Perscriber Orders Suzanne Gordon DOB 09/27/1988
Orders
| Date/Time | Order Category | Signature |
| Labor/ Epidural Order 1840 | Labor/Epidural Orders 1. This patient has received the following via Epidural at 1840: Drug: 0.08% Buvivacaine 12.5 mg Drug: Fentanyl 10 mcg Drug: Morphine 100 mcg 2. Maintain IV access at all times and 12 hrs after epidural discontinued. 3. Vital sign monitoring: a) RR and Sedation score Q 1 hr for 18 hours b) BP/P q 30 mins x 2 hours post removal, then q 4 hr 4. Pain assessment q2hr while awake. 5. Postural BP and Pulse prior to first ambulation. 6. Moror assessment, sensory/dermatome level, catheyer/dressing check q4hr unitl 18hrs post epicatheter removal 7. Medications: Follow Post-Op Caesarean section orders. 8. Discontinue Epidural orders 18hrs post removal. | L.Devi |
| Postpartum order 1930 | Post-Op Caesarean Section: 1. Diet: -Gestational Diabetic Diet -Use Diabetes- Gestational & Pre-Gestational type 2 Managment of Intrapartum and Postpartum Guidelines for Decision Making 2. Activity and Monitering: -If patient had spinal/ epidural, follow Anesthetic orders for activity and vital sign monitoring. -Acitivity as tolerated. May shower after 24 hours post-op -For Postpartum monitoring follow Perinatal Services BC Postpartum Nursing Care Pathway -Fluid intake and output. Contact MRP if urine output less than 20 ml per hour for 4 consecutive hours -Facilitate hand expression or pumping of breast milk if infant and mother are separated for more than 3 hours 3. Laboratory: -CBC post-op day 1 4. Treatments: -Intermittent Pneumatic Compression until ambulating well -Remove foley catheter postop day 1 if successfully dangling -Remove staples post op day 7 and apply steristrips 5. IV & Medications: -0.9 % Sodium chloride IV @ 1OO ml/ hr. -May change to salin lock or discontinue IV after first 1000ml/ IV Fluid if no medications infusing, vital signs are stable, uterus is firm, no excessive bleeding, and when voiding -Contact MRP if signs of symptoms of postpartum hemorrhage -Diabetes-Gestational Protocal -Venous Thromoboembolism (VTE) PPO -Sennosides 12mg to 24mg PO HS PRN Follow Anesthetist Epidural/Spinal Orders as per Epidural Orders, then: -DiphenhydrAMINE 25 to 50 mg PO or IV q6h PRN for itching -Ondansetron 4mg PO or IV q8h PRN -DimenhyDRINATE 25-50mg PO or IV q4h PRN for nausea or vomiting -Hydromorphone 2mg q4h PRN -Naproxen 500 mg PO Q12h PRN -Acetaminophen 500mg-1000mg PO q6hx 24 hrs, then q6hrs PRN (Max 4000mg/ 24hr) | L.Devi |
| Postpartum orders 1930 | Venous Thromboembolism (VTE) Prophylaxis- Adult Protocal •heparin 5000 units SC q12hrs start post-op until discharge. | L.Devi |
| Postpartum 1930 | Diabetes- Gestational & Pre-Gestational Type 2 Management of Intrapartum and Postpartum 1. Diet: Gestational Diabetic Diet 2. Monitering -Target Capillary Blood Glucose (CBG)= 4-7mmol/L *Correction of blood glucose may occur below 7mmol/L due to delayed response to insulin -Measure CBG on admission and every 2 hrs -Measure CBG hourly if patient is started on insulin -Nurse to use Accu-Check meter to measure CGB. If patient self monitering, nurse to do supplemental CBG checks using TRU Accu-Chek meter QID (AC meals and at bedtime) -Record CBG levels on BC Perinatal Triange & Assessmet Record -If abnormal CBG follow Decision Making Guidelines 3. Insulin • Discontinue previous subcutaneous insulin orders. • If Capillary Blood Glucose (CBG) is less than 4 mmol/L or greater than 6 mmol/L, start on subcutaneous sliding scale insulin orders (as indicated in the chart below) and notify prescriber. Measure CBG hourly. • Notify prescriber if CBG is less than 4 mmol /L or greater than 6 mmol IL on 2 consecutive readings. If patient is started on subcutaneous sliding scale insulin, measure CBG hourly. • If CBG has fallen by 2 mmol/L or greater with a sliding scale dose of aspart (Novorapid®), wait an additional hour, recheck CBG, then assess need for subsequent dose (as indicated in the chart below) Insulin Aspart (NovoRapid) SC Hypoglysemia protocal 4-6= none 6.1-7= 2 units 7.1-8= 3 units 8.1-9= 4 units 9.1-10= 5 units greater than 10= call physician & see type 1 diabetes orders 4. Postpartum Managment • Discontinue all previous insulin orders • Gestational Diabetic Diet as tolerated • Record CBG on the IH Subcutaneous Insulin Administration and Blood Glucose Record-Adult Eating/Bolus Enteral Feeds. • CBG before breakfast and before dinner postpartum day 1 • If CBG less than 7 mmol/L, discontinue CBG monitoring | L.Devi |
