Unique Plan Description: GI EUS and Double Balloon (MH)
Plan Selection Display: GI EUS and Double Balloon (MH)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-02-15 16:30:15
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-07-31 14:56:21
Available at all facilities: Yes

GI EUS and Double Balloon (MH)
Admit/Discharge/Transfer
	Discharge
		to: Home
			Comment: when meet discharge criteria
	Discharge Conditional
		Conditions to be met: When ok with anesthesia
		Conditions to be met: To nursing unit or previous level of care with spontaneous and unassisted aldrete of 7 or greater or returns to pre procedure aldrete status
	Discharge Instructions Other
		to be driven home by responsible adult.  May resume activities in the morning.
Vital Signs
	Vital Signs
		T;N
			Comment: until awake and stable per sedation protocol.
Activity
	Position Patient
		On left side
			Comment: left decubitus position if appropriate until awake.
Laboratory
	INR - MH/WH/JE
		Stat, spec type = Blood
	PTT - MH/WH/JE
		Stat, spec type = Blood
	CBC with Diff
		Stat, spec type = Blood
	Pregnancy Test Urine
		Stat, spec type = Urine
IV Solutions
	Lactated Ringers Injection
		1,000 mL, IV, 20 ml/hr
Medications
	Ancef
		2,000 mg, Syringe, IV Push, Once, Surgical prophylaxis
	ampicillin IVPB
		2,000 mg, Solution, Injection, IVPB, Once, Other- type in, surgical prophylaxis
	gentamicin IVPB
		80 mg, Injection-Premix, IVPB, Once, Surgical prophylaxis
			Comment: In NS 100 mL.
	Levaquin IVPB
		500 mg, Injection-Premix, IVPB, Once, Surgical prophylaxis
	sodium chloride 0.9% flush injectable soln
		10 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush
		The following medications are for IVSM(NOTE)*
	benzocaine topical 20% mucous membrane spray
		2 spray, Aerosol, By Mouth, Once, T;N
	Versed 5 mg/5 mL vial
		5 mg, Injection, IV Push, Q5MIN, PRN, sedation
			Comment: titrate 1-5mg to affect per MD
	meperidine
		25 mg, Syringe, IV PUSH, Q5MIN, PRN, sedation, 4 Dose(s)/Time(s)
			Comment: titrate 25-50mg to affect per MD
	fentaNYL
		25 mcg, Injection, IV Push, Q5MIN, PRN, sedation, T;N, 4 Dose(s)/Time(s)
			Comment: titrate 25-50mg to affect per MD
	glucagon
		0.5 mg, Injection, IV PUSH, Once
	vancomycin IVPB
		1,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
Patient Care
	Resuscitation Status
		Full Code
		No Code
	Obtain Consent/Permit for:
		Esophagogastroduodenoscopy with possible biopsies and/or dilation
		T;N, 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
		T;N, esophagogastroduodenoscopy & colonoscopy with possible biopsies, dilation and/or polyectomy.
		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
		T;N, 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
	Discontinue Peripheral Lock
		T;N
			Comment: prior to dismissal when patient awake
Therapies
	Oxygen Therapy
		Via Nasal Cannula, O2 @ 2L/min
			Comment: titrate until awake and stable, then discontinue.

VTE Prophylaxis Pre Op
Medications
	HEParin 5000 units/mL SUBCUTANEOUS
		5,000 units, Injection, SUBCUTANEOUS, PREOP, T;N
	Lovenox
		40 mg, Syringe, SUBCUTANEOUS, PREOP, T;N
		30 mg, Syringe, SUBCUTANEOUS, PREOP, T;N
Patient Care
	Sequential Compression Device Pre Procedure
		T;N, Apply, Once
			Comment: knee high
	Anti Embolism Stockings Pre Procedure
		T;N, Apply, Once
			Comment: knee high

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