Download Cardiovascular Surgery ICU Transfer Post Op Orders

PLACE LABEL HERE
CARDIOVASCULAR SURGERY
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:  CV Telemetry OR  Intermediate Care
 Other: ______________________________
CONSULTS:
2. Cardiac Rehab Phase II
3. Smoking cessation education if patient has smoked in the past year
4. Physical Therapy – evaluate and treat
5. Hospitalist if history of diabetes or Hgb a1C ≥ 6.5
6. Diabetic Educator if history of diabetes or Hgb a1C ≥ 6.5
7. Other: ______________________________________________________________________________
DIET:
8. Maintain diabetic clear liquid diet until 24 hrs from admission to CVICU, then:
 Cardiac Diet
 ______ calorie Consistent Diabetic Diet
 Fluid restriction __________ ml/24 hrs
VITAL SIGNS:
9. Telemetry monitoring. Transport with telemetry for testing.
10. VS q 4 hrs and as needed with pulse oximetry.
11. Strict I&O q 4 hours
Notify Physician for:

SBP < 90 or > 160 mm Hg.

HR is < 50 or > 120, or any change in the baseline cardiac rhythm.

Temperature > 101º F after 48 hrs post-op, obtain urine, sputum, and blood cultures x 2;

O2 Sat below 90% or SOB or increased work of breathing

UOP < 150ml in 4 hours unless ESRD

CT output > 200ml/hr
DIAGNOSTICS AND LAB:
12. Daily CXR while chest tubes are in; PA / Lateral AM after chest tube removal
13. CXR on ________ (date)  PA / Lateral  Portable
14. Labs:
 Chem 7 on ________ (date)
 CBC on ________ (date)
 PT/INR on ________ (date)
 PTT on ________ (date)
15. ABGs prn for respiratory distress
16. Stat 12 Lead EKG prn chest pain or ST segment elevation
BLOOD GLUCOSE MANAGEMENT:
17. If patient on ENDOTOOL, maintain insulin infusion per ENDOTOOL Insulin Infusion Orders (form #
38635). Transition to SQ insulin per ENDOTOOL generated orders. If patient is diabetic or HgB a1C ≥
6.5, maintain ENDOTOOL until 24 hrs after admission to CVICU.
18. If Patient on SQ Insulin, maintain current SQ orders
Order writer’s initials ___________
Copy to pharmacy
*3-40026*
FORM 3-40026 REV. 09/2015
Page 1 of 3
PLACE LABEL HERE
CARDIOVASCULAR SURGERY
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:
19. Maintain INT at all times
20.  Leave Cordis / Introducer
21.  Maintain Central Venous Catheter
22. DC Foley Catheter
 Leave Foley in due to _______________________________________________________
23. Daily weights at 0600 and record in kg
24. Mechanical DVT: Sequential Compression Device while in bed
25. Chest tubes to (-20) cm pleural suction
 Do not ambulate off suction
26. Temporary Pacemaker:
Insulate, secure and label epicardial wires
Initiate ventricular pacing if HR < 50 with symptomatic bradycardia and notify physician afterwards
Settings: mA 20 Rate 80 Mode VVI
Tamponade Precautions following Pacing Wire Removal
27. Incision Care:
Paint Incisions Daily with betadine. May use CHG if allergic
Change chest tube and pacing wire dressings daily and PRN
Change sternal and leg incision dressings daily and PRN if applicable
28. Activity:
Up in chair for all meals
Daily ambulation progression TID
 On POD #3 pt may shower without telemetry with staff in room
29. O2 per Protocol (form # 34431)
SCHEDULED MEDICATIONS:
Do Not Start Or Change Any Anti-Coagulant Without Cardiovascular Surgery Approval
30. Do not give Pneumonia and/or Influenza vaccines until 1 month post-op
31. Stress Ulcer Prophylaxis:  Pepcid (famotidine) 20 mg po bid



or  Protonix (pantoprazole) 40 mg po daily
32. Aspirin (ASA):  ASA per med reorder form
or
 ASA 81 mg po daily (hold for plt count < 100,000)
or
 ASA contraindicated __________________________________________________
33. Beta Blocker:  Beta Blocker per med reorder form
or
 Lopressor (metoprolol) ____ mg po q 12 hr. Hold if SBP < 100, HR < 60, or receiving
inotropic drug
or
 Other: ___________________________. Hold if SBP < 100, HR < 60, or receiving
inotropic drug
or
 DC Betablocker. Contraindicated due to: __________________________________
Copy to pharmacy
FORM 3-40026 REV. 09/2015
Order writer’s initials ___________
Page 2 of 3
PLACE LABEL HERE
CARDIOVASCULAR SURGERY
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).
SCHEDULED MEDICATIONS CONTINUED:
34. Anti-lipemic:
or
or
 Lipitor (atorvastatin) 10mg po qhs
 Other_______________________________________________________________
 DC Antilipemic. Contraindicated due to: ___________________________________
35. ACE/ARB:
or
or
or
or
 ACE/ARB (EF%____) per med reorder form Hold for SBP < 100mmHg
 Altace (Ramipril) _____ mg po daily Hold for SBP < 100mmHg
 Lisinopril (Zestril) _____ mg po daily Hold for SBP < 100mmHg
 Other: ____________________________ Hold for SBP < 100mmHg
 DC ACE/ARB Contraindicated due to: ____________________________________
36. ADP Receptor Inhibitor: ADP Receptor Inhibitor per med reorder form
or Plavix (clopidogrel) 75 mg po daily
or ADP receptor inhibitors contraindicated due to recent cardiac surgery
and/or __________________.
37. Colace (docusate) 100 mg po bid, hold for diarrhea
38. Mirilax 17 gm po Daily
39.  Lasix (furosemide) _____ mg po q____________ (frequency)
40.  K-Dur (potassium chloride) ____ mEq po q_________ (frequency) while taking daily Lasix (furosemide)
41. Respiratory/wheezing: Xopenex (levalbuterol) 1.25 mg with
Atrovent (ipratropium) 0.5 mg aerosol q 4 hrs prn
or per Medication Reorder Form
or Other: _______________________________________________________
42. If History of COPD:  Xopenex (levalbuterol) 1.25 mg q 6 hrs and q 3 hrs PRN for wheezing or SOB
PRN MEDICATIONS See policy 520-06 for range orders and pain intensity guidelines.
43. CV Care Unit Electrolyte Replacement Protocol (form # 40046)
44. Chest pain: Nitroglycerin 0.4 mg sublingual q 5 minutes x 3 doses prn and notify physician.
45. Mild Pain, Temp >100.5F, HA: Tylenol (acetaminophen) 650 mg po or PR q 4 hrs prn
46. Moderate Pain:
Percocet (oxyCODONE/acetaminophen) 5/325 mg or 10/325 mg 1 tab po q 4 hrs prn.
 DC Percocet. Norco (HYDROcodone/acetaminophen) 5/325 mg or 10/325mg 1 tab po q 4 hrs prn
47. Severe Pain for CV Step Down:
Morphine sulfate 1-4 mg IV q 3 hr prn. DC if CrCl < 30, see below order.
 If morphine ineffective after 2 doses or CrCl < 30, DC morphine; give Dilaudid (HYDROmorphone)
0.25-1 mg IV q 3 hrs prn (if CrCl < 30 start at 0.25 mg)
48. Sleep:
 Melatonin 5 mg po q HS prn
 Other: _____________________________________
49. Indigestion:
Maalox XS (aluminum/magnesium/simethicone) 30 ml po four times daily prn
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
50. Sore Throat:
Chloraseptic (phenol/sodium phenolate) throat spray q 2 hrs prn
51. Anxiety:  Ativan (lorazepam) 0.5 -1 mg po q 8 hrs prn
______________
Date
_____________
Time
_________________________________
Physician Signature
___________
PID Number
Copy to pharmacy
FORM 3-40026 REV. 09/2015
Page 3 of 3