Unique Plan Description: Cards Femoral Heart Cath Post Op EKM
Plan Selection Display: Cards Femoral Heart Cath Post Op
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2017-12-22 07:45:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-20 09:42:07
Available at all facilities: Yes

Cards Femoral Heart Cath Post Op EKM
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N
	Admit to Observation Status
		T;N
	Discharge Conditional
		Conditions to be met: after bedrest complete, and arterial insertion site is stable
		Conditions to be met: after bedrest complete, and arterial insertion site is stable, T;N
Vital Signs
	Vital Signs
		T;N, Routine post op
			Comment: Incision/drain assessment and vascular assessment with each vital signs check
Activity
	Bedrest
		T;N, 2, hr
			Comment: Keep right/ left leg flat
		T;N, 4, hr
			Comment: Keep right/ left leg flat
		T;N, 6, hr
			Comment: Keep right/ left leg flat
	Elevate head of bed
		T;N
			Comment: May elevate head of bed max 30 degrees
	Ambulate
		T;N
			Comment: After bedrest discontinued
Diet
	NPO
		T;N
	Cardiac Diet
		T;N
Laboratory
Tomorrow's Lab
	CBC with Diff
		T+1;0400, Routine, spec type = Blood
	Basic Metabolic Panel
		T+1;0400, Routine, spec type = Blood
Diagnostic Tests

	ECG
		T;N, Routine, Indication: Post Cardiac Procedure
IV Solutions
	Sodium Chloride 0.9%
		1,000 mL, IV, 2 hr, 75 ml/hr
		1,000 mL, IV, 2 hr, 100 ml/hr
		1,000 mL, IV, 2 hr, 150 ml/hr
		1,000 mL, IV, 2 hr, 200 ml/hr
		1,000 mL, IV, 2 hr, 250 ml/hr
Medications
	aspirin
		324 mg, Tablet-Chew, By Mouth, DAILY
		81 mg, Tablet-Chew, BY MOUTH, DAILY
	Plavix
		75 mg, Tab, BY MOUTH, DAILY
			Comment: Verify patient received loading dose of Plavix in the Cath Lab before starting maintenance dose.  Notify Cardiologist if patient has not received loading dose.
	Brilinta (ticagrelor)
		180 mg, Tab, By Mouth, Once, NOW
		90 mg, Tab, By Mouth, Q12H, T;N+720
	morphine  IV
		2 mg, Syringe, IV PUSH, Q2H, PRN, pain-mild
	sodium chloride 0.9% flush injectable soln
		10 mL, Syringe, IV PUSH, BID
		10 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush
	Tylenol
		650 mg, Tab, BY MOUTH, Q4H, PRN, fever
			Comment: headache or fever > 100.6
Patient Care
	Resuscitation Status
		Full Code
		No Code
	VTE Advisor
		Medical
	Notify MD
		if urine output less than 200 ml per 2 hours OR if site bleeding, decreased/absent distal pulses.
		T;N, Cardiologist if affected extremity becomes cool, numb, excessive swelling or bleeding.
		T;N, If chest pain or chest pain equivalent, ST segment changes, HR <45, HR >120, SBP >180, SBP <90, DBP >100, oxygen sat <90%, rhythm change.
	Straight Catheter
		Insert, unable to void
	Bladder Scan
		unable to void
	Discontinue Sheath
		T;N
			Comment: Discontinue q1h PTT when sheath remove when PTT < / = to 40. Apply transparent dressing over puncture site
		T;N
			Comment: when PTT < / = to 40. Apply transparent dressing over puncture site
	Order Lab
		T;N, If sheath in place, order PTT 4 hours after heparin stopped.  If PTT >40, recheck in 1 hour.
			Comment: If sheath in place, order PTT 4 hours after heparin stopped. If PTT >40 , recheck in one hour
	Incision/Dressing Care
		T;N
			Comment: Instruct pt to remove transparent dressing in 24 hours.
	Patient Education
		T;N, Instructions: No driving for 24 hours. No lifting > 10 lbs for 48 hours
	Cardiac Telemetry Monitoring
		Telemetry Indications: Cardiologist Recommendation
	Hemostatic Compression Device
		T;N, Apply Femoral
Therapies
	Oximetry/Monitoring
		
	Smoking Cessation Education
		T;N
	Smoking Cessation Education RT (FH)
		T;N
Consults/Follow-up
	Consult Cardiac Rehab: Inpatient
		T;N
	Consult Cardiac Rehab: Outpatient
		T;N

Oxygen Protocol
Therapies
Respiratory Therapy
	Oxygen Therapy
		T;N
	Pulse Oximetry Spot Check RT
		T;N, BID
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID

Peripheral Lock - Access
Medications

	sodium chloride 0.9% flush injectable soln
		10 mL Syringe IV PUSH BID
		10 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush
	lidocaine 1% injectable solution (MH/WH/FH)
		0.1 mL, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start
	sodium chloride bacteriostatic 0.9% injectable soln
		0.1 mL, Injection, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start, use if patient has lidocaine allergy.
	Sodium Chloride 0.9% IVPB Flush
		25 mL, IVPB, Q1H, PRN, IV line flush, 5 min(s)
			Comment: Use if medication not compatible with primary line or there is no primary line;  infuse 25mL.
Patient Care
	Peripheral Lock-Insert
		T;N

*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