Condition

4. Vital signs: q1h with neurochecks. Call physician if BP >160/90, <90/60; P >120, <50; R>25, <10; T >38.5°C; or change in neurologic status.

5. Activity: Up as tolerated.

6. Nursing: Guaiac stools.

7. Diet: Dysphagia ground with thickened liquids or regular diet.

8. IV Fluids: Heparin lock with flush q shift.

9. Special Medications: -Aspirin 325 mg PO qd OR -Clopidogrel (Plavix) 75 mg PO qd OR -Ticlopidine (Ticlid) 250 mg PO bid OR

-Heparin (only if recurrent TIAs or cardiogenic or vertebrobasilar source for emboli) 700-800 U/h (12 U/kg/h) IV infusion without a bolus (25,000 U in 500 mL D5W); adjust q6-12h until PTT 1.2-1.5 x control. -Warfarin (Coumadin) 5.0-7.5 mg PO qd for 3d, then 2-4 mg PO qd. Titrate to INR of 2.0-2.5.

10. Symptomatic Medications: -Ranitidine (Zantac) 150 mg PO bid. -Docusate sodium (Colace) 100 mg PO qhs. -Milk of magnesia 30 mL PO qd prn constipation.

11. Extras: CXR, ECG, CT without contrast; carotid duplex scan, echo-cardiogram, 24-hour Holter monitor. Physical therapy, neurology consults.

12. Labs: CBC, glucose, SMA 7&12, fasting lipid profile, VDRL, drug levels, INR/PTT, UA.

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