Unique Plan Description: ColoRec Colectomy ACO Post op (JE) EKM
Plan Selection Display: ColoRec Colectomy ACO Post op (JE)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2014-01-08 17:50:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-09-21 09:56:58
Available at all facilities: Yes

ColoRec Colectomy ACO Post op (JE) EKM
Vital Signs
	Vital Signs
		Routine
Activity
	Dangle
		Once
			Comment: Day of surgery
	Up in Chair
		T;N, TID
	Ambulate
		With assistance, TID
			Comment: start day of surgery if back on unit by 2pm.
Diet
	Clear Liquid Diet
		T;N+240
			Comment: if nausea free. Increase to full liquids on post op day 2, and low residue on post op day 3
		T;N
			Comment: 60ml, every 2 hours, do not advance diet from clear liquids until seen by surgeon
	Oral Supplement
		Impact Advanced Recovery, As Needed
Laboratory
Tomorrow's Lab
	CBC with Diff
		T+1;0400, Routine, Q24H, spec type = Blood
		T+1;0400, Routine, spec type = Blood
	BMP
		T+1;0400, Routine, Q24H, spec type = Blood
		T+1;0400, Routine, spec type = Blood
IV Solutions

	Dextrose 5% with 0.45% NaCl w/KCl 20 mEq
		1,000 mL, IV, 125 ml/hr
	Lactated Ringers Injection
		1,000 mL, IV, 125 ml/hr
Medications
	Mefoxin IVPB
		2,000 mg, Injection-Premix, IVPB, Q6H, Surgical prophylaxis, 3 Dose(s)/Time(s)
	Tylenol
		650 mg, Tab, By Mouth, Q6H, PRN, pain-mild
		650 mg, Tab, By Mouth, Q4H, PRN, pain-mild
		650 mg, Suppository, RECTALLY, Q6H, PRN, pain-mild
			Comment: only if unable to take oral meds
		650 mg, Suppository, RECTALLY, Q4H, PRN, pain-mild
			Comment: only if unable to take oral meds
		1,000 mg, Tab, By Mouth, Q8H, 10 Dose(s)/Time(s)
		1,000 mg, Tab, By Mouth, Q6H, 10 Dose(s)/Time(s)
	acetaminophen 10 mg/mL intravenous solution
		1,000 mg, Solution-Injection, IVPB, Q8H, PRN for pain-mild, duration: 24 hr
			Comment: Only if unable to take oral or rectal formulation
		1,000 mg, Solution-Injection, IVPB, Q6H, PRN for pain-mild, duration: 24 hr
			Comment: Only if unable to take oral or rectal formulation
	ibuprofen
		600 mg, Tab, By Mouth, Q8H, PRN, pain-mild
			Comment: Do not give if systolic blood pressure is < 90mm Hg or if serum creatinine is greater than 1.5mg/dL (or creatinine clearance < 50ml/min).  Notify MD of any dose not given with a note in the chart.
	ketorolac injectable
		15 mg, Injection, IV PUSH, Q6H, 12 Dose(s)/Time(s)
			Comment: Do not give if systolic blood pressure is < 90mm Hg or if serum creatinine is greater than 1.5mg/dL (or creatinine clearance < 50ml/min).  Notify MD of any dose not given with a note in the chart
	alvimopan
		12 mg, Capsule, By Mouth, Q12H, 14 Dose(s)/Time(s)
			Comment: or until first BM
	Buprenex
		0.15 mg, Injection, IV Push, Q4H, PRN, pain-mild
		0.3 mg, Injection, IV Push, Q4H, PRN, pain-moderate
	acetaminophen-hydrocodone 325 mg-5 mg oral tablet
		1 TAB, Tab, By Mouth, Q6H, PRN, pain-mild
		2 TAB, Tab, By Mouth, Q6H, PRN, pain-moderate
		1 TAB, Tab, By Mouth, Q4H, PRN, pain-mild
		2 TAB, Tab, By Mouth, Q4H, PRN, pain-moderate
Patient Care
	Resuscitation Status
		Full Code
		No Code
	VTE Advisor
		General surgery
	Discontinue Urinary Catheter
		T+2;0600
			Comment: remove foley on or before post op day 2, if patient has epidural, confirm with surgeon prior to removal
		T+3;0600
			Comment: with low anterior perineal resection. Check with surgeon prior to foley removal if patient has epidural, confirm with surgeon prior to removal
	Intake and Output
		Q4H, 24, hr
			Comment: then routine
	Notify MD
		T;N, urine output less than 120ml/4 hours
		T;N, Temp >101.5, pulse <50, urine output <120 mL/4 hr
	PCA Parameters
		No Basal rate for PCA
	On Q Pain Management System
		T;N, Do not change dressing. May reinforce
	IV-Convert to Peripheral Lock
		T+1;0600
			Comment: if tolerating PO fluids.
	On Q Pain Management System
		T;N, Do not change dressing. May reinforce PRN.
	Wound Drain
		T;N, Bulb Suction
	Foley Catheter
		T;N, To dependent drainage, Pt. undergoing abdominal/pelvic surgery
	Incentive Spirometer
		Q2HAWAKE
Therapies
Consults/Follow-up
	Consult Dietitian
		T+2;1000
			Comment: to see prior to discharge to reinforce discharge diet of low fiber to be transition to high fiber in 2 weeks, unless otherwise determined by surgeon
	Consult Wound Care
		Reason for Referral: if ostomy present to initiate self care education

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

Nausea Protocol EKM
Medications
	ondansetron
		4 mg, Injection, IV PUSH, Q24H, PRN for nausea and/or vomiting
			Comment: Administer for nausea if not previously administered by anesthesia, PACU, or ED and unable to take oral meds.
		4 mg, Injection, IV PUSH, Q6H, PRN for nausea and/or vomiting
			Comment: Administer for nausea if not previously administered by anesthesia, PACU, or ED and unable to take oral meds.
		4 mg, Tablet-Disintegrating, By Mouth, Q6H, PRN for nausea and/or vomiting
			Comment: Administer for nausea if not previously administered by anesthesia, PACU, or ED
		Select either promethazine or prochlorperazine orders:(NOTE)*
	prochlorperazine
		10 mg, Injection, IV PUSH, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures
		25 mg, Suppository, RECTALLY, BID, PRN, nausea
			Comment: Give if ondansetron ineffective and if no history of seizures, give if IV access not available
	Phenergan (JE)
		25 mg, Tab, By Mouth, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures
		25 mg, Suppository, RECTALLY, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures, give if IV access not available
	Phenergan (MH/WH)
		25 mg, Tab, By Mouth, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
		25 mg, Suppository, RECTALLY, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
		6.25 mg, Injection, IM-Intramuscular, Q6H, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds
	Phenergan (FH)
		25 mg, Tab, By Mouth, BID, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
		25 mg, Suppository, RECTALLY, BID, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
		12 mg, INT, IVPB, Q6H, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
	Benadryl
		12.5 mg, Injection, IV PUSH, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron and phenothiazine ineffective
	Ativan
		1 mg, Tab, BY MOUTH, Q8H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, phenothiazine, or other anti-nausea medications ineffective
		1 mg, Injection, IV PUSH, Q8H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, phenothiazine, or other anti-nausea medications ineffective
	Reglan
		10 mg, Injection, IV PUSH, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, phenothiazine, or other anti-nausea medications ineffective; avoid in patients > 65yo
		10 mg, Injection, IM-Intramuscular, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, phenothiazine, or other anti-nausea medications ineffective; avoid in patients > 65yo

*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