Rehabilitation hospital

GENERAL ORTHOPAEDIC
POST-OPERATIVE ORDERS
Orders with an open box must be checked if desired Indicates routine order, Strike through if not desired ADMISSION
Admit as Observation Dr. ________________________, MD/DO Monitored Bed (Telemetry) preferably on Ortho Unit DIAGNOSIS
PROCEDURE
CONDITION
CATEGORY OF CARE
ALLERGIES
NKDA Other ____________________________________________________________________ Ice chips, advance to regular diet as tolerated _________ kCal ADA diet Other Boost TID with meals Protein shakes with meals VITAL SIGNS
Vital signs and neurovascular assessments: per policy. Call MD if: HR> _______or < _________; RR > ______ or < _______; Temp > _______ F SBP > _______ or < _________, SaO2 < _____% WOUND CARE
Wet to dry saline dressing changes every____hours to____ UE; ____LE WoundVac to 125mmHg continuous suction, change every 72 hrs Pin care every ___ hours with hydrogen peroxide/normal saline 1:1 solution, per Nursing Standard of Dry dressing change every day and as needed ACTIVITY
Weight bearing as tolerated _______________UE; _______________LE Non weight-bearing _______________ UE; ______________ LE Toe touch weight-bearing _______________ UE; _______________ LE Physical Therapy to evaluate and treat daily Occupational Therapy to evaluate and treat daily Out of bed to chair daily starting _______________________________________ Bedrest Overhead trapeze to bed Fall precautions CONSULTS
General Internal Medicine for :_______________________________________ Infectious Disease: ________________________________________________ Physical Medicine and Rehab: ___________________________________________________ Trauma: Patient with multiple fractures/injuries DVT PROPHYLAXIS
Pharmacologic VTE Prophylaxis must be started within 24 hours of surgery for hip replacements
(Refer to DVT/PE
unless epidural is in use or reason documented (reason:____________________________________ )
Prevention
Assessment Order
[NU285] for
EPC cuffs OR
PlexiPulse on at all times while in bed recommendations if
Arixtra 2.5 mg subcutaneously ever 24 hours (CrCl must be > 30 ml/min, Weight must be > 50 kg) Lovenox 40 mg subcutaneously daily
Lovenox 30 mg subcutaneously daily (for CrCl < 30 ml/min)
Lovenox 30 mg subcutaneously twice daily (knee surgery)
Lovenox 40 mg subcutaneously twice daily (morbid obesity)
Coumadin __________ mg oral evening of surgery, then per sliding scale daily at 5 PM.
If INR is: Give Coumadin
> 2 None INR target _______________________________
1.5 – 2 2.5 mg
1 – 1.4 5 mg Total duration of anticoagulation ______________
<1 7.5 mg
Pharmacy to Dose Coumadin
If epidural in use, hold Arixtra, Lovenox and Coumadin until after epidural discontinued
GENERAL ORTHOPAEDIC
POST-OPERATIVE ORDERS
RESPIRATORY AND
02 @ 2-3 liters per nasal cannula to keep Sa02> 92% Foley to gravity, discontinue post-operative day #1 CBC with diff every morning Basic Metabolic Panel every morning PT/INR every morning BLOOD & BLOOD
Please complete Blood/Blood Products Doctor’s Orders
PRODUCTS
X-RAYS/RADIOLOGY
Study_______________________________________ Reason _____________________________ Study_______________________________________ Reason ____________________________ Study_______________________________________ Reason_____________________________ IV FLUIDS
Other__________________________ Rate__________ Change IV to saline lock when I & O are adequate ANTIBIOTICS
Please complete POST-Operative Antibiotic Surgical/Procedure Prophylaxis Doctor’s Order Form
(PH033) or Anti-Infective Doctor’s Orders (PH019)
PAIN MANAGEMENT
May give oral and IV medications simultaneously for pain level of 8 or above, respiratory rate of at least Changes in this the
10, and level of consciousness (arousable, able to follow simple command). same as the TKA 5/23
OxyContin _______ mg oral every 12 hours
Tylenol 650 mg oral every 4 hrs PRN mild pain rated 1 to 3 out of 10
Percocet 5/325 mg 1-2 oral every 4 hrs PRN moderate pain 4-7 out of 10 Choose either Percocet
Vicodin 5/500 mg 1-2 oral every 4 hrs PRN moderate pain 4-7 out of 10 or Vicodin, Not Both
Oxycodone IR 5 mg oral every 2 hrs PRN pain rating 8 – 10 out of 10 severe pain
Morphine Sulfate 2 mg IV every 2 hrs PRN moderate pain 4-7 out of 10 or not able to take oral meds
Morphine Sulfate 4 mg IV every 2 hrs PRN severe pain 8-10 out of 10 or not able to take oral meds
Caution: Consider reduced morphine doses in patients with impaired renal function
PCA – See completed PCA Protocol (PH011)
Pain Management Team Consult
ADJUNCTIVE PAIN
MEDICATION
FOR INSOMNIA
Benadryl 25 mg oral at bedtime PRN insomnia Choose only one
Ambien 10 mg oral at bedtime PRN insomnia
Sonata 5 mg oral every HS PRN insomnia (Preferred sleep aid for geriatric patients)
Lunesta 1 mg oral every HS PRN insomnia (Second choice sleep aid for geriatric patients)
DAILY BOWEL
Miralax 17 gm oral daily starting post-operative day, may increase to TID FOR CONSTIPATION
Dulcolax 10 mg PR daily PRN if no BM for 3 days Fleet enema PR every day PRN if no BM for 3 days Concentrated MOM 10 ml oral every 6 hrs PRN if no BM for 3 days FOR NAUSEA
Zofran 4 mg IV every 4-6 hrs PRN nausea, use first and if no relief in 2 hours use Phenergan Phenergan 25 mg IM or oral every 6 hrs PRN nausea, use if Zofran not relieving after 2 hours DIABETES
Finger stick blood glucose before meals and at bedtime MANAGEMENT
Scale to house
Blood sugar less than 60: give 25 mL IV Dextrose 50% and call MD standard
Blood sugar 75 – 150; none Blood sugar 151 – 200: 2 units SC x 1 Blood sugar 201 – 250: 4 units SC x 1 Blood sugar 251 – 300: 6 units SC x 1 Blood sugar 301 – 350: 8 units SC x 1 Blood sugar 351 – 400; 10 units SC x 1 Blood sugar greater than 401+; 12 units SC x 1 and call MD ADDITIONAL
MEDICATIONS
Oscal 500 + D 1 oral TID
Multivitamin 1 oral daily
Benadryl 25 mg oral every 4-6 hrs PRN itching
Valium 5 mg IV or oral TID PRN muscle spasms
Ativan 0.5mg IV/oral PRN muscle spasms or anxiety (Geriatric Patients)
Albuterol 2.5 mg nebulizer every 6 hrs PRN wheezing or shortness of breath
GENERAL ORTHOPAEDIC
POST-OPERATIVE ORDERS
ADDITIONAL
MEDICATIONS
(continued)
CONTACT MD
For urinary output less than 30ml/hr (240ml in 8 hrs) IMMEDIATELY
For inadequate analgesia For oversedation Other: If HemoVac in place, empty drains every shift and record output Discontinue Foley when ordered (Monitor daily and contact MD if no order written to discontinue) Straight Cath Q 6 hrs PRN no void after Foley discontinued (if applicable) Turn and reposition Q 2 hrs Ice pack as needed for edema Incentive spirometry Q 1 hr while awake I & O every shift and record ADDITIONAL ORDERS


PRECISION BUSINESS SOLUTIONS 419.661.8700 UTMC ORDER FORM

Specifications
Form Description
Current Form Number OC027
Letter Fold
Finishing
Drilling
Unit Size
Packaging

Special Instructions:

Source: https://cp.utoledo.edu/portal/forms/OC027.pdf