Download Transcatheter Aortic Valve Replacement (TAVR) ICU

PLACE LABEL HERE
TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR)
ICU TRANSFER 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).
1. Unit:  CVC Telemetry OR  CVC Intermediate Care  Cardiac Services (5N)  Other: __________
CONSULTS:
2. Smoking cessation education if patient has smoked in the past year
3. Other: ______________________________________________________________________________
DIET:
4.  Cardiac Diet
 Diabetic ______ calorie
 Other: ____________________________________________________________________________
 Fluid restriction __________ ml/24 hrs
VITAL SIGNS:
5. Telemetry monitoring. Transport with telemetry for testing, complete Telemetry Orders (form # 36084)
6. VS q 4 hrs and as needed with pulse oximetry
7. Strict I&O q 4 hrs
NOTIFY PHYSICIAN FOR:

SBP <90 or >160 mm Hg

HR is < 50 or > 120, or any change in the baseline cardiac rhythm

Temperature > 101°F after 48 hrs postop: obtain urine, sputum, and blood cultures x 2

O2 Sat below 90% or SOB or labored breathing

UOP < 150 ml in 4 hrs unless ESRD

CT output > 200 ml/hr
DIAGNOSTICS AND LAB:
8. CXR on ________ (date)  PA / Lateral  Portable
9. Labs:
 Chem 7 in AM
 CBC in AM
 Magnesium Level in AM
 PT/INR on ________ (date)
 ABGs prn for respiratory distress
10. Stat 12 Lead EKG prn chest pain or ST segment elevation
11.  ECG routine in AM. Hold if ventricularly paced.
BLOOD GLUCOSE MANAGEMENT:
12. If on insulin infusion at 2200 on POD#1: initiate Insulin Infusion to SQ Insulin Transition Orders (form #
32242)
13. If patient is receiving insulin, initiate Hypoglycemia Treatment Standing Orders (form # 2513)
14.  Sliding Scale: Humolog (insulin Lispro): BG-100/
= # of units AC & HS
15. Other:
Copy to pharmacy
*3-37010*
Order writer’s initials ___________
FORM 3-37010 INITIATED 11/2015
Page 1 of 3
PLACE LABEL HERE
TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR)
ICU TRANSFER 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).
ADDITIONAL ORDERS:
16. Maintain IV access at all times
17.  Maintain Central Venous Catheter
18. DC Foley Catheter POD # 1 and intitate
Foley Catheter Removal and Voiding Assessment/Interventions Standing Orders (form # 31620)
19. Daily weights at 0600 and record in kg
20. Venous Thromboembolism (VTE) Prophylaxis Orders (form # 33058)
21. Chest tubes to (-20) cm pleural suction  Do not ambulate off suction
22. Incentive Spirometry q 1 hr while awake
23. Temporary Pacemaker:
Insulate, secure and label temporary pacemaker wires
Initiate ventricular pacing if HR < 50 with symptomatic bradycardia and notify Physician afterwards
Settings: mA 20 Rate 80 Mode VVI
24. Activity:
Up in chair for all meals, Daily ambulation progression TID
25. Dressings:
Change chest tube and pacing wire dressings daily. Start 48 hrs post-op.
Change incision dressings daily if applicable. Start 48 hrs post-op.
26. O2 per Protocol (form # 34431)
SCHEDULED MEDICATIONS:
27. Stress Ulcer Prophylaxis:  Pepcid (famotidine) 20 mg po bid



or  Protonix (pantoprazole) 40 mg po daily
28.  Aspirin 81 mg po daily (hold for plt count < 100,000)
29.  Plavix (clopidogrel) 75 mg po daily
30. Beta Blocker:
or
 Lopressor (metoprolol) ____ mg po q 8 hr. Hold if SBP < 100, HR < 60
 Other: ___________________________. Hold if SBP < 100, HR < 60
31. Anti-lipedemic:
or
 Lipitor (atorvastatin) 80 mg po q hs
 Other:
32. ACE/ARB:
 Lisinopril
mg PO daily. Hold for SBP < 100mmHg
 Other:
. Hold for SBP < 100mmHg
 D/C ACE/ARB. Contraindicated due to:
Copy to pharmacy
FORM 3-37010
INITIATED 11/2015
Order writer’s initials ___________
Page 2 of 3
PLACE LABEL HERE
TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR)
ICU TRANSFER 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).
PRN MEDICATIONS See policy 520-06 for range orders and pain intensity guidelines.
33. Mild Pain, Temp >100.5F, HA:  Tylenol (acetaminophen) 650 mg po or PR q 4 hrs prn
34. Moderate Pain:
 Norco (HYDROcodone/acetaminophen) 5/325 mg or 10/325mg 1 tab po q 4 hrs prn. DC if Percocet ordered.
or  If patient cannot take tablet, Hycet elixir (HYDROcodone/acetaminophen 7.5/325 mg/15 ml) 15 ml po q 4
hrs prn intead of Norco. DC if Percocet ordered.

or  Percocet (oxyCODONE/acetaminophen) 5/325 mg or 10/325 mg 1 tab po q 4 hrs prn. DC if Norco ordered.
and/or  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.
35. 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.
36. Nausea/Vomiting:  Zofran (ondansetron) 4 mg IV or po q 6 hrs prn
 If N/V persists, add Reglan (metoclopramide) 10 mg IV q 6 hrs prn (5 mg if > 65 y/o)
37. Sleep:  Ambien (zolpidem) 5 mg (female or males ≥ 65 y/o) or 5-10 mg (male < 65 y/o) po at HS prn
38. Indigestion:
 Maalox XS (aluminum/magnesium/simethicone) 30 ml po four times daily prn
39. Stool Softener:
 Colace (docusate) 100 mg po bid prn; if patient has not had a bowel movement
40. Constipation:
 Milk of Magnesia (MOM) 30 ml po daily prn
If no BM after 48 hrs,  Dulcolax (biscodyl) 10 mg per rectum daily prn
and/or
 Senokot-S (docusate/senna) 2 tablets po at bedtime nightly
41. Cough:
 Robitussin (guaifenesin) 15 ml po q 4 hrs prn
42. Sore Throat:  Chloraseptic (phenol/sodium phenolate) throat spray q 2 hrs prn
ADDITIONAL ORDERS:
______________
Date
______________
Time
_________________________________
Physician Signature
___________
PID Number
Copy to pharmacy
FORM 3-37010
INITIATED 11/2015
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