ACUTE MENTAL STATUS CHANGE admission order
Name: ______________________________________________ Age: _______ DOB: ____ /____ /____ Medical record #: _______________
1. Status: l Observation l Admission l Medical floor
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ACUTE MENTAL STATUS CHANGE admission order
Name: ______________________________________________ Age: _______ DOB: ____ /____ /____ Medical record #: _______________
1. Status: l Observation l Admission l Medical floor l Monitored bed l Other ______________________
2. Attending: Dr: __________________________________ phone: ________-_____________
3. Admitting Diagnosis: Acute Mental Status Change
Associated Diagnoses: __________________________________________________________________________
4. Condition: l Stable l Fair l Serious l Critical Code Status: l Full Code l DNR
5. Allergies: ______________________________________________________________________________________________________________________
6. Diet: l NPO l Clear liquid l AHA step 2 l ADA ______ calories l Other______________________
7. Activity: l Bed rest with bedside commode l Bathroom privileges l Up ad lib l Fall precautions
8. Nursing: l Vital signs with neuro every 4 hrs for 24 hrs then every shift
l Notify MD for: T > 101.5, HR > 120, BP < 90/60 or > 180/110, decline in neurostatus, O2
sat < 92%
l Pulse ox every 8 hrs nasal cannula/face mask to maintain O2
sat > 92%
l I&O
9. Medications: For aggressive or psychotic behavior management
Acutely agitated and over 200 lbs without renal/hepatic impairment
l Haldol 10 mg PO/IM, Ativan 4 mg PO/IM and Cogentin 1 mg PO/IM every 6 hrs prn; hold if BP <
100/60 mmHg, OR
l Geodon 20 mg IM every 8 hrs prn; hold if BP < 100/60 mmHg
Acutely/moderately agitated and under 200 lbs without renal/hepatic impairment
l Risperdal 2 mg and Ativan 2 mg PO every 6 hrs prn, OR
l Haldol 5 mg IM and Ativan 2 mg IM and Cogentin 1 mg IM every 4 hrs prn; hold if BP < 100/60
mmHg, OR
l Geodon 20 mg IM every 8 hrs prn; hold if BP < 100/60 mmHg
Mildly agitated with renal/hepatic impairment
l Risperdal 2 mg PO and Ativan 2 mg PO every 8 hrs prn
Elderly/Frail
l Risperdal 0.5 mg PO and Ativan 0.5 mg PO every 8 hrs prn (not to exceed 3 in 24 hrs), or
l Haldol 2 mg IM and Ativan 1 mg every 8 hrs prn; hold if BP < 100/60 mmHg
10. IV: l IV lock; flush per routine l IV __________________________@ mL/hr
11. Lab: l Admission: CBC, sed rate, comp met profile, serum ammonia, HIV, RPR, TSH, urine drug screen
l Consider: serum for lead and heavy metals and lumbar puncture
l Other labs: ___________________________________________________
12. Diagnostic Studies: l CT head without contrast l CXR 2 view; reason: rule out bony abnormality/infiltrate
l Consider carotid Doppler
13. Consult: _____________________________________________
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