Unique Plan Description: URO Nephrectomy, Pre Op
Plan Selection Display: URO Nephrectomy, Pre Op
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2023-12-12 14:54:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-12-12 14:54:00
Available at all facilities: Yes

URO Nephrectomy, Pre Op
Admit/Discharge/Transfer
		MH/WH only:  For total nephrectomy patients, select admit to Inpatient Status. For partial nephrectomy patients, select observation status.(NOTE)*
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
	Admit to Observation Status
		T;N
Diet
	NPO
		After Midnight, NPO Except for: Medications
			Comment: After Midnight, day before surgery except for meds
Laboratory
	CBC with Diff
		Stat, spec type = Blood
	PTT - MH/WH/JE
		Stat, spec type = Blood
	Partial Thromboplastin Time (PTT) - FH
		Stat, spec type = Diagnostic Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	Urinalysis
		Nurse Collect, Stat, Stat, spec type = Urine
	UA (Culture if Positive)
		T;N, Stat, Stat, spec type = Urine
	Type and Screen (No Product on hold)
		T;N, Stat, spec type = Blood
	Type and Crossmatch (Product Available)
		T;N, Stat, For Possible Transfusion
Medications
	Ancef (JE)
		1,000 mg, Injection, IV Push, PREOP, Surgical prophylaxis
	Ancef (MH/WH)
		2,000 mg, Syringe, IV Push, PREOP, Surgical prophylaxis
	Ancef (FH)
		2,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis, T;N
			Comment: 80-120kg
		1,000 mg, INT, IVPB, PREOP, Surgical prophylaxis, T;N
			Comment: <80kg
		3,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis, T;N
			Comment: >120kg
		If allergic to cefazolin (Ancef) or penicillins:(NOTE)*
	Levaquin IVPB
		500 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
	Cipro IVPB
		400 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: Not to exceed 400 mg (10 mg/kg) for patients under age 18
		If allergic to cefazolin (Ancef) or penicillins and quinolones:(NOTE)*
	Cleocin IVPB
		600 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
	gentamicin IVPB
		1.5 mg/kg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
		5 mg/kg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
	gentamicin IVPB (FH)
		1.5 mg/kg, INT, IVPB, PREOP, Surgical prophylaxis
		5 mg/kg, INT, IVPB, PREOP, Surgical prophylaxis
Patient Care
	Obtain Consent/Permit for:
		
	Consult Anesthesia/Post Surgical Pain
		Reason for Referral: Post-Surgical Pain, Refer to/Consult with: Anesthesia on Call, No Provider Notified
			Comment: Consult Anesthesia for post-surgical pain management that is non-routine and requires the expertise of an anesthesia provider, uniquely trained and qualified to assist with post-surgical pain management, including but not limited to administration of nerve blocks or epidural catheter placement.

VTE Prophylaxis Pre Op
Medications
	HEParin 5000 units/mL SUBCUTANEOUS
		5,000 units, Injection, SUBCUTANEOUS, PREOP, T;N
	Lovenox
		40 mg, Syringe, SUBCUTANEOUS, PREOP, T;N
		30 mg, Syringe, SUBCUTANEOUS, PREOP, T;N
Patient Care
	Sequential Compression Device Pre Procedure
		T;N, Apply, Once
			Comment: knee high
	Anti Embolism Stockings Pre Procedure
		T;N, Apply, Once
			Comment: knee high

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