Unique Plan Description: OB C-Section, Pre op UNSCHEDULED ENHANCED RECOVERY
Plan Selection Display: OB C-Section, Pre op UNSCHEDULED ENHANCED RECOVERY
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-21 19:19:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-04-25 10:33:28
Available at all facilities: Yes

OB C-Section, Pre op UNSCHEDULED ENHANCED RECOVERY
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
Vital Signs
	Vital Signs
		T;N, Per protocol
Diet
	NPO
		T;N
Laboratory
	Type and Screen (No Product on hold)
		T;N, Stat, spec type = Blood
	CBC with Diff
		T;N, Stat, spec type = Blood
IV Solutions
		This IV is to be initiated immediately postpartum(NOTE)*
	Pitocin 30 units/lactated ringers 500 mL Premix IV
		500 mL, IV, Routine, T;N, 24 hr
			Comment: Infuse 15 units over 15 minutes (999mL/hr) immediately post partumFollowed by 15 units over 3 hours (83.3mL/hr) immediately after first bolus dose is completed - The Initial postpartum infusion rate may be decreased prior to 15 minutes based on patient's clinical status and communication between the surgeon and anesthesia provider. - RN will be responsible to adjust IV rate.
		30 units, EVERY BAG, 59.94 units/hr
Medications
	Ancef (JE)
		2,000 mg, Injection, IV Push, PREOP, Indication: Surgical prophylaxis, T;N
		3,000 mg, Syringe, IV Push, PREOP, Indication: Surgical prophylaxis, T;N
	Ancef (MH/WH)
		2,000 mg, Syringe, IV Push, PREOP, Indication: Surgical prophylaxis, T;N
		3,000 mg, Syringe, IV Push, PREOP, Indication: Surgical prophylaxis, T;N
	Ancef (FH)
		2,000 mg, Injection-Premix, IVPB, PREOP, Indication: Surgical prophylaxis, T;N
		3,000 mg, Solution-IV, IVPB, PREOP, Indication: Surgical prophylaxis, T;N
		If Labored and/or rupture of membranes, order Azithromycin in addition to Ancef(NOTE)*
	Zithromax IVPB
		500 mg, INT, IVPB, PREOP, Surgical prophylaxis, T;N
		Order clindamycin AND Gentamicin if patient allergic to penicillin or cephalosporin with anaphylaxis reaction(NOTE)*
	Cleocin IVPB
		900 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis, T;N
	gentamicin IVPB
		5 mg/kg, Injection, IVPB, PREOP, Surgical prophylaxis, T;N
			Comment: Dose based on Adjusted Body Weight; Give with Clindamycin Preop if patient has Cephalosporin allergy or anaphylactic penicillin allergy
	gentamicin IVPB (FH)
		5 mg/kg, INT, IVPB, PREOP, Surgical prophylaxis, T;N
	Reglan
		10 mg, Injection, IV Push, PREOP, for nausea, T;N
	ondansetron
		4 mg, Injection, IV Push, PREOP, T;N
	ondansetron  2 mg/ml injectable solution
		4 mg, Injection, IV Push, PREOP, T;N
	Alka-Seltzer Gold
		2 TAB, Tablet-Effervescent, By Mouth, PREOP, T;N
	acetaminophen
		1,000 mg, Tab, By Mouth, PREOP
	acetaminophen 10 mg/mL intravenous solution
		1,000 mg, Solution-Injection, IVPB, Once, PRN for see comment, duration: 1 Dose(s)/Time(s)
			Comment: Use only if strict NPO for all oral medications pre-op; Anesthesia to determine dose timing - pre-op or intra-op.
Patient Care
	Delivery Indication
		T;N, Repeat Cesarean, Gestation Confirmed: US done between 14 to 20 wks +/- 10 days, Gestation Confirmed: US done between 14 to 20 wks +/- 10 days
	Sequential Compression Device Pre Procedure
		T;N, Apply, Once
			Comment: knee high
	Notify MD
		Obstetric Call Parameters: SBP >160 mmHg and/or DBP >110 mmHg, P: >120 or <50, O2 Sat: <90%, RR: <10 or >30, Oliguria: <60 mL in 2 hours, Single Temp > 39.0C (102.2F), OR 2 temps between 38.0C (100.4F) and 39C (102.2F), at least 30 min apart
	Obtain Consent/Permit for:
		Cesarean Section
	Vaginal Preparation
		Once, Povidone/Iodine prep prior to OR
	Foley Catheter
		T;N, Insert, Pt. undergoing abdominal/pelvic surgery, Once
			Comment: Insert in preop if general anesthesia.  Insert in OR for epidural/spinal anesthesia.
	Glucose Level, patient to do own
		T;N, Once

Multi-Modal Pre-Op Analgesics
Medications
	gabapentin
		300 mg, Capsule, BY MOUTH, PREOP
			Comment: Administer 1-2 hr prior to surgery; contact Anesthesia if not given. Give 300mg if patient < or = 60 years old and > or = 63.6kg (140 lbs); pharmacy to modify dose to 200mg if patient 61-70 years old or weighs 54.5-63.5kg (120-139 lbs); pharmacy to modify dose to 100mg if patient 71-75 years old or weighs < 54.5kg (< 120 lbs).  If patient 76 years old or older, discontinue order.
		200 mg, Capsule, BY MOUTH, PREOP
			Comment: If 61-70 years old or weighs 54.5-63.5kg (120-139 lbs); administer 1-2 hr prior to surgery; contact Anesthesia if not given.
		100 mg, Capsule, BY MOUTH, PREOP
			Comment: If 71-75 years old or weighs <54.4kg ( < 120 lbs); administer 1-2 	hr prior to surgery; contact Anesthesia if not given.
	meloxicam
		7.5 mg, Tab, BY MOUTH, PREOP
			Comment: Do not use if CrCl < 30ml/min or if systolic blood pressure <90mmHg; administer 1-2hr prior to surgery; contact Anesthesia if not given. Any post-operative NSAID dose should be given no sooner than 12hr after pre-op dose unless otherwise directed by Anesthesia.
		15 mg, Tab, By Mouth, PREOP
			Comment: Comment: Do not use if CrCl < 30ml/min or if systolic blood pressure <90mmHg; administer 1-2hr prior to surgery; contact Anesthesia if not given. Any post-operative NSAID dose should be given no sooner than 24hr after pre-op dose unless otherwise directed by Anesthesia.
	acetaminophen
		1,000 mg, Tab, BY MOUTH, PREOP
			Comment: For case duration < 6 hrs.
	acetaminophen 10 mg/mL intravenous solution
		1,000 mg, Solution-Injection, IVPB, Once, PRN for see comment, duration: 1 Dose(s)/Time(s)
			Comment: Use only if strict NPO for all oral medications pre-op; Anesthesia to determine dose timing - pre-op or intra-op.

*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