PLACE LABEL HERE

BARIATRIC SURGERY

PRE-OP ORDERS

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

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

DIAGNOSIS: ______

PROCEDURE:Laparoscopic Adjustable Gastric Banding (Patient to be placed in outpatient status)

Laparoscopic Gastric Bypass (Admit to inpatient status pre-operatively)

Laparoscopic Sleeve Gastrectomy (Admit to inpatient status pre-operatively)

Open Gastric Bypass (Admit to inpatient status pre-operatively)

 Laparoscopic Duodenal Switch(Admit to inpatient status pre-operatively)

1.Labs: CBC, CMP, PT/PTT, Iron Panel, B12, Total Vitamin D (25 OH), HGB A1C

2.Additional Labs:  CRP, Thiamine, Plasma Vitamin A, Vitamin E, Vitamin K, Parathyroid level,

Pre-albumin, Thyroid panel with TSH, Phosphorus, Zinc, Magnesium, Copper

3.Diagnostics:  CXR  EKG  ABG

Ultrasound of:  Gallbladder  Pelvis  Other: ______

4. CPAP/BIPAP - Instruct patient to bring CPAP from home.

5.  Incentive spirometry

6. Call Bariatric Program Nurse with all abnormal Lab/Diagnostic values

7. Skin Prep: Instruct patient to wash with antibacterial soap the morning of surgery.

8. Diet: Clear liquids diet the day before surgery, then NPO at midnight (night before surgery)

9. H & P to be FAXED to Surgical Interview when completed by Surgeon

10. Home Lovenox (enoxaparin) for history of DVT/PE, wheelchair bound, lymphedema, previously placed IVC filter, current use of aromatase inhibitors (anastrazole, exemestane, letrozol) or tamoxifen.

Case Manager to arrange for home Lovenox (enoxaparin) 40 mg SQ q 12 hrs x 2 weeks post-op

Nurse to perform teaching for home Lovenox use

DAY OF SURGERY:

11. Apply antiembolic device: Knee high SCDs with Knee high TED hose

12. Clip surgical site for procedure as indicated

PRE-OP MEDICATIONS:

13. Ofirmev (acetaminophen) 1 gm IV over 15 mins to be givenin OR

14. Pepcid (famotidine) 20 mg IV X1 dose to be given preoperatively

15. Scopolamine Transdermal apply 1 patch behind the ear preoperatively (1 patch delivers 1 mg over 3 days)

16. Antibiotics:  Mefoxin (cefoxitin) 2 gm IV x 1 dose (given by Anesthesia in OR)

OR  If allergic to Mefoxin (cefoxitin) or a penicillin reaction history of hives or anaphylaxis,

Avelox (moxifloxacin) 400 mg IV x 1 dose

 *Vancomycin

If patient weight < 90 kg, 1 gm IV x 1 dose (infuse over 1 hr)

If patient weight 90 kg, 1.5 gm IV x 1 dose (infuse over 1.5 hrs)

* REQUIRED-Rationale for using vancomycin as antimicrobial prophylaxis:

History of MRSA/positive screen

 Allergy to penicillin and cephalosporins

17.  Heparin 5,000 units SQ x1 dose in pre-op OR  Lovenox 40 mg SQ x 1 dose in pre-op

ADDITIONAL ORDERS:

18. Patient to be placed on a Bariatric Bed per Policy # 6580-400-007

19. Gainesville patient, please contact 770-534-0110 (ext 3829) for any additional documents needed

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DateTimePhysician SignaturePID Number

*1-27810*FORM 1-27810 REV. 01/2018 WHITE: Medical Record CANARY: Pharmacy Page 1 of 1