Download CAROTID ENDARTERECTOMY POST-OP ORDERS

PHYSICIAN'S ORDERS
DATE
ALL ORDERS WILL BE IMPLEMENTED UNLESS MARKED OUT
ORDERS: A FORMULARY APPROVED GENERIC OR THERAPEUTIC EQUIVALENT DRUG MAYBE SUBSTITUTED
Do Not Use: 'QD', 'QOD', 'U', 'IU', 'MS', 'MSO4', 'MgSO4', 'µg', 'X.0', '.X'
CAROTID ENDARTERECTOMY POST-OP ORDERS:
1. Unit:
Telemetry
yes
no
2. Allergies:
3. V/S and neuro checks every 15 min x 4, every 30 min x 2, every 1 hr x 4, then every 4 hrs.
4.
Remove dressing in a.m., cleanse with H202.
5. Elevate HOB.
6. BRP today; ambulate tonight.
7. Diet:
Regular diet as tolerated
2000 kcal ADA diet as tolerated
8. Full liquids post nausea. Progress to regular diet tonight.
9. Incentive spirometer (IS) every 2 hour while awake. Nurse to instruct and supervise until patient
can use IS independently.
10. Medications:
ECASA 325 mg PO daily.
Darvocet N-100 1-2 tablets PO every 4 hrs prn mild pain.
Analgesic: Hydrocodone/Acetaminophen (Lortab) 5 mg 1 tab 2 tabs PO every 4
hours PRN moderate pain
Meperidine (Demerol) 25-50 mg IM/IV every 3 hrs PRN severe pain unrelieved with Lortab.
Antiemetic: Ondansetron HCI (Zofran) 4 mg IV every 6 hrs PRN nausea
mL/hr. Discontinue IV
@
IV Fluids:
fluids
@ HS tonight, heplock IV.
Antibiotics:
Cefazolin 1 gram IV every 8 hours x 2 doses total
OR
(If allergic to Penicillin) Vancomycin 1 gram IV every 12 hours x 1 dose total.
Clonidine 0. 1 mg PO every 1-2 hours PRN SBP greater than 175
2.5 mg IV every 6 hours PRN SBP greater than 180
Enalaprilat (Vasotec)
1.25 mg
sustained
Nitroglycerin Paste 1 inch to chest wall every 6 hours. Hold for SBP less than 105 or
headache. Discontinue Nitroglycerin paste upon patient's discharge.
Other:
See Medication Reconciliation Sheet.
10. Prior to discharge, schedule appointment
11. Anticipated date and time of discharge
prescription.
weeks for follow-up.
with instructions and
I
Date___________________Time__________
TRINITY MOTHER FRANCES
HOSPITALS AND CLINICS
*DT171*
PHYSICIAN ORDERS
Carotid Endarterectomy Post Op Orders
E.F. 171-0979 Rev. 03/11 Pg. 1 of 1
M.D.
PHYSICIAN'S ORDERS
Mark  in  for desired orders. If  is blank, order is inactive.
DVT ADULT PROPHYLAXIS
Start medications*:  _____ hours after surgery
 ____________________________________
*Unless otherwise indicated above, all medication orders will be initiated upon receipt of order.
 Pharmacologic thromboprophylaxis is NOT INDICATED due
to patient condition.
 Contraindication:
Use:  TED hose
 SCD's
A. Risk Factors - 1 point each
 Age 41-60 years
 Family history of DVT/PE
 Leg swelling, ulcers, stasis,
varicose veins
 Inflammatory bowel disease
 Central Line
 Bed confinement / immobilization
greater than 24 hours
 Pregnancy, or postpartum less
than one month
 Obesity (greater than 20% over IBW)
 Minor Surgery
 Estrogen Therapy
Low Risk: 1 Point

Patient is on therapeutic anticoagulation. Additional
pharmacologic thromboprophylaxis is not required.
B. Risk Factors - 2 points each
 Age 61-70 years
 Major Surgery
 Malignancy
 Multiple Trauma
 Spinal cord injury with paralysis
Total Risk Score: _______
Moderate Risk: 2 Points High Risk: 3-4 Points
C. Risk Factors - 3 points each
 Age greater than 70 years
 Prior history of DVT/PE
 Acute MI / CHF
 Severe sepsis (sepsis with more
than one organ failure)
 Stroke with paralysis
 Hyperviscosity syndromes
 Hip or Knee Replacement*
 Inherited thrombophilia
 Acquired thrombophilia
Very High Risk: > 4 Points
Low Risk: 1 point OR may order IN ADDITION to pharmacologic orders below- Choose ALL that apply:
 TED hose
 Ambulate:_______________________________
 SCD's
Moderate Risk: 2 points - Choose ONE of the following:
 heparin 5000 units subcutaneous every 8 hours
 fondaparinux (ARIXTRA) 2.5 mg SQ daily
 enoxaparin (LOVENOX) 40 mg subcutaneous every 24 hours
 enoxaparin (LOVENOX) 30 mg subcutaneous every 24 hours
(dosing for CrCl less than 30 mL/min.)
High Risk / Very High Risk: 3 points or greater - Choose ONE of the following:
 heparin 5000 units subcutaneous every 8 hours
 For abdominal surgery only:
fondaparinux (ARIXTRA) 2.5 mg SQ daily
 enoxaparin (LOVENOX) 40 mg subcutaneous every 24 hours
 enoxaparin (LOVENOX) 30 mg subcutaneous every 24 hours
(dosing for CrCl less than 30 mL/min.)
Hip and Knee Replacement
 TED hose and Sequential compression device (SCD)
 fondaparinux (ARIXTRA) 2.5 mg subcutaneous every 24 hours
 enoxaparin (LOVENOX) 30 mg subcutaneous twice daily
 enoxaparin (LOVENOX) 40 mg subcutaneous every 24 hours  aspirin 325 mg PO daily
Trauma  enoxaparin (LOVENOX) 30 mg subcutaneous every 12 hours
Laboratory
 CBC (baseline initial, then every three days)
 Other:
 PT/INR and PTT (baseline only)
 NOTE: fondaparinux (ARIXTRA) contraindicated in patients with severe renal impairment (creatinine clearance <30 mL/min)
EPIDURAL WARNING: do not begin anticoagulants if patient currently has an epidural/intrathecal catheter.
Date:____________
(Required)
Time:_______________
(Required)
Cell/Pager:__________________________
_______________________________________
Prescriber's or Attending's Signature
_______________________________________
Printed Name
Scanned to pharmacy / entered into TDS by:
_______________________Date_____________Time______
TRINITY MOTHER FRANCES
HOSPITALS AND CLINICS
*DT177*
PHYSICIAN ORDERS
DVT Adult Prophylaxis
E.F. 177-1294 Rev. 1/10 Pg. 1 of 1
Orders verified by:
_______________________Date_____________Time______