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, nurse collect

    [ ] Comprehensive Metabolic Panel

    (CMP)

    Routine, T+1;N, qam, Blood, nurse collect

    [ ] Prothrombin Time ( PT/INR) Routine, T+1;N, qam, Blood, nurse collect

    [ ] Partial Thromboplastin Time ( PTT) Routine, T+1;N, qam, Blood, nurse collect

    [ ] Magnesium Level Routine, T+1;N, qam, Blood

    [ ] Phosphorus Level Routine, T+1;N, qam, Blood, nurse collect

    Medications

    TRANS Liver and Kidney Transplant Post-Op Plan

    22427-PP- QM1112-Rev110414

    NOTE: If patient is allergic to morPHINE place one order below :

    NOTE: If Hepatitis B Prophylaxis needed for HBV positive recipient, consider placing orders below:

    NOTE: If Hepatitis B Prophylaxis needed for core antibody positive donor, consider placing order below:

    Laboratory

    Other Medications (continued)

    Page 4 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)

    [ ] Hepatitis B Antibody Routine, T+7;N, once, Blood, nurse collect

    [ ] Chest 1VW Frontal T;N, Reason: Other, Comment: post transplant, STAT, Transport: Portable

    [ ] Chest 1VW Frontal T+1; 0400, Reason : Other, Comment: post transplant, Routine, Transport :

    Portable

    [ ] Chest 1VW Frontal T+2; 0400, Reason : Other, Comment: post transplant, Routine, Transport :

    Portable

    [ ] Chest 1VW Frontal T+3; 0400, Reason : Other, Comment: post transplant, Routine, Transport :

    Portable

    [ ] US Abd Comp w/Delay Diet Plan T;N, Reason for exam : ________________________Other, Routine, Bedside

    [ ] US Abd/Retroper Dup Art in/Vein

    Out Cmp

    T;N, Reason for exam :________________________ Other, Routine, Bedside

    [ ] Notify Physician For Vital Signs Of T;N, Who: Surgical Transplant Resident or Fellow, BP Systolic less than 100 or

    greater than 180, BP Diastolic less than 60 or greater than 90, Celsius Temp greater

    than 38.3, Heart Rate less than 60 or greater than 120, Oxygen Sat less than 94%,

    Urine Output less then 20 mL/hr, Blood Glucose less than 60 or greater than 200,

    CVP less than 2 or greater than 12.

    [ ] Notify Physician- Continuing T;N, Who: Surgical Transplant Resident, For: Platelets less than 25,000 per

    microliter and/or Phosphorus Level less than 3 mg/dL

    [ ] Dietitian Consult T;N, Type of Consult: Other, Nutrition Management

    [ ] Transplant Coordinator Consult T;N, Reason for consult: Transplant Patient arrival to ICU

    [ ] Medical Social Work Consult T;N, Routine, Reason: Other, Comment: Psychosocial Assessment

    [ ] Physical Therapy Initial Eval & Tx T;N, routine

    __________________ __________________ _________________________________________________ __________________

    Date Time Physician's Signature MD Number

    TRANS Liver and Kidney Transplant Post-Op Plan

    22427-PP- QM1112-Rev110414

    Consults/Notifications

    Laboratory continued

    Diagnostic Tests

    NOTE : If patient transplanted for Hepatitis B Virus place order below :

    Page 5 of 5

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