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medical_student:diep_post-op_protocol

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medical_student:diep_post-op_protocol [2021/02/14 13:31] – jonathanmedical_student:diep_post-op_protocol [2022/05/11 14:28] (current) – ryan
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-*For Kaoutzanis ERAS DIEP Protocol, see the link to his page. +==== DIEP Post-Op Protocol ====
- +
-Admission Order\\ +
-Admit: Chong (Unit: Stepdown)\\ +
-Admit: Mathes (Unit: Stepdown)\\ +
-Admit: Other (Unit: Stepdown)\\ +
- +
-Code Status\\ +
-Full Code\\ +
- +
-Nursing Orders\\ +
-Strict I&O, Every 4 hours\\ +
-Weight patient on admit\\ +
-Weigh patient every morning\\ +
- +
-Nursing Flap Checks and Vital Signs\\ +
-PACU: Q15 minutes for 4 hours\\ +
-POD#0: Q1H\\  +
-POD#1: Q1H\\  +
-POD#2: Q2H\\  +
-POD#3: Q4H\\ +
- +
-Nursing Communications\\ +
-Notify physician for increased swelling or color changes to flap\\ +
-Notify physician for increasing redness or drainage from the wound\\ +
- +
-Notify physician for Vioptix parameter change by 15% or greater than baseline\\ +
-Flow Coupler on at all times\\ +
-Notify physician if there is a change in the sound of the venous coupler device\\ +
- +
-No Caffeine, Every Shift\\ +
-Call physician for vital signs outside of normal ranges\\ +
-Flexed at waist including for ambulation\\ +
-No ice to breasts\\ +
-Elevate head of bed to 30 degrees\\ +
-Maintain Foley\\ +
-BCIV with good PO intake\\ +
-Telemetry monitoring\\ +
-Continuous pulse oximetry\\ +
-Incentive spirometer q1 while awake\\ +
-Wean supplemental O2 as tolerated to keep sats above 88%\\ +
- +
-Neuro:\\ +
-APAP 1g q6h PRN\\ +
-Oxy 5mg q6h PRN\\ +
-No toradol\\ +
-PCA Dilaudid 0.2 q 10 min lockout\\ +
-**Discontinue PCA POD#2**\\ +
-Zofran IV q6 PRN\\ +
-Ativan 1 mg q8 PRN\\ +
- +
-Pulm: IS, wean O2\\ +
- +
-CV: Hold home HTN medications POD#0\\ +
- +
-FEN/GI:\\ +
-mIVF D5W-1/2NS+20KCl at 100cc/hr\\ +
-POD#0, NPO, except medications\\ +
-POD#1, CLD, no caffeine\\ +
-POD#2, Reg, no caffeine\\ +
-Colace sch BID\\ +
-Miralax daily prn\\ +
- +
-GU:\\ +
-**Discontinue Foley on POD#1 if able to get OOB to chair\\** +
- +
-Heme: \\ +
-POD#0 ASA suppository\\ +
-POD#1: ASA 81 and Lovenox 40 mg qd if no concern for bleeding\\ +
- +
-ID: Periop ABX for 24 hours (Ancef, Clinda or Vanc)\\ +
- +
-Labs:\\ +
-POD#1 CBC, BMP, Mg, Phos\\ +
-Continue labs if patient remains NPO or discretion of resident\\ +
- +
-Activity Consults:\\ +
-POD#0: Bedrest\\ +
-**PT/OT\\** +
-Restrictions: BUE <5 lbs weight limit. No pushing or pulling. Okay to rest hands on walker for transfers and ambulation. Limit ROM of shoulders to 45 degrees abduction and extension, 90 degrees for flexion. Keep patient flexed at waist at approximately 30 degrees or greater, including while ambulating and transferring.\\   +
-POD#1: OOB to chair\\ +
-POD#2: Walk\\ +
- +
-Discharge: +
-**Lovenox 40 qd for 2 weeks (prophylactic dosing- ASK. Cohen and Kaoutzanis do not send out with ppx Lovenox)**\\ +
-ASA 81 for 1 month\\ +
-Pain Meds\\ +
-Valium\\ +
-No caffeine for 1 month (Cohen says caffeine is OK)\\ +
- +
-Order Set Name:\\ +
-Physician Owner:\\ +
-Nurse Owner:\\+
  
 +Minor differences are **bolded**.\\
 +Subject to change.\\
 +Use the Surgical Pathway --> Plastic and Reconstructive Sugery --> DIEP order tab for streamlined orders; only confusion is the PACU flap check order.\\
 +\\
 +{{url>https://docs.google.com/spreadsheets/d/e/2PACX-1vRkasIRJjEXC09Y2L8TqAdJbv3VTU9ygPpEFyr3O4PkkJrPVP3Zd3Nzd8KWyg8C-oYPBko7aoPgG_5u/pubhtml?gid=0&single=true  1400, 1500, noborder}}
medical_student/diep_post-op_protocol.1613327476.txt.gz · Last modified: 2021/02/14 13:31 by jonathan
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