and sensitivity for the ff: worsening signs and symptomspregnant women acute uncomplicated pyelonephritis suspected complicated UTI.

Schedule for renal ultrasound if with any of the ff: gross hematuriaobstructive symptoms persistent infectionhistory or symptoms suggestive of urolithiasisBlood culture if with sepsis

Management May be sent home with oral antibiotic ORAdmit if:uncomplicated pyelonephritis in women and unable to take oral antibioticspregnant women with acute pyelonephritiscomplicated UTI

ADMITTING ORDERS• Admitting Impression: Urinary Tract Infection• Concomitant diagnosis: ____________________________• • Please admit to room of choice under the service of Dr. ________________• Diet: __________________________• Vital signs: __ every 4 hours __every hour every _____________

• Lab:

– 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 ACQUIREDPNEUMONIA

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 lateralCBC

Sputum GS, C/SBlood Culture

BUN, CreatinineSerum 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 lateralCBC

Sputum GS, C/SBlood Culture

BUN, CreatinineSerum 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•