Unique Plan Description: Cards Radial Heart Cath Post Op EKM
Plan Selection Display: Cards Radial Heart Cath Post Op
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2017-12-22 07:46:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-12-11 12:54:49
Available at all facilities: Yes

Cards Radial 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
	Cardiac Telemetry Monitoring
		
Activity
	Bedrest
		T;N, 1, hr
			Comment: Elevate affected hand on pillow
		T;N, 2, hr
			Comment: Elevate affected hand on pillow
		T;N, 4, hr
			Comment: Elevate affected hand on pillow
		T;N, 6, hr
			Comment: Elevate affected hand on pillow
	Elevate head of bed
		T;N, Elevate head of bed 30 degrees
			Comment: Continuously
	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
	Brilinta (ticagrelor)
		180 mg, Tab, By Mouth, Once, NOW
		90 mg, Tab, By Mouth, Q12H, T;N+720
	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.
	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
	Hemostatic Compression Device
		T;N
			Comment: 1 hour (if no intervention) OR 2 hours (if PCI) after compression device application, withdraw 2ml of air. Repeat every 15minutes. If bleeding observed, re-inflate 2ml of air and recheck in 30 min.
	VTE Advisor
		Medical
	Notify MD
		if urine output less than 200 ml per 2 hours OR if site bleeding, decreased/absent distal pulses.
	No BPs
		T;N, Affected arm
	Notify MD
		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
	Incision/Dressing Care
		T;N
			Comment: When hemostatic compression device removed, place transparent dressing over puncture site.  Instruct pt to remove in 24 hours.
	Patient Education
		T;N, Instructions: No Driving for 24 hours. Limited use of affected hand for 48 hours. No lifting > 10 lbs with affected limb for 48 hours. No dishwashing for 48 hours.
	Cardiac Telemetry Monitoring
		Telemetry Indications: ACS/Arrhythmia/QTc
	Limb Alert
		No lab draws or IV access to affected limb for 48 hours
Therapies
	Oximetry/Monitoring
		
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID
			Comment: keep o2 sat monitor on thumb/index finger of affected hand. Notify MD if SaO2 below 90% continuously
	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