Unique Plan Description: Anes OB Neuraxial Opioid Analgesia
Plan Selection Display: Anes OB Neuraxial Opioid Analgesia
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-03-15 09:44:53
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-10-24 09:04:41
Available at all facilities: No

Anes OB Neuraxial Opioid Analgesia
IV Solutions
	Narcan 0.8 mg/NS 250 mL
		250 mL, IV, 25 ml/hr
			Comment: as needed for severe itching
		0.8 mg, EVERY BAG
	naloxone 0.8mg/LR 1000mL
		0.8 mg, EVERY BAG
		1,000 mL, IV, Routine, 100 ml/hr
			Comment: To run as mainline infusion for Pruritis, call pharmacy if/when needed
Medications
	Ativan
		1 mg, Injection, IV PUSH, Q6H, PRN, anxiety, 24 hr
			Comment: /pain
	Benadryl
		25 mg, Injection, IV PUSH, Q6H, PRN, itching, 24 hr
		50 mg, Injection, IV PUSH, Q6H, PRN, itching-severe, 24 hr
	ePHEDrine
		10 mg, Solution, IV PUSH, Q10MIN, PRN, systolic blood pressure < ...., 24 hr
			Comment: 90 or symptomatic hypotension and HR<60.
		15 mg, Solution, IV PUSH, Q10MIN, PRN, systolic blood pressure < ...., 24 hr
			Comment: 90 or symptomatic hypotension and HR<60.
	morphine  IV
		2 mg, Syringe, IV PUSH, Q2H, PRN, pain-breakthrough, 24 hr
			Comment: Maximum dose 6 mg per hour
		2 mg, Syringe, IV PUSH, Q10MIN, PRN, pain-severe, 24 hr
			Comment: Maximum dose 6 mg per hour
	Narcan
		0.1 mg, Injection, IV PUSH, Q5MIN, PRN, severe respiratory depression (RR<8), 2 Dose(s)/Time(s)
		0.2 mg, Injection, IV PUSH, Q5MIN, PRN, severe respiratory depression (RR<8), 2 Dose(s)/Time(s)
	nalbuphine
		2.5 mg, Injection, IV PUSH, Q4H, PRN, itching, 24 hr
		5 mg, Injection, IV PUSH, Q4H, PRN, itching, 24 hr
	ondansetron
		4 mg, Injection, IV PUSH, Q6H, PRN for nausea, duration: 24 hr
			Comment: for nausea not relieved by Reglan if ordered
	ketorolac injectable
		15 mg, Injection, IV PUSH, Q6H, PRN for pain-moderate, duration: 24 hr
			Comment: Do not give oral NSAID withing 6 hours of ketorolac.
	Phenergan (MH/WH)
		6.25 mg, Injection, IV PUSH, Q6H, PRN, nausea and/or vomiting, 24 hr
			Comment: use if Zofran not effective
	Phenergan (FH)
		12.5 mg, INT, IVPB, Once, for nausea and/or vomiting
			Comment: in PACU
		25 mg, INT, IVPB, Once, for nausea and/or vomiting
			Comment: in PACU
	Reglan
		10 mg, Injection, IV PUSH, Q6H, PRN, nausea and/or vomiting, 24 hr
			Comment: use first if Zofran already given during procedure
	Neo-Synephrine (JE/WH)
		80 mcg, Syringe, IV PUSH, Q10MIN, PRN, systolic blood pressure < ....
			Comment: < 90, symptoms of hypotension and HR > = 60bpm.
		40 mcg, Syringe, IV PUSH, Q10MIN, PRN, systolic blood pressure < ....
			Comment: < 90, symptoms of hypotension and HR > = 60bpm.
	Neo-Synephrine (NMH)
		80 mcg, Injection, IV Push, Q10MIN, PRN for systolic blood pressure < (see comment)
			Comment: < 90, symptoms of hypotension and HR > = 60bpm.
		40 mcg, Injection, IV Push, Q10MIN, PRN for systolic blood pressure < (see comment)
			Comment: < 90, symptoms of hypotension and HR > = 60bpm.
Patient Care
	IV-Maintain
		24, hr
			Comment: after last dose of epidural/spinal
		12, hr
			Comment: after last dose of epidural/spinal
	Do not give medication
		T;N, No narcotics or sedatives if respiratory rate less than 12 breaths/minute or if patient not fully awake without notifying Anesthesia first
	Notify Anesthesia if:
		Systolic BP less than 90 mmHG
		T;N
			Comment: Progression to pre-op motor function is not achieved within 3-4 hours after neuraxial analgesia
		T;N
			Comment: SAO2 less than 90%, respiratory rate <10 breaths/min, pain control inadequate, patient lethargic.
	No Anticoagulants/antiplatelets/thrombolytics
		T;N
			Comment: Refer to guidelines for timing of AC/antiplatelet dose administration post epidural dose. This order may be discontinued 6hr after intrathecal dose.
	Epidural Catheter
		Discontinue, in PACU.
	Neuraxial Assessment
		Q1H, 4, hr
		T;N+120, Q4H-Sch, 24, hr
	Pulse Oximetry Spot Check by nurse
		T;N
			Comment: Complete with routine post-operative vitals per policy
	Oxygen Therapy, Nurse to Administer
		Via Nasal Cannula, Titrate->Keep Sats>/= to 92

*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