My post-op admit order notes
Thyroid
Hemithyroid:
Drain: .cdldrain
.cdldrainteach
HTN:
Change parameters for call if SBP >150
Nursing communication duplicate: call for SBP > 150
For BP > 150 treat pain rated > 5/10. Perform bladder scan*.
Resume held ace-i
labetolol 10 mg - 20 mg slow IV push every 2 minutes for SBP > 150 (max 300 mg/24 hr), HOLD for HR < 60 or wheezing. [CI: RAD, bradycardia, 2 or 3 heart block, HF]
Hydralazine 10 mg - 20 mg slow IV push, repeat every 4 hrs for SBP > 150 (max 200 mg/24 hr). (“10 mg slow IV push x1. Re-check BP 20 minutes after the first dose and give 10 mg if SBP > 150 mmHg. Re-check BP 20 minutes after 2nd dose and notify MD for SBP > 150 mmHg.)
Enalaprilat 1.25 mg IV over 5 minutes, with doses up to 5 mg every 6 hrs prn SBP > 150 (max 50 mg/24 hr). (“Re-check BP 20 minutes after each dose, and if SBP > 150 mmHg, add another dose 1.25 mg more than the last up to 5 mg per dose. Notify MD if SBP > 150 mmHg after 4th dose.”)
Bladder scan for SBP > 150 or for reported difficulty voiding. If bladder volume < 350 mL, perform straight catheterization. Notify MD for drained urine volume > 700 mL.
OSA:
Contiuous SaO2
RT consult
Order CPAP
.cdlOsaAvoidO2
Total or completion thyroid:
All of the hemithyroid orders plus:
Albumin, calcium, magnesium in PACU
Serial calcium (set iPhone alarms for t+90 min)
Nursing communication: .cdllowcaproto
Tracheostomy
At BroMenn, all new trachs go to the ICU
If ventilated, ICU management. If not ventilated, hospitalists may manage.
“Consult RT”: new trach, trach teaching, including self-suctioning, replacement of the inner cannula, and awareness of mucus plugging
“Trach care” order: Trach cuff to be deflated/inflated, RN to remove trach flange sutures at day 7, change trach ties per protocol
“Nursing communication” Keep a spare size cuffed trach and a spare size cuff less trach at bedside. Transfer these with the patient with any room changes.
“Nursing communication” Keep the obturator taped to the head of bed.
Consult SLP: new trach, trach teaching including cuff education, finger occlusion of the trach, phonation, and use of PMV when a leak is present
24 hrs of antimicrobial prophylaxis, e.g. Unasyn
G tube: Gen Surg usually deflects, Mater (GI) will perform, IR may perform