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Postpartum Cesarean Section Orders

By Donna Graham,2014-05-12 08:06
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Postpartum Cesarean Section Orders

POSTPARTUM CESAREAN SECTION PLACE LABEL HERE

    POST-OP ORDERS

The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.

OTHER DIAGNOSES: ___________________________________________________________________

    Allergies: _______________________________________________________________________________

    1. Maternal/Infant Unit High Risk Pregnancy Unit

     May transfer care to Maternal/Infant Unit _____ hrs after magnesium sulfate discontinued

     or when ________________________________________________________

    2. Consults: ___________________ Concerning: ______________________ Routine Urgent

    3. Labs: H&H postpartum day #1

     Rh(D) immune globulin workup if Rh negative (Rh ______) o

     Glucose monitoring: FBS q AM 2 hrs postprandial at Bedtime at 3 AM Other: _________

    4. Vital signs on admission to unit, then q 30 min x 2, then q hr x 2, then q 4 hrs x 48 hrs, then q 8 hrs until discharge

     Vital signs, DTRs, breath sounds, I & O per magnesium sulfate orders (form # 20). After magnesium sulfate is

    discontinued, obtain vital signs q 4 hrs or q ______hrs

     TPR q ______ hrs; BP q ______ hrs

     I & O q ______ hrs

    5. Foley to bedside bag. Discontinue at 12 hrs post-op. May straight cath once if patient unable to void in 6 hrs after

    removal of Foley or becomes uncomfortable. If unable to void a second time, reinsert Foley and notify

    Physician/CNM

    6. Notify physician for temperature above 100.4?F twice, four hrs apart, or 101?F once, unstable vital signs, or

    excessive vaginal bleeding, systolic BP above _______ or diastolic BP above ________

     FBS above _______ or below _______; 2 hrs postprandial glucose above _______ or below ________ 7. Diet: clear liquids; advance as tolerated to regular diet with snacks

     __________ calorie consistent carbohydrate gestational diabetic diet with no added juice or fruit at breakfast

     Other: __________________________________________________________________________________ 8. Activity: Up on side of bed with assistance first 6-12 hrs post-op. Up with assist first time, first 4 hrs after

    magnesium sulfate discontinued, and until stable; then ad lib

     Bedrest with bedside commode Bathroom privileges only Bathroom and shower privileges

    9. VTE Prophylaxis: SCDs with TEDs OR Plexi-pulses with TEDs maintain until ambulatory ad lib

     OR ______________________________

    10. ChloraPrep to incision site 48 hrs after surgery (at discharge if <48 hrs). Repeat in 48 hrs (patient may do at home) 11. Incentive Spirometry q 1-2 hrs while awake for patients on magnesium or that had general anesthesia

     Incentive Spirometry q 1-2 hrs while awake

    IV FLUIDS:

    12. D5LR at 125 ml/hr IV OR __________________ at _________ml/hr IV

    13. Discontinue IV at 12 hrs post-op if afebrile, tolerating po fluids, vital signs are stable, bleeding is not excessive,

    and/or when PCA/Epidural pain medications are discontinued. For Rh negative patients, maintain IV access until

    cord blood results obtained. Convert to INT if diabetic (> Class A) 2

    SCHEDULED MEDICATIONS:

    14. Prenatal vitamin po daily patient may self-administer own prenatal vitamin after pharmacist identifies medication -+15. Rh(D) immune globulin 300 micrograms x 1 dose if indicated (Rh mother, Rh infant). Rophylac is administered IV o

    or IM , RhoGAM must be given IM only.

    16. MMR II (Mumps/Measles/Rubella) vaccine 0.5 ml SQ x 1 dose if rubella non-immune or equivocal 17. Tdap vaccine (tetanus, diphtheria, acellular pertussis) 0.5 ml IM x 1 dose if patient is candidate (policy 7002-01)

     Cancel Tdap (reason:____________)

    18. Implement “Insulin Subcutaneous for Obstetrics” orders (form # 21502), send to pharmacy

    19. Implement “Magnesium Sulfate for Pre-Eclampsia” orders (form # 20), send to pharmacy

    20. VTE Prophylaxis: Heparin 5,000 units SQ q 12 hrs (do not begin heparin until epidural has been out for two

     hrs)

    *3-10806* FORM 3-10806 REV. 03/2011 Send copy to pharmacy _______

    (initials) Page 1 of 3

POSTPARTUM CESAREAN SECTION PLACE LABEL HERE

    POST-OP ORDERS

     Lovenox (enoxaparin) 40 mg SQ q 24 hrs at 1700; if CrCl < 30, give 30 mg SQ q 24 hrs (do

    not begin enoxaparin until epidural has been out for 12 hrs)

The following orders will be implemented. Orders with a “ are choices and are NOT implemented unless checked.

21. Stool Softener: Colace (docusate) 100 mg po bid. Hold for loose stools

    22. Antibiotics: ___________________________________________________________________________________ 23. Antihypertensives: _____________________________________________________________________________

    PRN MEDICATIONS:

    24. Excessive bleeding: Establish IV access if not present; Pitocin (oxytocin) 40 units in 1,000 ml NS or LR IV and infuse

    wide open; decrease rate to 125 ml/hr once bleeding has decreased and fundus is firm. If not hypertensive or pre-

    eclamptic, give Methergine (methylergonovine) 0.2 mg IM x 1 dose

    25. Breast feeding discomfort: Lanolin breast cream topically prn after breastfeeding 26. Severe pain: PCA/epidural for post-op pain per preprinted order. Discontinue PCA/epidural at 12 hrs post-op

    ; Toradol (ketorolac) 30 mg IV (or IM if no IV access) q 6 hrs prn (if patient weight <50 kg, give 15 mg) 27. Moderate pain:

    Percocet (oxyCODONE/acetaminophen) 5/325 mg 1-2 tabs po or 10/325 mg 1 tab po q 4 hrs prn.

    Give first dose 4 hrs prior to DC of PCA/epidural, and give second dose at time of DC of PCA/epidural

    OR Lortab (HYDROcodone/acetaminophen) 5/500 mg 1-2 tabs po or 10/500 mg 1 tab po q 4 hrs prn, DC

    Percocet. Give first dose 4 hrs prior to DC of PCA/epidural, and give second dose at time of DC of

    PCA/epidural.

    OR Other: ____________________________________________________________. DC Percocet 28. Mild pain: Ibuprofen 600 mg po q 6 hrs prn. Hold if Toradol (ketorolac) is also ordered; may resume 6 hrs after

    Toradol (ketorolac) is discontinued. May use while on PCA or 1-2 hrs prior to DC of epidural.

    If unable to take ibuprofen: Tylenol (acetaminophen) 1,000 mg po q 6 hrs prn 29. Patient may self-medicate and keep these medications at bedside:

    a. Episiotomy pain: Dermoplast (benzocaine) spray topically prn

    b. Episiotomy or hemorrhoid discomfort/pain: Witch hazel pads topically with pericare prn

    c. Hemorrhoid discomfort/pain: Dibucaine ointment topically with pericare prn

    30. Nausea:

    Phenergan (promethazine) 12.5 - 25 mg po q 4 hrs prn mild nausea. If unable to tolerate po, may give Phenergan

    (promethazine) 12.5 - 25 mg suppository per rectum q 4 hrs prn nausea

     OR Zofran (ondansetron) 4 mg IV q 6 hrs prn. DC Phenergan

     OR Other: ________________________________________________. DC Phenergan

    31. Sleep: Ambien (zolpidem) 5-10 mg po at bedtime prn. If 5 mg given, may repeat x 1 dose after 2 hrs 32. Indigestion: Maalox XS (aluminum/magnesium/simethicone) 30 ml po four times daily prn 33. Constipation: Dulcolax (bisacodyl) 10 mg suppository rectally prn, may repeat x 1 in 1 hr if no bowel movement 34. Gas pain: Simethicone 80 mg po four times daily prn

    35. Pruritis: Benadryl (diphenhydramine) 25-50 mg po q 4 hrs prn

     Benadryl (diphenhydramine) 12.5-25 mg IV q 4 hrs prn

    36. Congestion: Saline nose spray q 2 hrs prn

    ;;;;;; Sudafed PE (phenylephrine) 10 mg po q 4 hrs prn

    ;;;; Mucinex (guaifenesin) 600 mg q 12 hrs prn

    37. Cough: Robitussin DM (guaifenesin/dextromethorphan) 10-20 ml po q 6 hrs prn. DC if Mucinex (guaifenesin) ordered

    ADDITIONAL ORDERS:

    ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________

FORM 3-10806 REV. 03/2011 Send copy to pharmacy _______ (initials) Page 2 of 3

POSTPARTUM CESAREAN SECTION PLACE LABEL HERE

    POST-OP ORDERS

    ______________ ___________________ _________________________________ __________ Date Time Physician Signature PID Number

    *3-10806* FORM 3-10806 REV. 03/2011 Send copy to pharmacy _______ (initials) Page 3 of 3

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