Unique Plan Description: Anes Intrathecal Acute Post Op Pain
Plan Selection Display: Anes Intrathecal Acute Post Op Pain
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2017-11-13 13:53:11
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-10-10 18:07:21
Available at all facilities: No

Anes Intrathecal Acute Post Op Pain
IV Solutions
	phenylephrine 20 mg/NS 250 mL
		20 mg, EVERY BAG, 25 mcg/min
		250 mL, IV, Routine, Start: T;N, Maintain Parameter Goal: MAP> 65, Increment Increase: 5 mcg/min, Increment Decrease: 5 mcg/min, Increment Freq: 5 min(s), Max Dose: 25 mcg/min
			Comment: **NEO-SYNEPHRINE**, Concentration: 80mcg/mL.  Discontinue drip when at 5mcg/min and patient has sustained MAP>65 continuously for at least 60 minutes without any dose titration. If a dose 25mcg/min or less requires to be increased due to hypotension at any point, allow at least 60 minutes before weaning dose down again.If hypotension persists despite max dose of 25mcg/min, notify MD, ICU Core, and follow RRT policy/protocol based on critical vital signs.  Discontinue drip If SBP > 150mmHg.
	naloxone 0.8mg/LR 1000mL
		1,000 mL, IV, Routine, 100 ml/hr
			Comment: To run as mainline infusion for Pruritis, call pharmacy if/when needed
		0.8 mg, EVERY BAG
Medications
	Narcan
		0.1 mg, Injection, IV PUSH, Q5MIN, PRN, severe respiratory depression (RR<8), 2 Dose(s)/Time(s)
			Comment: Until desired response; follow with 10 mL sodium chloride flush.
		0.4 mg, Injection, IV PUSH, Q5MIN, PRN, severe respiratory depression (RR<8)
			Comment: then call anesthesia
	Nubain (NMH/WH/FH)
		4 mg, Injection, IV PUSH, Q4H, PRN, itching
			Comment: from intrathecal injection
		2.5 mg, Injection, IV Push, Q4H, PRN, itching
			Comment: from intrathecal injection
		5 mg, Injection, IV Push, Q4H, PRN, itching
			Comment: from intrathecal injection
	Reglan
		10 mg, Injection, IV PUSH, Q8H, PRN, nausea
		10 mg, Injection, IV PUSH, Q6H, PRN, nausea
	ondansetron
		4 mg, Injection, IV PUSH, Q6H, PRN, nausea
			Comment: for nausea not responsive to metoclopramide.
	ketorolac injectable
		15 mg, Injection, IV PUSH, Q6H, PRN, pain-moderate, 24 hr
			Comment: if CrCl <30; wt<50 or age > 65
		30 mg, Injection, IV PUSH, Q6H, PRN, pain-moderate, 24 hr
			Comment: if CrCl <30; wt<50 or age > 65
	Benadryl
		25 mg, Injection, IV PUSH, Q6H, PRN, itching-severe
Patient Care
	IV-Maintain
		T;N
			Comment: For 24 hours after last dose of epidural / spinal / Morphine (i.e. IV drip, peripheral lock)
	No Opioids
		For 24 hours, if respiratory rate less than 12 breaths/minute  or if patient not fully awake & without notifying Anesthesia first
	No Sedatives
		For 24 hours, if respiratory rate less than 12 breaths/minute  or if patient not fully awake & without notifying Anesthesia first
	No Anticoagulants/antiplatelets/thrombolytics
		T;N
			Comment: Refer to guidelines for timing of AC/antiplatelet dose administration post intrathecal dose.  This order may be discontinued 6hr after intrathecal dose
	Notify Anesthesia if:
		Marked change in sedation or CMS status | Persistent pain | Persistent side effect despite treatment | Respiratory rate less than 10 | Systolic BP less than 90 mmHG
	Cardiac Telemetry Monitoring
		T;N, Telemetry Indications: Other
	Vital Signs/Hemodynamic Monitoring
		T;N, MAP goal>65mmHg, unless otherwise directed by MD, vitals Q15MIN for first hour and Q15MIN after any decrease dosage, q60MIN once MAP sustained >65mmHG after first hour, and Q15MIN for 1 hour once phenylephrine IV discontinued. If MAP drops below and
			Comment: does not sustain >65mmHg, monitor vitals q5min with increase dosage changes until MAP reaches goal, then resume q15MIN monitoring per initial step.
Therapies
	Oxygen Therapy
		Via Nasal Cannula, Titrate->Keep Sats>/= to 92
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID
Consults/Follow-up
	Consult Anesthesiologist
		Reason for Referral: thoracic epidural, intrathecal opioid, or tap block
			Comment: Single Intrathecal Dose (of preservative free morphine < or = to 0.2 mg). or Thoracic Epidural

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase