PLACE LABEL HERE
ABDOMINAL AORTIC ANEURYSM
POST-OP 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).
PACU:
1. Diagnostics (Stat): q CBC q Chem 7 q Calcium q Magnesium q Phosphorus q PT/PTT
q ABGs q PCXR q EKG q Other: ______
POST-OP
2. 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
3. If admitted as inpatient, Inpatient Physician Certification:
Diagnosis: ______
Level of Care: q Critical q Intermediate q Acute Care Location/Specialty Unit Preference______
4. q Telemetry: If patient Medical/Surgical, must complete form # 36084
5. q Isolation: q Contact q Droplet q Airborne For: ______
6. Diagnostics in AM: q CBC q Chem 7 q Calcium q Magnesium q Phosphorus
q PT/PTT q ABG’s q PCXR q Other:______
7. Vitals per ICU routine, pedal pulses q 4 hrs, Strict I & O
8. Central Venous Catheter Care Standing Orders # 32657
9. O2 per protocol (form # 34431)
10. Incentive spirometry q 4 hrs
11. NG tube to low intermittent suction
12. q Foley catheter
13. Do not remove Foley catheter until ordered , Reason:______
14. Foley Catheter Removal and Voiding Assessment/Interventions Standing Orders (form # 31620)
15. NPO
16. Activity: q Bed rest q Out of bed with assistance q Up ad lib q Other: ______
SCHEDULED MEDICATIONS
17. IVF: q NS q LR q D5NS q D5 ½ NS with 20 KCl at ______ml/hr
18. Antibiotic: Post-op antibiotic will be automatically stopped within 24 hrs unless indication is documented.
q Ancef (cefazolin) 1 gm IV q 8 hrs x 2 doses or q continue > 24 hrs for ______(Reason REQUIRED)
q Other______x 24 hrs or q continue > 24 hrs for ______(Reason REQUIRED)
19. Antihypertensive: q Nitroglycerin paste 1 inch to chest wall q 6 hrs to keep SBP < 130 mmHg
q Remove for SBP < 90 mmHg
20. Stress Ulcer Prophylaxis: q Pepcid (famotidine) 20 mg IV q 12 hrs
21. VTE prophylaxis, Initiate Venous Thromboembolism (VTE) Prophylaxis Orders (form # 33058)
q Heparin 5,000 units SQ q 8 hrs (q 12 hrs if wt < 50 kg or age > 75)
or q Lovenox (enoxaparin) 40 mg SQ q 24 hrs, begin in AM on POD #1 (30 mg if CrCl < 30 ml/min)
and/or q Mechanical devices: SCDs
*3-18573* FORM 3-18573 REV. 11/2016 WHITE: Medical Record CANARY: Pharmacy Page 1 of 2
PLACE LABEL HERE
ABDOMINAL AORTIC ANEURYSM
POST-OP 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).
PRN MEDICATIONS See policy 520-06 for range orders and pain intensity guidelines.
22. q Electrolyte Replacement Protocol (form # 21340)
23. Mild Pain, Temp >100.5°F, HA: q Tylenol (acetaminophen) 650 mg po or PR q 4 hrs prn
24. 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 If patient cannot take tablet, Hycet elixir (HYDROcodone/acetaminophen 7.5/325 mg/15 ml) 15 ml po q 4 hrs prn instead of Norco. 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.
and/or q Toradol (ketorolac) 30 mg IV (or IM if no IV access) q 6 hrs prn (15 mg if CrCl 31-50, > 65 y/o old or <50 kg) or 10 mg po q 6 hrs prn (max combined duration of IV and po ketorolac is 5 days). DC if CrCl < 30.
25. 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.
26. Nausea/Vomiting: q Zofran (ondansetron) 4 mg IV or po q 6 hrs prn
q If N/V persists, add Reglan (metoclopramide) 10 mg IV q 6 hrs prn (5 mg if > 65 y/o)
27. Respiratory: q Albuterol 2.5 mg via nebulizer four times daily q prn
28. Antihypertensive:
q / Vasotec (enalapril) / · 1.25 mg IV q 4 hrs prn SBP greater than ______mmHg❑ / Nitroglycerin / · Dosing Range: 5 mcg/min to unit specific max, *May be ordered as set rate*
· Change Rate: 5-20 mcg/min q 5 min to maintain relief of chest pain and SBP > 100
q / CardENE
(nicardipine) / · Dosing Range: 5-15 mg/hr
· Change Rate: 2.5 mg/hr q 15 min titrate to maintain SBP between ______to ______mmHg
ADDITIONAL ORDERS:
______
______
______
______
Date Time Physician Signature PID Number
FORM 3-18573 REV. 11/2016 WHITE: Medical Record CANARY: Pharmacy Page 2 of 2