PHILHEALTH CLINICAL PATHWAYS CLINICAL 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 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

ADMITTING ORDERS Concomitant diagnosis: ____________________________ 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: __________________________ __________________________

ADMITTING ORDERS Ancillary Therapy: Referral to other services: 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 TRACT INFECTION

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

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 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 ACQUIRED PNEUMONIA

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 CBC Sputum GS, C/S Blood Culture BUN, Creatinine 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: __________________________

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 CBC Sputum GS, C/S Blood Culture BUN, Creatinine 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: __________________________

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