Prescriber Orders Natasha Featherstone 10/15/1958
Orders
| Date/Time | Order Category | Order | Signature | ||||||
| Today/0100 | Post-Op | Use Enhanced Recovery After Surgery (ERAS) Post Op Order Set | DH | ||||||
| Today/0100 | Medications | Use VTE prophylaxis order set | DH | ||||||
| Today/0100 | Medication | Use anesthesia pain management order set | DH | ||||||
| Today/0400 | Diet | Enhanced Recovery After Surgery Post-Op Order Set • Sugar-free chewing gum 30 min TID and PRN • 1 can of nutritional supplement BID every day • Day of Surgery: Full Fluids to DAT (General or Diabetic Diet) | |||||||
| Today/0400 | Activity | Enhanced Recovery After Surgery Post-Op Order Set • Day of Surgery: walk from stretcher to bed; sit at bedside or in chair; time out of bed 10-15 minutes • Post-op day 1: chair for all meals; 1 lap or more of ward, 2-3 times/day; time out of bed 1-3 hours • Post-op day 2 and on: chair for all meals; 2-3 laps, 3 times/day or more; time out of bed 6 hours • incentive spirometry 01 H while awake • Physiotherapy referral (consider for patients with compromised pulmonary function and I or with limited mobility) | |||||||
| Today/0400 | Urinary Catheter | Enhanced Recovery After Surgery Post-Op Order Set Post-op day 1: remove indwelling catheter in the morning | |||||||
| Today/0400 | Vital Signs/Monitoring | Enhanced Recovery After Surgery Post-Op Order Set In PAR: give oxygen at 10 L/min via mask x 1 hour In PAR: BGM • Follow vital signs protocol for Epidural or PCA, then vital signs TID when protocol discontinued. • Without epidural or PCA vital signs Q4H x 24 hours then TID • Monitor urine output Q4H over first night post-op, then Q shift if urine output greater than 100 ml/ 4 hr • If urine output less than 100 ml over 4 consecutive hours on Day of Surgery, give: Ringer’s Lactate 250 ml IV x 1, and run over 30 minutes If urine output does not improve in the next hour (greater than 20 ml/hr), call surgeon and order CBC, Lyles 4 and creatinine STAT | |||||||
| Today/0400 | Diagnostics | Enhanced Recovery After Surgery Post-Op Order Set •Post op days 1: CBC | |||||||
| Today/0400 | Intravenous Fluids | Enhanced Recovery After Surgery Post-Op Order Set •Ringers Lactate @ 75 ml/hr •Post-op day 1 and on: saline lock IV if drinking well (drinking 1,200-1,500 ml/ 24 hours) | |||||||
| Today/0400 | Additional Orders | •May shower Post-op Day 2 •Remove ICD (SCD) morning of post=op Day 1 | |||||||
| Today/0400 | Medications | Enhanced Recovery After Surgery Post-Op Order Set •VTE Preprinted orders (see below) •Ondansetron 4 mg PO / IV Q6H x 24 hours, then Q6H PRN – nausea nausea •Metoclopramide 10 mg PO/IV Q8H x 24 hours, then QSH PRN • nausea (Physician to adjust dose if eGFR less than 60) •DimenhyDRINATE 25 to 50 mg PO/IV Q4H PRN • nausea •Magnesium hydroxide liquid 30 ml PO BID laxative to start Post-op day 2 (hold if diarrhea) | |||||||
| Today/0400 | Medications- Analgesia | •Follow Anesthesia Pain Management Orders (Epidural/PCA orders) •Use Pain Management Flow Sheet and Monitoring Protocol •Acetaminophen 1,000 mg PO Q6H x 72 hours, then Q6H PRN – pain •Diclofenac 50 mg PO/PR Q12H x 48 hours, then Q12H PRN – pain | |||||||
| Today/0400 | Anesthesia Pain Management Orders | see below | |||||||
| Today/0400 | VTE Prophylaxis Order and VTE Risk Assessment Recommendations | see below | ||||||
