Unique Plan Description: Pulm Bronchoscopy
Plan Selection Display: Pulm Bronchoscopy
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-19 22:41:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-12-12 14:20:08
Available at all facilities: No

Bronchoscopy Preop
Admit/Discharge/Transfer
	Admit to Observation Status
		T;N
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
Diet
	NPO
		After Midnight
Laboratory
	Basic Metabolic Panel
		Stat, spec type = Blood
	Blood Gases Arterial (ABG) - MH/WH/JE
		Stat, spec type = Blood
			Comment: 2 Units Preop Request
	Blood Gases Arterial (ABG) - FH
		T;N, Stat, spec type = Blood
	CBC with Diff
		Stat, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	INR - MH/WH/JE
		Stat, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Stat, spec type = Diagnostic Blood
		T;N, Stat, spec type = Therapeutic Blood
	PTT - MH/WH/JE
		Stat, spec type = Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Stat, spec type = Diagnostic Blood
	Magnesium Level
		Stat, spec type = Blood
	Platelet Function Assay - MH/WH/JE
		Stat, spec type = Blood
Diagnostic Tests
	ECG
		Stat, Indication: Pre-op Release
			Comment: DO NOT repeat if done within 2 weeks
IV Solutions
	Dextrose 5% in Water
		1,000 mL, IV, 40 ml/hr
	Dextrose 5% with 0.45% NaCl
		1,000 mL, IV, 40 ml/hr
	Dextrose 5% in Lactated Ringers
		1,000 mL, IV, 40 ml/hr
	Dextrose 5% with 0.9% NaCl
		1,000 mL, IV, 40 ml/hr
Patient Care
	Obtain Consent/Permit for:
		fiberoptic bronchoscopy with possible transbronchial biopsies and bronchoalveolar lavage
		flexible bronchoscopy
		flexible bronchoscopy with endobronchial ultrasound
		flexible bronchoscopy with cryotherapy
		flexible bronchoscopy with navigation
	No IM Injections
		if INR greater than 2.
	Discontinue Medication
		anticoagulants
	Isolation Precautions
		T;N
Therapies
	Bronchoscopy-Order

Bronchoscopy Post Op
Admit/Discharge/Transfer
	Discharge Conditional
		Conditions to be met: Vital signs stable, weaned from oxygen if not chronic, and able to swallow. Call when discharge conditions met.
Vital Signs
	Vital Signs
		Q15MIN, 4, Dose(s)/Time(s)
		T;N+60, Q30MIN, 2, Dose(s)/Time(s)
		T;N+120, Q1H, 2, Dose(s)/Time(s)
		T;N+240, Q4H
Diet
	NPO
		Until gag reflex returns
Diagnostic Tests
	Chest 1 View
		Pt in PACU.  Post Bronchoscopy, Stat, Post Op F/U
Medications
	albuterol-ipratropium 2.5 mg-0.5 mg/3 mL inhalation solution
		3 mL, Solution-Nebulization, NEBULIZED, Once, STAT
	albuterol 2.5 mg/3 mL (0.083%) inh soln
		3 mL, Solution-Nebulization, NEBULIZED, Once, T;N
			Comment: If on Spiriva at home
Patient Care
	Notify MD
		pulse >130 or <60, respirations >32 or <8, BP systolic >180 or <90, hempotysis >30ml, oxygen saturation <90%
		If FIO2 >50%, or oxygen saturation <90%
	Bladder Scan
		PRN unable to void
Therapies
	Oxygen Set Up-MH/JE
		Stat, Orders per Respiratory Protocol
	Oxygen Therapy
		Via Nasal Cannula, Orders per Respiratory Protocol, Constant Indicator, titrate to keep sats > 92%
	Pulse Oximetry Spot Check RT
		BID-RT
		1, Dose(s)/Time(s), Up walking on room air prior to discharge.  Keep greater than or equal to 90%
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID

zzlevalbuterol (Xopenex) 1.25mg (ONCE)
Medications
	levalbuterol 1.25 mg/3 ml inhalation solution
		0.5 mL, Solution-Nebulization, NEBULIZED, Once
	sodium chloride 0.9% inhalation solution
		3 mL, Solution-Nebulization, NEBULIZED, Once

*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