Nephrectomy Post-Op Orders

Nephrectomy Post-Op Orders

PLACE LABEL HERE

NEPHRECTOMY

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. 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?

Yes, admit as inpatient, proceed to # 2No, place in observationNo, outpatient, DC home

2. If admitted as inpatient, Inpatient Physician Certification:

Diagnosis: ______

Level of Care:  Critical  Intermediate  Acute Care Location/Specialty Unit Preference______

  1. Telemetry: If patient Medical/Surgical, must complete form # 36084
  2. Isolation:  Contact  Droplet  Airborne For: ______

5.Consult: Hospitalist for medical management Notified

 Other: ______Reason: ______ Notified

6.Diagnostics: CXR in PACU In AM: CBC  H&H  Chem 7  Other: ______

7.Foley catheter to drainage bag

Discontinue Foley catheter on post op day (POD) #1 at 6 am

8. Foley Catheter Removal and Voiding Assessment/Interventions Standing Orders (form # 31620)

9. Incentive spirometry 10 times q 1 hr while awake

10. Dressing:Reinforce prnChange: ______Other: ______

  1. Diet:  NPO  Gum/hard candy  Sips of clear  Clear

 Advance as tolerated Other: ______

  1. Oral Nutrition Supplement Standing Order (form # 31417), initiate if patient meets criteria

13. Progressive ambulation: Dangle @ 4 hrs post-op with assist; ambulate @ 6 hrs post-op with assist.
. Advance to 4-6 times/day starting POD # 1, then progress to up ad lib

ORBedrest today Other: ______

SCHEDULED MEDICATIONS

14.IVF: D5 ½ NS with KCl 20 mEq/L at 125 ml/hr

15.Antibiotic:Post-op antibiotic will be automatically stopped within 24 hrs unless indication is documented

 Ancef (cefazolin) 1 gm IV q 8 hrs x 2 doses or continue > 24 hrs for ______(Reason REQUIRED)

16.Pain:PCA  PCA orders # 2119 or Sleep Apnea PCA orders # 21261

17. VTE prophylaxis, Initiate Venous Thromboembolism (VTE) Prophylaxis Orders (form # 33058)

Heparin 5,000 units SQ q 8 hrs (q 12 hrs if wt < 50 kg or age > 75)

or Lovenox (enoxaparin) 40 mg SQ q 24 hrs in am POD # 1 (30 mg if CrCl < 30 ml/min)

and/or Mechanical devices: SCDs

Copy to pharmacy Order writer’s initials______

*3-18192*FORM 3-18192 REV. 07/2015 Page 1 of 2

PLACE LABEL HERE

NEPHRECTOMY

POST-OPORDERS

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).

PRN MEDICATIONS: See policy 520-06 for range orders and pain intensity guidelines.

  1. Electrolyte Replacement Protocol (form # 21340)
  2. Mild Pain, Temp>100.5F, HA: Tylenol (acetaminophen) 650 mg po or PR q 4 hrs prn
  3. Moderate Pain:

Norco (HYDROcodone/acetaminophen) 5/325 mg or 10/325mg 1 tab po q 4 hrs prn. DC if Percocet ordered.

or 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 Percocet (oxyCODONE/acetaminophen) 5/325 mg or 10/325 mg 1 tab po q 4 hrs prn. DC if Norco ordered.

and/or  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.

  1. Severe Pain (Begin when Epidural or PCA has been discontinued)

Morphine 1-2 mg IV q 3 hrs prn, DC if CrCl < 30. Hold for excessive sedation. DC if Dilaudid ordered.

or  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.

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

If N/V persists, add Reglan (metoclopramide) 10 mg IV q 6 hrs prn (5 mg if > 65 y/o)

  1. Sleep: Ambien (zolpidem)5 mg (female or males ≥ 65 y/o) or 5-10 mg (male < 65 y/o) po at HS prn
  2. Indigestion: Maalox XS (aluminum/magnesium/simethicone) 30 ml po four times daily prn
  3. Stool Softener: Colace (docusate) 100 mg po bid prn; if patient has not had a bowel movement
  4. Constipation: Milk of Magnesia (MOM) 30 ml po daily prn

If no BM after 48 hrs,  Dulcolax (biscodyl) 10 mg per rectum daily prn

and/or Senokot-S (docusate/senna) 2 tablets po at bedtime nightly

  1. Cough:Robitussin (guaifenesin) 15 ml po q 4 hrs prn
  2. Sore Throat:Chloraseptic (phenol/sodium phenolate) throat spray q 2 hrs prn

ADDITIONAL ORDERS:

______

______

______

DateTimePhysician SignaturePID Number

Copy to pharmacy

FORM 3-18192 REV. 07/2015 Page 1 of 2

Top View