Download Post-Op orders Receiving Hospital

ADDRESSOGRAPH
GREY BRUCE HEALTH NETWORK
Page 1 of 4
SITE: _____________________
Allergies: □ NKA or: ________________________
Weight (kg) _______________
Post-Operative Total Hip Replacement Order Set
(Receiving Hospital)
Open Box indicates optional order, activated when checked .
 Checked box indicates mandatory order unless crossed out.
Processed
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Admit to _______________: Dr. ___________________
Diagnosis: Post Operative Total Hip Arthroplasty
to consult or
assume MRP
Comorbidities: a) ______________ b) _____________ c) ________________
Code Status:
Full Resuscitation
No Defibrillation
No CPR
No Intubation
Defibrillation only
Do Not Resuscitate
________ Family Physician:
Same as MRP, or __________________________________
Kardex
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Clinical Pathway  Cerner Order for Total Hip Replacement pathway
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Consults
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____________________ Reason: ______________________________ ________
CCAC
Clinical Nutrition
Discharge Planning
Occupational Therapy
Speech/Language Pathologist
Pharmacy
Social Work
Physiotherapy
Diet
________
Regular Diet
NPO
Energy Controlled _____kcal
Healthy Heart Diet
________ Other Diet: __________________________________________________
Activity
 Activity as tolerated
________  Weight bearing status:
Non
Partial (_____%) as per physiotherapist directives
Full
Vital Signs
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VS + O2 sats q4h x 24h, QID x 24h, then BID when stable
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O2 to keep O2 sats greater than 92%
COPD Patient: O2 to keep O2 sats 88% - 92%
O2 ____L/minute via NP
O2 ___________________
VS + O2 sats q4h
VS + O2 sats q ______ h
VS + O2 sats qshift
Respiratory
Patient Care
Direct Care:
________
________
 Height and Weight on admission
 Skin assessment q shift
Tubes and Drains:  Foley to straight drainage. Remove when able to use commode
 Measure and empty drainage device. Remove in 24-48 hours if drainage
less than 50 mL
Physician’s Signature __________________________Date ___________Time__________
C/1/GBHN/Surg/-/THR_Receiving/MD/07-07/v1/-
Copyright © 2007 Grey Bruce Health Network
NOTE: this is a CONTROLLED document as are all files on this server. Any documents appearing in paper form are not
controlled and should ALWAYS be checked against the server file versions (electronic version) prior to use.
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ADDRESSOGRAPH
GREY BRUCE HEALTH NETWORK
Page 2 of 4
SITE: _____________________
Allergies: □ NKA or: ________________________
Weight (kg) _______________
Processed
Post-Operative Total Hip Replacement Order Set
(Receiving Hospital)
Incision/Wound Care:  Remove sutures/staples 2 weeks post op if wound is dry
 Change pressure dressing in 48 hours. Cover with Island dressing,
change PRN only
 After 7 days post op may remove dressing if wound clean and dry
________ POC:
POC Capillary glucose QID x 2 days
POC Capillary glucose daily
Kardex
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Laboratory
(Order details routine and blood unless otherwise noted)
Culture Blood x 2 if temp greater than or equal to 385 ° C
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________ Additional follow up labs: __________________________________________
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Diagnostic Tests
 Stat ECG with chest pain and notify MD
IV Solutions
________ IV Drip: 2/3 1/3
NS
With 20 mmol KCl per L of IV fluid
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Other _________________
With 40 mmol KCl per L of IV fluid
________
Rate ___________________ mL/h
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 Decrease IV to TKVO when drinking well then discontinue IV if Pt not on any IV medications.
Saline Lock
Medications
Anemia Management:
 Ferrous gluconate 300 mg PO TID starting post-op day 1
Pain Control: ***Max acetaminophen dose from all sources is 4000 mg/24 hours***
Acetaminophen 650 mg PO q4h PRN
Morphine 2-4 mg
IV or
IM or
subcutaneous q4h PRN
Morphine 5-10 mg PO q4h PRN
Hydromorphone 0.5 mg
IM or
subcutaneous q4h PRN
Hydromorphone 1 mg PO q4h PRN
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Other _______________________________________________
________ Sedation:
________
Zopiclone 3.75-7.5 mg PO QHS PRN, or
Lorazepam 1 mg
PO or
sublingual QHS PRN
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PRN Medication:
________
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 dimenhyDRINATE 25-50 mg
IV or
NG or
PO q4h PRN
Aluminum hydroxide/magnesium hydroxide oral suspension 30 mL PO q4h PRN
Adult Potassium Oral Dosing Clinical Protocol
Bowel Care Clinical Protocol
Physician’s Signature __________________________Date ___________Time__________
C/1/GBHN/Surg/-/THR_Receiving/MD/07-07/v1/-
Copyright © 2007 Grey Bruce Health Network
NOTE: this is a CONTROLLED document as are all files on this server. Any documents appearing in paper form are not
controlled and should ALWAYS be checked against the server file versions (electronic version) prior to use.
________
________
________
________
ADDRESSOGRAPH
GREY BRUCE HEALTH NETWORK
Page 3 of 4
SITE: _____________________
Allergies: □ NKA or: ________________________
Weight (kg) _______________
Post-Operative Total Hip Replacement Order Set
(Receiving Hospital)
Processed
Kardex
Diabetes Management
________
 Hypoglycemia Clinical Protocol greater than or equal to 16 years
Adult Subcutaneous Insulin Order Set
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DVT Prophylaxis
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If Creatinine clearance is greater than 30 mL/min, consider (check with pharmacy to determine
calculated Creatinine clearance -- Height, Weight and serum creatinine are required for this
calculation):
Enoxaparin 40 mg subcutaneous daily.
Dalteparin 5000 units subcutaneous daily (HDH only).
If Creatinine clearance is less than 30 mL/min OR serum Creatinine greater than 150 mmol/L,
consider:
Heparin 5000 units subcutaneous q12h. If Heparin ordered, then
 CBC, APTT, INR, Creatinine prior to initiating therapy if not already ordered
 CBC, day 1, 3, 7, and 14 to monitor platelet count
 CBC weekly for patients on therapy greater than 14 days
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Communication Orders
Notify physician if:
 Haemovac drain is greater than 500 mL over 8 hours
 Hgb less than 85 g/L or has decreased greater than 15 g/L from previous result
 Platelets less than 100 x 109/L
 Increased swelling, bleeding at the operative site
 Abnormal bleeding (haematuria, GI bleeding)
 If patient on Warfarin and 6 doses of Enoxaparin given and INR is still sub therapeutic
Admission/Discharge/Transfer
________  Plan discharge transfer to ______________ on date _________
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Follow up:
________
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Ambulatory Care
Hip X-Ray
Other: ______________ Date: _________
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________ __________________________________________________________ ________
__________________________________________________________
__________________________________________________________
Physician’s Signature __________________________Date ___________Time__________
C/1/GBHN/Surg/-/THR_Receiving/MD/07-07/v1/-
Copyright © 2007 Grey Bruce Health Network
NOTE: this is a CONTROLLED document as are all files on this server. Any documents appearing in paper form are not
controlled and should ALWAYS be checked against the server file versions (electronic version) prior to use.
GREY BRUCE HEALTH NETWORK
ADDRESSOGRAPH
Page 4 of 4
SITE: _____________________
Allergies: □ NKA or: ________________________
Weight (kg) _______________
Processed
Post-Operative Total Hip Replacement Order Set
(Receiving Hospital)
__________________________________________________________
__________________________________________________________
Physician’s Signature __________________________Date ___________Time__________
C/1/GBHN/Surg/-/THR_Receiving/MD/07-07/v1/-
Copyright © 2007 Grey Bruce Health Network
NOTE: this is a CONTROLLED document as are all files on this server. Any documents appearing in paper form are not
controlled and should ALWAYS be checked against the server file versions (electronic version) prior to use.
Kardex