Unique Plan Description: IR Drains and Tubes EKM
Plan Selection Display: IR Drains and Tubes
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-11-04 21:40:58
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-03-07 09:42:06
Available at all facilities: Yes

IR Drains and Tubes EKM
Admit/Discharge/Transfer
	Discharge Conditional
		Conditions to be met: Discharge only after "Patient Educational" requirements have been met. Patient will need flush.
			Comment: Check to see if their pharmacy has flush, if not, closest pharmacy is Express Pharmacy 78th St. . Call Rx: 0.9% sodium chloride injection, USP 10ml "flush" Syringe #30 Refill #5.
		Conditions to be met: May discharge after 3-4 hours if stable, and pain free, and patient education requirements have been met. Patient will need flush.
			Comment: Check to see if their pharmacy has flush, if not, closest pharmacy is Express Pharmacy 78th St.. Call Rx: 0.9% sodium chloride injection, USP 10ml "flush"Syringe #30 Refill #5.
Vital Signs
	Vital Signs
		Routine Post Op
			Comment: and assess incision / drain site with each vitals
Activity
	Bedrest
		4, hr
		3, hr
		2, hr
	Up with Assistance
		T;N, after 4 hours of bedrest
	Ambulate
		
	Activity-Increase
		T;N, after bedrest advance activity to previously ordered activity.
	Discharge Activity
		Previously ordered activity, Activity: Activity as Tolerated
		No heavy lifting for 24 hours. Do not drive today.
Diet
	Diet as ordered prior to procedure/transfer
		T;N, if patient NPO for this test only, resume diet as ordered prior to procedure prep.
	Regular Diet
		Advance as Tolerated
			Comment: Advance to home diet
	Discharge Diet
		Resume previous diet
Laboratory
	Culture Routine
		T;N, Stat, Aspirate, spec type = Body Fluid, Pleural Fld
	Culture Fungus
		T;N, Stat, Aspirate, spec type = Body Fluid, Pleural Fld
	Culture AFB
		T;N, Stat, Aspirate, spec type = Body Fluid, Pleural Fld
IV Solutions
	Dextrose 5% with 0.45% NaCl
		1,000 mL, IV, 75 ml/hr
Medications
	Tylenol
		650 mg, Tab, By Mouth, Q4H, PRN, pain-mild
Patient Care
	Resuscitation Status
		Full Code
		No Code
	Record Output
		T;N, Q12H-End of Shift
		Nephrostomy Tube(NOTE)*
	Nephrostomy Tube
		T;N, DAILY
			Comment: Irrigate with Normal Saline 10ml (flush 5 ml into patient, flush 5 ml into drainage device).  If patient or family cannot flush, arrange home health care. Emphasize to patient to track output and bring output sheet to next tube check.
	Discharge Lines, Tubes and Drains
		Drain Care: Daily, Irrigate with Normal Saline 10 ml (flush 5 ml into patient, flush 5 ml into drainage device). Please track output and bring output sheet to next tube check.
	Dressing Care
		Change
			Comment: Change dressing with gauze and cover with transparent dressing, 2 times per week or more as needed.
	Discharge Incisional, Wound, Stoma Care
		T;N, Change dressing, 2 times per week or more as needed. If the dressing around the tube becomes saturated, there is a possibility the drain is not working properly and needs checked. Call 354-2580 to schedule a tube check.
	Patient Education
		Instructions: Provide the "IR Taking Care of your Drainage Tube (Custom)" Education sheet.
			Comment: Please customize "Instruct Patient on Flushing Instructions" listed in Wound Drain Instructions. Instruct patient on flushing tube, recording output and dressing changes.
	Discharge Diagnostics
		Call 354-2580 to schedule patient for tube check.
		Biliary Tube(NOTE)*
	Biliary Tube
		T;N, Connect to gravity drainage, DAILY
			Comment: Irrigate with Normal Saline 10 ml (flush 5 ml into patient, flush 5 ml into drainage device). If patient or family cannot flush, arrange home health care. Emphasize to patient to track output and bring output sheet to next tube check.
	Discharge Lines, Tubes and Drains
		Drain Care: Daily, Irrigate with Normal Saline 10 ml (flush 5 ml into patient, flush 5 ml into drainage device). Please track output and bring output sheet to next tube check.
	Dressing Care
		Change
			Comment: Change dressing with gauze and cover with transparent dressing, 2 times per week or more as needed.
	Discharge Incisional, Wound, Stoma Care
		T;N Change dressing 2 times per week or more as needed. If the dressing around the tube becomes saturated, there is a possibility the drain is not working properly and needs checked. Call 354-2580 to schedule a tube check.
	Patient Education
		Instructions: Provide the "IR Taking Care of your Drainage Tube (Custom)" Education sheet.
			Comment: Please customize with flushing instructions (listed in Wound Drain instructions). Instruct patient on flushing instructions on flushing tube, recording output, and dressing changes.
	Discharge Diagnostics
		Call 354-2580 to schedule patient for tube check.
		Gastrostomy Tube(NOTE)*
	Gastrostomy Tube
		T;N, Per Gastrostomy Tube (PEG), DAILY
			Comment: Irrigate with sterile water, keep to low intermittent suction (20ml) when in room overnight.
		T;N, Per Gastrostomy Tube (PEG), DAILY
			Comment: Keep tube capped when not in use.
	Dressing Care
		Change
			Comment: Change dressing with gauze and cover with transparent dressing, 2 times per week or more as needed.
	Discharge Incisional, Wound, Stoma Care
		T;N 2 times per week or more as needed. If the dressing around the tube becomes saturated, there is a possibility the drain is not working properly and needs checked. Call 354-2580 to schedule a tube check.
	Patient Education
		Instructions: Provide the "Discharge Instuctions: Caring for your Gastrostomy Tube (G-Tube)" Education sheet. Please customize instruct patient on flushing instructions on flushing tube, recording output, and dressing changes.
	Consult Dietitian
		T;N, Regarding: Tube feeding
		Cholecystostomy Tube(NOTE)*
	Cholecystostomy Tube
		T;B, Irrigate with normal saline, DAILY
			Comment: Irrigate with Normal Saline (flush 5 ml into patient, flush 5 ml into drainage device If patient or family cannot flush, arrange home health care. Emphasize to patient to track output and bring output sheet to next tube check.
	Discharge Lines, Tubes and Drains
		Drain Care: Daily, Irrigate with Normal Saline 10 ml (flush 5 ml into patient, flush 5 ml into drainage device). Please track output and bring output sheet to next tube check.
	Dressing Care
		Change
			Comment: Change dressing with gauze and cover with transparent dressing, 2 times per week or more as needed.
	Discharge Incisional, Wound, Stoma Care
		T;N Change dressing 2 times per week or more as needed. If the dressing around the tube becomes saturated, there is a possibility the drain is not working properly and needs checked. Call 354-2580 to schedule a tube check.
	Patient Education
		Instructions: Provide the "IR Taking Care of Your Drainage Tube (custom)" education sheet.
			Comment: Please customize with flushing instructions listed in wound drain instructions. Instruct patient on flushing instructions on flushing tube, recording output, and dressing changes
	Discharge Diagnostics
		Call 354-2580 to schedule patient for tube check.
		Abscess Drain-JP Drain(NOTE)*
	Wound Drain
		T;N, DAILY
			Comment: IR drain #1, connect to compressed suction, continuously. Irrigate with Normal Saline (flush 5 ml into patient, flush 5 ml into drainage device If patient or family cannot flush, arrange home health care. Emphasize to patient to track output and bring output sheet to next tube check.
	Discharge Incisional, Wound, Stoma Care
		T;N Squeeze the container and close the spout. Make sure the container stays collapsed.
	Dressing Care
		Change
			Comment: Change dressing with gauze and cover with transparent dressing, 2 times per week or more as needed.
	Discharge Incisional, Wound, Stoma Care
		T;N  change dressing 2 times per week or more as needed. If the dressing around the tube becomes saturated, there is a possibility the drain is not working properly and needs checked. Call 354-2580 to schedule a tube check.
	Patient Education
		Instructions: Provide the "IR Taking Care of Your Drainage Tube (custom)" education sheet.
			Comment: Please customize with flushing instructions listed in wound drain instructions. Instruct patient on flushing instructions on flushing tube, recording output, and dressing changes.
	Notify MD
		T;N, Interventional Radiologist of discharge
	VTE Advisor
		General surgery
	Discharge Diagnostics
		Call 354-2580 to schedule patient for tube check on ___/___
Consults/Follow-up
	Pharmacy Consult
		Anticoagulants/antiplatelets may have been held for an IR procedure; if held, may restart as follows: SC/IV heparin 6hr, enoxaparin 12hr, fondaparinux/apixaban/rivaroxaban/dabigatran 24hr, clopidogrel/ticagrelor/prasugrel/aspirin POD1

Rad Post Glucophage
Patient Care
	Notify MD
		T;N, Call attending: pt on a brand of metformin and has received iodinated contrast placing pt at risk of lactic acidosis.
	Patient Education
		Instructions: Provide patient with printed handout information sheet with date/time to restart metformin containing medications.
Consults/Follow-up
	Pharmacy Consult
		T;N, Patient is on a brand of metformin, and has received iodinated contrast.  Please check that medications have been discontinued
			Comment: Patient is on a brand of metformin, and has received iodinated contrast.  Please check that medications have been discontinued

DVT VTE Prophylaxis (FH)
Laboratory
	CBC with Diff
		T;N, Routine, spec type = Blood
		T+1;0500, Routine, EVERY OTHER DAY, spec type = Blood
		T+1;0500, Routine, Q24H 3 Day(s), spec type = Blood
		T+1;0500, Routine, Q24H, spec type = Blood
	BMP
		T;N, Routine, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Routine, spec type = Diagnostic Blood
		T+1;0500, Q24H, spec type = Therapeutic Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Routine, spec type = Diagnostic Blood
Medications
		See VTE Risk Assessment for patient risk score(NOTE)*
	Lovenox
		40 mg, Syringe, SUBCUTANEOUS, DAILY
			Comment: NOTIFY physician if platelets < 130,000
		30 mg, Syringe, SUBCUTANEOUS, BID
			Comment: NOTIFY physician if platelets < 130,000
		For CrCl < 30 mL/min(NOTE)*
		30 mg, Syringe, SUBCUTANEOUS, DAILY
			Comment: NOTIFY physician if platelets < 130,000. D/C lovenox if INR > 1.8
		For Patients > 150 kg(NOTE)*
		40 mg, Syringe, SUBCUTANEOUS, BID
			Comment: NOTIFY physician if platelets < 130,000
		40 mg, Syringe, SUBCUTANEOUS, DAILY
			Comment: NOTIFY physician if platelets < 130,000
Anticoagulants
		Baseline INR required for Coumadin(NOTE)*
	warfarin
		5 mg, Tab, By Mouth, Once
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		2.5 mg, Tab, By Mouth, Once
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		10 mg, Tab, By Mouth, Once
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		5 mg, Tab, By Mouth, DAILY
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		2.5 mg, Tab, By Mouth, DAILY
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		10 mg, Tab, By Mouth, DAILY
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		ORTHO ONLY(NOTE)*
	Xarelto
		10 mg, Tab, By Mouth, DAILY
	dabigatran
		150 mg, Capsule, By Mouth, BID
			Comment: Check renal function
	Eliquis
		2.5 mg, Tab, By Mouth, BID
			Comment: Hip Replacement: Duration of therapy 35 days  Knee Replacement: 12 days
	HEParin 5000 units/mL SUBCUTANEOUS
		5,000 units, Syringe, SUBCUTANEOUS, TID
		5,000 units, Syringe, SUBCUTANEOUS, BID
Patient Care

	Impulse Foot Pumps
		To be worn at all time while patient is not bearing weight
	Sequential Compression Device
		T;N, Wear, Both legs
			Comment: To be worn at all times while patient is not bearing weight
	Anti Embolism Stockings
		TED hose, knee high, Both legs
		TED hose, knee high, Left leg
		TED hose, knee high, Right leg
		TED hose, thigh high, Both legs
		TED hose, thigh high, Left leg
		TED hose, thigh high, Right leg
	Notify MD
		Contact Physician if INR < 1.8 on Day of Dismissal
Therapies
	Consult Physical Therapy, Evaluate and Treat
		
Consults/Follow-up
	Pharmacy Consult
		D/C Lovenox if INR > 1.8
		D/C Lovenox if INR > 2.0
		Contact MD and Hold Coumadin if INR > 2.5
		Contact MD and Hold Coumadin if INR > 3.0
		Contact MD and Hold Coumadin if INR > 3.5

Pain Constipation Nausea Protocol </= to 65 EKM
Medications
		Select only one medication in each category(NOTE)*
Mild Pain
	Tylenol
		650 mg, Tab, By Mouth, Q4H, PRN, see comment
			Comment: discomfort and/or pain-mild (pain rating 1-3) in opiate intolerant patient
		650 mg, Suppository, RECTALLY, Q6H, PRN, see comment
			Comment: discomfort and/or pain-mild (pain rating 1-3) in opiate intolerant patient
	ibuprofen
		600 mg, Tab, By Mouth, Q6H, PRN, pain-mild
			Comment: pain rating 1-3
		800 mg, Tab, By Mouth, Q8H, PRN, pain-mild
			Comment: pain rating 1-3
	acetaminophen-hydrocodone 325 mg-5 mg oral tablet
		1 TAB, Tab, By Mouth, Q4H, PRN, pain-mild
			Comment: pain rating 1-3
	Percocet 5 mg-325 mg oral tablet
		1 TAB, Tab, By Mouth, Q4H, PRN, pain-mild
			Comment: pain rating 1-3
	Dilaudid Injectable
		0.2 mg, Injection, IV Push, Q2H, PRN, pain-mild
			Comment: for pain rating 1-3 and if NPO
	morphine  IV
		2 mg, Syringe, IV Push, Q2H, PRN, pain-mild
			Comment: for pain rating 1-3 and if NPO
Moderate Pain
	acetaminophen-hydrocodone 325 mg-5 mg oral tablet
		1 TAB, Tab, By Mouth, Q4H, PRN, pain-moderate
			Comment: For pain rating 4-6. If inadequate relief after 1 hour, may repeat dose if pain level moderate (pain rating 4-6) to severe (pain rating 7-10).  If repeat dose given, administer next dose at 4hr minimum unless otherwise prescribed.
	acetaminophen-hydrocodone 325 mg-7.5 mg oral tablet
		1 TAB, Tab, By Mouth, Q4H, PRN, pain-moderate
			Comment: For pain rating 4-6. If inadequate relief after 1 hour, may repeat dose if pain level moderate (pain rating 4-6) to severe (pain rating 7-10).  If repeat dose given, administer next dose at 4hr minimum unless otherwise prescribed.
	acetaminophen-hydrocodone 325 mg-10 mg oral tablet
		1 TAB, Tab, By Mouth, Q4H, PRN, pain-moderate
			Comment: For pain rating 4-6. If inadequate relief after 1 hour, may repeat dose if pain level moderate (pain rating 4-6) to severe (pain rating 7-10).  If repeat dose given, administer next dose at 4hr minimum unless otherwise prescribed.
	Percocet 5 mg-325 mg oral tablet
		1 TAB, Tab, By Mouth, Q4H, PRN, pain-moderate
			Comment: For pain rating 4-6. If inadequate relief after 1 hour, may repeat dose if pain level moderate (pain rating 4-6) to severe (pain rating 7-10).  If repeat dose given, administer next dose at 4hr minimum unless otherwise prescribed.
	Percocet 7.5 mg-325 mg oral tablet
		1 TAB, Tab, By Mouth, Q4H, PRN, pain-moderate
			Comment: For pain rating 4-6. If inadequate relief after 1 hour, may repeat dose if pain level moderate (pain rating 4-6) to severe (pain rating 7-10).  If repeat dose given, administer next dose at 4hr minimum unless otherwise prescribed.
	Percocet 10 mg-325 mg oral tablet
		1 TAB, Tab, By Mouth, Q4H, PRN, pain-moderate
			Comment: For pain rating 4-6. If inadequate relief after 1 hour, may repeat dose if pain level moderate (pain rating 4-6) to severe (pain rating 7-10).  If repeat dose given, administer next dose at 4hr minimum unless otherwise prescribed.
	Roxicodone
		5 mg, Tab, By Mouth, Q4H, PRN, pain-moderate
			Comment: For pain rating 4-6. If inadequate relief after 1 hour, may repeat dose if pain level moderate (pain rating 4-6) to severe (pain rating 7-10).  If repeat dose given, administer next dose at 4hr minimum unless otherwise prescribed.
	morphine  oral immediate release
		15 mg, Tab, By Mouth, Q4H, PRN, pain-moderate
			Comment: Pain rating 4-6
	Dilaudid Injectable
		0.2 mg, Injection, IV Push, Q2H, PRN, pain-moderate
			Comment: For pain rating 4-6; may give if NPO or for breakthrough pain if on oral analgesics
		0.4 mg, Injection, IV Push, Q2H, PRN, pain-moderate
			Comment: For pain rating 4-6; may give if NPO or for breakthrough pain if on oral analgesics
	morphine  IV
		2 mg, Syringe, IV Push, Q2H, PRN, pain-moderate
			Comment: For pain rating 4-6; may give if NPO or for breakthrough pain if on oral analgesics
		4 mg, Syringe, IV Push, Q2H, PRN, pain-moderate
			Comment: For pain rating 4-6; may give if NPO or for breakthrough pain if on oral analgesics
	ketorolac injectable
		15 mg, Injection, IV Push, Q6H, PRN, pain-moderate, 48 hr
			Comment: For pain rating 4-6.
Severe Pain
	acetaminophen-hydrocodone 325 mg-5 mg oral tablet
		2 TAB, Tab, By Mouth, Q4H, PRN, pain-severe
			Comment: Pain rating 7-10
	acetaminophen-hydrocodone 325 mg-7.5 mg oral tablet
		2 TAB, Tab, By Mouth, Q4H, PRN, pain-severe
			Comment: Pain rating 7-10
	Percocet 5 mg-325 mg oral tablet
		2 TAB, Tab, By Mouth, Q4H, PRN, pain-severe
			Comment: Pain rating 7-10
	Percocet 7.5 mg-325 mg oral tablet
		2 TAB, Tab, By Mouth, Q4H, PRN, pain-severe
			Comment: Pain rating 7-10
	Percocet 10 mg-325 mg oral tablet
		2 TAB, Tab, By Mouth, Q4H, PRN, pain-severe
			Comment: Pain rating 7-10
	Roxicodone
		10 mg, Tab, By Mouth, Q4H, PRN, pain-severe
			Comment: Pain rating 7-10
	morphine  oral immediate release
		30 mg, Tab, By Mouth, Q4H, PRN, pain-severe
			Comment: Pain rating 7-10
	Dilaudid Injectable
		0.4 mg, Injection, IV Push, Q2H, PRN for pain-severe
			Comment: For pain rating 7-10 if NPO or for breakthrough pain if on oral analgesics. Use 0.4mg if over age 70.
		0.5 mg, Injection, IV Push, Q2H, PRN, pain-severe
			Comment: For pain rating 7-10 if NPO or for breakthrough pain if on oral analgesics. Use 0.4mg if over age 70.
		0.6 mg, Injection, IV Push, Q2H, PRN, pain-severe
			Comment: For pain rating 7-10 if NPO
		0.8 mg, Injection, IV Push, Q2H, PRN, pain-severe
			Comment: For pain rating 7-10 if NPO
		1 mg, Injection, IV Push, Q2H, PRN, pain-severe
			Comment: For pain rating 7-10 if NPO
	morphine  IV
		4 mg, Syringe, IV Push, Q2H, PRN, pain-severe
			Comment: For pain rating 7-10; may give if NPO or for breakthrough pain if on oral analgesics.
		6 mg, Syringe, IV Push, Q2H, PRN, pain-severe
			Comment: For pain rating 7-10; may give if NPO or for breakthrough pain if on oral analgesics.
		Opiate Reversal(NOTE)*
	Narcan
		0.2 mg, Injection, IV Push, Q2MIN, PRN for see comment
			Comment: if patient has received opiate agents in the past 24 hours and/or if patient becomes somnolent with minimal or no response to stimuli or respiratory rate is 10 or less per minute.  RN may administer naloxone prior to contacting MD.  Notify MD immediately upon administration of naloxone.  May give 0.2mg every 2 min up to 1mg total dose.
Constipation
	docusate
		100 mg, Capsule, By Mouth, DAILY
			Comment: Hold for diarrhea
	Senokot S 50 mg-8.6 mg oral tablet
		2 TAB, Tab, By Mouth, QHS
	MiraLax oral powder for reconstitution
		17 gm, Packet, By Mouth, Q12H, PRN, constipation
			Comment: Mix in 6 oz juice or water
		17 gm, Packet, By Mouth, DAILY, PRN, constipation
			Comment: Mix in 6 oz juice or water
	Milk of Magnesia 8% oral suspension
		30 mL, Suspension, By Mouth, DAILY, PRN for constipation
			Comment: If Miralax not effective; do not use if creatinine clearance or GFR < 30mL/min
		30 mL, Suspension, By Mouth, Q12H, PRN for constipation
			Comment: If Miralax not effective; do not use if creatinine clearance or GFR < 30mL/min
	Dulcolax
		10 mg, Suppository, RECTALLY, DAILY, PRN, constipation
			Comment: If MOM ineffective or if patient NPO
		10 mg, Suppository, RECTALLY, Q12H, PRN, constipation
			Comment: If MOM ineffective or if patient NPO
	Fleet Enema 19 gm-7 gm rectal enema
		1 EA, Enema, RECTALLY, Q12H, PRN, constipation
			Comment: If bisacodyl ineffective
	Enema-Administer
		Tap water, Q1H, constipation
			Comment: if suppository ineffective
Nausea Vomiting
	ondansetron
		4 mg, Injection, IV PUSH, Q6H, PRN for nausea and/or vomiting
			Comment: Administer for nausea if not previously administered by anesthesia, PACU, or ED
		4 mg, Tablet-Disintegrating, By Mouth, Q6H, PRN for nausea and/or vomiting
			Comment: Administer for nausea if not previously administered by anesthesia, PACU, or ED
		Select either promethazine or prochlorperazine orders(NOTE)*
	prochlorperazine
		10 mg, Injection, IV Push, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures.
		25 mg, Suppository, RECTALLY, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures, give if IV access not available.
	Phenergan (MH/WH)
		25 mg, Tab, By Mouth, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures.
		25 mg, Suppository, RECTALLY, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
		6.25 mg, Injection, IV Push, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
	Phenergan (FH)
		12.5 mg, INT, IVPB, Once, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
		25 mg, INT, IVPB, Once, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
	Phenergan (JE)
		25 mg, Tab, By Mouth, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures
		25 mg, Suppository, RECTALLY, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
	Reglan
		10 mg, Injection, IV Push, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron and phenothiazine ineffective; avoid in patients > 65 y/o.
		10 mg, Injection, IM-Intramuscular, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron and phenothiazine ineffective; avoid in patients > 65 y/o.
Patient Care

	Notify MD
		If patient develops itching
		if no results from enema.

Pain Constipation Nausea Protocol > 65 Geriatric E
Medications
		Select only one medication in each category(NOTE)*
Mild Pain
	acetaminophen
		1,000 mg, Tab, By Mouth, Q8H-Sch, T;N
			Comment: For pain rating 1-3; Consider IV Acetaminophen (Ofirmev) if NPO.
		1,000 mg, Tab, By Mouth, Q8H, PRN pain-mild
			Comment: For pain rating 1-3; Consider IV Acetaminophen (Ofirmev) if NPO.
		1,000 mg, Tab, By Mouth, Q8H-Sch, T+1;N
			Comment: For pain rating 1-3; Consider IV Acetaminophen (Ofirmev) if NPO.
	acetaminophen 10 mg/mL intravenous solution
		1,000 mg, Solution-Injection, IVPB, Q8H, T;N, duration: 3 Dose(s)/Time(s)
			Comment: For pain rating 1-3.
Moderate Pain
	oxyCODONE
		2.5 mg, Tab, By Mouth, Q4H, PRN pain-moderate
			Comment: For pain rating 4-6
	traMADol
		25 mg, Tab, By Mouth, Q6H, PRN pain-moderate
			Comment: For pain rating 4-6; Screen for drug interactions (e.g.SSRI), and adjust dose for CrCl<30ml/min; avoid use if history of seizures.
	Dilaudid Injectable
		0.2 mg, Injection, IV Push, Q4H, PRN pain-moderate
			Comment: For pain rating 4-6; may give if NPO or for breakthrough pain if on oral analgesics.
Severe Pain
	oxyCODONE
		5 mg, Tab, By Mouth, Q4H, PRN pain-severe
			Comment: For pain rating 7-10.
	traMADol
		50 mg, Tab, By Mouth, Q6H, PRN pain-severe
			Comment: For pain rating 7-10; screen for drug interactions (e.g.SSRI), and adjust dose for CrCl<30ml/min; avoid use if history of seizures.
	Dilaudid Injectable
		0.4 mg, Injection, IV Push, Q2H, PRN pain-severe
			Comment: For pain rating 7-10 if NPO or for breakthrough pain if on oral analgesics.
		Opiate Reversal(NOTE)*
	Narcan
		0.2 mg, Injection, IV Push, Q2MIN, PRN see comment
			Comment: If patient has received opiate agents in the past 24 hours and/or if patient becomes somnolent with minimal or no response to stimuli or respiratory rate is 10 or less per minute.  RN may administer naloxone prior to contacting MD.  Notify MD immediately upon administration of naloxone.  May give 0.2mg every 2 min up to 1mg total dose.
PRN Discomfort
	trolamine salicylate 10% topical cream
		1 appl, Cream, TOPICAL, TID, PRN discomfort
			Comment: Apply to affected area.
	menthol-methyl salicylate topical
		1 appl, Cream, TOPICAL, TID, PRN discomfort
			Comment: Apply to affected area.
	lidocaine 4% topical patch
		1 patch, Patch, TransDERMAL, DAILY
	lidocaine Patch Removal
		Patch Removal, Patch, TransDERMAL, QHS
	Medication patch site check
		T;N+720, Q12H
Constipation
	Senokot S 50 mg-8.6 mg oral tablet
		1 TAB, Tab, By Mouth, BID, PRN for constipation
			Comment: Hold for loose stools
	MiraLax oral powder for reconstitution
		17 gm, Packet, By Mouth, BID
			Comment: Hold for loose stools.  Mix in 6oz juice or water.
	Dulcolax
		10 mg, Suppository, RECTALLY, Q12H, PRN constipation
			Comment: If other agents ineffective or if patient NPO.
	Fleet Enema 19 gm-7 gm rectal enema
		1 EA, Enema, RECTALLY, Q12H, PRN constipation
			Comment: If suppository ineffective.
	Enema-Administer
		Tap water, Q1H, see comment
			Comment: If suppository ineffective.
Nausea Vomiting
	ondansetron
		4 mg, Tablet-Disintegrating, By Mouth, Q6H, PRN nausea and/or vomiting
		4 mg, Injection, IV Push, Q6H, PRN nausea and/or vomiting
			Comment: If unable to take by mouth.

*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