[ ] Cardiac monitoring Routine, Until discontinued, Starting today, PACU (only)

Transcription

1 If appropriate for patient condition, please consider the following order sets: Hydration Order for Reducing Risk of Radiocontrast Induced Nephrotoxicity #683 Over the Counter Patient Care Products #767 Height Weight Allergies General - Prior to Discharge Vital Signs [X] Frequent vital signs Indication: Q15 minutes x (# of occurrences): 4 Q30 minutes x (# of occurrences): 2 Q1 hour x (# of occurrences): 2 Q2 hours x (# of occurrences): Q4 hours x (# of occurrences): Then: Per unit routine, Until discontinued, Starting today Cardiac Monitoring [ ] Cardiac monitoring, Until discontinued, Starting today, PACU (only) Notify Provider [ ] Notify provider, Until discontinued, Starting today Pulse greater than: Respiratory rate less than: Respiratory rate greater than: Temperature greater than (celsius): Urine output less than (ml/hr): Systolic BP greater than: Systolic BP less than: Diastolic BP greater than: Diastolic BP less than: Other: Notify Provider: 1) /any Bleeding, hematoma formation, or change on skin color and/or temperature of incision site. 2) Any change or instability of vital signs and /or cardiac rhythm. 3) Any complaint of pain, especially pleuritic., Activity [ ] Bed rest with bathroom privileges only, Until discontinued, Starting today, Page 1 of 9

2 [ ] Head of bed elevated, Until discontinued, Starting today Degrees: 30 degrees [ ] May be out of bed in, Until discontinued, Starting today Number of hours: [ ] Nursing communication, Until discontinued, Starting today Number of weeks: Keep operative side elbow below shoulder height. May use arm sling/immobilizer as needed., Diet/Nutrition [ ] Diet liquid Diet effective now, Starting today Diet: Additional Modifiers: Viscosity/Liquids: Diet Comments: [ ] Diet General Diet effective now, Starting today Patient Age: Additional Modifiers: Viscosity/Liquids: Texture: Fluid Restriction / day: Supplement: Diet Comments: [ ] Diet Cardiac Diet effective now, Starting today Additional Modifiers: Low Fat Viscosity/Liquids: Texture: Fluid Restriction / day: Supplements: [ ] Diet NPO Diet effective now, Starting today NPO Except: Diet Comments: Page 2 of 9

3 [ ] Diet Diabetic Diet effective now, Starting today Diet, Diabetic: Additional Modifiers: Viscosity/Liquids: Texture: Fluid Restriction / day: Sodium Modifiers: Supplements: Total Calories: Nursing Interventions [ ] Keep operative side(s) leg straight, Until discontinued, Starting today Leg(s): If femoral site present, keep leg(s) straight until: [ ] Retention Catheter Panel [ ] Insert Foley catheter, As needed, Starting today, Insert as needed for inability to void or feelings of discomfort or distention. Initiate Medical Staff Approved Urinary Catheter Protocol, [ ] Urinalysis with culture, if indicated, upon insertion Daily, Starting today with First Occurrence Include Now For 2 Occurrences Obtain a UA-R upon insertion and repeat UA-R prior to 48 hours post-insertion., [X] Encourage cough and deep breathing, Until discontinued, Starting today, [X] Apply heat/cold, As needed, Starting today Type: Ice to affected area For 24 hours. Do not exceed 8 hours of continuous use (remove for 30 minutes every 8 hours)., [ ] Nursing communication, Until discontinued, Starting today, Maintain pressure dressing to incision site., [ ] Apply to affected side, Once, Starting today Device: Sling Type: Extremity: Extremity: Length: [ ] Nursing communication, Until discontinued, Starting today, Discharge after chest xray., Discharge Instructions - Prior to Discharge [X] Ambulate patient fully before discharge, Until discontinued, Starting today, Page 3 of 9

4 [ ] Discharge instructions, Prior to discharge, Starting today, Contact physician for final status update prior to discharge, [ ] Discharge instructions, Prior to discharge, Starting today, If stable, discharge patient when all discharge criteria is met., [ ] Discharge instructions, Prior to discharge, Starting today, Provide and review device discharge instructions with patient and family., [ ] Tobacco cessation education, Prior to discharge, Starting today, Provide smoking cessation information to patient, if appropriate, [ ] Discharge instructions, Once, Starting today, General - AMB Orders - Post Discharge Activities - Discharge [ ] Wound care, Clinic Performed, Post Discharge [ ] Activity as tolerated, Clinic Performed, Post Discharge [ ] Discharge activity, Clinic Performed, Post Discharge [ ] Follow-up, Clinic Performed, Post Discharge Diet - Discharge [ ] Diet Cardiac, Clinic Performed, Post Discharge [ ] Diet NPO, Clinic Performed, Post Discharge [ ] Diet General, Clinic Performed, Post Discharge [ ] Diet Diabetic, Clinic Performed, Post Discharge Respiratory Interventions - Discharge [ ] May use home CPAP equipment, Clinic Performed, Post Discharge Discharge Instructions-Post Discharge [ ] Follow-up with Physician, Clinic Performed, Post Discharge [ ] Discharge instructions, Clinic Performed, Post Discharge Labs - Prior to Discharge Hematology [ ] CBC, no diff (hemogram) Morning draw, Starting today For 1 Occurrences, Page 4 of 9

5 Chemistry [ ] BMP Morning draw, Starting today For 1 Occurrences, [ ] Urinalysis with culture, if indicated Once, Starting today, Coagulation [ ] PT/INR Morning draw, Starting today For 1 Occurrences, Imaging - Prior to Discharge Cardiac Studies [ ] ECG, Once, Starting today Reason for Exam (Signs & Symptoms): On arrival to unit. If with or without magnet, call Electrophysiology Nurse to assist., [ ] ECG, Once, Starting today Reason for Exam (Signs & Symptoms): In AM by 0700., Pulmonary [ ] Nursing communication, Until discontinued, Starting today, May go to diagnoistic imaging without nurse and monitor., [ ] CXR: Portable PA (chest single view), 1 time imaging, Starting today For 1 On arrival to unit or: [ ] Portable PA (chest single view), 1 time imaging, Starting today For 1 In AM by Reason for Exam: Is the patient pregnant? (Required) Transport Mode: Bed [ ] Upright PA and lateral (chest 2 view), 1 time imaging, Starting today For 1 In AM by If Upright PA and lateral (chest 2 view) ordered, keep procedure elbow below shoulder during imaging. Reason for Exam: Is the patient pregnant? (Required) Transport Mode: Bed VTE Prophylaxis - Prior to Discharge SAH, SCH, SFH, SJMC & Harrison VTE Prophylaxis Mechanical Page 5 of 9

6 [X] Maintain sequential compression device, Until discontinued, Starting today, [X] Place TED hose, Until discontinued, Starting today Stocking type: Leg choice: [ ] Reason for No VTE Prophylaxis (Mech) Reason for no VTE prohphylaxis (mechanical): Note to provider: Reason required to be in in compliance with CMS SCIP guidelines Highline Post-op VTE Prophylaxis Mechanical [X] Place sequential compression device, Until discontinued, Starting today Apply sequential compression device: Both Legs Ensure correct VTE choices, need mechanical VTE prophylaxis if no pharmacologic prophylaxis, please see SCIP guidelines, PACU & Post-op [ ] Reason for No VTE Prophylaxis (Mech) Reason for no VTE prohphylaxis (mechanical): Note to provider: Reason required to be in in compliance with CMS SCIP guidelines VTE Prophylaxis Pharmacological [ ] heparin (porcine) injection 5,000 units/ml 5,000 Units, SubCutaneous, Every 8 hours,, [ ] enoxaparin (LOVENOX) injection 40 mg 40 mg, SubCutaneous, Daily,, [ ] Reason for No VTE Prophylaxis (Pharm) Reason for no VTE prophylaxis (pharmacological): Note to provider: Reason required to be in in compliance with CMS SCIP guidelines IV Fluids - Prior to Discharge IV Fluids [ ] Saline Flush and Lock Panel [ ] sodium chloride 0.9 % syringe 2 ml, IntraVENous, Every 8 hours, Post-op, [ ] Saline lock IV, Continuous, Starting today, Post-op [ ] sodium chloride infusion 0.9% 100 ml/hr, IntraVENous, Continuous,, Medications - Prior to Discharge Initiate Over the Counter Meds [ ] Nurse may initiate OTC Pt Care Products, As needed, Starting today, Analgesia Page 6 of 9

7 Note: Number only those medications desired. The nurse will select #1 as the first medication to be given. If ineffective, #2 will be used next, and then #3, #4 ect. If orders are not numbered, the nurse will contact the prescriber for clarification [ ] morphine injection 2-10 mg, IntraVENous, Every 1 hour PRN, pain, Avoid use in renal dysfunction (serum creatinine greater than 2 mg/dl or patient on dialysis [ ] acetaminophen (TYLENOL) tablet mg, Oral, Every 4 hours PRN, mild pain,, [ ] ibuprofen (MOTRIN) tablet 400 mg, Oral, Every 6 hours PRN, mild pain,, [ ] HYDROcodone-acetaminophen (NORCO) tablet mg [ ] oxycodone-acetaminophen (PERCOCET) tablet mg [ ] oxycodone (ROXICODONE) immediate release tablet Antibiotics 1-2 tablet, Oral, Every 4 hours PRN, moderate pain, severe pain, Priority #: tablet, Oral, Every 4 hours PRN, moderate pain, severe pain, Priority #: mg, Oral, Every 3 hours PRN, pain, PRN Comment: For breakthrough pain. If other oral pain medications ineffective after 1 hour minimum use [ ] cefazolin (ANCEF) IV 1 g, IntraVENous, Every 8 hours, For 2 Doses, First dose 8 hours from pre-procedure dose. [ ] cefazolin (ANCEF) IV - For patients greater than 80 kg 2 g, IntraVENous, Every 8 hours, For 2 Doses, First dose 8 hours from pre-procedure dose. For patients greater than 80 kg [ ] clindamycin (CLEOCIN) IV syringe 600 mg, IntraVENous, Every 8 hours, For 2 Doses, First dose 8 hours from pre-procedure dose. If PCN Allergic plus Beta-Lactam Allergy. [ ] clindamycin (CLEOCIN) IV syringe - For patients greater than 100 kg 900 mg, IntraVENous, Every 8 hours, For 2 Doses, First dose 8 hours from pre-procedure dose. If PCN Allergic plus Beta-Lactam Allergy. For patients greater than 100 kg Page 7 of 9

8 [ ] vancomycin (VANCOCIN) IVPB 250 ml (base) 1,000 mg, IntraVENous, Every 12 hours, For 1 Doses, First dose 12 hours from pre-procedure dose. If PCN Allergic plus Beta-Lactam Allergy. * Must document indication Indication for Use: (trough goal in parenthesis): Anticoagulants [ ] warfarin (COUMADIN) tablet 0.5 mg, Oral, Daily (warfarin),, [ ] rivaroxaban (XARELTO) tablet 20 mg, Oral, Daily,, Nausea/Vomiting [ ] Ondansetron - Promethazine Panel [ ] ondansetron (ZOFRAN) 4 mg/2 ml injection 4 mg, IntraVENous, Every 4 hours PRN, nausea, vomiting,, [ ] promethazine (PHENERGAN) 25 mg/ml injection mg, IntraVENous, Every 4 hours PRN, nausea / vomiting, PRN Comment: (Required) Use mg IV for patients age 65 and over. Give ondansetron first. If ineffective give promethazine. [ ] promethazine (PHENERGAN) 25 mg/ml injection mg, IntraVENous, Every 4 hours PRN, nausea / vomiting, PRN Comment: (Required) Give ondansetron first. If ineffective give promethazine. Medications - AMB Orders - Post Discharge Prescriptions during downtime should be written on prescription paper Oral Analgesia - Discharge [ ] ACETAMINOPHEN 325 MG TABLET Normal [ ] IBUPROFEN 200 MG TABLET Normal [ ] HYDROCODONE-ACETAMINOPHEN 5 MG-325 MG Print TABLET [ ] OXYCODONE-ACETAMINOPHEN 5 MG-325 MG Print TABLET [ ] OXYCODONE 2.5 MG TABLET Print Anticoagulants - Discharge [ ] WARFARIN 0.5 MG TABLET Normal Page 8 of 9

9 [ ] DABIGATRAN ETEXILATE 75 MG CAPSULE Normal [ ] RIVAROXABAN 10 MG TABLET Normal Sedative - Discharge [ ] TEMAZEPAM 15 MG CAPSULE Normal AMB - Post Discharge - Nicotine Replacement Therapy Nicotine Replacement therapy will be avoided if possible in patient with unstable acute coronary syndrome for 72 hours. After 72 hours if chest pain, arrhythmias, and/or blood pressure have stabiliized, Nicotine replacement may be considered at ONE STEP below the calcuated replacement dose. NOTE: 1/2 pack = 10 cigarettes The nicotine products listed below may be used as monotherapy or in combination therapy. Combination therapy should include a nicotine patch plus either nicotine gum or nicotine lozenges. Smoking History Recommended Starting Dose Step down therapy after initial nicotine Replacement for 6-7 weeks 10 Cigarettes per Day or less, past history Of cardiovascular disease, or weight under 45 kg Heavy smokers (More than 10 cigarettes/day Smokeless tobacco users, pipe Smokers or at patient request Nicotine patch, 7mg Nicotine patch, 14 mg Nicotine patch, 21 mg Nicotine Gum, 2mg Note to provider: Insulin requirements may change - monitor blood sugars. Topical Steroids and oral antihistamines may be recommended to treat less severe skin irritations. [ ] No Smoking while on nicotine replacement therapy, Clinic Performed, Post Discharge [ ] NICOTINE 7 MG/24 HR DAILY PATCH Normal [ ] NICOTINE 14 MG/24 HR DAILY PATCH Normal [ ] NICOTINE 21 MG/24 HR DAILY PATCH Normal [ ] NICOTINE (POLACRILEX) 2 MG GUM Normal Date: Time: Printed Name of Ordering Provider: Provider Signature: Date: Time: RN Acknowledged: Page 9 of 9