Download Thoracotomy Post Op Orders

PLACE LABEL HERE
THORACOTOMY 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).
Allergies: __________________________________________________________________________________________________
Surgical Procedure(s): ___________________________________________________ Date of Procedure: __________________
1.  Status order was addressed pre-procedure and has NOT CHANGED.
or
 Status order was addressed pre-procedure and HAS CHANGED to  Admit as Inpatient, expected stay will cross two midnights
 Place in Observation
2. Diagnosis: ______________________________________________________________________________________________
Level of Care:  Critical
 Intermediate
 Acute Care
Location/Specialty Unit Preference: _____________
3.
 Telemetry: If patient Medical/Surgical, must complete form # 36084
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 Isolation:  Contact  Droplet
 Airborne For: ____________________
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 Consult Pulmonologist today.  Already called  Call back #: __________________ Reason: Pulmonary Management
Vital signs per unit routine
I & O q 2 hrs x 12 hrs, then q 4 hrs
Diagnostics/labs:  Portable CXR in PACU or in ICU immediate post-op and in AM. Reason: Post-op pulmonary surgery
 CBC, Chem 7 in AM
 Other: ___________________
Foley to bedside bag
Foley Catheter Removal and Voiding Assessment/Interventions Standing Orders (form # 31620)
Chest tubes to -20 cm Pleuravac suction
Change Chest Tube dressing q other day and PRN
Elevate HOB 15-30 degrees
Incentive spirometry q hr while awake
O2 per protocol (form # 34431)
 NGT to Low Intermittent Suction (LIS). DO NOT move, remove, or replace. NO medications or tube feedings per NGT.
 Jejunostomy Tube Begin TF in am. ______________________________________ @ 25 ml/hr.
Registered Dietician Consult per policy # 500-20. Dietician to see on Post-op day # 2.
 Full liquid diet; advance as tolerated
 Strict NPO
Out of bed to chair 4-6 hours post-op, then three times daily
Chlorahexidine Gluconate Bath cloths daily for 2 days, then routine bathing
SCHEDULED MEDICATIONS
21.
IVF:
D5 ½ NS with ______ mEq KCL/liter at _______ ml/hr
22.
Pain:
 Epidural per Anesthesia
 See PCA orders (form # 2119)
23.
Antibiotic:  Rocephin 1 gm IV q 24 hrs x1 dose
 Other: __________________________________________
Post-op antibiotic will be automatically stopped within 48 hrs unless indication is documented
For Antibiotic > 24 hrs, document indication REQUIRED: _________________________________________
Post-op antibiotic will be automatically stopped within 24 hrs inless indication is documented above.
OR Beta lactam (penicillin and cephalosporin) allergy only:
 Cleocin (clindamycin) 600 mg IV q 8 hrs x 2 doses
For antibiotic > 24 hrs, document indication REQUIRED: _____________________________________
Post-op antibiotic will be automatically stopped within 24 hrs unless indication is documented above
24. VTE Prophylaxis: Initiate Venous Thromboembolism (VTE) Prophylaxis Orders (form # 33058)
Lovenox (enoxaparin) 40 mg SQ q 24 hrs (if CrCl < 30, give 30 mg SQ q 24 hrs), begin in am on POD #1
If patient has epidural, do not begin lovenox until epidural has been out for 12 hrs.
Mechanical devices: SCD (Sequential Compression Devices)
 Compression stockings
25. Stress Ulcer Prophylaxis:
 Pepcid (famotidine) 20 mg po or IV q 12 hrs OR
 Other: _______________________________________________________________________
26. Bowel Management: Senokot-S (docusate/senna), 2 tablets po at bedtime nightly
Order writer’s initials _______
Copy to pharmacy
*3-18040*
FORM 3-18040 REV. 01/2015
Page 1 of 2
PLACE LABEL HERE
THORACOTOMY POST-OP
ORDERS
 Miralax 1 packet q 12 hrs until BM
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.
27. Moderate Pain:
 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.
28. 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.
29. Nausea/Vomiting:  Zofran (ondansetron) 4 mg IV or po q 6 hrs prn
30. Constipation, If no BM after 48 hrs:
 Dulcolax (biscodyl) 10 mg per rectum daily prn
31. Sore Throat:  Chloraseptic (phenol/sodium phenolate) throat spray q 2 hrs prn
ADDITIONAL ORDERS:
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Date
_______________
Time
_________________________________
Physician Signature
__________
PID Number
Copy to pharmacy
FORM 3-18040 REV. 01/2015
Page 2 of 2