At the 2015 Dr. Wendell Sadler Distinguished Scholar Series

PHYSICIAN'S ORDERS
CHECK OR CIRCLE DESIRED ORDERS
ORDERS:
DATE
A FORMULARY APPROVED GENERIC OR THERAPEUTIC EQUIVALENT DRUG MAYBE SUBSTITUTED
Do Not Use: 'QD', 'QOD', 'U', 'IU', 'MS', 'MSO4', 'MgSO4', 'µg', 'X.0', '.X'
MAJOR VASCULAR SURGERY POST-OP ORDERS
5 Ornelas A/B
Unit:
ICU
IMC
Telemetry monitoring:
Yes
No
CBC & ABG's in PACU.
Check One:
Call to
Fax to
to read.
4. Upright Chest X-Ray in PACU:
5. Vital Signs and urine output every 1 hr x 8, then every 4 hrs.
6. Notify physician if
• Pulse less than 50 or greater than 120
• Urine output less than 30 mL/hr
Extremity
pulses with vital signs and notify surgeon if decreased.
7.
8. Elevate head of bed 30 degrees.
9. Turn, cough and deep breath every 2 hours.
L/min per cannula mask.
10. Pulse Oximeter every 4 hours and record in progress notes. O2 at
11. Incentive Spirometry every 1 hr while awake.
12. Diet:
NPO except ice chips, sips of water and popsicles.
13. Foley to drainage. Discontinue on POD #2 unless specified by physician.
14. NG tube to low suction; irrigate with Normal Saline every 4 hr.
15. Dressings:
• Remove dressings after 48 hrs and leave off if incision is dry
• May shower after dressings removed. No tub baths until instructed otherwise at post-op visit.
• Cleanse site with Chlorhexidine Gluconate and rinse with normal saline every 24 hrs
• Re-dress any draining areas using sterile technique and change dressings every 24 hrs
cleaning with Chlorhexidine Gluconate and normal saline
1.
2.
3.
16.
17.
Labs: CBC, Chem 8, ABG's in AM
Medications:
Cefazolin 1 Gm. IV piggyback every 8 hrs. x 24 hrs. for patients weighing equal to or
less than 70 kilograms, if no penicillin allergy
Cefazolin 2 Gm. IV piggyback every 8 hrs. x 24 hrs. for patients weighing greater than 70
kilograms, if no penicillin allergy
Vancomycin 1 gm IV piggyback every 12 hrs x 24 hrs if used as pre-op antibiotic for
previous positive MRSA.
Do Not redose if patient has renal disease or significant renal impairment.
Nitroglycerin paste 1/2'' to chest every a.m.
Morphine Sulfate 2-4 mg IV every
hrs. PRN severe pain.
, M.D. / D.O.
Date:_______________________Time:___________
TRINITY MOTHER FRANCES
HOSPITALS AND CLINICS
*DT171*
PHYSICIAN ORDERS
Major Vascular Surgery Post Op Orders
E.F. 171-1132 Rev. 3/11 Pg. 1 of 3
PHYSICIAN'S ORDERS
CHECK OR CIRCLE DESIRED ORDERS
ORDERS:
DATE
FORMULARY APPROVED GENERIC OR THERAPEUTIC EQUIVALENT DRUG MAYBE SUBSTITUTED
Do Not Use: 'QD', 'QOD', 'U', 'IU', 'MS', 'MSO4', 'MgSO4', 'µg', 'X.0', '.X'
MAJOR VASCULAR SURGERY POST-OP ORDERS
17.
Medication (continued):
Promethazine (Phenergan) 12.5 mg IV or IM every 4 hrs PRN nausea and vomiting.
Acetaminophen (Tylenol) 650 mg suppository per rectum PRN temp greater than
or mild pain.
Meperidine (Demerol) 75mg and Promethazine (Phenergan) 50mg IM every 6 hours PRN
pain not relieved with Morphine.
Dopamine for renal perfusion (2mcg/kg/min) x 24 hrs then discontinue
Famotidine (Pepcid) 20 mg IV BID.
Famotidine (Pepcid) 20 mg PO BID.
Beta Blocker: (check one)
Atenolol
mg IV every 12 hrs.
mg IV every 6 hrs.
Labetalol
18.
If diabetic: Continue ICU IV insulin protocol until discontinued by endocrinologist / surgeon.
Sliding scale insulin protocol Low
Medium
High
IV Fluids: 1000 ml of
D5 1/2 NS with 20 mEq. Potassium Chloride (KCl) at 150 ml/hr x 8 hrs then 125 ml/hr
Ringers Lactate at 150 ml/hr x 8 hrs then 125 ml/hr
Normal Saline at 150 ml/hr x 8 hrs then 125 ml/hr
19.
20.
EKG in AM;
21.
Hospitalist to follow. Notify Dr.
to read.
Additional orders for patients admitted to IMC/ICU:
22. Hemodynamics every 4 hrs.
23. Vent orders per Dr.
24.
25.
26.
Arterial line to monitor, flush with saline every 4 hr. No Heparin.
Notify surgeon for CVP greater than 13 or less than 3.
EKG monitor - notify Dr.
for arrhythmias.
27.
28.
Epidural orders per Dr.
Put patient on Dr.
29.
DVT Prophylaxis (not for therapeutic anticoagulant ion)
Enoxaparin (Lovenox) 40 mg subcutaneous daily
Enoxaparin (Lovenox) 30 mg every 12 hours subcutaneous
SCD / Ted hose
consult list and notify for non-surgical issues.
M.D. / D.O.
Date:_______________________Time:___________
TRINITY MOTHER FRANCES
HOSPITALS AND CLINICS
*DT171*
PHYSICIAN ORDERS
Major Vascular Surgery Post Op Orders
E.F. 171-1132 Rev. 03/11 Pg. 2 of 3
PHYSICIAN'S ORDERS
CHECK OR CIRCLE DESIRED ORDERS
ORDERS:
DATE
A FORMULARY APPROVED GENERIC OR THERAPEUTIC EQUIVALENT DRUG MAYBE SUBSTITUTED
Do Not Use: 'QD', 'QOD', 'U', 'IU', 'MS', 'MSO4', 'MgSO4', 'µg', 'X.0', '.X'
MAJOR VASCULAR SURGERY POST-OP ORDERS
30. Stress Ulcer Prophylaxis:
Pantoprazole (Protonix) 40 mg daily PO
Pantoprazole (Protonix) 40 mg IV push every 24 hrs
Lansoprazole (Prevacid) 30 mg daily per feeding tube
31. Other Medications only as listed:
32. Other Orders:
, M.D. / D.O.
Date:_______________________Time:___________
TRINITY MOTHER FRANCES
HOSPITALS AND CLINICS
*DT171*
PHYSICIAN ORDERS
Major Vascular Surgery Post Op Orders
E.F. 171-1132 Rev 03/11 Pg. 3 of 3
PHYSICIAN'S ORDERS
Mark  in  for desired orders. If  is blank, order is inactive.
DVT ADULT PROPHYLAXIS
Start medications*:  _____ hours after surgery
 ____________________________________
*Unless otherwise indicated above, all medication orders will be initiated upon receipt of order.
 Pharmacologic thromboprophylaxis is NOT INDICATED due
to patient condition.
 Contraindication:
Use:  TED hose
 SCD's
A. Risk Factors - 1 point each
 Age 41-60 years
 Family history of DVT/PE
 Leg swelling, ulcers, stasis,
varicose veins
 Inflammatory bowel disease
 Central Line
 Bed confinement / immobilization
greater than 24 hours
 Pregnancy, or postpartum less
than one month
 Obesity (greater than 20% over IBW)
 Minor Surgery
 Estrogen Therapy
Low Risk: 1 Point

Patient is on therapeutic anticoagulation. Additional
pharmacologic thromboprophylaxis is not required.
B. Risk Factors - 2 points each
 Age 61-70 years
 Major Surgery
 Malignancy
 Multiple Trauma
 Spinal cord injury with paralysis
Total Risk Score: _______
Moderate Risk: 2 Points High Risk: 3-4 Points
C. Risk Factors - 3 points each
 Age greater than 70 years
 Prior history of DVT/PE
 Acute MI / CHF
 Severe sepsis (sepsis with more
than one organ failure)
 Stroke with paralysis
 Hyperviscosity syndromes
 Hip or Knee Replacement*
 Inherited thrombophilia
 Acquired thrombophilia
Very High Risk: > 4 Points
Low Risk: 1 point OR may order IN ADDITION to pharmacologic orders below- Choose ALL that apply:
 TED hose
 Ambulate:_______________________________
 SCD's
Moderate Risk: 2 points - Choose ONE of the following:
 heparin 5000 units subcutaneous every 8 hours
 fondaparinux (ARIXTRA) 2.5 mg SQ daily
 enoxaparin (LOVENOX) 40 mg subcutaneous every 24 hours
 enoxaparin (LOVENOX) 30 mg subcutaneous every 24 hours
(dosing for CrCl less than 30 mL/min.)
High Risk / Very High Risk: 3 points or greater - Choose ONE of the following:
 heparin 5000 units subcutaneous every 8 hours
 For abdominal surgery only:
fondaparinux (ARIXTRA) 2.5 mg SQ daily
 enoxaparin (LOVENOX) 40 mg subcutaneous every 24 hours
 enoxaparin (LOVENOX) 30 mg subcutaneous every 24 hours
(dosing for CrCl less than 30 mL/min.)
Hip and Knee Replacement
 TED hose and Sequential compression device (SCD)
 fondaparinux (ARIXTRA) 2.5 mg subcutaneous every 24 hours
 enoxaparin (LOVENOX) 30 mg subcutaneous twice daily
 enoxaparin (LOVENOX) 40 mg subcutaneous every 24 hours  aspirin 325 mg PO daily
Trauma  enoxaparin (LOVENOX) 30 mg subcutaneous every 12 hours
Laboratory
 CBC (baseline initial, then every three days)
 Other:
 PT/INR and PTT (baseline only)
 NOTE: fondaparinux (ARIXTRA) contraindicated in patients with severe renal impairment (creatinine clearance <30 mL/min)
EPIDURAL WARNING: do not begin anticoagulants if patient currently has an epidural/intrathecal catheter.
Date:____________
(Required)
Time:_______________
(Required)
Cell/Pager:__________________________
_______________________________________
Prescriber's or Attending's Signature
_______________________________________
Printed Name
Scanned to pharmacy / entered into TDS by:
_______________________Date_____________Time______
TRINITY MOTHER FRANCES
HOSPITALS AND CLINICS
*DT177*
PHYSICIAN ORDERS
DVT Adult Prophylaxis
E.F. 177-1294 Rev. 1/10 Pg. 1 of 1
Orders verified by:
_______________________Date_____________Time______
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