Unique Plan Description: HN Onc Total/Completion Thyroid Post-Op EKM
Plan Selection Display: HN Onc Total/Completion Thyroid Post-Op
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2019-11-05 10:00:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2026-05-14 09:41:22
Available at all facilities: Yes

HN Onc Total/Completion Thyroid Post-Op EKM
Admit/Discharge/Transfer
	Discharge Conditional
		Conditions to be met: May discharge 2 hours after arrival to floor. Notify MD with PTH level, T;N
	Discharge
		T;N
			Comment: from Phase II
	Admit to Observation Status
		T;N
Vital Signs
	Vital Signs
		Routine Post Op
Activity
	Up in Chair
		T;N
	Ambulate
		T;N
	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
Diet
	Clear Liquid Diet
		T;N, Advance as Tolerated
	Discharge Diet
		T;N, Diet as tolerated. Ice chips or Popsicles for sore throat as needed.
Laboratory
	Intact PTH
		T;N, Stat, spec type = Blood
			Comment: In PACU, notify MD if PTH < 15.
	Parathyroid Hormone - Post OP- MH/JE/FH
		T;N, Stat, spec type = Blood
	Discharge Labs
		T;N, Pt to have TSH at 4-6 weeks post op if total thyroidectomy.
IV Solutions
	Discontinue IV Fluids
		When taking adequate PO
			Comment: and discontinue lock prior to discharge.
Medications
	ibuprofen
		400 mg, Tab, By Mouth, Once, T;N+360
			Comment: Give 6 hours after preop NSAID x once only. Only received half dose of meloxicam prior to surgery.
		600 mg, Tab, By Mouth, Q6H, for see comment, T;N+900, duration: 48 hr
			Comment: Okay to hold the dose at nighttime if sleeping. Alternate with acetaminophen.  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)
	acetaminophen
		1,000 mg, Tab, By Mouth, Q6H, T;N+360, duration: 48 hr
			Comment: Okay to hold the dose at nighttime if sleeping. Alternate with ibuprofen.
	ondansetron
		4 mg, Injection, IV Push, Q4H, PRN for nausea
	promethazine oral tablet
		25 mg, Tab, BY MOUTH, Q4H, PRN for nausea
	VTE Advisor
		General surgery
	levothyroxine
		1.7 mcg/kg, Tab, By Mouth, ACBKFST
			Comment: Dosed 1.7mcg/kg based on Ideal Body Weight. Pharmacy to round to most appropriate dose.
Prescriptions
		Post op PTH < 6 - Consider admission at attending's discretion(NOTE)*
	Citracal Maximum + D oral tablet
		2 TAB, By Mouth, BID, # 120 TAB, 0 Refill(s)
	Rocaltrol 0.25 mcg oral capsule
		2 CAP, By Mouth, BID, # 120 CAP, 0 Refill(s)
		Post op PTH 6-14(NOTE)*
	Citracal Maximum + D oral tablet
		2 TAB, By Mouth, BID, # 120 TAB, 0 Refill(s)
		Post op PTH >14 - no prescription needed(NOTE)*
Patient Care

	Resuscitation Status
		Full Code
		No Code
	Incision/Dressing Care
		Cleanse with normal saline, BID
			Comment: Cleanse incisions with normal saline, apply petroleum jelly and change
	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
	Discharge Instructions Other
		T;N, Instructions: If you experience numbness or tingling around the lips or of the finger tips or muscle cramping, take 2-3 TUMS and if it does not resolve, call the doctor.
	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.
	Discharge Instructions Other
		Instructions: If prescribed, take thyroid replacement medication regularly and on time without food, or other medication. Signs you have too much thyroid hormone in your body include: restlessness, rapid weight loss, sweaty palms, and palpitations.
		Instructions: Signs you may have too little thyroid hormone in your body include: Fatigue, puffy hands, feet or face, dry coarse skin; hoarseness; muscle pain; slow pulse (less than 60 beats per minute).
	Discharge Symptoms to Report
		Instructions: Call immediately for difficulty swallowing, change in voice, increasing neck swelling, difficulty breathing, muscle cramps or severe pain.
	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
			Comment: See education sheet: "Step by Step: How to Empty Your Drain After Surgery"
		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
	Discharge Instructions Other
		Instructions: Take Levothyroxine/Synthyroid as prescribed by Endocrinologist
		Instructions: Stop Methimazole after surgery
		Instructions: Continue with betablockers until seen by your endocrinologist
	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
	Cold Therapy
		Ice bag, Incision, as desired
			Comment: immediately in PACU, and then on for 20 min, off for 20 min for 3 Days
Therapies
	Consult Physical Therapy, Evaluate and Treat
		Reason to See: Range of Motion
			Comment: to shoulder. Post op head and neck.
Consults/Follow-up
	Consult Social Work
		Home Health Care

*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