Unique Plan Description: Trach Collar
Plan Selection Display: Trach Collar
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-03-01 13:55:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-06-01 10:59:06
Available at all facilities: Yes

Trach Collar
Activity
	Activity-As Tolerated
		T;N
Diet
	NPO
		T;N
Laboratory
	Blood Gases Arterial (ABG) - MH/WH/JE
		T+1;0400, Routine, Q24H, spec type = Blood
		T+1;0400, Routine, spec type = Blood
	Blood Gases Arterial (ABG) - FH
		T+1;0400, Routine, Q24H, spec type = Blood
Diagnostic Tests
	Chest 1 View
		T;N, Stat, Tube Placement F/U
		T+1; 0001, Routine, Infiltrate, DAILY, Portable
IV Solutions
	dexmedetomidine 400 mcg/NS 100 mL Premix IV
		100 mL, IV, Routine, Start: T;N, RASS Goal: 0 to -1, Incremental Increase: 0.1 mcg/kg/hr, Incremental Decrease: 0.1 mcg/kg/hr, Incremental Freq: 15 min(s), Max Dose: 1.5 mcg/kg/hr
			Comment: Begin at 0.2mcg/kg/hr and titrate to goal RASS 0 to -1 OR BIS 45-60, Notify MD if target RASS OR BIS not met at 0.7mcg/kg/hr. Hold if HR<50, SBP<100mmHg or MAP<50 and notify MD.
		400 mcg, EVERY BAG, 0.2 mcg/kg/hr
	dexmedetomidine 400 mcg/NS 100 mL
		100 mL, IV, Routine, Start: T;N, RASS Goal: 0 to -1, Incremental Increase: 0.1 mcg/kg/hr, Incremental Decrease: 0.1 mcg/kg/hr, Incremental Freq: 15 min(s), Max Dose: 1.5 mcg/kg/hr
			Comment: Begin at 0.2mcg/kg/hr and titrate to goal RASS 0 to -1 OR BIS 45-60, Notify MD if target RASS OR BIS not met at 0.7mcg/kg/hr. Hold if HR<50, SBP<100mmHg or MAP<50 and notify MD.
		400 mcg, 0.2 mcg/kg/hr, T;N
			Comment: Begin at 0.2mcg/kg/hr and titrate to goal RASS 0 to -1, Notify MD if target RASS not met at 0.7mcg/kg/hr. Hold if HR<50, SBP<100mmHg or MAP<50 and notify MD.
Medications
	pantoprazole IV
		40 mg, Injection, IV Push, DAILY
			Comment: Reconstitute with 10mL normal saline and infuse over 2 minutes.  Does NOT require filtration.
	docusate
		100 mg, Liquid, Gastric Tube, BID
			Comment: If patient has feeding tube or NG tube, hold if diarrhea
	Dulcolax
		10 mg, Suppository, RECTALLY, Q3D
			Comment: If no BM
	Tylenol
		650 mg, Tab, By Mouth, Q4H, PRN see comment
			Comment: discomfort and/or pain-mild, or CPOT 1-2
		650 mg, Suppository, RECTALLY, Q4H, PRN see comment
			Comment: discomfort and/or pain-mild
	acetaminophen-hydrocodone 325 mg-5 mg oral tablet
		1 TAB, Tab, By Mouth, Q4H, PRN pain-moderate
			Comment: or CPOT 3-5
		2 TAB, Tab, By Mouth, Q4H, PRN pain-severe
			Comment: or CPOT 6-8
	acetaminophen-hydrocodone 108 mg-2.5 mg/5 mL oral liquid
		10 mL, Elixir, NASOGASTRIC, Q4H, PRN pain-moderate
			Comment: or CPOT 3-5
		20 mL, Elixir, NASOGASTRIC, Q4H, PRN pain-severe
			Comment: or CPOT 6-8
	acetaminophen-hydrocodone 325 mg-7.5 mg/15 mL oral solution
		10 mL, Elixir, NASOGASTRIC, Q4H, PRN pain-moderate
			Comment: or CPOT 3-5
		20 mL, Elixir, NASOGASTRIC, Q4H, PRN pain-severe
			Comment: or CPOT 6-8
	chlorhexidine 0.12% oral rinse
		15 mL, Solution, Mouthwash, BID
Patient Care
	Discontinue
		T;N, Restraints
	Discontinue Medication
		T;N, PRIOR to initiation of trach collar; includes continuous sedation (propofol, fentanyl) PRN fentanyl, PRN Ativan PRN Versed
	Complete Nurse Swallow Screen
		T;N, Once
	Notify MD
		T;N, if unable to wean off continuous sedation (except precedex)
	Discontinue
		T;N, Mechanical Ventilation Powerplan
Therapies
	Mechanical Ventilator Settings
		
			Comment: PRN/Night settings
	RT -Trach Collar
		
	Consult Physical Therapy, Evaluate and Treat
		T;N, Reason to See: Evaluate and Treat
			Comment: Patient on trach collar. Patient on ventilator.
	Consult Occupational Therapy, Evaluate and Treat
		T;N, Reason to See: Evaluate and Treat
			Comment: Patient on trach collar
	Consult Speech Therapy (JE)
		T;N
			Comment: Evaluate 24 hours after trach collar initiation, MBS if appropriate.
	Consult Speech Language (MH), Evaluate and Treat
		T;N
			Comment: Evaluate 24 hours after trach collar initiation, MBS if appropriate. MH Speech Therapy; call 402-354-4461 and leave message for consult
	Consult Speech Language (FH), Evaluate and Treat
		T;N
Respiratory Therapy
	Oxygen Therapy
		T;N
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID, 24, hr

*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