Download Neurosurgery Spinal Orders

The licensed independent practitioner must check () the desired boxes. All order sheets must be signed with date/time by the licensed independent practitioner
with ID #. A generic or therapeutically equivalent drug as approved by the P&T Committee may be dispensed unless other wise specifically stated.
Diagnosis:
Allergies:
Attending:
Consultants:
Consult:  PT
Precautions:
 OT
 Seizure
 Speech
 Pastoral Care  Social Work
 Nutrition
 Diabetic Educator
 Aspiration
AUTOMATIC STOP ORDERS INCLUDE: Narcotics – 7 days (Demerol 48 hrs) Antibiotics – 7 days
Admit to:  ICU (4300)
 Unit 2200
Activity:
 No Over Bed Trapeze Bar
 Bed rest
 Head of Bed FLAT
 Head of Bed
degrees
 Out of Bed with Assistance
 Out of Bed with assistance in AM
 Out of bed for ALL meals
Monitoring/Treatments:
 Vital Signs and Neuro checks every four hours x 24 hours, then per routine
 Strict Intake & Output measurements and record
 Foley Catheter to gravity
 D/C Foley in AM
 Oxygen therapy - Maintain SpO2 (Oxygen Saturation) greater than 94% with Nasal cannula @
l/minute
 Incentive spirometry, 10 breaths per hour while awake
 Sequential Compression Devices to bilateral lower extremities
Drains:
 All drains to self suction and record output every 4 hours
Medications:
Analgesia/antipyretics
 Patient Controlled Analgesia (PCA): see PCA order sheet
 D/C PCA in AM
 morphine sulfate 2 mg intravenously every 2 hours as needed for pain (pain severity score 7 to 10)
 morphine sulfate 1 mg intravenously every 2 hours as needed for pain (pain severity score 4 to 6)
 morphine sulfate 0.5 mg intravenously every 2 hours as needed for pain (pain severity score 1 to 3)
 hydrocodone/acetaminophen (Vicodin) (5/500) 2 tablets orally every 6 hours as needed for pain (pain severity score 7 to 10)
 hydrocodone/acetaminophen (Vicodin) (5/500) 1 tablet orally every 4 hours as needed for pain (pain severity score 4 to 6)

acetaminophen (Tylenol) 650 mg orally every 4 hours as needed for Temp. greater than 99 degree Fahrenheit OR pain (pain severity score 1
to 3)

acetaminophen (Tylenol) 650 mg suppository rectally every 4 hours as needed for Temp. greater than 99 degree Fahrenheit OR pain (pain
severity score 1 to 3)
 Telephone order:
_________________________________________ MD / NP / PA_/__________________________________ Date________ Time_______  RB&C
(circle one)
Provider Signature_______________________________________ ID #___________________ Date____________ Time______
RN Signature___________________________ Date_______ Time_______ USC Signature______________________ Date________ Time________
Patient Identification
barcode
NEUROSURGERY
SPINAL ORDERS
WAH 601-524 1/09
page 1 of 2
The licensed independent practitioner must check () the desired boxes. All order sheets must be signed with date/time by the licensed independent
practitioner with ID #. A generic or therapeutically equivalent drug as approved by the P&T Committee may be dispensed unless other wise specifically stated.
AUTOMATIC STOP ORDERS INCLUDE: Narcotics – 7 days (Demerol 48 hrs) Antibiotics – 7 days
GI Prophylaxis
 famotidine (Pepcid) 20 mg IV daily
 famotidine (Pepcid) 20 mg po daily at hs
 pantoprazole (Protonix) 40 mg IV daily
 pantoprazole (Protonix) 40 mg po daily before breakfast
Bowel Management
 docusate sodium (Colace) 100 mg orally every eight hours
 polyethylene glycol (Miralax) one packet orally daily at 10 am
 psyllium (Metamucil) one packet orally daily at 10 pm
Wound Healing Promotion
 Vitamin A 25,000 International Units orally daily at 10 am
DVT Prophylaxis
 enoxaparin (Lovenox) 40 mg SQ daily
 enoxaparin (Lovenox) 30 mg SQ daily (Cr Cl < 30 mL/min)
Antibiotic prophylaxis
 cefazolin (Ancef) 1 gram intravenously every 8 hours times 2 doses, then discontinue
 cefazolin (Ancef) 1 gram intravenously every 8 hours until after all drain(s)/ventriculostomy are removed, give one additional dose when
drains are removed, then notify the pharmacy to discontinue the medication
 vancomycin (use only if Cefazolin is contraindicated) 1 gram intravenously every 12 hours times 2 doses, then discontinue
 vancomycin (use only if Cefazolin is contraindicated) 1 gram intravenously every 12 hours until after all drain(s)/ventriculostomy are
removed, give one additional dose, then notify the pharmacy to discontinue the medication.
 Check Peak and Trough vancomycin levels before and after the 2nd dose
Fluid and Nutrition management:
Intravenous Fluids
 Normal Saline (0.9%) at
mL/hour
 Lactated Ringers at
mL/hour
 Other:
mL/hour
Diet:
 NPO
 Regular diet
 Other:
Diagnostics:



AM Labs:
 CBC with Differential
 BMP, Magnesium and Phosphorus
 PT/INR/aPTT
Other: __________________________________________________________________________________________________________________
 Telephone order:
_________________________________________ MD / NP / PA_/__________________________________ Date________ Time_______  RB&C
(circle one)
Provider Signature_______________________________________ ID #___________________ Date____________ Time______
RN Signature___________________________ Date_______ Time_______ USC Signature_______________________ Date________ Time________
Patient Identification
barcode
NEUROSURGERY
SPINAL ORDERS
WAH 601-524 1/09
page 2 of 2