PLACE LABEL HERE

RADIATION SEED

POST-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).

1.Diagnosis Same as preprocedure plan ______(initials)

and Admit asInpatient ______(reason for admission)

Status: Place in Observation for ______(reason for observation)

2.Unit:  ICU  IMCU/PCU  Telemetry Floor  Any Floor Telemetry  Any Floor (No Telemetry)

  1. VS per PACU routine
  2. Foley to leg bag
  3.  Ice to perineum
  4. Diet: Advance as tolerated
  5. Activity:  Ambulate with assistance Other:______
  6. IVF: LR at 125 ml/hr. Discontinue IV fluids when po fluid tolerated

PRN MEDICATIONS (If > one drug is ordered for the same indication, clinical assessment will be used per policy 520-06)

(if not ordered by Anesthesia during peri-operative phase)

  1. Severe pain:  Morphine 1-4 mg q 3 hrs prn
  2. Moderate pain:

Lortab (HYDROcodone/acetaminophen) 5/500 mg 1-2 tabs or 10/500 mg 1 tab po q 4 hrs prn

11.Mild pain/temp>100.5F/HA: Tylenol (acetaminophen) 650 mg po or per rectum q 4 hrs prn

12.Nausea/Vomiting:Zofran (ondansetron) 4 mg IV q 6 hrs prn

Reglan (metoclopramide) 10 mg po or IV q 6 hrs prn (5 mg if 65 y/o)

Phenergan (promethazine) 12.5-25 mg po or per rectum q 4 hrs prn

ADDITIONAL ORDERS:

______

______

DISCHARGE:

  1.  Discontinue catheter

14.May go when discharge criteria met:

a. Tolerating po fluidsd. Voiding quantity sufficient

b. No nausea and vomiting e. Ambulatory- minimal assistance

c. Pain managed by po analgesia

  1.  May go in _____ hrs if discharge criteria met
  2.  May go in AM if discharge criteria met
  3. Return to office  ____ days/week(s)  As scheduled

18.Discharge instructions to patient/family (to include CT scan as scheduled)

19.Prescriptions:  Give to patient  Patient has

______

DateTimePhysician SignaturePID Number

*1-18213*FORM 1-18213 REV. 07/2012 WHITE: Medical Record CANARY: Pharmacy Page 1 of 1