PLACE LABEL HERE

ROBOTIC GYN POST-OP

ORDERS

The following orders will be implemented. Orders with a “” are choices and are NOTimplemented unless checked.

Initial all handwritten order modifications and the bottom of each page when indicated (multipage).

1. DiagnosisSame as preprocedure plan ______(initials)

andAdmit as Inpatient ______(reason for admission)

Status:Place in Observation ______(reason for observation)

2. Diagnostics: CBC, Magnesium, and CMP in am

3. Vital signs per post-op routine, then q 4 hrs

4. Urine output q 2 hrs X 2, then q 4 hrs

5. Notify Physician for temp greater than 101°F, urine output less than 30 ml/hr for 2 consecutive hrs, BP

greater than 180/90 or less than 90/60, RR greater than 30 or less than 10, or excessive bleeding

6. Foley catheter care,  D/C Foley @______complete Foley leg bag teaching for home

7. Turn, cough, deep breath & Incentive spirometer 10 repetitions q1hr while awake

8. Activity: Bedrest Ambulate in ____hrs Ambulate in am Up ad lib

9. Sequential compression device (SCD) until ambulating

10. Diet: Clear liquids, advance as tolerated Other:______

Scheduled Medications:

11. D5 ½ NS at 125 ml/hr Other:______

12. Estradiol patch 0.05mg or 0.1 mg apply topically X 1 dose in PACU

PRN Medications

13. Severe Pain: (Choose one if needed) Morphine 1-4 mg IV q3hrsprn

Dilaudid (hydromorPHONE) 0.5-1 mg IV q 3 hrs prn

See PCA orders (form # 2119)

14. Moderate pain: (Choose one if needed)

Percocet (oxycodone/acetaminophen) 5/325 mg-10/325 mgpo q 4 hrs prn

Lortab (hydrocodone/acetaminophen) 5/500 mg-10/500 mg po q 4 hrs prn

Toradol (ketorolac) 10mg po q 6 hrs prn (5 mg if > 65 y/o or weight < 50 kg)

Toradol (ketorolac) 30 mg IV (or IM if no IV access) q 6 hrs prn (15 mg if > 65 y/o

or weight < 50 kg)

15. Nausea/vomiting:Zofran (ondansetron) 4 mg IV q6hrs prn

Other: ______

16. Anxiety: (Choose one if needed)Ativan (lorazepam) 0.5-1 mg po or IV q 8 hrs prn

Xanax (alprazolam) 0.25-0.5 mg po q 6 hrs prn

DISCHARGE

17. May go when discharge criteria met

18. May go in ______hrs if discharge criteria met

19. Return to office _____days/week(s) As scheduled

20.Remove vaginal packing prior to discharge.

21.May remove surgical dressings and shower in_____ hrs.

22. Additional Orders:______

______

______

DateTime Physician SignaturePID Number

*1-25632* FORM 1-25632 REV. 07/2012 WHITE: Medical Record CANARY: Pharmacy Page 1 of 1