Edemf2389 north star surgery general surgery orders.indd

Vineet Choudhry, M.D.
12414 Alderbrook Dr., Ste 101
Austin, Texas 78758
512-491-6542 office
512-491-0161 fax
General Surgery Admission / Post-Op Orders
Admit to ObservaƟ on Services Admit to InpaƟ ent DisconƟ nue all preoperaƟ ve orders including medicaƟ ons LocaƟ on:
ICU Med/Surg Med/Surg w /Tel OB Other ________________________________ Diagnosis /Procedure Preformed: __________________________________________________________________
AƩ ending Physician:______________________________ ConsulƟ ng Physician: _____________________________
Vital Signs :
Strict Intake and Output every 4 hours for 24 hours, then every shiŌ Other: ______________________________________________________________________________________ Call Physician if:
Temperature 100.4 degrees F or greater Ɵ mes 2 taken 4 hours apart or 101.5 degrees F or greater one Ɵ me Sustained pulse of greater than 110 or less than 50 for more than 10 minutes RespiraƟ on greater than 25 or less than 8 Sustained blood pressure greater than 160 SBP or 90 DBP on 2 occasions taken 30 minutes apart; or SBP less than 90 or DBP less than 50 Allergies: No Known Drug Allergies Latex __________________________________________________________
AcƟ vity:
Out of bed in the AM out of bed ad lib / as tolerated Other ____________________________________ At least out of bed to halls 3 Ɵ mes a day and to chair 2 Ɵ mes a day Strict NPO Strict NPO aŌ er midnight NPO except ice chips Clear liquid Regular diet ( 1800 calorie AHA 1800 calorie ADA 1800 Calorie Renal) SoŌ mechanical ADAT to Regular 1800 calorie AHA 1800 calorie ADA 1800 calorie Renal diet Other: ______________________________________________________________________________________ North Star Surgery
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General Surgery Orders
Vineet Choudhry, M.D.
12414 Alderbrook Dr., Ste 101
Austin, Texas 78758
512-491-6542 office
512-491-0161 fax
IV Fluids:
10 mEq KCL/ liter IVF 20 mEq KCL/ liter IVF Other _____________________________ IVF rate @ ___________________________ml/HR HLIV when toleraƟ ng good oral intake Nursing:
NoƟ fy physician if urine output is less than 120 ml in 4 hours, less than 250 ml in 8 hours, or DisconƟ nue Foley in AM, replace Foley if unable to void within 6 hours In/out catheterizaƟ on every 4 hours PRN if paƟ ent is unable to void NG tube low intermiƩ ent wall sucƟ on IncenƟ ve spirometry: every 30 minutes while awake with RT to demonstrate. Encourage cough and deep Oxygen O2 @ 2 liters per nasal canula Other________________ Wean O2 per protocol Dressing/Wound Care: ________________________________________________________________________ ________________________________________________________________________ Drains: _____________________________________________________________________________________ MedicaƟ ons:
See MedicaƟ on ReconciliaƟ on Form for all meds AnƟ bioƟ cs:
Post- Op AnƟ bioƟ cs: Physician to choose any one for paƟ ents without Beta-lactam allergy –
not allergic to Penicillin or Cephalosporins Cefazolin (Ancef) 1 gm (2 gm if paƟ ent weight is 80 kg or greater) IV every 8 hours for 24 hours. Post-op doses to be scheduled from the pre-op dose start Ɵ me; AND
Metronidazole (Flagyl) 500 mg IV every 8 hours for 24 hours. Post-op doses to be scheduled from the pre-op dose start Ɵ me CefoxiƟ n (Mefoxin) 1 gm (2 gm if paƟ ent weight is 80 kg or greater) IV every 8 hours for 24 hours. Post-op doses to be scheduled from the pre-op dose start Ɵ me Piperacillin/tazobactam (Zosyn) 3.375 gm IV every 6 hours for 24 hours. Post-Op doses to be scheduled from pre-op dose start Ɵ me Vancomycin 1 gm IV every 12 hours for 24 hours. Post-Op doses to be scheduled from Other : _______________________________________________________________________________ North Star Surgery
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General Surgery Orders
Vineet Choudhry, M.D.
12414 Alderbrook Dr., Ste 101
Austin, Texas 78758
512-491-6542 office
512-491-0161 fax
Post-Op AnƟ bioƟ cs: Physician to choose any one for paƟ ents with Beta-lactam allergy –
Clindamycin (Cleocin) 600 mg (900 mg if paƟ ent weight is 80 kg or greater) IV every 8 hours for 24 hours. Post-op doses to be scheduled from the pre-op dose start Ɵ me; AND
Gentamicin 80 mg (120 mg if paƟ ent weight is 80 kg or greater) IV every 12 hours for 24 hours. Post-Op doses to be scheduled from the pre-op dose start Ɵ me Clindamycin (Cleocin) 600 mg ( 900 mg if paƟ ent weight is 80 kg or greater ) IV every 8 hours for 24 hours. Post–Op doses to be scheduled from the pre-op dose start Ɵ me; AND
Levofl oxacin (Levaquin) 500 mg IV Ɵ mes 1 dose to be scheduled 24 hours from the Metronidazole (Flagyl) 500 mg IV every 8 hours for 24 hours. Post-Op doses to be scheduled from the pre-op dose start Ɵ me; AND
Levofl oxacin (Levaquin) 500 mg IV Ɵ mes 1 dose to be scheduled 24 hours from the Other: _________________________________________________________________________ ConƟ nuous AnƟ bioƟ cs: Reason for conƟ nuing anƟ bioƟ cs : ______________________________________ Piperacillin/tazobactam (Zosyn) 3.375 gm IV every 6 hours Levofl oxacin (Levaquin) 500 mg IV every day Ciprofl oxacin (Cipro) 400 mg IV every 12 hours Metronidazole (Flagyl) 500 mg IV every 8 hours Imipenem/cilastaƟ n (Primaxin) 500 mg IV every 6 hours Other: _________________________________________________________________________ DVT Prophylaxis:
PneumaƟ c Compression Devices and TED hose on paƟ ent unƟ l ambulaƟ ng independently. These should be placed immediately upon arrival to unit if not already in place Pharmacological prophylaxis for DVT not recommended due to excessive intra-operaƟ ve If pharmacological prophylaxis not contraindicated choose one of the following(to be started within 24 hours of surgery Ɵ me if started post-operaƟ vely): Enoxaparin (Lovenox) 40 mg SubQ daily (If creaƟ nine clearance less than 30ml/min,
give enoxaparin 30 mg SubQ daily)
Fondaparinux (Arixtra) 2.5 mg SubQ Daily Stress Ulcer Prophylaxis: Not indicated
Omeprazole (Prilosec) 40 mg PO daily OR Nexium (Esomeprazole) 40 mg IV daily
Pantoprazole (Protonix) 40 mg PO OR IV daily
Famotodine (Pepcid) 20 mg twice daily PO OR IV (If creaƟ nine clearance less
than 50ml/min, give famoƟ dine daily)
North Star Surgery
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General Surgery Orders
Vineet Choudhry, M.D.
12414 Alderbrook Dr., Ste 101
Austin, Texas 78758
512-491-6542 office
512-491-0161 fax
Comfort MedicaƟ ons:
Metoclopramide (Reglan) 10 mg IV every 4 hours PRN nausea Ondansetron (Zofran) 4 mg IV every 6 hours PRN for breakthrough nausea or vomiƟ ng Promethazine (Phenergan) 6.25 mg IV every 6 hours PRN severe nausea or vomiƟ ng Ketorolac (Toradol) 30 mg IV iniƟ al dose, then 30 mg IV every 6 hours PRN pain Ɵ mes 48 hours or as anƟ -infl ammatory or as adjunct to pain medicaƟ on (no other non- steroidal anƟ -infl ammatories while Toradol order in eff ect) Morphine: ______________________________________________________________________ Dilaudid: _______________________________________________________________________ Hydrocodone/acetaminophen 325 mg (Norco) 5mg 7.5 mg 10 mg 1-2 tabs Ibuprofen: ______________________________________________________________________ Acetaminophen (Tylenol): __________________________________________________________ Other: _________________________________________________________________________ Acetaminophen (Tylenol) 650 mg PO every 4 hours PRN headache or temp > 101.1 F Aluminum/ Magnesium/Simethicone (Maalox Plus) 30 ml PO every 4 hours PRN indigesƟ on/gas Aluminum Hydroxide 30 ml PO every 4 hours PRN indigesƟ on ( for Renal paƟ ents) Milk of Magnesia (MOM) 30 ml PO every 6 hours PRN for consƟ paƟ on Docusate Calcium (Surfak) 240 ml PO daily PRN consƟ paƟ on as stool soŌ ener Bisacodyl (Dulcolax) 10 mg PO BID PRN consƟ paƟ on. If unable to take PO, give suppository PR Psyllium (Metamucil) 1 package PO BID PRN consƟ paƟ on, as fi ber supplement Zolpidem (Ambien) 5 mg OR 10 mg PO at bedƟ me PRN insomnia
Temazepam (Restoril) 15 mg PO at bedƟ me PRN insomnia If 65 or over use 7.5 mg PO at bedƟ me and repeat 1 Ɵ me if needed Diphenhydramine (Benadryl) 25 mg PO every 6 hours PRN itching/rash. If unable to Guaifensin/Dextromethorphan (Robitussin DM) 10 ml PO every 4 hours PRN cough/congesƟ on NicoƟ ne patch: Apply daily to skin PRN nicoƟ ne withdrawal. Dose: 21 mg 14 mg 7 mg
Docusate sodium (Colace) 100 mg PO BID Other: _________________________________________________________________________ Other MedicaƟ ons :
Cardiac Meds: ____________________________________________________________________________ _________________________________________________________________________________ DiabeƟ c Meds: ___________________________________________________________________________ _________________________________________________________________________________ Other: _________________________________________________________________________________ _________________________________________________________________________________ North Star Surgery
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General Surgery Orders
Vineet Choudhry, M.D.
12414 Alderbrook Dr., Ste 101
Austin, Texas 78758
512-491-6542 office
512-491-0161 fax
Lab/DiagnosƟ c :
None In AM (Date:______) Post-op ( PACU Upon arrival to fl oor) Admission (ASAP) Other: ______________________________________________________________________________________ Evaluate and Treat: N/A
Case Manager / SW to start discharge planning Other Orders: None
__________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ PRINTED PHYSICIAN’S NAME: ___________________________________________________________________________________
PHYSICIAN’S SIGNATURE: ______________________________________________________________________________________
TIME: ____________________________________ DATE: ____________________________________
North Star Surgery
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General Surgery Orders

Source: http://www.northstarsurgery.com/forms/RRMCOrderSet.pdf