POSTPARTUMCesarean Section PLACE LABEL HERE

POST-OP Orders

The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.

OTHER DIAGNOSES: ______

Allergies: ______

  1. Maternal/Infant Unit  High Risk Pregnancy Unit

 May transfer care to Maternal/Infant Unit _____ hrs after magnesium sulfate discontinued

or when ______

  1. Consults: ______Concerning: ______ Routine  Urgent
  1. Labs:H&H postpartum day #1

Rho(D) immune globulin workup if Rh negative (Rh ______)

 Glucose monitoring:  FBS q AM  2 hrs postprandial  at Bedtime  at 3 AM  Other: ______

  1. Vital signs on admission to unit, then q30 min x 2, then qhr x 2, then q 4 hrs x 48 hrs, then q 8 hrs until discharge

 Vital signs, DTRs, breath sounds, I & O per magnesium sulfate orders (form # 20). After magnesium sulfate is discontinued, obtain vital signs q 4 hrs or q ______hrs

 TPR q ______hrs; BP q ______hrs

 I & O q ______hrs

  1. Foley to bedside bag. Discontinue at 12 hrs post-op. May straight cath once if patient unable to void in 6 hrs after removal ofFoley or becomes uncomfortable. If unable to void a second time, reinsert Foley and notify Physician/CNM
  2. Notify physician for temperature above 100.4°F twice, four hrs apart, or 101°F once, unstable vital signs, or excessive vaginal bleeding, systolic BP above ______or diastolic BP above ______

 FBS above ______or below ______; 2 hrs postprandial glucose above ______or below ______

  1. Diet: clear liquids; advance as tolerated to regular diet with snacks

 ______calorie consistent carbohydrate gestational diabetic diet with no added juice or fruit at breakfast

 Other: ______

8.Activity: Up on side of bed with assistance first 6-12 hrs post-op. Up with assist first time, first 4 hrs after magnesium sulfate discontinued, and until stable; then ad lib

Bedrest with bedside commode  Bathroom privileges only  Bathroom and shower privileges

9. VTE Prophylaxis: SCDs  with TEDs OR Plexi-pulses with TEDs maintain until ambulatory ad lib

OR ______

10. ChloraPrep to incision site 48 hrs after surgery (at discharge if <48 hrs). Repeat in 48 hrs (patient may do at home)

  1. Incentive Spirometry q 1-2 hrs while awake for patients on magnesium or that had general anesthesia

 Incentive Spirometry q 1-2 hrs while awake

IV FLUIDS:

  1. D5LR at 125 ml/hr IV OR  ______at ______ml/hr IV
  2. Discontinue IV at 12 hrs post-op if afebrile, tolerating po fluids, vital signs are stable, bleeding is not excessive, and/or when PCA/Epidural pain medications are discontinued. For Rh negative patients, maintain IV access until cord blood results obtained. Convert to INT if diabetic (> Class A2)

SCHEDULED MEDICATIONS:

  1. Prenatal vitamin po daily patient may self-administer own prenatal vitamin after pharmacist identifies medication
  2. Rho(D) immune globulin 300 micrograms x 1 dose if indicated (Rh-mother, Rh+ infant). Rophylac is administered IV or IM , RhoGAM must be given IM only.
  3. MMR II (Mumps/Measles/Rubella) vaccine 0.5 ml SQ x 1 dose if rubella non-immune or equivocal
  4. Tdap vaccine (tetanus, diphtheria, acellular pertussis)0.5 ml IM x 1 dose if patient is candidate (policy 7002-01)

 Cancel Tdap (reason:______)

  1.  Implement“Insulin Subcutaneous for Obstetrics” orders (form # 21502), send to pharmacy
  2.  Implement “Magnesium Sulfate for Pre-Eclampsia” orders (form # 20), send to pharmacy
  3. VTE Prophylaxis:  Heparin 5,000 units SQ q 12 hrs (do not begin heparin until epidural has been out for two

hrs)

 Lovenox (enoxaparin) 40 mg SQ q 24 hrs at 1700; if CrCl < 30, give 30 mg SQ q 24 hrs (do not begin enoxaparin until epidural has been out for 12 hrs)

The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.

21.Stool Softener: Colace (docusate) 100 mg po bid. Hold for loose stools
22.Antibiotics: ______
23.Antihypertensives: ______

PRN MEDICATIONS:

  1. Excessive bleeding: Establish IV access if not present; Pitocin (oxytocin) 40 units in 1,000 ml NS or LR IV and infuse wide open; decrease rate to 125 ml/hr once bleeding has decreased and fundus is firm. If not hypertensive or pre-eclamptic, give Methergine (methylergonovine) 0.2 mg IM x 1 dose
  2. Breast feeding discomfort: Lanolin breast cream topically prn after breastfeeding
  3. Severe pain: PCA/epidural for post-op pain per preprinted order. Discontinue PCA/epidural at 12 hrs post-op

 Toradol (ketorolac) 30 mg IV (or IM if no IV access) q 6 hrs prn (if patient weight <50 kg, give 15 mg)

  1. Moderate pain:

Percocet (oxyCODONE/acetaminophen) 5/325 mg 1-2 tabs po or 10/325 mg 1 tab po q 4 hrs prn.

Give first dose 4 hrs prior to DC of PCA/epidural, and give second dose at time of DC of PCA/epidural

OR  Lortab (HYDROcodone/acetaminophen) 5/500 mg 1-2 tabs po or 10/500 mg 1 tab po q 4 hrs prn, DC Percocet. Give first dose 4 hrs prior to DC of PCA/epidural, and give second dose at time of DC of PCA/epidural.

OR Other: ______. DC Percocet

  1. Mild pain: Ibuprofen 600 mg po q 6 hrs prn. Hold if Toradol (ketorolac) is also ordered; may resume 6 hrs after Toradol (ketorolac) is discontinued. May use while on PCA or 1-2 hrs prior to DC of epidural.

If unable to take ibuprofen: Tylenol (acetaminophen) 1,000 mg po q 6 hrs prn

  1. Patient may self-medicate and keep these medications at bedside:
a. Episiotomy pain: Dermoplast (benzocaine) spray topically prn
b. Episiotomy or hemorrhoid discomfort/pain: Witch hazel pads topically with pericare prn
  1. Hemorrhoid discomfort/pain: Dibucaineointmenttopically with pericare prn
  1. Nausea:

Phenergan (promethazine) 12.5 - 25 mg po q 4 hrs prn mild nausea. If unable to tolerate po, may give Phenergan (promethazine) 12.5 - 25 mg suppository per rectum q 4 hrs prn nausea

ORZofran (ondansetron) 4 mg IV q 6 hrs prn. DC Phenergan

OR Other: ______. DC Phenergan

  1. Sleep: Ambien (zolpidem) 5-10 mg po at bedtime prn. If 5 mg given, may repeat x 1 dose after 2 hrs
  2. Indigestion: Maalox XS (aluminum/magnesium/simethicone) 30 ml po four times daily prn
  3. Constipation: Dulcolax (bisacodyl) 10 mg suppository rectally prn, may repeat x 1 in 1 hr if no bowel movement
  4. Gas pain: Simethicone 80 mg po four times daily prn
  5. Pruritis: Benadryl (diphenhydramine) 25-50 mg po q 4 hrs prn

 Benadryl (diphenhydramine) 12.5-25 mg IV q 4 hrs prn

  1. Congestion: Saline nose spray q 2 hrs prn

Sudafed PE (phenylephrine) 10 mg po q 4 hrs prn

 Mucinex (guaifenesin) 600 mg q 12 hrs prn

  1. Cough: Robitussin DM (guaifenesin/dextromethorphan) 10-20 ml po q 6 hrs prn. DC if Mucinex (guaifenesin)ordered

ADDITIONAL ORDERS:

______

______

______

______

DateTimePhysician SignaturePID Number

*3-10806*FORM 3-10806 REV. 03/2011 Send copy to pharmacy ______(initials)

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