CARDIAC SURGERY ADMISSION ORDERS by djd18436

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									Allergies _________________________________________________________________                                        Diabetic

Orders NOT preceded by a check   box will be followed unless lined out.
Orders preceded by a check  box will be followed when box is checked. Completed blank lines supercede
pre-printed text.

Patient Care
1.   Admit to:     Inpatient acute care     Inpatient monitored bed     ACC
2.   Notify Cardiac Surgery Nurse Practitioner of admission
3.   Vital Signs every 4 hours.
4.   Weigh daily.
5.   Activity:    Up ad lib    BR with BRP       Bedrest
6.   Diet:     Heart Healthy        _____________Calorie ADA         Other: ____________________________
7.   Hibiclens shower (bath if on bedrest) night before surgery.
8.   Surgical Prep to be done 3 hours prior to surgery: Clip neck to groin (including groin) and inner aspect of both
     legs, groin to ankle. Do not include arms unless radial artery graft is included. Shower (bath if on bedrest) with
     Hibiclens after clipping.
9.   Pre-operative teaching per Nurse.
10. Document current weight and BP readings from both arms on the Pre-Op Checklist.
11. Place signed, informed consent on chart. Procedure:
               Coronary artery bypass grafting                            Atrial septal defect repair
               Aortic valve replacement                                   Ventricular septal defect repair
               Mitral valve repair or replacement                         Replacement of ascending aorta
               MAZE Procedure                                             Left Ventricular Aneurysmectory
               Tricuspid valve repair or replacement                      Transmyocardial Revascularization
               Transesophageal echocardiogram                             Blood Transfusion
               Permanent pacemaker insertation or revision
12.      OK to transport to OR without monitor
13.      NPO after midnight on ______________________________________________________________
Medications
1.  DISCONTINUE:          Clopidogrel (Plavix)      Ticlopidine (Ticlid)      ASA      Warfarin (Coumadin)
                          Enoxaparin (Lovenox)      Heparin              Other ___________________________
2.    NTG 0.4 mg po sublingual prn chest pain. May repeat every 5 minutes x 2, then call MD.
3.       Metoprolol (Lopressor) 25 mg po bid or _______mg every ____ . Hold for HR <65 or SBP <100mmHg.
4.    Bisacodyl (Dulcolax) suppository 10 mg prn or Fleets Enema prn constipation.
5.    Pre-meds per Anesthesiologist.
6.    Alprazolam (Xanax) 0.25 mg po every 4 hours PRN anxiety, may repeat x1 if anxiety unrelieved.
7.    Chlorhexidine Gluconate (Peridex) 0.12% oral rinse 15 mL morning of surgery.
8.    Mupirocin (Bactroban Nasal): apply 0.5 gm to each nostril on PM prior to and AM of surgery.
9.       Temazepam (Restoril) 15 mg (7.5 mg if age >65 years) po HS prn sleep. MR x1.       Zolpidem (Ambien) 5
      mg po HS prn insomnia. MR x1.
     Other: _________________________________________________________________________________
Blood Glucose Monitoring and Insulin
1.    SIOS (Subcutaneous Insulin Order Set)
2. RBS on call to O.R.
Date _____/_____/_____   Time_____:_____ am/pm   MD Signature _____________________________________________   VO/TO Readback
Date _____/_____/_____   Time_____:_____ am/pm   RN Signature _____________________________________________   Initials _________


                                                                                Patient Identification



      CARDIAC SURGERY ADMISSION ORDERS

GHF-PO-3-NS (Rev 10/18/06) page 1 of 2
Laboratory and Diagnostic Tests (use pedi-tubes for lab draws)
1.  CXR (PA and Lateral) on admission (if not performed within 1 week in this hospital).
2.  EKG on admission (if not performed within 1 week in this hospital).
3.  Hemogram, BMP, renal panel, fasting BG (NPO at least 4 hours), HbA1c for diabetic patients.
4.  Type and crossmatch_____ units of RBCs for surgery. Date of surgery: _____________ .
5.  Have available _____ units of FFP or _______units Platelets.
6.  Urinalysis.
7.  Nares screen to r/o MRSA on admission (if not done in PAES).
8.  O2 sat on RA.
9.     Bilateral Carotid Duplex Study.
10.    TEG.
11.    PT/PTT.
12.    Platelet function assay.
13.    Pulmonary to do bedside spirometry on patients >45 years old with positive smoking history.
14.    Complete PFT.
15. Other ___________________________________________________________________________________
    ________________________________________________________________________________________




Date _____/_____/_____   Time_____:_____ am/pm   MD Signature _____________________________________________

Date _____/_____/_____   Time_____:_____ am/pm   RN Signature _____________________________________________
                                                                        Patient Identification



CARDIAC SURGERY ADMISSION ORDERS



GHF-PO-3-NS (Rev 10/18/06) page 2 of 2

								
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