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Post-Op Total Hip Replacement Or

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Post-Op Total Hip Replacement Or Powered By Docstoc
					                O                        O                     O                         O                       O
                                                                                           Patient Name:_________________________
                                                                                                    MRN:_________________________
Admit to inpatient status on the HMI unit.

CONSULT: Dr.__________________________________________________              for   ___________________________________

ACTIVITY
Routine Hip Replacement Position Precaution:  Anterior/Lateral approach    Posterior approach
 Pillow between legs in bed.       Abduction splint between legs in bed.
 Knee Immobilizer           OOB         at Night
 OOB Day of Surgery        OOB POD 1
Weight Bearing Status: ___________WBAT ___________ %PWB ___________TDWB __________NWB

Physical Therapy Consult
Occupational Therapy Consult                                                 MRSA Screening/Swab Result:
                                                                              Positive  Pending
MD ORDERS FOR NURSING CARE                                                    Negative  Patient has history
Initiate HMI Glucose Management Protocol.
If patient has a documented history of MRSA or positive screening (refer to box above):
     Mupirocin (Bactroban) 2 % Ointment to both nares BID for a total of 5 days (preoperative doses included).
     Hibiclens Soap: Wash Neck to toe Daily for a total of 5 days (preoperative days included).
     Contact Precautions
Place patient on High Risk Fall Precautions.
If a Wound Team consult is written by nursing for a skin integrity issue, they may evaluate and treat.
Routine Post Op Vitals.
Incentive Spirometry every hour while awake.
O2 2L/min via NC overnight or titrate to keep O2 sat greater than 90%.
Foley Catheter to gravity. Discontinue on POD 1.
Straight catheter every 6 hours and p.r.n. inability to void.
Dressing Change Daily starting on POD_____. Change with ____________________________________.
 Foot pumps         Ted hose        SCDs
 Hemovac: Empty and record drainage every shift. Discontinue POD 1.
 Auto Transfusion: Drain per protocol. Other ________________________________________________.

LABS/TESTS
PACU:  XRAY AP Pelvis  Right Hip  Left Hip    Hgb& HCT              CBC
Hgb & Hct every AM on POD1 & POD2, CBC POD 3
 Prothrombin time every AM
 Other: ______________________________________________

DIET:
Clear liquids, and then advance to _____________________________ when tolerated.

DISCHARGE PLANNING
Discharge Planning Consult
 Home Health __________________  Short Term Rehab_________________  Other_____________
 Discharge home on Enoxaparin (Lovenox) 40 mg subcutaneous daily X ___________ days.
Durable medical equipment for post-discharge use:
 Walker  Cane  Bedside Commode (3 in 1)  Crutches
 Elevated toilet seat (Requires letter of medical necessity from physician to Insurance Company)
 Other __________________________________________________________________

PHYSICIAN'S SIGNATURE ____________________________________________Date/Time______________
           Bolded items will be implemented unless marked through and dated to indicate orders NOT wanted.
                                                   Total Hip Replacement
                                                      Post Op Orders
                                                Tab: Physician Orders
                                                Page: 1 of 2      Inventory#: 1023
                                                Revision Date: 12/2008
                                                Rx Code: OS1023P1
                 O                          O                        O                           O                        O
                                                                                                   Patient Name:_________________________
                                                                                                            MRN:_________________________
MEDICATIONS

IV:   _____________________________________ at________________ml/hr. Heplock IV when tolerating PO.

See Adult Post-Operative Prophylactic Antibiotic Order Set (SCIP)
 For Patients with a known and documented infection that fall out of SCIP parameters:
  Antibiotic: _____________________________ IV / PO every _______ hours for a total of _______ doses / days.
 Colace 100 mg PO BID.
 Iron ____________________________ daily.
 Celebrex (Celecoxib) 200 mg PO BID. First dose tonight at 2100.
 Warfarin (Coumadin)              mg PO today. Check daily with physician for orders for future Warfarin doses.
 Warfarin (Coumadin) per pharmacy protocol.
 Enoxaparin (Lovenox) 30 mg Subcutaneous every 12 hrs, starting_______________(First dose POD #1 at 0600 if not specified – within
  24 hours of surgery end time)
 Other __________________________________________________________________________________

ANALGESIA FOR SEVERE PAIN
 PCA: per PCA order sheet.  Discontinue PCA POD_______
 Morphine 6 - 8 mg IV every hour p.r.n.*
 Hydromorphone (Dilaudid) 0.5 mg IV every hour p.r.n.*
  *Note: If both Morphine and Dilaudid are ordered, use only one agent unless the patient is allergic or intolerant to the other option.
 Other _______________________________________________________________________________

ANALGESIA FOR MILD to MODERATE PAIN
 Morphine 2 - 4 mg IV every 2 hours as needed p.r.n.
 Hydromorphone (Dilaudid) 0.2 mg - 0.4 mg IV every 2 hours p.r.n.
  *Note: If both Morphine and Dilaudid are ordered, use only one agent unless the patient is allergic or intolerant to the other option.
 Oxycodone/Acetaminophen 5/325 mg (Percocet) 1 or 2 tablets PO every 4 hrs p.r.n
 Hydrocodone/Acetaminophen 7.5/500 mg (Lortab) 1 or 2 tablets PO every 4 hrs p.r.n.
 Oxy IR (Oxycodone immediate release) 5 or 10 mg PO every 4 hrs p.r.n.
 Other _______________________________________

ROUTINE ANALGESIA
 Oxycontin 10 mg PO BID                  First Dose in PACU
 Oxycontin 20 mg PO BID                  First Dose in PACU

ANTIEMETIC/ANTIHISTAMINE
 Ondansetron (Zofran) 4 mg IV every 6 hrs p.r.n. for nausea.
 Promethazine (Phenergan) 6.25-12.5 mg IV every 6 hrs p.r.n. for nausea.
 Metoclopramide (Reglan) 10 mg IV every 6 hrs p.r.n. for nausea.
 Hydroxyzine (Vistaril) 25 or 50 mg PO every 4 hrs p.r.n. for itching.

PRN MEDICATIONS
Acetaminophen (Tylenol) 650 mg PO every 4 hrs p.r.n. temp greater than 101.5 F or for mild pain.
Maalox 30 ml PO every 4 hrs p.r.n. heartburn
Glycerin suppository per rectum daily p.r.n., Fleets enema daily p.r.n., Milk of Magnesia 10 ml PO daily p.r.n. constipation
 Zolpidem (Ambien) PO nightly p.r.n. for insomnia  5 mg  10 mg
 Other: ___________________________________________________________________________

PHYSICIAN'S SIGNATURE ___________________________________Date/Time_______________________
            Bolded items will be implemented unless marked through and dated to indicate orders NOT wanted.
                                                        Total Hip Replacement
                                                           Post Op Orders
                                                     Tab: Physician Orders
                                                     Page:2 of 2       Inventory#: 1023
                                                     Revision Date: 12/2008
                                                     Rx Code: OS1023P2

				
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