Download Postpartum Cesarean Section Post Op Orders

PLACE LABEL HERE
POSTPARTUM CESAREAN SECTION
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).
OTHER DIAGNOSES: ___________________________________________________________________
Allergies: _______________________________________________________________________________
Maternal/Infant Unit
 High Risk Pregnancy Unit
 May transfer care to Maternal/Infant Unit _____ hrs after magnesium sulfate discontinued
or when ________________________________________________________
2.
Consults: ___________________ Concerning: ______________________  Routine  Urgent
3.
Labs: H&H postpartum day #1
Rho(D) immune globulin workup if Rh negative (Rh ______)
 Glucose monitoring:  Fasting q AM  2 hrs postprandial  at Bedtime  at 3 AM  Other: _________
4.
Vital signs on admission to unit, then q 30 min x 2, then q hr x 2, then q 4 hrs x 48 hrs, then q 8 hrs until discharge
 Vital signs, DTRs, breath sounds, I & O per magnesium sulfate orders (form # 20). After magnesium sulfate is
discontinued, obtain vital signs q 4 hrs or q ______ hrs
 TPR q ______ hrs; BP q ______ hrs
 I & O q ______ hrs
5.
Foley to bedside bag. Discontinue at 12 hrs post-op. May straight cath once if patient unable to void in 6 hrs after
removal of Foley or becomes uncomfortable. If unable to void a second time, reinsert Foley and notify
Physician/CNM
6.
Notify physician for temperature above 100.4°F twice, four hrs apart, or 101°F once, unstable vital signs, or
excessive vaginal bleeding, systolic BP above _______ or diastolic BP above ________
 Fasting glucose above _______ or below _______; 2 hrs postprandial glucose above _______ or below _______
7.
Diet: clear liquids; advance as tolerated to regular diet with snacks
 Carbohydrate-controlled gestational diabetic diet with no added juice or fruit at breakfast
 Other: __________________________________________________________________________________
8.
Activity: Up on side of bed with assistance first 6-12 hrs post-op. Up with assist first time, first 4 hrs after
magnesium sulfate discontinued, and until stable; then ad lib
 Bedrest with bedside commode  Bathroom privileges only
 Bathroom and shower privileges
9.
VTE Prophylaxis: Plexi-pulses  with TEDs OR
 Sequential Compression Device (SCDs)  with TEDs
maintain until discharge OR ______________________________
10. Remove dressing 24 hours after surgery OR : __________________________________
11. ChloraPrep to incision site 48 hrs after surgery (at discharge if < 48 hrs). Repeat in 48 hrs (patient may do at home)
12. Incentive Spirometry q 1-2 hrs while awake for patients on magnesium or that had general anesthesia
 Incentive Spirometry q 1-2 hrs while awake
1.
IV FLUIDS:
13. D5LR at 125 ml/hr IV OR  ______________________________________ at _________ ml/hr IV
14. Discontinue IV at 12 hrs post-op if afebrile, tolerating po fluids, vital signs are stable, bleeding is not excessive,
and/or when PCA is discontinued. For Rh negative patients, maintain IV access until cord blood results obtained.
Maintain IV access for 24 hrs post Duramorph (morphine). Convert to INT if diabetic (> Class A 2).
SCHEDULED MEDICATIONS:
15. Prenatal vitamin po daily at 0900  patient may self-administer own prenatal vitamin after pharmacist identifies
medication
16. Rho(D) immune globulin 300 micrograms x 1 dose if indicated (Rh- mother, Rh+ infant). Rophylac is administered IV
or IM, RhoGAM must be given IM only.
17.  Implement “Insulin Subcutaneous for Obstetrics” orders (form # 21502), send to pharmacy
18.  Implement “Magnesium Sulfate for Pre-Eclampsia” orders (form # 20), send to pharmacy
19. VTE Prophylaxis:  Heparin 5,000 units SQ q 12 hrs (do not begin heparin until epidural has been out for two hrs)
OR Lovenox (enoxaparin) 40 mg SQ q 24 hrs at 1700; if CrCl < 30, give 30 mg SQ q 24 hrs (do
Order writer’s initials __________
Copy to pharmacy
*3-10806*
2
FORM 3-10806 REV. 05/2017
Page 1 of
PLACE LABEL HERE
POSTPARTUM CESAREAN SECTION
POST-OP ORDERS
not begin enoxaparin until epidural has been out for two hrs)
Order writer’s initials __________
Copy to pharmacy
*3-10806*
2
FORM 3-10806 REV. 05/2017
Page 2 of
PLACE LABEL HERE
POSTPARTUM CESAREAN SECTION
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).
20. Stool Softener: Colace (docusate) 100 mg po bid at 0900 and 2100. Hold for loose stools
21. Antibiotics: ___________________________________________________________________________________
22. Antihypertensives: _____________________________________________________________________________
PAIN MANAGEMENT See policy 520-06 for range orders guidelines.
23. If PCA is ordered, discontinue PCA at 12 hrs post-op.
24. IV regimen (select one):
 Toradol (ketorolac) 30 mg IV q 6 hrs X 3 doses (may start in PACU, if not given by anesthesia)
(if patient weight < 50 kg, give 15 mg). Next dose due at ________
OR  Ofirmev (acetaminophen) 1 gm IV over 15 mins q 6 hrs X 2 doses (may start in PACU, if not
given by anesthesia). Next dose due at ________
25. Ibuprofen 600 mg PO q 6 hrs; if Toradol (ketorolac) is given, begin 6 hours after last Toradol (ketorolac).
26. Select one {Do not start this until 24 hours after Duramorph (morphine) was given. If patient has PCA, may
begin after PCA is DC’d}:
 Percocet (oxyCODONE/acetaminophen) 5/325 mg 1-2 tabs po or 10/325 mg 1 tab po q 4 hrs prn,
DC if Norco ordered.
OR  Norco (HYDROcodone/acetaminophen) 5/325 mg 1-2 tabs po or 10/325 mg 1 tab po q 4 hrs prn,
DC if Percocet ordered.
PRN MEDICATIONS See policy 520-06 for range orders and pain intensity guidelines.
27. Excessive bleeding: Establish IV access if not present; Pitocin (oxytocin) 40 units in 1,000 ml NS or LR IV and infuse
wide open; decrease rate to 125 ml/hr once bleeding has decreased and fundus is firm. If not hypertensive or
pre-eclamptic, give Methergine (methylergonovine) 0.2 mg IM x 1 dose
28. Breast feeding discomfort: Lanolin breast cream topically prn after breastfeeding
29. Patient may self-medicate and keep these medications at bedside:
Episiotomy pain:
Dermoplast (benzocaine) spray topically prn
Episiotomy or hemorrhoid discomfort/pain:
Witch hazel pads topically with pericare prn
Episiotomy or hemorrhoid discomfort/pain:
Dibucaine ointment topically with pericare prn
30. Nausea:
 Zofran (ondansetron) 4 mg IV or PO q 6 hrs prn
31. Sleep:
 Ambien (zolpidem) 5 mg po at bedtime prn
32. Indigestion:
 Maalox XS (aluminum/magnesium/simethicone) 30 ml po four times daily prn
33. Constipation:
 Dulcolax (bisacodyl) 10 mg suppository rectally prn, may repeat x 1 in 1 hr if no bowel movement
34. Gas pain:
 Simethicone 80 mg po four times daily prn
35. Cough:
 Robitussin (guaifenesin) 15 ml po q 4 hrs prn
ADDITIONAL ORDERS:
______________________________________________________________________________________
______________________________________________________________________________________
______________
______________
_________________________________
__________
Date
Time
Physician Signature
PID Number
Copy to pharmacy
FORM 3-10806 REV. 05/2017
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