PHILHEALTH CLINICAL PATHWAYS CLINICAL GUIDELINES

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PHILHEALTHCLINICAL PATHWAYSCLINICAL GUIDELINES
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DENGUE CLINICAL PATHWAY
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1st 30 min 2nd 30 min 3rd 30 min
Assessment Ascertained with fever of 2-7 days duration with any of the following skin flushing rashes headache retro-orbital pain myalgia/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 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.
Teaching Give information on Dengue fever and measures to control infection at home
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ADMITTING ORDERS

• Admitting Impression Dengue Fever
• Concomitant 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 __________________________
• __________________________

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ADMITTING ORDERS

• IVF __________________________
• Other medications
• _______________________________________________
  __
• _______________________________________________
  __
• Ancillary Therapy
• ______________________________________________
  ___
• _______________________________________________
  __
• _______________________________________________
  __
• Referral to other services
• Hematology __________________________________
  _______________
• Others _____________________________
  ____________________
•  
• Inform attending physician(s) and
  resident-on-duty of patients room number
• Refer for any undue development.
• ______________________
• Signature over printed name
• Attending Physician

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URINARY TRACTINFECTION
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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 DM pregnancy
Diagnostics Routine urinalysis ordered Urine culture and sensitivity for the ff worsening signs and symptoms pregnant women acute uncomplicated pyelonephritis suspected complicated UTI. 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
Management 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
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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 __________________________

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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
• _______________________________________________
  __

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ADMITTING ORDERS

• Ancillary Therapy ____________________________
  _____________________
• _________________________________________________
  
• Referral to other services
• Infectious Disease
• Nephrology
•  Others ________________________________________
  _________
• ________________________________________________
  _
• ________________________________________________
  _
•  
• Inform attending physician(s) and
  resident-on-duty of patients room number
• Refer for any undue development.
•  
• ______________________
• Signature over printed name
• Attending Physician

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COMMUNITY ACQUIREDPNEUMONIA
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CLINICAL DIAGNOSIS

• Cough
• Fever
• Difficulty of breathing
• Chills
• Within the past 24 hours to less than 2 weeks

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CLINICAL DIAGNOSIS

• Associated with
• Tachypnea (RR gt 20 breaths/min)
• Tachycardia (HR gt 100/min)
• Fever (T gt 37.8oC)
• With at least one of the ff
• Diminished breath sounds
• Rhonchi
• Crackles
• Wheeze

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DIAGNOSTIC TESTS

• Chest Xray
• Gram stain and culture of appropriate pulmonary
  secretions
• Pre-treatment Blood Cultures

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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 __________________________

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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 _______________________________________
  __________

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ADMITTING ORDERS

• Other medications
• Pneumococcal vaccine prior discharge
• Influenza vaccine prior to discharge
  ________________________________________________
• _____________________________________________
  ____
• Ancillary Therapy
• O2 inhalation _________________________________
  ___
• Others __________________________________________
  _______

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ADMITTING ORDERS

• Referral to other services
• Infectious Disease________________________________
  ____________
• Pulmonary _____________________________
  _______________
• Others __________________________________
  __________
• Inform attending physician(s) and
  resident-on-duty of patients room number
• Refer for any undue development.
•  
• _____________________
• Signature over printed name
• Attending Physician
•  

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CAP SEVERE
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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 __________________________

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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 _____________________________________
  ____________
• ___________________________
  ______________________

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ADMITTING ORDERS

• Other medications
• Pneumococcal vaccine prior discharge
• Influenza vaccine prior to discharge
  ________________________________________________
• _____________________________________________
  ____
• Ancillary Therapy
• O2 inhalation _________________________________
  ___
• Others __________________________________________
  _______

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ADMITTING ORDERS

• Referral to other services
• Infectious Disease________________________________
  ____________
• Pulmonary _____________________________
  _______________
• Others __________________________________
  __________
• Inform attending physician(s) and
  resident-on-duty of patients room number
• Refer for any undue development.
•  
• _____________________
• Signature over printed name
• Attending Physician
•  

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