PLACE LABEL HERE
CESAREAN SECTION POST-OP
DURAMORPH (morphine, preservative free)
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).
STARTED IN OR (Pharmacy, do not profile)
q DURAMORPH (Morphine, preservative free) given in OR:
Dose: ______mg Route: ______Date: ______Time: ______
1. Maintain IV access (may KVO or INT with NS flush) for 24 hrs after Duramorph (morphine, preservative free)
2. No continuous rate PCA or IV opioids for 24 hours following Duramorph (morphine, preservative free).
3. Monitor sedation scale, oxygen saturation, and respiratory rate q 2 hours × 18 hours following Duramorph (morphine, preservative free)
Sedation Scale:
0 - Awake, alert
1 - Occasionally drowsy, easy to arouse
2 - Frequently drowsy or normal sleep, easy to arouse
3 - Somnolent, difficult to arouse
4 - Obtunded, unable to arouse
4. Call anesthesiologist for:
· Inadequate pain relief
· Upper airway obstruction
· Altered mental status
· Epidural catheter obstruction/dislodgement
SEDATION AND RESPIRATORY DEPRESSION:
5. If respiratory rate is less than 10 per minute or sedation scale is 3:
· Administer O2 by NRB @ 10 L/min, obtain oxygen saturation and call the Anesthesiologist and Respiratory Therapy STAT.
6. If respiratory rate less than 8 per minute or sedation scale 4:
· Administer 100% O2 via NRB @ 10 L/min STAT
· Narcan (naloxone) 0.4 mg diluted in Normal Saline 10 ml (0.04 mg/ml) and administer 1 ml prn STAT and then q 2 min until respiratory rate ≥ 10
· Obtain oxygen saturation
· Call Anesthesiologist and Respiratory Therapist STAT
7. If apneic:
· Call Code Blue
· Begin bag and mask ventilation with ambu bag and oxygen
· Give naloxone 0.4 mg IV prn STAT
· Call Anesthesiologist and Respiratory Therapy STAT
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:
8. Pain: For the first 24 hrs after Duramorph given, if sedation score 0 or 1, give:
q Norco (HYDROcodone/acetaminophen) 5/325 mg po q 6 hrs prn. No other narcotics for the first 24 hours post Duramorph administration.
or q Percocet (oxyCODONE/acetaminophen) 5/325 mg po q 6 hrs prn. No other narcotics for the first 24 hours post Duramorph administration.
9. Pruritus: Zofran (ondansetron) 8 mg IV prn x 1 dose. Do not give if Zofran (ondansetron) has already
been given.
Nubain (nalbuphine) 5 mg IV prn x 1 dose if Zofran (ondansetron) not effective
If Nubain (nalbuphine) not effective or unavailable, start naloxone 400 mcg (0.4 mg) in 100 ml NS (concentration = 4 mcg/mL) prn. Infuse at 0.25 mcg/kg/hr × 4 hrs.
DC Phenergan (promethazine) if previously ordered. Do NOT give Phenergan for 24 hours after Duramorph administration.
OTHER ORDERS:
10. Lovenox (enoxaparin) or any other low molecular weight heparin (LMWH) is NOT to be given during epidural infusion. Lovenox or other LMWH may be restarted 4 hrs after the epidural catheter has been removed.
11. Heparin SQ (low dose) can be given in the presence of epidural catheter post-operatively and post-partum. Heparin IV is NOT to be given during epidural infusion.
· Wait a minimum of 4 hrs following administration of Heparin SQ dose before epidural catheter removal.
· Heparin SQ may be resumed 4 hrs after the catheter is removed.
12. Do not discharge home earlier than 24 hrs after the last dose of Duramorph (morphine, preservative free)
______
Date Time Physician Signature PID number
Copy to pharmacy Order writer’s initials ______
*3-36816* FORM 3-36816 REV. 09/2015 Page 1 of 2