PLACE LABEL HERE
PERCUTANEOUS TRANSHEPATIC
CHOLANGIOGRAM (PTC)
POST PROCEDURE ORDERS
The following orders will be implemented. Orders with a “q” are choices and are NOT implemented unless checked.
Initial all handwritten order modifications and the bottom of each page when indicated (multipage).
1. Do you expect that the patient’s condition will require a hospital stay that will cross two midnights (includes the time spent in outpatient- ED, surgery, OBS) and the patient has medical necessity for an inpatient admission?
q Yes, admit as inpatient, proceed to # 2 q No, place in observation q No, outpatient, DC home
2. If admitted as inpatient, Inpatient Physician Certification:
Diagnosis: ______
Level of Care: q Critical q Intermediate q Acute Care Location/Specialty Unit Preference______
3. q Telemetry: If patient Medical/Surgical, must complete form # 36084
4. q Isolation: q Contact q Droplet q Airborne For: ______
5. Consults: ______
6. Diagnostics: portable chest x-ray for shortness of breath; notify radiologist and notify primary physician
7. Liver drain to gravity and record output q shift. Flush drain with NS 10 ml bid.
8. Vital signs: q 15 min x 4,
then q 30 min x 4,
then unit routine.
9. Change dressing on drain site q other day and prn. If wafer or Stat-loc comes loose, notify radiology nurse.
10. Diet: NPO for 2 hrs post procedure, then start clear liquids. If liquids tolerated, advance diet as tolerated.
11. Activity: bedrest x 6 hrs, then up with assistance for 24 hrs
MEDICATIONS:
12. IVF: NS at ______ml/hr until taking fluids well
13. Mild Pain, Temp >100.5°F, HA: q Tylenol (acetaminophen) 650 mg po or PR q 4 hrs prn
14. Moderate Pain:
q Norco (HYDROcodone/acetaminophen) 5/325 mg or 10/325mg 1 tab po q 4 hrs prn. DC if Percocet ordered.
OR
q Percocet (oxyCODONE/acetaminophen) 5/325 mg or 10/325 mg 1 tab po q 4 hrs prn. DC if Norco ordered.
15. Severe Pain (Begin when Epidural or PCA has been discontinued)
q Morphine 1-2 mg IV q 3 hrs prn, DC if CrCl < 30. Hold for excessive sedation. DC if Dilaudid ordered.
OR
q Dilaudid (HYDROmorphone) 0.25-0.5 mg IV q 3 hrs prn. If CrCl < 30, dose at 0.25 mg. Hold for excessive sedation. DC if Morphine ordered.
16. Nausea/Vomiting: q Zofran (ondansetron) 4 mg IV or po q 6 hrs prn
ADDITIONAL ORDERS:
______
______
______
Date Time Physician Signature PID Number
Copy to pharmacy
*1-16757* FORM 1-16757 REV. 02/2016 Page 1 of 1