Unique Plan Description: Cards Radial Post PCI EKM
Plan Selection Display: Cards Radial Post PCI
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-20 11:41:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-12-11 12:55:28
Available at all facilities: Yes

Cards Radial Post PCI EKM
Admit/Discharge/Transfer
	Discharge Conditional
		Conditions to be met: after bedrest complete, and arterial insertion site is stable with ambulation
Vital Signs
	Vital Signs
		T;N, Routine post op
			Comment: Incision/drain assessment and vascular assessment with each vital signs check
Activity
	Bedrest
		1, hr
			Comment: Elevate affected hand on pillow
		2, hr
			Comment: Elevate affected hand on pillow
		4, hr
			Comment: Elevate affected hand on pillow
		6, hr
			Comment: Elevate affected hand on pillow
	Elevate head of bed
		Continuously; 30 degrees
	Ambulate
		T;N
			Comment: after bedrest discontinued
Diet
	NPO
		T;N
	Cardiac Diet
		T;N
Laboratory
Today's Lab
	hs Troponin I - FH
		Timed, Q8H, 2 Dose(s)/Time(s), spec type = Blood
	Myoglobin
		Timed, Q8H, 2 Dose(s)/Time(s), spec type = Blood
Tomorrow's Lab
	CBC with Diff
		T+1;0400, Routine, spec type = Blood
	Basic Metabolic Panel
		T+1;0400, Routine, spec type = Blood
	Lipid Panel
		T+1;0400, Routine, spec type = Blood
Diagnostic Tests

	ECG
		T;N, Stat, Indication: Post Cardiac Procedure
IV Solutions
	Sodium Chloride 0.9%
		1,000 mL, IV, 75 ml/hr
		1,000 mL, IV, 100 ml/hr
		1,000 mL, IV, 150 ml/hr
		1,000 mL, IV, 200 ml/hr
		1,000 mL, IV, 250 ml/hr
	nitroglycerin 50 mg/D5W 250 mL Premix IV
		50 mg, EVERY BAG, 5 mcg/min
		250 mL, drug form: IV Large Volume, route of administration: IV, pharmacy order priority: Routine, requested start date/time T;N, Maintain Parameter: SBP> Parameter Goal: 90, Increment Dose Increase: 5 mcg/min, Increment Dose Decrease: 5 mcg/min, Incremen
			Comment: If no response at 20mcg/min, may increase by 10mcg/min every 5 min.  If the dose has been titrated twice within the specified timeframe and goal parameter is not achieved, the titration dose can be doubled until the ordered parameter is achieved or maximum dose is reached.  IV may be re-initiated after weaning within 12hours, re-initiate at the last dosing rate that maintained Goal parameter. Discontinue order after 12hr if patient does not require IV re-initiation.
Medications
	aspirin
		324 mg, Tablet-Chew, BY MOUTH, DAILY
		Option One:(NOTE)*
		81 mg, Tablet-Chew, BY MOUTH, DAILY, T+1; 0900
	Plavix
		75 mg, Tab, BY MOUTH, DAILY, T+1;0900
			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.
		Option Two:(NOTE)*
	aspirin
		81 mg, Tablet-Chew, By Mouth, DAILY, T+1; 0900
	Brilinta (ticagrelor)
		180 mg, Tab, By Mouth, Once, NOW
		90 mg, Tab, By Mouth, Q12H, T;N+720
		Option Three: Only available at MH and JE(NOTE)*
	Effient
		60 mg, Tab, By Mouth, Once, NOW
			Comment: if not previously loaded
		For patients >/= 60kg(NOTE)*
	aspirin
		81 mg, Tablet-Chew, By Mouth, DAILY, T+1; 0900
	Effient
		10 mg, Tab, BY MOUTH, DAILY, T+1;0900
			Comment: Verify patient received loading dose of Effient or Plavix before starting maintenance dose the next day. Use not recommended in patients age 75 or older (UNLESS history of diabetes or MI).  Contraindicated in patients with active bleeding or history of stroke or TIA.
		For patients <60kg(NOTE)*
	aspirin
		81 mg, Tablet-Chew, By Mouth, DAILY, T+1; 0900
	Effient
		5 mg, Tab, By Mouth, DAILY, T+1;0900
			Comment: Verify patient received loading dose of Effient or Plavix before starting maintenance dose the next day. Use not recommended in patients age 75 or older (UNLESS history of diabetes or MI).  Contraindicated in patients with active bleeding or history of stroke or TIA.
	Ambien
		5 mg, Tab, BY MOUTH, QHS, PRN, insomnia
			Comment: DO NOT REPEAT
	morphine  IV
		2 mg, Syringe, IV Push, Q15MIN, PRN, pain-mild
	Nitrostat
		0.4 mg, Tab, SUBLINGUAL, Q5MIN, PRN, chest pain
	Tylenol
		650 mg, Tab, BY MOUTH, Q4H, PRN, pain-mild
			Comment: for or temperature > 100.6 degrees F.
	lisinopril
		5 mg, Tab, BY MOUTH, DAILY
			Comment: Do not give if SBP <100
	Lopressor
		25 mg, Tab, BY MOUTH, BID
			Comment: Do not give if SBP <100 and HR < 55
	Lipitor
		80 mg, Tab, BY MOUTH, QHS
	Xanax
		0.25 mg, Tab, BY MOUTH, TID, PRN, anxiety
Patient Care
	Resuscitation Status
		T;N, Full Code
		T;N, No Code
	Cardiac Telemetry Monitoring
		T;N, Telemetry Indications: ACS/Arrhythmia/QTc
			Comment: Continuously
	VTE Advisor
		Medical
	Straight Catheter
		Straight, Insert, unable to void
	Foley Catheter
		T;N
			Comment: Remove foley when off bedrest
	Notify MD
		T;N, if urine output less than 200 ml per 2 hours OR if site bleeding, decreased/absent distal pulses
	Order ECG
		Stat if chest pain or chest pain equivalent, ST segment changes, and notify MD
	Bladder Scan
		unable to void
	Order Lab
		T;N, If PTT >40, recheck in 1 hour.
	No BPs
		T;N, Affected arm
	Notify MD
		T;N, Cardiologist if affected extremity becomes cool, numb, excessive swelling or bleeding.
	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.
	Limb Alert
		No lab draws or IV access to affected limb for 48 hours
	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.
Therapies
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID
			Comment: Keep O2 sat monitor on thumb/index finger of affected hand. Notify MD if SaO2 drops below 90% continuously.
Consults/Follow-up
	Consult Cardiac Rehab: Outpatient
		
	Consult Cardiac Rehab: Inpatient
		
	Smoking Cessation Education
		T;N
	Smoking Cessation Education RT (FH)
		T;N

eptifibatide Integrilin Protocol
Laboratory
	CBC with Diff
		T+1;0400, spec type = Blood
	Notify MD of Lab results
		T;N, platelet count less than 100,000
IV Solutions
		Length of Therapy:  ACS w/PCI=18-24 hours or sooner if discharged; ACS w/o PCI=until discharge,  CABG up to 72 hours; PCI w/o ACS=12-24 hours or sooner if discharged.(NOTE)*
	Integrilin 0.75 mg/mL 100 mL Premix IV
		100 mL, IV
			Comment: Give 2 mcg/kg/min for patients with a creatinine clearance >/= 50 mL/min; maximum dose 15 mg/hr for patients over 121 kg. Pharmacist to calculate crcl using ACTUAL body weight.
		75 mg, EVERY BAG, 2 mcg/kg/min
		100 mL, IV
			Comment: Give 1 mcg/kg/min for patients with a creatinine clearance < 50 mL/min; maximum dose 7.5 mg/hr for patients over 121 kg. Pharmacist to calculate crcl using ACTUAL body weight.
		75 mg, EVERY BAG, 1 mcg/kg/min
Medications
	eptifibatide
		180 mcg/kg, Injection, IV Push, Once, STAT
			Comment: Maximum 22.6 mg for weight greater than 121 kg.  Administer over 1-2 minutes.
		180 mcg/kg, Injection, IV Push, Once, T;N+10
			Comment: Repeat dose 10 minutes after initial bolus if PCI. Maximum 22.6mg for weight greater than 121 kg. Administer over 1-2 minutes.

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

bivalirudin (Angiomax) 250 mg/NS 50 mL (JE)
IV Solutions

		For CrCl > 30 mL/min(NOTE)*
	bivalirudin 250 mg/NS 50 mL
		50 mL, IV, STAT, T;N, 4 hr
		250 mg, EVERY BAG, 1.75 mg/kg/hr, T;N
		For CrCl < or = 30 mL/min(NOTE)*
		50 mL, IV, STAT, T;N, 4 hr
		250 mg, EVERY BAG, 1 mg/kg/hr
		For dialysis dependent patients(NOTE)*
		50 mL, IV, STAT, T;N, 4 hr
		250 mg, EVERY BAG, 0.25 mg/kg/hr

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

hs Troponin T - MH/WH/JE
Laboratory
	hs Troponin T - MH/WH/JE
		Stat, spec type = Blood
		T;N+120, Timed, spec type = Blood
		T;N+360, Timed, spec type = Blood

hs Troponin I - FH (Stat and 2hr and 6hr)
	hs Troponin I - FH
		T;N, Stat, spec type = Blood
		T;N+120, Timed, spec type = Blood
		T;N+360, Timed, spec type = Blood

*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