glucose, CBC, LFTs, ECG. Acetaminophen Overdose 1. Admit to: Medical intensive
care unit. 2. Diagnosis: Acetaminophen overdose 3. Condition: 4. Vital signs:
q1h with neurochecks. Call physician if BP >160/90, <90/60; P >130, <50 <50;
R>25, <10; urine output <20 cc/h for 3 hours. 5. Activity: Bed rest with bedside
commode. 6. Nursing: Inputs and outputs, aspiration and seizure precautions.
Place large bore (Ewald) NG tube, then lavage with 2 L of NS. 7. Diet: NPO 8.
IV Fluids: 9. Special Medications: -Activated Charcoal 30-100 gm doses, remove
via NG suction prior to acetylcysteine. -Acetylcysteine (Mucomyst, NAC) 5% solution
loading dose 140 mg/kg via NG tube, then 70 mg/kg via NG tube q4h x 17 doses
OR acetylcysteine 150 mg/kg IV in 200 mL D5W over 15 min, followed by 50 mg/kg
in 500 mL D5W, infused over 4h, followed by 100 mg/kg in 1000 mL of D5W over
next 16h. Complete all NAC doses even if acetaminophen levels fall below toxic
range. -Phytonadione 5 mg IV/IM/SQ (if INR increased). -Fresh frozen plasma
2-4 U (if INR is unresponsive to phytonadione). -Trimethobenzamide (Tigan) 100-200
mg IM/PR q6h prn nausea 10. Extras: ECG. Nephrology consult for hemodialysis
or charcoal hemope- rfusion. 11. Labs: CBC, SMA 7&12, LFTs, INR/PTT, acetaminophen
level now and in 4h. UA. Theophylline Overdose 1. Admit to: Medical intensive
care unit. 2. Diagnosis: Theophylline overdose 3. Condition: 4. Vital signs:
Neurochecks q2h. Call physician if BP >160/90, <90/60; P >130; <50; R >25, <10.
5. Activity: Bed rest 6. Nursing: ECG monitoring until level <20 mcg/mL, aspiration
and seizure precautions. Insert single lumen NG tube and lavage with normal
saline if recent ingestion. 7. Diet: NPO 8. IV Fluids: D5 1 NS at 125 cc/h