Unique Plan Description: Neurosurg Gamma Knife, Post op EKM
Plan Selection Display: Neurosurg Gamma Knife, Post op
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-11-04 18:17:43
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-21 09:22:38
Available at all facilities: Yes

Neurosurg Gamma Knife, Post op EKM
Admit/Discharge/Transfer
	Discharge Conditional
		Conditions to be met: To home after completion of radiosurgery.
Vital Signs
	Vital Signs
		Q2H, 2, Dose(s)/Time(s), Sch minus Q12 Start of Shift
Activity
		Select bedrest order below for patients with frame on(NOTE)*
	Elevate head of bed
		Elevate head of bed 30 degrees
	Bedrest with Bathroom Privileges
		
		Select up as tolerated order below for patients without frame on(NOTE)*
	Activity-As Tolerated
		
Diet
	Regular Diet
		Advance as Tolerated
Medications
	morphine  IV
		1 mg, Syringe, IV PUSH, Q2H, PRN, pain-severe
		2 mg, Syringe, IV PUSH, Q2H, PRN, pain-severe
		3 mg, Syringe, IV PUSH, Q2H, PRN, pain-severe
	acetaminophen-hydrocodone 325 mg-5 mg oral tablet
		1 TAB, Tab, BY MOUTH, Q4H, PRN, pain-mild
		2 TAB, Tab, BY MOUTH, Q4H, PRN, pain-moderate
	Tylenol
		650 mg, Tab, BY MOUTH, Q4H, PRN, discomfort
	aluminum hydroxide/magnesium hydroxide/simethicone 200 mg-200 mg-20 mg/5 mL oral susp
		30 mL, Suspension-Oral, BY MOUTH, Q4H, PRN for indigestion
	VTE Advisor
		Neurosurgery - craniotomy
Patient Care
	Bladder Scan
		unable to void
			Comment: Assess for Residual
	Resuscitation Status
		Full Code
		No Code

Nausea Protocol EKM
Medications
	ondansetron
		4 mg, Injection, IV PUSH, Q24H, PRN for nausea and/or vomiting
			Comment: Administer for nausea if not previously administered by anesthesia, PACU, or ED and unable to take oral meds.
		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 and unable to take oral meds.
		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
			Comment: Give if ondansetron ineffective and if no history of seizures, give if IV access not available
	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 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; give if unable to take oral meds.
		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, IM-Intramuscular, Q6H, 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 (FH)
		25 mg, Tab, By Mouth, BID, 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, Suppository, RECTALLY, BID, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
		12 mg, INT, IVPB, Q6H, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
	Benadryl
		12.5 mg, Injection, IV PUSH, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron and phenothiazine ineffective
	Ativan
		1 mg, Tab, BY MOUTH, Q8H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, phenothiazine, or other anti-nausea medications ineffective
		1 mg, Injection, IV PUSH, Q8H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, phenothiazine, or other anti-nausea medications ineffective
	Reglan
		10 mg, Injection, IV PUSH, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, phenothiazine, or other anti-nausea medications ineffective; avoid in patients > 65yo
		10 mg, Injection, IM-Intramuscular, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, phenothiazine, or other anti-nausea medications ineffective; avoid in patients > 65yo

*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