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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 >100.5F, 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 Page 3 of 3