Unique Plan Description: GI Endoscopy Inpatient
Plan Selection Display: GI Endoscopy Inpatient
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2011-11-14 18:48:32
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-14 09:02:19
Available at all facilities: Yes

GI Endoscopy Inpatient Pre Procedure
Vital Signs
	Vital Signs
		T;N, Per protocol
			Comment: Routine
Activity
	Activity-As Tolerated
		T;N
			Comment: with assistance, as necessary
Diet
	NPO
		T;N, After Midnight
			Comment: May have po medications in the am if scheduled for the afternoon, with small amounts of water
	Clear Liquid Diet, with no red, purple or blue Jello or Fluids
		T;N
			Comment: the day prior to scheduled colonscopy
	Clear Liquid Diet
		T;N
			Comment: the day prior to scheduled colonscopy
Laboratory
	Pregnancy Test Urine
		T;N, Stat, Stat, spec type = Urine
IV Solutions
	Dextrose 5% with 0.9% NaCl
		500 mL, IV, 20 ml/hr
			Comment: Start if no current IV orders.
	Lactated Ringers Injection
		1,000 mL, IV, 20 ml/hr
	Sodium Chloride 0.9%
		500 mL, IV, 20 ml/hr
Medications
	NuLYTELY
		4,000 mL, Powder-Reconstitution, By Mouth, Once
	GoLYTELY
		4,000 mL, Powder-Reconstitution, By Mouth, Once
	sodium biphosphate-sodium phosphate
		45 mL, Solution-Oral, By Mouth, Once
Patient Care
	Resuscitation Status
		T;N, Full Code
		T;N, No Code
	Enema-Administer
		T;N, Tap water
			Comment: PRN as needed
	Obtain Consent/Permit for:
		Esophagogastroduodenoscopy with possible biopsies and/or dilation
		Esophagogastroduodenoscopy & Colonoscopy with possible biopsies, dilation, and/or polypectomy
		Esophagogastroduodenoscopy with Fluoroscopy, possible biopsies and/or dilation
		Esophagogastroduodenoscopy with PH capsule placement with possible biopsies and/or dilation
		Colonoscopy with possible biopsies and/or polypectomy
		Flexible Sigmoidoscopy with possible biopsies and/or polypectomy
		Pouchoscopy with possible biopsies and/or polypectomy
		Ilioscopy with possible biopsies and/or polypectomy
		Endoscopic Retrograde Cholangiopancreatogram with possible biopsies, brushings, cholangioplasty, dilation sphincterotomy, stent placement and/or stent removal
		Esophagogastroduodenoscopy & Flexible Sigmoidoscopy with possible biopsies, dilation, and/or polypectomy
		Esophagoscopy with Ablation with possible biopsies and/or dilation
		Esophagogastroduodenoscopy with Ablation with possible biopsies and/or polypectomy
		Colonoscopy with Ablation with possible biopsies and/or polypectomy
		Flexible Sigmoidoscopy with Ablation with possible biopsies and/or polypectomy
		Esophagogastroduodenoscopy with Double Balloon Enteroscopy with possible biopsies and/or dilation
		Colonoscopy with Double Balloon Enteroscopy with possible biopsies, dilation, and/or polypectomy
		Percutaneous Endoscopic Gastrostomy Tube Placement
		Percutaneous Endoscopic Gastrostomy Tube Replacement
		Liver Biopsy
		Paracentesis
		Small Bowel Capsule
		Small Bowel Agile Capsule
		Esophagogastroduodenoscopy with Small Bowel Capsule Placement with possible biopsies and/or dilation
		Esophagogastroduodenoscopy with Endoscopic Ultrasound with possible biopsies, dilation and/or fine needle aspiration
		Colonoscopy with Endoscopic Ultrasound with possible biopsies, dilation and/or fine needle aspiration
		Flexible Sigmoidoscopy with Endoscopic Ultrasound with possible biopsies, dilation and/or fine needle aspiration
		Esophagogastroduodenoscopy with Endoscopic Ultrasound & Endoscopic Retrograde Cholangiopancreatogram with possible biopsies, dilation fine needle aspiration, sphinterotomy, stent placement and/or stent
		Esophagogastroduodenoscopy with possible biopsies, dilation, and/or Endoscopic Mucosal Resection
		Colonoscopy with possible biopsies, dilation and/or Endoscopic Mucosal Resection
		Transanal Ultrasound
		Transrectal Ultrasound
		Transanal/Transrectal Ultrasound rectal Electromyogram, Anorectal Manometry, Pudendal Nerve Study
		Rectal Electromyogram, Anorectal Manometry, with Pudendal Nerve Study
		Esophageal Manometry
		Esophageal Manometry with 24h or 48h pH monitoring
		Proctoscopy with possible biopsies
		Esophagogastroduodenoscopy with possible biopsies and/or dilation
		Esophagogastroduodenoscopy & Colonoscopy with possible biopsies, dilation, and/or polypectomy
		Esophagogastroduodenoscopy with Fluoroscopy, possible biopsies and/or dilation
		Esophagogastroduodenoscopy with PH capsule placement with possible biopsies and/or dilation
		Colonoscopy with possible biopsies and/or polypectomy
		Flexible Sigmoidoscopy with possible biopsies and/or polypectomy
		Pouchoscopy with possible biopsies and/or polypectomy
		Ilioscopy with possible biopsies and/or polypectomy
		Endoscopic Retrograde Cholangiopancreatogram with possible biopsies, brushings, cholangioplasty, dilation sphincterotomy, stent placement and/or stent removal
		Esophagogastroduodenoscopy & Flexible Sigmoidoscopy with possible biopsies, dilation, and/or polypectomy
		Esophagoscopy with Ablation with possible biopsies and/or dilation
		Esophagogastroduodenoscopy with Ablation with possible biopsies and/or polypectomy
		Colonoscopy with Ablation with possible biopsies and/or polypectomy
		Flexible Sigmoidoscopy with Ablation with possible biopsies and/or polypectomy
		Esophagogastroduodenoscopy with Double Balloon Enteroscopy with possible biopsies and/or dilation
		Colonoscopy with Double Balloon Enteroscopy with possible biopsies, dilation, and/or polypectomy
		Percutaneous Endoscopic Gastrostomy Tube Placement
		Percutaneous Endoscopic Gastrostomy Tube Replacement
		Liver Biopsy
		Paracentesis
		Small Bowel Capsule
		Small Bowel Agile Capsule
		Esophagogastroduodenoscopy with Small Bowel Capsule Placement with possible biopsies and/or dilation
		Esophagogastroduodenoscopy with Endoscopic Ultrasound with possible biopsies, dilation and/or fine needle aspiration
		Colonoscopy with Endoscopic Ultrasound with possible biopsies, dilation and/or fine needle aspiration
		Flexible Sigmoidoscopy with Endoscopic Ultrasound with possible biopsies, dilation and/or fine needle aspiration
		Esophagogastroduodenoscopy with Endoscopic Ultrasound & Endoscopic Retrograde Cholangiopancreatogram with possible biopsies, dilation fine needle aspiration, sphinterotomy, stent placement and/or stent
		Esophagogastroduodenoscopy with possible biopsies, dilation, and/or Endoscopic Mucosal Resection
		Colonoscopy with possible biopsies, dilation and/or Endoscopic Mucosal Resection
		Transanal Ultrasound
		Transrectal Ultrasound
		Transanal/Transrectal Ultrasound rectal Electromyogram, Anorectal Manometry, Pudendal Nerve Study
		Rectal Electromyogram, Anorectal Manometry, with Pudendal Nerve Study
		Esophageal Manometry
		Esophageal Manometry with 24h or 48h pH monitoring
		Proctoscopy with possible biopsies
		Esophagogastroduodenoscopy with possible biopsies and/or dilation
		Esophagogastroduodenoscopy & Colonoscopy with possible biopsies, dilation, and/or polypectomy
		Esophagogastroduodenoscopy with Fluoroscopy, possible biopsies and/or dilation
		Esophagogastroduodenoscopy with PH capsule placement with possible biopsies and/or dilation
		Colonoscopy with possible biopsies and/or polypectomy
		Flexible Sigmoidoscopy with possible biopsies and/or polypectomy
		Pouchoscopy with possible biopsies and/or polypectomy
		Ilioscopy with possible biopsies and/or polypectomy
		Endoscopic Retrograde Cholangiopancreatogram with possible biopsies, brushings, cholangioplasty, dilation sphincterotomy, stent placement and/or stent removal
		Esophagogastroduodenoscopy & Flexible Sigmoidoscopy with possible biopsies, dilation, and/or polypectomy
		Esophagoscopy with Ablation with possible biopsies and/or dilation
		Esophagogastroduodenoscopy with Ablation with possible biopsies and/or polypectomy
		Colonoscopy with Ablation with possible biopsies and/or polypectomy
		Flexible Sigmoidoscopy with Ablation with possible biopsies and/or polypectomy
		Esophagogastroduodenoscopy with Double Balloon Enteroscopy with possible biopsies and/or dilation
		Colonoscopy with Double Balloon Enteroscopy with possible biopsies, dilation, and/or polypectomy
		Percutaneous Endoscopic Gastrostomy Tube Placement
		Percutaneous Endoscopic Gastrostomy Tube Replacement
		Liver Biopsy
		Paracentesis
		Small Bowel Capsule
		Small Bowel Agile Capsule
		Esophagogastroduodenoscopy with Small Bowel Capsule Placement with possible biopsies and/or dilation
		Esophagogastroduodenoscopy with Endoscopic Ultrasound with possible biopsies, dilation and/or fine needle aspiration
		Colonoscopy with Endoscopic Ultrasound with possible biopsies, dilation and/or fine needle aspiration
		Flexible Sigmoidoscopy with Endoscopic Ultrasound with possible biopsies, dilation and/or fine needle aspiration
		Esophagogastroduodenoscopy with Endoscopic Ultrasound & Endoscopic Retrograde Cholangiopancreatogram with possible biopsies, dilation fine needle aspiration, sphinterotomy, stent placement and/or stent
		Esophagogastroduodenoscopy with possible biopsies, dilation, and/or Endoscopic Mucosal Resection
		Colonoscopy with possible biopsies, dilation and/or Endoscopic Mucosal Resection
		Transanal Ultrasound
		Transrectal Ultrasound
		Transanal/Transrectal Ultrasound rectal Electromyogram, Anorectal Manometry, Pudendal Nerve Study
		Rectal Electromyogram, Anorectal Manometry, with Pudendal Nerve Study
		Esophageal Manometry
		Esophageal Manometry with 24h or 48h pH monitoring
		Proctoscopy with possible biopsies
	Glucose POC - RN
		T;N, Once
			Comment: Prior to initiating IV fluid
		T;N, Once
			Comment: If patient is on Insulin perform POC glucose before giving liquid tray
	Notify MD
		T;N, if INR >1.5

GI Endoscopy Inpatient Post Procedure
Vital Signs
	Vital Signs
		T;N, Per protocol
			Comment: routine
Activity
	Activity-As Tolerated
		T;N
	Bedrest
		T;N, On left side
			Comment: with head of bed elevated continuously until fully awake
Diet
	NPO
		T;N
	Clear Liquid Diet
		T;N
	Clear Liquid Diet, with no red, purple or blue Jello or Fluids
		T;N
	Regular Diet
		T;N
Patient Care
	Resuscitation Status
		T;N, Full Code
		T;N, No Code
	VTE Advisor
		General surgery
	Dressing Care
		T;N+1440
			Comment: Remove 24 hours post procedure and leave site open to air
	Wound Care
		T;N, Cleanse with soap and water, gastrostomy tube, Q12H-Start of Shift
	GI Tube
		T;N, PEG, Connect to gravity drainage | Irrigate with tap water, 20ml
			Comment: use for medications only for 24 hours
	Notify MD
		T;N, if temp > 101, if severe abdominal pain or unstable
	IV-Convert to Peripheral Lock
		T;N, When oral intake adequate

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