Unique Plan Description: HN Onc Simple Post-Op EKM
Plan Selection Display: HN Onc Simple Post-Op
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-11-02 14:48:06
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-03-27 15:36:13
Available at all facilities: Yes

HN Onc Simple Post-Op EKM
Vital Signs
	Vital Signs
		Routine Post Op
Activity
	Up in Chair
		TIDWM
			Comment: start evening of surgery.
	Ambulate
		TID Between Meals
			Comment: May start evening of surgery.
	Elevate head of bed
		Elevate head of bed 30 degrees
	Discharge Activity
		Avoid lifting more than 20 pounds for the first week then gradually increase to normal activity. Resume full activities at 2-3 weeks. Very important to ambulate (walk around) same day as surgery and routinely thereafter., Bathing Activities: May shower 24
		Resume activity as tolerated
Diet
	NPO
		
	Clear Liquid Diet
		
		Advance as Tolerated
			Comment: to General Diet
	Discharge Diet
		Diet as tolerated. Ice chips or Popsicles for sore throat as needed.
IV Solutions
	Dextrose 5% with 0.45% NaCl w/KCl 20 mEq
		1,000 mL, IV, 125 ml/hr
			Comment: Total tube feeding and IV fluid to be 125ml/hr (independent of free water) Convert to peripheral lock when at goal.
		1,000 mL, IV, 100 ml/hr
			Comment: Total tube feeding and IV fluid to be 125ml/hr (independent of free water) Convert to peripheral lock when at goal.
		1,000 mL, IV, 75 ml/hr
			Comment: Total tube feeding and IV fluid to be 125ml/hr (independent of free water) Convert to peripheral lock when at goal.
		1,000 mL, IV, 150 ml/hr
			Comment: Total tube feeding and IV fluid to be 125ml/hr (independent of free water) Convert to peripheral lock when at goal.
Medications
	ondansetron
		4 mg, Tablet-Disintegrating, By Mouth, Q4H, PRN for nausea
	promethazine oral tablet
		25 mg, Tab, BY MOUTH, Q4H, PRN for nausea
	morphine  IV
		2 mg, Syringe, IV PUSH, Q2H, PRN, pain-breakthrough
	acetaminophen-hydrocodone 325 mg-5 mg oral tablet
		1 TAB, Tab, BY MOUTH, Q4H, PRN, pain-moderate
		2 TAB, Tab, BY MOUTH, Q4H, PRN, pain-severe
	ibuprofen
		800 mg, Tab, By Mouth, Q8H, PRN, pain-mild
	acetaminophen
		650 mg, Tab, By Mouth, Q4H
	pantoprazole IV
		40 mg, Injection, IV Push, DAILY
			Comment: Dilute each 40mg vial with 10ml NS.
Patient Care
	Resuscitation Status
		Full Code
		No Code
	Notify MD
		T;N, Head and Neck Surgery House Officer for bleeding, temp >101.5 or <96.0, SBP >160 or <90, DBP >110 or <50, RR >30 or < 10, Oxygen sat <92%, UO <100ml/4hr
	Foley Catheter
		T;N, To dependent drainage, Foley Removal Protocol
	Incision/Dressing Care
		Cleanse with normal saline, BID
			Comment: Cleanse incisions with normal saline, apply petroleum jelly and change dressing.
	Wound Drain
		Connect to compressed suction
	Record Output
		T;N, Bulb suction, Q4H-Sch, 48, hr
			Comment: Strip JP and record output
		T;N, Bulb suction, Q12H-End of Shift
			Comment: Strip JP and record output
	Cold Therapy
		Ice bag, Incision, as needed
	VTE Advisor
		General surgery
	Non Invasive Cardiac Monitoring Device
		Q1H, 48, hr
	Discharge Symptoms to Report
		Instructions: Call the doctor for signs of an infection including temperature at or greater than 100.5, and or redness swelling or foul smelling drainage from incision or drain site.
	Discharge Incisional, Wound, Stoma Care
		May apply ice to neck for 20 minutes on, 20 minutes off as needed for pain for 48 hours and then as needed.
		Incisional Care: Cleanse wound with soap and water and apply petroleum jelly twice a day
	Discharge Lines, Tubes and Drains
		Drain Care: Keep bulb of JP drain compressed. Strip, empty, record measurement and dispose of drainage fluid twice a day. If drainage greater than 300 ml in 24 hours, notify MD. Comments: See education sheet: "Step by Step: How to Empty Your Drain After S
		Drain Care: How to strip tubing: Hold the tubing where it leaves the skin with one hand. Pinch the tubing with the thumb and first finger of other hand and slowly/firmly pull down the tubing
Therapies
Physical Therapy
	Consult Physical Therapy, Evaluate and Treat
		Reason to See: Range of Motion
			Comment: to shoulder. Post op head and neck.
Social Work
	Consult Social Work
		Home Health Care
Consults/Follow-up

	Consult Dietitian
		T+1;0600, Regarding: Nutrition Assessment
	Pharmacy Consult
		Recommendations for crushing meds

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

Insulin Sliding Scale - NovoLOG
Laboratory
	Glucose POC - RN
		T;N, QIDACHS
		T;N, 15 minutes after carbohydrate source or medication administered
	Hemoglobin A1C
		T+1;0400, Routine, spec type = Blood
	Order Lab
		T;N
			Comment: Blood Glucose (POC) as needed for signs and symptoms of hypoglycemia for patients with diabetic medication orders or known diabetic.
Medications
	Standard Dose NovoLOG
		2 - 12 units, Injection, SUBCUTANEOUS, QIDACHS, PRN, sliding scale, Routine
			Comment: << Sliding Scale Comments >>Under 150, Do not give any insulin150 - 199 = 2 units,200 - 249 = 4 units,250 - 299 = 6 units,300 - 349 = 8 units,350 - 399 = 10 units.Over 399 = 12 units,<< Sliding Scale Comments >> Check  POC in 3 hours; notify physician if repeat POC  greater than or equal to 400mg or less than or equal to 100.  Do not give insulin based on repeat POC value.  RN may change sliding scale insulin order and POC glucose order to every 6 hours if patient is NPO or not on oral diet (tube/enteral feedings, TPN, etc).  Enter as Q6H-SCH  PRN
	Moderate Dose NovoLOG
		4 - 24 units, Injection, SUBCUTANEOUS, QIDACHS, PRN, sliding scale
			Comment: << Sliding Scale Comments >>Under 150, Do not give any insulin150 - 199 = 4 units,200 - 249 = 8 units,250 - 299 = 12 units,300 - 349 = 16 units,350 - 399 = 20 units.Over 399 = 24 units,<< Sliding Scale Comments >> Check  POC in 3 hours; notify physician if repeat POC  greater than or equal to 400mg or less than or equal to 100.  Do not give insulin based on repeat POC value.  RN may change sliding scale insulin order and POC glucose order to every 6hours if patient is NPO or not on oral diet (tube/enteral feedings,TPN, etc). Enter as Q6H-SCH PRN
	High Dose NovoLOG
		5 - 30 units, Injection, SUBCUTANEOUS, QIDACHS, PRN, sliding scale
			Comment: << Sliding Scale Comments >>Under 150, Do not give any insulin150 - 199 = 5 units,200 - 249 = 10 units,250 - 299 = 15 units,300 - 349 = 20 units,350 - 399 = 25 units.Over 399 = 30 units, << Sliding Scale Comments >>Check  POC in 3 hours; notify physician if repeat POC  greater than or equal to 400mg or less than or equal to 100.  Do not give insulin based on repeat POC value.  RN may change sliding scale insulin order and POC glucose order to every 6hours if patient is NPO or not on oral diet (tube/enteral feedings, TPN, etc).  Enter as Q6H-SCH  PRN
	glucose oral gel (JE)
		15 gm, Gel, By Mouth, Q15MIN, PRN, low blood sugar
			Comment: For blood glucose is 60-70mg/dL as an alternative to apple juice. Notify provider if given with corresponding POC glucose recheck value
	Dextrose 50%
		25 mL, Injection, IV PUSH, Q15MIN, PRN for low blood sugar, Routine
			Comment: Give if blood glucose less than 60mg/dL or 60-70 mg/dL and patient unable to tolerate oral intake. Notify provider if given with corresponding POC glucose recheck value.
	Dextrose 10% in Water (FH)
		250 mL, Injection, IVPB, Q30MIN, PRN for low blood sugar, infuse over 30 min(s)
			Comment: Give if blood glucose less than 60mg/dL or 60-70 mg/dL and patient unable to tolerate oral intake. Notify provider if given with corresponding POC glucose recheck value.
	glucagon
		1 mg, Injection, IV Push, Q15MIN, PRN for low blood sugar, T;N
			Comment: Give if blood glucose < 70mg/dL AND if dextrose 50% injectable unavailable OR inadequate response to IV dextrose 50%. May give SubQ or IM if patient does not have IV access. Notify provider if given with corresponding POC glucose recheck value.
Patient Care
	Order Lab
		T;N, RN may change schedule of point of care glucose and sliding scale insulin order to every 6 hours if patient is NPO or not on oral diet (tube/enteral feedings, TPN, etc).. Enter POC order as Q6H-SCH, TIMED and medication order as Q6H-SCH PRN.
	Diabetic Snack
		T;N, Give snack (1 complex carb (15g), 1 protein snack (7g) ) anytime insulin is administered after the evening meal is complete and POC glucose is <150mg/dL.
	IV-Maintain
		T;N
			Comment: Patient should have IV site while on hypoglycemia protocol
	Hypoglycemia Treatment Parameters
		T;N, Hypoglycemia protocol initiated for patients with glucose <70mg/dl. Patient should have an IV while in Hypoglycemia protocol.
		T;N, glucose <60 mg/dL treat with Dextrose 50% 25 mL OR glucagon 1mg as per medication orders. Notify provider as per critical result protocol.
			Comment: Repeat treatment as outlined in hypoglycemia parameters. Notify provider of all treatments given and POC glucose recheck values. When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy
		T;N, glucose 60-70 mg/dL, administer 4 oz apple juice, 4 oz non-diet soda, or glucose gel (MJE/MFH).  If patient NPO or unable to tolerate oral intake, give Dextrose 50% 25 mL OR glucagon 1mg as per medication orders.
			Comment: Repeat treatment as outlined in hypoglycemia parameters. Notify provider of all treatments given and POC glucose recheck values. When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy.
		T;N, After initial treatment of any glucose value </= 70 mg/dL, repeat POC glucose in 15 min; if result </= 70mg/dL continue treating as per protocol and rechecking glucose 15 min after treatment until glucose >70mg/dL.
			Comment: Notify provider of all treatments given and corresponding POC glucose recheck values. When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy.
		T;N, Once glucose is within normal limits, give 1 complex carb and 1 protein source (such as ½ sandwich OR 1 individual container of peanut butter and 3 packs of crackers) or patient meal if patient able to take orals to prevent recurrent hypoglycemia.
			Comment: When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy.

*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