Unique Plan Description: Extubation
Plan Selection Display: Extubation
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2015-04-13 14:37:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-10-10 18:19:07
Available at all facilities: Yes

Extubation
Activity
	Activity-As Tolerated
		T;N
Medications
	racepinephrine 2.25% inhalation soln
		0.5 mL, Solution-Nebulization, NEBULIZED, Q1H, PRN for stridor, T;N, duration: 48 hr
			Comment: Mix with 3 mL sodium chloride 0.9% inh soln
	sodium chloride 0.9% inhalation solution
		3 mL, Solution-Nebulization, NEBULIZED, Q1H, PRN for stridor, T;N, duration: 48 hr
			Comment: Mix with 0.5 mL racemic EPINEPHrine
Patient Care
	Enteral Tube
		T;N, Per Nasogastric Tube (NG), Insert, X Ray, prior to extubation
	Discontinue Feeding Tube
		T;N
	Discontinue
		T;N, Restraints, mechanical ventilation related medications ie: sedation, PRN morphine, dilaudid, Ativan, versed; related to vent
		T;N, Blood gases
	Complete Nurse Swallow Screen
		T;N, NOW
			Comment: to be done at least 2 hours post extubation
	Notify MD
		T;N, After 1 dose of Racemic epinephrine to update on patient status
	Discontinue Medication
		T;N, GI prophylaxis
	Discontinue
		T;N, Mechanical Ventilation Powerplan
	Incentive Spirometer
		T;N, Q2H-Sch
	Foley Catheter
		T;N, Maintain, Critically ill requiring accurate output
Therapies
	Respiratory Consult-Assess and Treat
		T;N
	Extubate
		T;N
	NIV (BiPAP)
		
	Consult Physical Therapy, Evaluate and Treat
		T;N, Reason to See: Evaluate and Treat
			Comment: Post Extubation
	Consult Occupational Therapy, Evaluate and Treat
		T;N, Reason to See: Evaluate and Treat
			Comment: Post Extubation
	Consult Speech Therapy (JE)
		T;N
			Comment: Evaluate 24 hours after extubation, MBS if appropriate.
	Consult Speech Language (MH), Evaluate and Treat
		
			Comment: Evaluate day after extubation, MBS if appropriate. MH Speech Therapy; call 402-402-354-4461 and leave message for consult
	Consult Speech Language (FH), Evaluate and Treat

Oxygen Protocol
Respiratory Therapy
	Oxygen Therapy
		T;N
	Pulse Oximetry Spot Check RT
		T;N, BID
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID

*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