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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 4. Isolation: Contact Droplet Airborne For: ____________________ 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 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: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________ Date _______________ Time _________________________________ Physician Signature __________ PID Number Copy to pharmacy FORM 3-18040 REV. 01/2015 Page 2 of 2