Unique Plan Description: OBGYN Rounds
Plan Selection Display: OBGYN Rounds
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-20 23:21:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-06-28 13:58:59
Available at all facilities: Yes

OBGYN Rounds
Diet
	NPO
		
	Regular Diet
		T;N
		T+1;0600
	Advance Diet as Tolerated
		
Laboratory
Today's Lab
	Basic Metabolic Panel
		Stat, spec type = Blood
	Beta-HCG Quantitative - Pregnancy
		Stat, spec type = Blood
	CBC with Diff
		Stat, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	Rhogam Workup
		Routine, spec type = Blood
	Urinalysis
		Routine, Routine, spec type = Urine
	UA (Culture if Positive)
		Routine, Routine, spec type = Urine
	Vaginitis Panel PCR
		T;N, Routine, spec type = Genital
Tomorrow's Lab
	CBC with Diff
		T+1;0400, Routine, spec type = Blood
	Comprehensive Metabolic Panel
		T+1;0400, Routine, spec type = Blood
Diagnostic Tests

	Venous Duplex Unilat Upper or Lower
		Location Left Lower
		Location Right Lower
	Venous Duplex Bil Upper or Lower
		Location Lower Bilateral
Radiology
	Chest 1 View
		Stat, Pneumonia
	US Transvaginal
		Routine
	US Pelvis Limited
		Routine
	US Abd Complete
		Routine
	US Abd Limited
		Routine
IV Solutions

Medications
	ibuprofen
		800 mg, Tab, By Mouth, Q8H, PRN, pain-mild
			Comment: 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).  Notify MD of any dose not given with a note in the chart.
		800 mg, Suspension-Oral, By Mouth, Q8H, PRN, pain-mild
			Comment: 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).  Notify MD of any dose not given with a note in the chart.
	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
	acetaminophen-hydrocodone 325 mg-7.5 mg/15 mL oral solution
		10 mL, Elixir, BY MOUTH, Q4H, PRN, pain-mild
	Dulcolax
		10 mg Suppository RECTALLY DAILY PRN constipation
	Pepcid
		20 mg Tab BY MOUTH BID
	Milk of Magnesia 8% oral suspension
		30 mL, Suspension, By Mouth, Q12H, PRN for constipation
			Comment: 10 mL concentrate equals Dose 30ml dose of regular concentration.
		30 mL, Suspension, By Mouth, DAILY, PRN for constipation
			Comment: 10 mL concentrate equals Dose 30ml dose of regular concentration.
	Ambien
		5 mg, Tab, BY MOUTH, QHS, PRN, insomnia
Immunizations
	tetanus-diphtheria toxoids (Td) adult/adolescent vaccine
		0.5 mL, Injection, IM-Intramuscular, Once, T;N
	Adacel (Tdap) intramuscular suspension
		0.5 mL, Suspension-Injection, IM-IntraMUSCULAR, Once, T;N
	Boostrix (Tdap) intramuscular suspension
		0.5 mL, Suspension-Injection, IM-Intramuscular, Once, T;N
	Prevnar 20
		0.5 mL, Suspension, IM-Intramuscular, Once
	M-M-R II injection
		0.5 mL, Injection, SUBCUTANEOUS, Once, T;N
Patient Care

	Anti Embolism Stockings
		Apply, Once
	Bladder Scan
		PRN unable to void
			Comment: Assess for Residual
	Dressing Care
		Remove, Once
	Foley Catheter
		T;N, Insert
	Discontinue Urinary Catheter
		T;N
	Glucose POC - RN
		T;N
	Heat Therapy
		Aqua K, PRN as needed
	Intake and Output
		
	IV-Decrease Rate
		
	Discontinue IV
		
	Discontinue Peripheral Lock
		
	Non-stress test
		Once
		DAILY
		BID
	Obtain Consent/Permit for:
		circumcision for newborn
	Remove Staples and Apply Steri-strips
		
	Dressing Care
		Apply, Steri strips, Once
		Remove, Steri strips, Once
	Vaginal Packing
		T;N
	Abdominal Binder
		
Diabetic Mother
	Glucose POC - RN
		ACBKFST
		TIDPC, 2 hours after meals
		TIDAC
	Glucose Level, patient to do own
		TIDPC
			Comment: 2 hours after meals
	Notify MD of Lab results
		
		blood sugar >180
		blood sugar results
Consults/Follow-up

	Consult Perinatologist
		
	Consult Infectious Disease
		
	Consult General Surgery
		
	Consult Endocrinologist
		
	Consult Cardiologist
		
	Consult Urology
		
	Consult Neonatologist
		Refer to/Consult with: Or NNP
	Consult Wound Care

Transfuse (Administer) Blood Products EKM
Vital Signs
		Refer to Transfusion Guidelines for Blood Components(NOTE)*
	Vital Signs
		T;N
			Comment: VS within 30 minutes before starting the transfusion, within 5-15 minutes after starting infusion, whenever a suspected adverse reaction occurs, and within 30 minutes of when transfusion complete
Laboratory
Packed Cells
	Crossmatch Red Blood Cells
		T;N, Routine
		T;N, Stat
	Administer blood products
		T;N, Packed cells
Plasma
	Frozen Plasma
		T;N, Routine
	Administer blood products
		T;N, Plasma-fresh frozen
Platelet Pheresis
	Platelet Pheresis
		T;N, Routine
	Administer blood products
		T;N, Platelet
Cryopreciptate
	Cryoprecipitate
		T;N, Routine
	Administer blood products
		T;N, Cryoprecipitate
IV Solutions

	Sodium Chloride 0.9%
		500 mL, IV, 1 Dose(s)/Time(s), 20 ml/hr
Medications
	Tylenol
		650 mg, Tab, By Mouth, Once, T;N
Patient Care
	Obtain Consent/Permit for:
		T;N, blood product transfusion
	Patient Education
		T;N, Review education leaflet "When you need a blood transfusion" prior to administering blood.
	Notify MD
		T;N, Temperature >100.0 F prior to transfusion

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

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

Hypoglycemia Protocol
Laboratory
	Glucose POC - RN
		T;N, 15 minutes after carbohydrate source or medication administered
	Order Lab
		T;N, Blood Glucose (POC) as needed for signs and symptoms of hypoglycemia for patients with diabetic medication orders or known diabetic.
	Hemoglobin A1C
		T+1;0400, Routine, spec type = Blood
Medications
	glucose oral gel (JE)
		15 gm, Gel, By Mouth, Q15MIN, PRN for see comment
			Comment: : for blood glucose 60-70mg/dL as an alternative to apple juice. Notify provider if given with corresponding POC glucose re-check 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.
	glucagon
		1 mg, Injection, IV Push, Q15MIN, PRN for low blood sugar, Routine, 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
	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.
	Communication to HOSPITAL RN
		T;N, 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