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DOCTOR WRITING ORDER IS TO RECORD DATE AND TIME WITH EACH SET OF ORDERS WRITTEN. AUTHENTICATE WITH FULL SIGNATURE AND BEEPER NUMBER.
MR FORM 1C
8/96
PHYSICIAN ORDERS
DIAGNOSIS:
DRUG SENSITIVITY:
Patient Identification
CARDIOTHORACIC SURGERY
ESOPHAGECTOMY POSTOP HOSPITAL ORDERS - Page 1
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your entry.
Primary Diagnosis _____________________________________________________________
Admitting Diagnosis ___________________________________________________________
LOCATION:
G PACU, then monitored bed
G PACU, then non-monitored bed
CONSULTANTS: 1.
2.
3.
CONDITION:
G SICU
Anesthesia consult for management of epidural
To speech Pathology: please evaluate speech and swallowing in this patient following esophageal
resection and treat as indicated.
If in SICU, call Cardiothoracic on call. Pager __________ for ALL calls after 6:00 p.m.
G stable G guarded G severe G critical
VITALS: Height __________ cm Weight __________ kg Start Date _______________
Routine per PACU/SICU/telemetry unit, then every 4h x 48 hours, then every shift.
Call H.O. if:
HR greater than 110 or less than 50
Temp greater than 38.5°C
SBP greater than 180 or less than 90
DBP 110 or greater
Urine output less than 30 ml/over 2 hr or less than 200 ml per shift
For pain score 5 or greater, call team managing pain.
Document I & O.
ACTIVITY:G 1. Bed rest.
G 2. Ambulate on ward greater than tid with assistance.
G 3. Out of bed to chair greater than tid for 1 hour and/or for each meal.
NUTRITION: NPO
NURSING ORDERS:
1. Head of bed to 30°
2. Foley to dependent drainage. May D/C Foley when epidural catheter removed.
3. DVT prophylaxis:
a. TED stockings (thigh high).
b. Compression stockings until fully ambulatory.
4. Chest tubes:
G Water seal OR G Pleurevac suction 20 cm OR G Emerson suction 40 cm
5. NGT to:
G Low continuous suction; irrigate gently with 30 ml NS every shift and prn.
G Low intermittent suction
Do not reposition NGT.
Irrigate J-tube with 30 ml NS every shift.
6. Standard oral hygiene
Diagnostic orders:
G PCXR Stat
G PCXR in am
G PA & lat CXR in am Reason _________________
G CBC Stat
G CBC in am
G ABG Stat
G Sodium, Potassium, Chloride, CO2, Magnesium, BUN, Creatinine
G Modified Barium Swallow on _____________ (date).
(Additional orders continued - See Next Page)
Rev. 9/12 cgr 9/21/12 Page 1 of 3
Signature: _______________________________________________________
C.G.Reiter, M.D./W.L.Knight, M.D./W.R. Smythe, M.D./E. Beyer, M.D.
Distribution: White - Chart Copy
WRITE WITH BLACK BALL POINT INK ONLY USING FIRM PRESSURE.
DOCTOR WRITING ORDER IS TO RECORD DATE AND TIME WITH EACH SET OF ORDERS WRITTEN. AUTHENTICATE WITH FULL SIGNATURE AND BEEPER NUMBER.
MR FORM 1C
8/96
PHYSICIAN ORDERS
DIAGNOSIS:
DRUG SENSITIVITY:
Patient Identification
CARDIOTHORACIC SURGERY
ESOPHAGECTOMY POSTOP HOSPITAL ORDERS - Page 2
MEDICATION ORDERS:
IV Fluids
D5 1/2 NS with 20 mEq Potassium Chloride at 125 ml/hr.
Antibiotics
1. Administer antibiotics as indicated below:
G Unasyn 3 gm IV every 8h x 3 doses (no PCN allergy)*.
G Ciprofloxacin 400 mg IVPB every 12h x 3 doses (PCN allergy).
DVT Prophylaxis
G See appended orders
Pain Medications
G 1. See appended PCA 0rders
2. When epidural or PCA discontinued, begin:
a. Hydrocodone 10 mg/Acetaminophen 325mg 1 tablet PO q4h prn, may repeat within 4 hours if pain persists
OR
b. Hydrocodone 2.5 mg/Acetaminophen 167 mg per 5 ml elixir 15 ml PO/per
J-tube q4h prn, may repeat within 4 hours if pain persists.
3. May wean PCA to PO analgesics after 4 days per patient tolerance*
Electrolyte Management Infuse electrolytes via pump(s)
*When both serum magnesium and serum potassium are low, replace magnesium first.
1. Notify physician if patient has or is:
a. Body weight less than 30 kg.
b. Serum Creatinine 2.0 mg/dl or greater or receiving dialysis.
c. Serum Creatinine doubled within last 24 hours.
2. Magnesium
Serum magnesium 1.8 - 2.0 mg/dl
G Magnesium sulfate 16 gm in 100 ml of 0.9% NaCl IVPB infused over 4 hrs.
Serum magnesium less than 1.8 mg/dl
G Magnesium sulfate 3200 mg in 100 ml of 0.9% NaCl IVPB infused over 6 hrs.
• Recheck serum magnesium with next AM labs or in 24 hours after end of
replacement infusion.
(Continue on next page)
Rev. 9/12
Signature: ______________________________________________
C.G.Reiter, M.D./W.L.Knight, M.D./W.R. Smythe, M.D./E. Beyer, M.D.
cgr 9/21/12 Page 2 of 3
Distribution: White - Chart Copy
WRITE WITH BLACK BALL POINT INK ONLY USING FIRM PRESSURE.
DOCTOR WRITING ORDER IS TO RECORD DATE AND TIME WITH EACH SET OF ORDERS WRITTEN. AUTHENTICATE WITH FULL SIGNATURE AND BEEPER NUMBER.
MR FORM 1C
8/96
PHYSICIAN ORDERS
DIAGNOSIS:
DRUG SENSITIVITY:
Patient Identification
CARDIOTHORACIC SURGERY
ESOPHAGECTOMY POSTOP HOSPITAL ORDERS - Page 3
3. Potassium
•
•
Serum potassium les than 4.0 mEq/L
Asymptomatic
G Potassium chloride 20 mEq IV 1000ml of D5 Centrally over 2 hrs x 2, or
G Potassium chloride 20 mEq IV 1000ml of D5 Peripherally over 2 hrs x 2 in minimal fluid, or
G Potassium chloride 20 mEq 1000ml of D5 PO/J-tube every 1h x 2.
Symptomatic (muscle weakness and/or cardiac arrhythmias)
G Potassium chloride 20 mEq IV 1000ml of D5 Centrally over 2 hrs x 4, or
G Potassium chloride 20 mEq IV 1000ml of D5 Peripherally over 2 hrs x 4 in minimal fluid, or
G Potassium chloride 20 mEq 1000ml of D5 PO/J-Tube every 1h x 4.
Contact physician if serum potassium is less than 2.5 mEq/L or > 5.5 mEq/L.
Recheck serum potassium 2 hours after end of replacement infusion.
Scheduled Medication
1. Surfak 1 PO daily.
Medications as needed (prn)
1. G Phenergan 12.5 IV/PO every 6h prn nausea. May repeat within 6 hrs. x 1 if N/V persists.
2. Comfort Medications
G
Milk of Magnesia 30 mL PO q12h PRN constipation, OR Dulcolax 5 mg PO once daily PRN
constipation (for patients with renal insufficiency)
G
Mylanta/Maalox 30 mL PO q6h PRN indigestion OR Calcium carbonate 15 mL PO q4h PRN
indigestion (for patients with renal insufficiency)
G
Acetaminophen 650 mg PO q6h PRN mild or headache pain (Unless patient is taking other
acetaminophen-containing meds)
G
Chloraseptic / Cepastat 1 lozenge q2h PRN dry mouth or sore / irritated throat
(Note: maximum dose of acetaminophen = 4 gm/24 hours)
3. Dulcolax suppository 1 PR daily as needed for constipation. May repeat x 1 if needed.
4. Diphenhydramine 12.5 mg IVPB every 4h prn itching.
MISC ORDERS:
Respiratory Care:
1. Ventilator setting as indicated below:
G SIMV ______ G AC ______ G TV ______
G PEEP ______ G FIO2 ______ G PS ______
2. Administer dose and medication indicated below
G Albuterol 0.3ml
G with 3 ml NS q4h
G Albuterol 0.5ml
G with 2 ml 10% mucomyst q 4h
G Ipratropium Bromide 0.5 mg in 2.5 ml NS q6h
3.
4.
5.
6.
7.
8.
Acapuella every 4h.
If cough ineffective, NT suction every 4h p.r.n. with soft coude tip catheter.
O2 therapy via nasal cannula or face shield: titrate O2 to maintain O2 saturation to 92% or greater.
Incentive spirometry (x10) and cough and deep breathe exercise by nurse every hour
while awake, every 2h at night.
O2 tank for ambulation.
Provide/reinforce teaching on care of J-tube if J-tube placed. Document all paient
teachingon interdisciplinary Patient Teaching Record.
_________/_________/_________
Date
_________________________________
Physician Last Name (Print)
Rev. 9/12
cgr 9/21/12 Page 3 of 3
_____________________
Time
____________________
Pager
Distribution: White - Chart Copy
____________________________________________
Physician Signature
White - Pharmacy Copy
Pink - Nurses Copy