| Clinical Area |
Goals |
Specifics |
| Pain Management - Acute Pain Service |
- Analgesia
- Convert to PO by POD #1-2 once enteral nutrition started
|
- Consult Acute Pain Service after surgery with full consultation to begin once patient extubated as per clinical team.
- If ketamine infusion started in the OR and continued in the PICU, dosing should be determined by the Pain Service and any dosing changes should be discussed with the Pain Service. In general, the ketamine infusion rate should not be increased and additional opioids and benzodiazepines should be given for increased pain.
|
| Blood Management |
|
- Transfusion Guidelines
- Consider transfusion if Hemoglobin < 9 g/dL and patient is symptomatic
- Transfuse for Hemoglobin < 7 g/dL
|
| Nutrition |
- Advance
- Begin/resume bowel regimen
- Monitor for ileus
|
- Advance diet per home routine as tolerated
- Advance to oral diet if eating by mouth
- If tube fed, consider conversation with primary caregiver; slowly advance baseline feeds as tolerated
- Discontinue IVF once patient tolerating clears/tube feeds
- Begin bowel regimen or resume home regimen
- Begin BID Famotidine POD #0 until tolerating oral/baseline diet.
- Convert to oral Famotidine or baseline PPI
- Monitor for symptomatic ileus:
- Consider adjustments to home bowel regimen, slower feed advances, mobility
- Coffee ground emesis
- Contact FLOC for further workup
|
| Tubes/ Drains |
- Normal UOP
- Incisional Monitoring
|
- Foley catheter
- Maintain and record urine output per unit standard until POD #2
- Remove Foley catheter on POD #2
- If no void 8 hours after removal, bladder scan and consider straight catheterization
- Surgical drains
- Record output from incisional VAC and JP drain(s) q8 hours
- Incisional VAC to be maintained until POD #5 and removed if less than 20 mL/shift
- Reinforce surgical incision site/surgical drain dressings as needed q4 hours
- If surgical incision site dressing becomes saturated, notify Ortho resident or APP
- Dressing change after drain and site inspection on POD #5
- Place Mepilex® Ag dressing with Steri-strips for 1 week
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| Infection Prevention |
|
- Completion of post-operative antibiotics as indicated
|
| Interdisciplinary Communication |
- Notify (via Epic secure chat) Orthopedic resident/NP if dressing is saturated or soiled for dressing change (see contact info on front page)
- Consults, as appropriate, to:
- PT/OT
- Nutrition (if tube-fed at baseline)
- Pulmonary (if followed or require additional intervention)
- Case Management (if needed or if homecare previously in place)
- Neurology (if require AED management while NPO)
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