CHN4528 Cranial Surgery Post Op Orders CSM.pdf

USE BALL POINT PEN – PRESS FIRMLY
CARONDELET HEALTH NETWORK
HOSPITAL PROVIDED PRE-PRINTED PHYSICIAN’S ORDERS
STAT/NOW
(Check Box to Left)
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CRANIAL SURGERY POST OP ORDERS - CSM
* LIST ALL ALLERGIES: (Medication, food, latex and/or Contrast Dye) * Required on Admission Orders
1. Admit Inpatient to Neurological ICU - Status Post:
2. Vital Signs and Neurovascular checks every _________ hours
3. Activity Head of bed at ____________ degrees
If full head wrap present, DO NOT lift it over the ears
4. Nursing: Foley catheter
A-Line monitoring
5. Diet:
6. IV Fluids:
D5 0.45% Sodium Chloride at __________ ml/hour
Additive: _____________________________________________ per liter
Other: __________________________________________________________
0.9% Sodium Chloride (Saline) lock IV once po intake is adequate
7. Medications:
Dexamethasone (Decadron) ____________mg _______route ________frequency____________
Phenytoin (Dilantin) ______ mg po at bedtime
Famotidine (Pepcid) 20mg IV every 12 hours Convert to po when tolerating oral fluids
HydrALAZINE (Apresoline) 5 mg IV every 2 hours p.r.n. for SBP greater than 160mmHg
For Pain:
Morphine 1 mg OR __________ mg IV every 1 hour p.r.n. severe pain
If not effective Other: _______________________________IV every ______hours p.r.n. severe pain
Acetaminophen 325 mg/OXYcodone 5 mg (Percocet) 1 tab po every 4 hours p.r.n. moderate pain
Acetaminophen (Tylenol) 650 mg po/PR every 6 hours p.r.n. temp greater than101°/mild pain
(Acetaminophen not to exceed 4 grams/24 hours)
For nausea/vomiting (Prescribe One):
Promethazine (Phenergan) 6.25 mg IV / po every 4 hours p.r.n nausea/vomiting
OR: Ondansetron (Zofran) 4 mg IV every 6 hours p.r.n. nausea/vomiting
LAXATIVE:
Docusate Sodium (Colace) 100 mg po twice daily
Milk of Magnesia concentrate 10 ml daily p.r.n. mild constipation
Other:
8. VTE prophylaxis:
Risk assessment and orders for VTE prophylaxis already done
Relative or Absolute Contraindications to Anticoagulant and/or Mechanical Prophylaxis (check all that apply)
If contraindications present, re-assess in 3-5 days.
Active bleeding
Risk of bleeding (including but not limited to:
coagulopathy, recent intracranial or intraocular
surgery or traumatic head injury)
Clinically significant thrombocytopenia
Physician Signature: Date Signed: Time Signed:
Physician Printed Name / License # / Telephone #:
Active bleeding
Risk of bleeding (including but not limited to:
coagulopathy, recent intracranial or intraocular
surgery or traumatic head injury)
Clinically significant thrombocytopenia
PATIENT IDENTIFICATION
MEC Approval CSM -01/27/11
CHN4528 Expires – 01/2014
Copy 03.18.13 Page 1 of 3
UNLESS NOTED AS PBO (PRESCRIBED BRAND ONLY), A FORMULARY EQUIVALENT MEDICATION MAY BE DISPENSED

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USE BALL POINT PEN – PRESS FIRMLY
CARONDELET HEALTH NETWORK
HOSPITAL PROVIDED PRE-PRINTED PHYSICIAN’S ORDERS
CRANIAL SURGERY POST OP ORDERS - CSM
9. VTE prophylaxis continued:
Physician Orders: See assessment tool on last page
TED hose bilaterally (caution in peripheral arterial insufficiency) Calf high Thigh high
SCDs bilaterally (caution in peripheral arterial insufficiency) Calf high Thigh high
Heparin 5000 units subq every 8 hours
Enoxaparin (Lovenox) 40 mg subq daily
Enoxaparin (Lovenox) 30 mg subq twice daily
Enoxaparin (Lovenox) 30 mg subq daily (if Creatinine Clearance is less than 30 mL/minute)
Warfarin (COUMAdin) ______mg PO daily with PT/INR daily
Fondaparinux (Arixtra) 2.5 mg subq daily (HIT patients only; contraindicated if weight less than 50 kg or
CrCl less than 30 mL/minute)
CBC w/ diff in AM (periodic monitoring recommended)
Other: __________________________________________
10. Labs to draw in A.M.:
11. Imaging Study:
12. Notify: _____________________________________________ of admission
STAT/NOW
(Check Box to Left)
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Physician Signature: Date Signed: Time Signed:
Physician Printed Name / License # / Telephone #:
PATIENT IDENTIFICATION
MEC Approval CSM -01/27/11
CHN4528 Expires – 01/2014
Page 2 of 3
UNLESS NOTED AS PBO (PRESCRIBED BRAND ONLY), A FORMULARY EQUIVALENT MEDICATION MAY BE DISPENSED

USE BALL POINT PEN – PRESS FIRMLY
CARONDELET HEALTH NETWORK
HOSPITAL PROVIDED PRE-PRINTED PHYSICIAN’S ORDERS
CRANIAL SURGERY POST OP ORDERS - CSM
VTE Risk Assessment
STAT/NOW
(Check Box to Left)
Risk Assessment (use the highest applicable risk category) Risk Level Suggested Prophylaxis Options
By Condition:
Very High Enoxaparin 40mg subq daily OR
• Total hip replacement
10 days of Enoxaparin 30mg subq twice daily
prophylaxis is
• Hip fracture Enoxaparin 40mg subq daily
suggested
• Total knee replacement Enoxaparin 30mg subq twice daily
By High Risk Group:
Very High Enoxaparin 30mg subq twice daily
• History of VTE
• Spinal cord injury within 1 month
• Thrombophilia
• Trauma (major or lower extremity)
• Immobility, paresis
• Pelvic fracture
By Risk Factor Assessment:*
• Surgery - general (high risk)
• Surgery - intracranial neurosurgery,
spinal, gynecologic, urologic
(moderate risk)
• Age greater than 40 years
• Heart failure
• Inflammatory bowel disease
• Ischemic CVA with paresis/plegia
• Nephrotic syndrome
• Obesity (BMI of 30kg/m 2 or greater)
• Sepsis/pneumonia
• Central line
• Severe respiratory distress
• Estrogen/SERM** within 2 weeks
• Malignancy or cancer therapy
• Mechanical ventilation
• Pregnancy or post-partum period
• Acute MI
• History of spinal cord injury
• Smoking
• Varicose veins
*List of risk factors is not all-inclusive
**SERM=selective estrogen receptor
modulator
High
(3 or more
risk factors)
Moderate
(1 or 2 risk
factors)
Low
(0-1 risk
factors)
Enoxaparin 40mg subq daily
+ mechanical prophylaxis
OR
Heparin 5000 units subq every 8 hour
+ mechanical prophylaxis
Heparin 5000 units subq every 8 hour
OR
mechanical prophylaxis
Early ambulation
Page 3 of 3
UNLESS NOTED AS PBO (PRESCRIBED BRAND ONLY), A FORMULARY EQUIVALENT MEDICATION MAY BE DISPENSED