Download (UPPP) Post Op Orders

PLACE LABEL HERE
SINUS / NASAL AIRWAY SURGERY, RHINOPLASTY,
ADENOIDECTOMY, TONSILLECTOMY,
UVULOPALATOPHARYNGOPLASTY (UPPP)
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 indicate (multipage).
1. Is this a CMS inpatient only procedure?  Yes, admit as inpatient, proceed to # 3
 No, proceed to # 2
2. Do you expect that the patient’s condition will require a hospital stay that will cross two midnights (includes the
time spent in outpatient- ED, surgery, OBS) and the patient has medical necessity for an inpatient admission?
 Yes, admit as inpatient, proceed to # 3
 No, place in observation
3. If admitted as inpatient, Inpatient Physician Certification:
Diagnosis: ___________________________________________________________________________
Level of Care:  Critical  Intermediate  Acute Care Location/Specialty Unit Preference______
4.  Telemetry: If patient Medical/Surgical, must complete form # 36084
5.  Isolation:  Contact  Droplet  Airborne For: ____________________
6. Vital signs per unit routine
7. Labs: If Pre-op PTT abnormal, Platelet Function Screen and repeat PTT in AM
8. Elevate HOB:  > 30°
 > 45°
 45-60° at all times
9. Ice bag/collar as tolerated
10. Crushed ice 4 x 4s to nasal bridge as tolerated
11. Activity - up as tolerated, BRPs with assistance
12. Thigh high anti-embolic (TED)
13. Clear, cold liquids/popsicles/Powerade x 24 hrs, then advance to full liquids as tolerated
14. Monitor intake and output q shift
15. Suction nasal canal with #10Fr. Suction catheter q shift and prn
16. For CNP and Rhinoplasty patients only: Continuous crushed ice compresses bilateral eyes x 48 hrs (4 x 4
with crushed ice/head wrap with towel)
17. Call physician for:
 Any evidence of respiratory distress (call Pulmonary Medicine Physician, then call Surgeon)
 Oxygen saturations below 88% (call Pulmonary Medicine Physician, then call Surgeon)
UPPP Patients additional Post-op orders
18. Consult Pulmonary Medicine Physician for perioperative medical care
19. Continuous face shield humidification
20. Telemetry with continuous pulse oximetry
21. Initiate Sleep Apnea Orders (form # 21266), if OSA screen is positive for suspected or reported sleep apnea
22. Incentive spirometer q 2 hrs while awake
23. If Bleeding excessive:
a.Check Blood pressure, make sure it is below 120/80.
i. If it is not, alert the pulmonary medicine physician on-call who is in charge of controlling blood pressure.
ii. If it is, then suction nasal cannulae with #10 catheter, all the way back through the tubes to the throat.
b. Place drip pad under nose, if continues to bleed, soak two cotton balls with Afrin (see PRN medication
orders), not gauze, the size of a nickle in afrin and place one in each nostril then apply drip pad.
c. If bleeding persists, do not change drip pad, leave in place and only reinforce. Change reinforced pad.
Leave cotton and original pad in place until am.
d. If significant bleeding continues where the reinforced pad soaks through more often than every 30 minutes,
please contact surgeon.
e. If bleeding is controlled, send to surgeon’s office on the way home to have pads and cotton removed.
Copy to pharmacy
*3-20344*
Order writer initials _______
FORM 3-20344 REV. 12/2015
Page 1 of 2
PLACE LABEL HERE
SINUS / NASAL AIRWAY SURGERY, RHINOPLASTY,
ADENOIDECTOMY, TONSILLECTOMY,
UVULOPALATOPHARYNGOPLASTY (UPPP)
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 indicate (multipage).
SCHEDULED MEDICATIONS
24. Antibiotics:  Ancef (cefazolin) 1 gm IV in PACU, then 8 hrs x 2 doses
25. Decadron (dexamethazone) 10 mg IV at 9 am x 1 dose on first UPPP post-operative day
26. D5LR IV at 125 ml/hr until patient is discharged
SCHEDULED PAIN MEDICATIONS
27. Toradol (ketorolac) 30 mg IV (or IM if no IV access) q 6 hrs (15 mg if CrCl 31-50, > 65 y/o old or < 50 kg), max
combined duration of IV and po ketorolac is 5 days. DC if CrCl < 30.
PRN MEDICATIONS - No Respiratory Depressant Narcotics may be given post-operatively
28. Mild Pain, Temp >100.5F, HA:  Tylenol (acetaminophen) 650 mg elixir po or PR q 4 hrs prn
29. 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 instead 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.
30. 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)
31. Throat Pain:  Viscous lidocaine 2%, 15 mls to be diluted in 15 mls of water (30 mls total), q 4 hrs prn, gargle
then spit out or may swallow, maximum 8 doses per day
and/or  Xylocaine (lidocaine) 4% nebulizer prn per Respiratory Therapy
32. Excessive bleeding: saturate cotton ball in Afrin (oxymetazoline) and insert into each nare PRN x 1 dose
DISCHARGE
33. Discontinue IV at discharge
34. UPPP and/or nasal discharge instructions to patient and family
35. Instruct patient on use of incentive spirometer
36. Thigh high anti-embolic (TED) to be worn for 2 weeks post-op
37. May go in AM when tolerating po fluids, tolerating activity, voiding without difficulty
38. Office appointment as scheduled: one week for T&A patients or 3 - 4 days for UPPP patients
39. ADDITIONAL ORDERS:
___________________________________________________________________________________________
___________________________________________________________________________________________
______________
Date
____________
Time
_________________________________
Physician Signature
___________
PID Number
Copy to pharmacy
FORM 3-20344 REV. 12/2015
Page 2 of 2