Unique Plan Description: Cards PFO ASD VSD Post op EKM
Plan Selection Display: Cards PFO ASD VSD Post op
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-14 22:14:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-20 09:43:18
Available at all facilities: Yes

Cards PFO ASD VSD Post op EKM
Admit/Discharge/Transfer
	Discharge
		T;N
			Comment: after 1 hour
		T;N
			Comment: after 3 hour bedrest. Follow up appt in 1 month with ECHO prior to appt
Vital Signs
	Vital Signs
		T;N, Routine post op
			Comment: venous access site assessment with each vital signs
Activity
	Bedrest
		1, hr
			Comment: Keep right/left leg flat
		2, hr
			Comment: Keep right/left leg flat
		4, hr
			Comment: Keep right/left leg flat
		6, hr
			Comment: Keep right/left leg flat
	Ambulate
		T;N
			Comment: after bedrest discontinued
Diet
	Diet as ordered prior to procedure/transfer
		
Laboratory
	CBC with Diff
		T+1;0400, Routine, spec type = Blood
	Basic Metabolic Panel
		T+1;0400, Routine, spec type = Blood
	PTT - MH/WH/JE
		T+1;0400, Routine, spec type = Blood
	Partial Thromboplastin Time (PTT) - FH
		T+1;0400, Routine, spec type = Diagnostic Blood
Diagnostic Tests
	ECG
		
Medications
	Ancef IVPB (MH/WH)
		1,000 mg, Injection-Premix, IVPB, Q8H, Surgical prophylaxis, 3 Dose(s)/Time(s)
			Comment: 1st dose to be given 8 hours after last OR dose
	Ancef IVPB (FH)
		1,000 mg, INT, IVPB, Q8H, Surgical prophylaxis, 3 Dose(s)/Time(s)
			Comment: 1st dose to be given 8 hours after last OR dose
	vancomycin IVPB
		1,000 mg, Injection-Premix, IVPB, Q12H, Surgical prophylaxis, T;N+720, 2 Dose(s)/Time(s)
			Comment: Infuse over 90 minutes.
	vancomycin IVPB (FH)
		1,000 mg, Injection-Premix, IVPB, Q12H, Surgical prophylaxis, T;N+720, 2 Dose(s)/Time(s)
			Comment: Infuse over 90 minutes.
	aspirin
		325 mg, Tablet-Chew, By Mouth, DAILY
		81 mg, Tablet-Chew, By Mouth, DAILY, T+1; 0900
	Plavix
		75 mg, Tab, By Mouth, DAILY, T+1;0900
		75 mg, Tab, By Mouth, STAT
			Comment: Start day of surgery
		300 mg, Tab, By Mouth, STAT
			Comment: Day of surgery
		600 mg, Tab, By Mouth, STAT
			Comment: Day of surgery
	Ambien
		5 mg, Tab, By Mouth, QHS, PRN insomnia
			Comment: DO NOT REPEAT
	morphine  IV
		2 mg, Syringe, IV Push, Q1H, for pain-mild
	Tylenol
		650 mg, Tab, By Mouth, Q4H, PRN pain-mild
			Comment: for or temperature > 100.6 degrees F.
Patient Care
	Resuscitation Status
		T;N, Full Code
		T;N, No Code
	Cardiac Telemetry Monitoring
		T;N, Telemetry Indications: Cardiologist Recommendation
			Comment: Continuously
	VTE Advisor
		Medical
	Straight Catheter
		Insert, unable to void
	Notify MD
		T;N, if urine output less than 200 ml per 2 hours OR if site bleeding, decreased/absent distal pulses
	Incision/Dressing Care
		T;N
			Comment: Instruct pt to remove in 24 hours.
	Patient Education
		T;N, Instructions: No Driving for 24 hours. No lifting >10 lbs for 48 hours
Therapies
	Oximetry/Monitoring
		
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID

Oxygen Protocol
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

DVT VTE Prophylaxis (FH)
Laboratory
	CBC with Diff
		T;N, Routine, spec type = Blood
		T+1;0500, Routine, EVERY OTHER DAY, spec type = Blood
		T+1;0500, Routine, Q24H 3 Day(s), spec type = Blood
		T+1;0500, Routine, Q24H, spec type = Blood
	BMP
		T;N, Routine, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Routine, spec type = Diagnostic Blood
		T+1;0500, Q24H, spec type = Therapeutic Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Routine, spec type = Diagnostic Blood
Medications
		See VTE Risk Assessment for patient risk score(NOTE)*
	Lovenox
		40 mg, Syringe, SUBCUTANEOUS, DAILY
			Comment: NOTIFY physician if platelets < 130,000
		30 mg, Syringe, SUBCUTANEOUS, BID
			Comment: NOTIFY physician if platelets < 130,000
		For CrCl < 30 mL/min(NOTE)*
		30 mg, Syringe, SUBCUTANEOUS, DAILY
			Comment: NOTIFY physician if platelets < 130,000. D/C lovenox if INR > 1.8
		For Patients > 150 kg(NOTE)*
		40 mg, Syringe, SUBCUTANEOUS, BID
			Comment: NOTIFY physician if platelets < 130,000
		40 mg, Syringe, SUBCUTANEOUS, DAILY
			Comment: NOTIFY physician if platelets < 130,000
Anticoagulants
		Baseline INR required for Coumadin(NOTE)*
	warfarin
		5 mg, Tab, By Mouth, Once
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		2.5 mg, Tab, By Mouth, Once
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		10 mg, Tab, By Mouth, Once
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		5 mg, Tab, By Mouth, DAILY
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		2.5 mg, Tab, By Mouth, DAILY
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		10 mg, Tab, By Mouth, DAILY
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		ORTHO ONLY(NOTE)*
	Xarelto
		10 mg, Tab, By Mouth, DAILY
	dabigatran
		150 mg, Capsule, By Mouth, BID
			Comment: Check renal function
	Eliquis
		2.5 mg, Tab, By Mouth, BID
			Comment: Hip Replacement: Duration of therapy 35 days  Knee Replacement: 12 days
	HEParin 5000 units/mL SUBCUTANEOUS
		5,000 units, Syringe, SUBCUTANEOUS, TID
		5,000 units, Syringe, SUBCUTANEOUS, BID
Patient Care

	Impulse Foot Pumps
		To be worn at all time while patient is not bearing weight
	Sequential Compression Device
		T;N, Wear, Both legs
			Comment: To be worn at all times while patient is not bearing weight
	Anti Embolism Stockings
		TED hose, knee high, Both legs
		TED hose, knee high, Left leg
		TED hose, knee high, Right leg
		TED hose, thigh high, Both legs
		TED hose, thigh high, Left leg
		TED hose, thigh high, Right leg
	Notify MD
		Contact Physician if INR < 1.8 on Day of Dismissal
Therapies
	Consult Physical Therapy, Evaluate and Treat
		
Consults/Follow-up
	Pharmacy Consult
		D/C Lovenox if INR > 1.8
		D/C Lovenox if INR > 2.0
		Contact MD and Hold Coumadin if INR > 2.5
		Contact MD and Hold Coumadin if INR > 3.0
		Contact MD and Hold Coumadin if INR > 3.5

*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