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Liver Transplant Post Op Plan - .Liver and Kidney Transplant Post Op Plan [R] ... Liver and Kidney

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    Physician Orders ADULT

    Liver and Kidney Transplant Post Op Plan[R] = will be ordered

    T= Today; N = Now (date and time ordered)

    Height: ___________cm Weight: __________kg

    Allergies: [ ] No known allergies

    [ ]Medication allergy(s):_____________________________________________________________________

    [ ] Latex allergy [ ]Other:__________________________________________________________________

    [ ] Initiate Power Plan Phase T;N, Phase: Liver and Kidney Transplant Postop Phase,

    When to Initiate:_________________

    [ ] Vital Signs T;N, V/S to Monitor:_________________ q15 minutes x4, q30 minutes x2, then q1h

    [ ] Pulmonary Capillary Wedge

    Pressure Monitoring

    T;N, q4h

    [ ] Bedrest T;N, Routine

    [ ] NPO T;N, except for meds

    [ ] VTE Other SURGICAL

    Prophylaxis Plan

    (Print separate sheet)

    [ ] Daily Weights T;N, qam

    [ ] Intake & Output T; N, Routine, q1hr

    [ ] Turn Cough and Deep Breathe T;N, Routine, q1h- Awake

    [ ] Incentive Spirometry NSG T;N, Routine, q1h- Awake

    [ ] O2 Sat Monitoring NSG T;N, Routine

    [ ] Nasogastric Tube T;N, Suction Strength: Low Intermittent, clamp for medications as tolerated

    [ ] Dressing Care T;N, Routine, Action: Change, Location: Central Line, Wednesday, and PRN for

    soiled, loosened and moist dressings.

    [ ] Indwelling Urinary Catheter Care T;N, q shift, PRN

    [ ] Continue Foley per protocol T;N, Reason: s/p Kidney, Liver or Pancreas Transplant

    [ ] SCD Apply T;N, Apply to: Lower Extremities

    [ ] Restraint Medical / Surgical (non-

    violent, non-self-destructive)

    T;N, For patients on mechanical ventilation. Site: _____________ Order Comment:

    Based on my assessment of the patient, I have concluded that protective restraint

    should be initiated/continued as specified until the indications are no longer present

    or throughout the following calendar day, whichever comes first.

    [ ] Restraint Medical Surgical Nursing T;N, Routine, q12h. For patients on mechanical ventilation. Special Instructions: for

    patients on mechanical ventilator. Order Comments: Based on my assessment of

    the patient, I have concluded that protective restraint should be initiated/continued

    as specified until the indications are no longer present or throughout the following

    calendar day, whichever comes first.

    *111*

    Uncategorized

    Vital Signs

    Food/Nutrition

    Patient Care

    Activity

    TRANS Liver and Kidney Transplant Post-Op Plan

    22427-PP- QM1112-Rev110414

    Page 1 of 5

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    Physician Orders ADULT

    Liver and Kidney Transplant Post Op Plan[R] = will be ordered

    T= Today; N = Now (date and time ordered)

    [ ] Whole Blood Glucose Nsg T;N, q4h

    [ ] Transplant Organ Perfusion Date

    and Time

    T;N, Perfusion date:_______________, Perfusion time________________

    [ ] Nursing Communication T;N, once extubated discontinue all IV narcotics and anxiolytics AND place one

    order for acetaminophen-oxycodone 5/325, 2 tab, Tab, PO, q6h, PRN Pain, Severe

    ( 8-10), Routine, T;N, Comment: May give 1 tab for Mild ( 1-3) to Moderate ( 4-7)

    pain.

    [ ] Nursing Communication T;N, Notify Transplant Research Coordinator of patient arrival to ICU

    [ ] ISTAT Blood Gases ( RT Collect) STAT, T;N, once

    [ ] ISTAT Blood Gases ( RT Collect) Routine, T;N, q4hrs, For 24 hrs

    [ ] Mechanical Ventilation T;N, Ventilator Mode: CMV/ Assist Control

    [ ] RT Communication T;N, once, Once patient is extubated, discontinue ABG order.

    [ ] D5 1/2NS 1000mL,IV,Routine, at 100 mL/hr

    [ ] 1/2 NS 1000mL,IV,Routine, (for 24 hr),replacement fluid,T:N, Replace UOP q1h, see

    comments for rates

    Comment:

    Urine output per hour IV fluid per hour

    1-300 mL replace 100% of urine output

    301-500 mL replace 80% of urine output

    greater than 500 mL replace 60% of urine output

    [ ] Nursing Communication T; N Contact physician within 24 hours after initiation of 1/2 NS replacement fluid

    order to determine if order is necessary beyond 24 hours.

    TRANS Liver and Kidney Transplant Post-Op Plan

    22427-PP- QM1112-Rev110414

    Respiratory Care

    NOTE: 1/2 NS replacement fluid order below is active for 24 hours. If a longer duration is necessary, modify the

    duration details.

    Patient Care (continued)

    Continuous Infusions

    Replacement Fluids

    NOTE: Ordering Physician MUST complete order details of Date & Time below:

    Nursing Communication

    Page 2 of 5

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    Physician Orders ADULT

    Liver and Kidney Transplant Post Op Plan[R] = will be ordered

    T= Today; N = Now (date and time ordered)

    [ ] mycophenolate mofetil (Cellcept) 1 g, Oral Susp, NG, bid, Routine, To be given at 0600 and 1800, Comment: Once

    extubated and tolerating PO change route to PO

    [ ] ampicillin-sulbactam 1.5 g, IV Piggyback, IV Piggyback, q6h, Routine, (for 2 days), Comments:

    Coordinate first dose with antibiotics given in surgery.

    [ ] clindamycin 600 mg, IV Piggyback, IV Piggyback, q8h, Routine, ( for 2 days), Comment:

    Coordinate first dose with antibiotics given in surgery.

    [ ] azetreonam 1 g, IV Piggyback, IV Piggyback, q8h, Routine, T;N ( for 2 days), Comment:

    Coordinate first dose with antibiotics given in surgery.

    [ ] valganciclovir 450 mg, Tab, PO, QODay, Routine, T+1;N (for 30 days), Comment: CMV

    prophylaxis

    [ ] valganciclovir 450 mg, Oral Susp, NG, QODay, Routine, T+1;N (for 30 days), Comment: CMV

    prophylaxis

    [ ] nystatin 100,000 units/mL, oral

    suspension

    5 mL, Oral Susp, PO, tid, Routine, Comment: Swish and Swallow. For fungal

    prophylaxis

    [ ] sulfamethoxazole-trimethoprim

    (Septra)

    80 mg, Tab, PO,q24hr, Routine, T+3;N, (for 30 3 days) Dose expressed as mg of

    trimethoprim, Comment: Please give at bedtime. PCP prophylaxis

    [ ] dapsone 25 mg, Tab, PO, Qday, Routine, T+3,N

    [ ] Transplant Sliding Scale Insulin Protocol (Print separate Sheet)[ ] famotidine 20 mg, Injection, IV Push, q12h, Routine, T;N

    [ ] esomeprazole 40 mg, Injection, IV Push, Qday, Routine, T; N

    [ ] Phytonadone Phytonadone (Vitamin K) 10mg IV Piggyback every 8hrs x3 doses. Comment: Begin

    first dose immediately post-op arrival to TICU.[ ] cloNIDine 0.1 mg, Tab, PO, q4h, PRN Hypertension, Routine,PRN SBP greater than 180

    mmHg or DBP greater than 90 mmHg

    [ ] LORazepam 0.5mg, Injection, IV Push, once, PRN Agitation, Routine, T;N, Comment:

    discontinue once patient is extubated

    [ ] morPHINE 2mg, Injection, IV Push, q4h, PRN Pain (severe 8-10), Routine, Comment:

    discontinue once patient is extubated

    [ ] morPHINE 1mg, Injection, IV Push, q4h, PRN Pain (moderate pain 4-7), Routine, Comment:

    discontinue once patient is extubated

    Medications

    Immunosuppression Medications

    TRANS Liver and Kidney Transplant Post-Op Plan

    22427-PP- QM1112-Rev110414

    Other Medications

    Anti-Infective Medications

    NOTE: If allergic to Penicillin/Cephalosporins place both orders below:

    NOTE: If allergic to Sulfa place order below:

    NOTE: Place only one order below :

    NOTE: If enrolled in research study, please check for research protocol and orders.

    Page 3 of 5

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    Physician Orders ADULT

    Liver and Kidney Transplant Post Op Plan[R] = will be ordered

    T= Today; N = Now (date and time ordered)

    [ ] HYDROmorphone 1mg, Injection, IV Push, q4h, PRN Pain (severe 8-10), Routine, Comment:

    discontinue once patient is extubated

    [ ] HYDROmorphone 0.5mg, Injection, IV Push, q4h, PRN Pain (moderate pain 4-7), Routine, Comment:

    discontinue once patient is extubated

    [ ] hepatitis B immune globulin

    intravenous solution

    9,360 units, Injection, IV, qDay (6 dose), Routine, T+1;N, Comment: Total of 6 post

    op doses, may round to nearest vial size

    [ ] acetaminophen 650 mg, Tab, PO, qDay (6 dose), Routine, T+1;N, Comment: Please give 30 min

    prior to Hepatitis B immune globulin administration.

    [ ] diphenhydrAMINE 25 mg, Cap, PO, qDay (6 dose), Routine, T+1;N, Comment: Please give 30 min

    prior to Hepatitis B immune globulin administration.

    [ ] lamivudine 150 mg, Tab, NG, qDay, Routine, Comment: once extubated and tolerating PO,

    change route to PO

    NOTE: Labs for first 24 hours

    [ ] O2 Saturation Meas Oximetry STAT, T;N, once, Blood, nurse collect

    [ ] CBC STAT, T;N, once, Blood

    [ ] Comprehensive Metabolic Panel STAT, T;N, once, Blood

    [ ] Calcium Ionized STAT, T;N, once, Blood

    [ ] Prothrombin Time ( PT/INR) STAT, T;N, once, Blood

    [ ] Partial Thromboplastin Time ( PTT) STAT, T;N, once, Blood

    [ ] Phosphorus Level STAT, T;N, once, Blood

    [ ] Magnesium Level STAT, T;N, once, Blood

    [ ] Fibrinogen Level STAT, T;N, once, Blood

    [ ] CBC Time Study, T;N+240, q4h, x5 occurrence, Blood

    [ ] AST Time Study, T;N+240, q4h, x5 occurrence, Blood

    [ ] Potassium Level Time Study, T;N+240, q4h, x5 occurrence, Blood

    [ ] Glucose Level Time Study, T;N+240, q4h, x5 occurrence, Blood

    [ ] Prothrombin Time ( PT/INR) Time Study, T;N+240, q4h, x5 occurrence, Blood

    NOTE: AM Labs

    [ ] O2 Saturation Meas Oximetry Routine, T+1;N, qam, Blood, nurse collect

    [ ] CBC Routine, T+1;N, qam, Blood,