Spinal Fusion, Post-Op, Adolescent Idiopathic Scoliosis (AIS) — Post-Operative Day 2 — Clinical Pathway: Inpatient

Inpatient Clinical Pathway for Adolescent Idiopathic Scoliosis (AIS) Spinal Fusion Rapid Recovery — Inpatient

Post-operative Day 2

Goals

  • Maintain PO pain regimen
  • Continue advancing mobility
  • Discharge preparation
Pain Management
  • IV Analgesia
    • Continue:
      • Hydromorphone rescue IV q3hr PRN for breakthrough pain
      • Nalbuphine IV q4hr PRN for itching
      • Ketorolac IV q6hr — max 8 doses
      • Ondansetron IV q8hr PRN for nausea/vomiting
    • Complete:
      • Hydromorphone PCA discontinued if not done on POD 1
  • Oral Analgesia
    • Continue:
      • Acetaminophen PO q4hr PRN
      • Oxycodone PO q4hr PRN
      • Diazepam PO q6hr PRN for muscle spasticity
Activity/PT
  • Log roll independently
  • PT and OT daily
  • Ambulate, OOB to chair TID
  • Begin stairs
  • Use brace as needed, if ordered
Nutrition Regular diet as tolerated
Tubes/Drains
  • Record drain output q8hrs — removal to be determined by Orthopaedics/Plastics
  • Reinforce incision site/drain dressings as needed
Respiratory Incentive spirometry q2hrs while awake
Medication Management
Ordered by
Orthopedic Team
  • Continue famotidine, bowel regimen as ordered
  • Severe nausea and vomiting unresponsive to dexamethasone/ondansetron:
    • Consider fluid bolus: 10 ml/kg lactated ringers
    • Additional dexamethasone: 0.1 mg/kg (max: 4 mg) IV over 15 mins (can give up to 2 doses post-op)
Laboratory Imaging
  • No labs unless clinically indicated
  • Scoliosis X-rays (if not obtained in the OR) to be obtained prior to discharge with EOS imaging system a when available
Discharge Planning
  • Ensure home health needs, transportation are available
  • Provide prescriptions for family
  • First incision dressing change at time of discharge
  • Discharge home when goals are met