Unique Plan Description: Cards TAVR Post op (MH)
Plan Selection Display: Cards TAVR Post op (MH)
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2019-05-28 10:13:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-03-10 14:38:54
Available at all facilities: Yes

Cards TAVR Post op (MH)
Vital Signs
	Vital Signs
		T;N, PACU vital signs, then routine postop vital signs
Activity
	Bedrest
		T;N
		T;N, Elevate head of bed 30 degrees, 1, hr
		T;N, Elevate head of bed 45 degrees, 1, hr
		T;N, Elevate head of bed 30 degrees, 2, hr
		T;N, Elevate head of bed 45 degrees, 2, hr
		T;N, Elevate head of bed 30 degrees, 3, hr
		T;N, Elevate head of bed 45 degrees, 3, hr
		T;N, Elevate head of bed 30 degrees, 4, hr
		T;N, Elevate head of bed 45 degrees, 4, hr
		T;N, Elevate head of bed: 60 degrees, 4, hr
		T;N, Elevate head of bed 30 degrees, 6, hr
		T;N, Elevate head of bed 45 degrees, 6, hr
		T;N, Elevate head of bed: 60 degrees, 6, hr
	Dangle
		T;N+240
			Comment: 4 hours post procedure, prior to ambulation
	Up in Chair
		T;N+360, Once
			Comment: 4 hours post procedure, prior to ambulation
		T+1;N, TIDAC
			Comment: for meals, with legs elevated
	Ambulate
		T+1;0600, In hall, QID
			Comment: 25 feet or more as tolerated
	Discharge Activity
		No lifting > 10 pounds for 10 days, Activity: Activity as Tolerated, Bathing Activities: no tub baths until seen by provider, ok to shower
Diet
	Cardiac Diet
		
	Diabetic Diet
		
	Discharge Diet
		Resume Previous Diet
Laboratory
Today's Lab
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	Blood Gases Arterial (ABG) - MH/WH/JE
		Stat, spec type = Blood
	Blood Gases Arterial (ABG) - FH
		T;N, Stat, spec type = Blood
	CBC with Diff
		Stat, spec type = Blood
	ProBNP
		Routine, spec type = Blood
Tomorrow's Lab
	CBC with Diff
		T+1;0400, Routine, spec type = Blood
	Basic Metabolic Panel
		T+1;0400, Routine, Q24H, spec type = Blood
	ProBNP
		T+1;0400, Routine, spec type = Blood
Diagnostic Tests

	Chest 1 View
		Stat, Post Op F/U
		T+1;0600, Routine, Post Op F/U
	ECG
		T+1;0600, Routine, Indication: Post op TAVR
			Comment: do post op day 1
		T+2;0600, Routine, Indication: Post op TAVR
			Comment: do post op day 2
	Echo w Doppler resting
		T+1;0600, Routine, Indication: Aortic valve disorder
		T;N, Stat, Indication: Aortic valve disorder
IV Solutions
	Dextrose 5% with 0.45% NaCl
		1,000 mL, IV, 24 hr, 25 ml/hr
			Comment: Discontinue after 6 hours
		1,000 mL, IV, 24 hr, 50 ml/hr
			Comment: Discontinue after 6 hours
		1,000 mL, IV, 24 hr, 100 ml/hr
			Comment: Discontinue after 6 hours
	Sodium Chloride 0.45%
		1,000 mL, IV, 24 hr, 25 ml/hr
			Comment: Discontinue after 6 hours
		1,000 mL, IV, 24 hr, 50 ml/hr
			Comment: Discontinue after 6 hours
		1,000 mL, IV, 24 hr, 100 ml/hr
			Comment: Discontinue after 6 hours
	Sodium Chloride 0.9%
		1,000 mL, IV, 24 hr, 25 ml/hr
			Comment: Discontinue after 6 hours
		1,000 mL, IV, 24 hr, 50 ml/hr
			Comment: Discontinue after 6 hours
		1,000 mL, IV, 24 hr, 100 ml/hr
			Comment: Discontinue after 6 hours
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
	vancomycin IVPB
		1,000 mg, Injection-Premix, IVPB, Q12H, Surgical prophylaxis, T;N+720, 2 Dose(s)/Time(s)
			Comment: Infuse over 90 minutes.
	aspirin
		81 mg, Tablet-Chew, By Mouth, DAILY
			Comment: start post op day 1
	albumin human 5% intravenous solution
		25 gm, 500 mL, Solution-Injection, IVPB, Q10MIN, PRN, see comment, 2 Dose(s)/Time(s)
			Comment: Rate: 900 mL/hr. SBP less than or equal to 100 mmhg PRN for a total of 1000mL. Call surgeon if SBP less than or equal to 100 mmhg after albumin. Discontinue PostOp Day 1.
	Lipitor
		10 mg, Tab, By Mouth, QHS, T+1;2100
			Comment: Start Post Op Day 1
	Toprol-XL
		25 mg, Tablet-Extended-Release, By Mouth, DAILY, T+1;0900, duration: 1 Day(s)
			Comment: If HR < 55 and /or SBP < 100 since the last dose given, Contact mD for further instructions prior to administration. These parameters apply unless otherwise specified by physician. DISCONTINUE IF PATIENT ON IONOTROPIC DRIP
		50 mg, Tablet-Extended-Release, By Mouth, DAILY, T+2;0900
			Comment: If HR < 55 and /or SBP < 100 since the last dose given, Contact mD for further instructions prior to administration. These parameters apply unless otherwise specified by physician.  DISCONTINUE IF PATIENT ON IONOTROPIC DRIP
	Tylenol
		650 mg, Tab, By Mouth, Q6H, PRN for discomfort
	acetaminophen 10 mg/mL intravenous solution
		1,000 mg, Solution-Injection, IVPB, Q8H, PRN for see comment, duration: 3 Dose(s)/Time(s)
			Comment: administer dose intra-op
	sodium chloride 0.9% flush injectable soln
		10 mL, Syringe, IV Push, BID, for IV line flush
	Plavix
		75 mg, Tab, By Mouth, DAILY, T+1;0900
			Comment: Start PostOp day 1.
		75 mg, Tab, By Mouth, DAILY
			Comment: Start day of surgery
Patient Care
	Resuscitation Status
		Full Code
		No Code
	Arterial Line Monitoring
		T;N, assess arterial line q1h while in place
	Discontinue Arterial Line
		T+1;0600, see comment
			Comment: Post Op Day 1 Remove arterial line and CVP when SaO2 >/=92% on 6L/min or less, BP S>/=100 x 1 hours
	Discontinue Central Line
		T;N+60
			Comment: IJ Sheath
		T;N+240
			Comment: IJ Sheath
		T+1;0600
			Comment: IJ Sheath
		                                       Hemostasis Compression Device(NOTE)*
	Hemostatic Compression Device
		T;N
			Comment: After 1 hour, withdraw 2ml of air. Repeat every 15minutes. If bleeding observed, re-inflate 2ml of air and recheck in 30 min. Remove 1 hour after hemostasis achieved. When hemostatic compression device removed, place transparent dressing over puncture site. Instruct patient to remove in 24 hours.
		T;N
			Comment: No BPs on affected arm
		T;N
			Comment: Focused CV assessment q15min x 4, q30 min x 2, q60min until hemostasis band removed.
	Bladder Scan
		unable to void, if residual volume > 400 may straight cath
	Straight Catheter
		Straight, Insert, Once, unable to void, after bladder scan
	Cardiac Telemetry Monitoring
		Telemetry Indications: Cardiologist Recommendation
	Dressing Care
		T;N+1440, Remove, Transparent dressing, groin, 24, hr
			Comment: post op
	Administer blood products
		T;N, Packed cells, 1 unit
			Comment: PRN Hgb </=7 within first 24 hours post op. Call Surgeon prior to administering packed cells. Notify surgeon if more than 2 units required. Enter order for stat hgb & hct after transfusion complete
	Notify MD
		BP S <85, > 160, P < 50, Rt or Lt BBB, any heart blocks
	Discharge Incisional, Wound, Stoma Care
		Cover groin with bandaide if drainage present.
	Discharge Symptoms to Report
		Instructions: pain swelling, redness, bleeding or drainage at insertion site. Severe pain, coldness, or a bluish color in either leg, blood in your urine, black or tarry stools or any other kind of bleeding, temp over 100. 4
Therapies
	Oxygen Therapy
		T;N
	Pulse Oximetry Spot Check RT
		T+1;N, BID
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID
			Comment: 24hrs. discontinue post op day 1, then spot check BID
	Consult Physical Therapy, Evaluate and Treat
		T;N, Reason to See: Evaluate and Treat
			Comment: Cards TAVR Post op (MH)
	Consult Occupational Therapy, Evaluate and Treat
		T;N, Reason to See: Evaluate and Treat
			Comment: Post op TAVR
Consults/Follow-up
	Consult Diabetes Educator
		Needs Diabetic Assessment
	Consult Cardiac Rehab: Inpatient
		T+1;0600, Indications Valve replacement/repair
			Comment: TAVR
	Consult Cardiac Rehab: Outpatient
		T+1;0600, Indications Valve replacement/repair
			Comment: TAVR
	Consult Cardio-Thoracic Surgery
		
	Consult Cardiologist

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