| Pain Management |
- Transition to oral analgesia when tolerating diet
- Start:
- Acetaminophen PO q4hr PRN for mild pain
- Oxycodone PO q4hr PRN for moderate pain
- Discontinue PCA once tolerated
- Continue:
- Diazepam PO q6hr PRN for muscle spasticity
- IV Analgesia
- Discontinue hydromorphone PCA if transition to oral analgesia is tolerated
- Continue:
- Hydromorphone IV q3hr PRN for breakthrough pain
- Nalbuphine IV q4hr PRN for itching
- Ketorolac IV q 6hr, Max 8 doses
- Ondansetron IV q8hr PRN for nausea/vomiting
- Complete:
- 3 doses acetaminophen IV, convert to PO
|
| Activity/PT |
- Turn q2hr and PRN until moving independently
- Toe touch weight bearing (TTWB) on affected extremity with hip ROM precautions
- PT and OT daily
- OOB to chair or bedside commode TID
- Ambulate with crutches or rolling walker
- Use CPM 0-50° on 2 hrs, off 2 hrs while awake when indicated
|
| GI |
- Transition famotidine to PO
- Start:
- Bowel regimen
- Polyethylene glycol 17 g daily
- Senna nightly
- Bisacodyl suppository PRN
- Severe PONV rescue plan:
- Consider 10 ml/kg lactated ringers IV bolus
- Consider scheduled ondansetron q8hrs
- Additional dexamethasone IV 0.1 mg/kg up to 4 mg over 15 mins,
max 2 doses post-op
|
| Nutrition |
- Advance diet as tolerated
- Discontinue IVF once tolerating clears
|
| Tubes/Drains |
- Remove Foley by 10 a.m.
- If no void in 6 hrs after Foley removal, bladder scan and notify provider
- Record Hemovac drain output q8hrs
- Reinforce incision site/drain dressings as needed
|
| Respiratory |
Incentive spirometry q2hrs while awake
|
| Other Medications |
|
| Laboratory |
- 0600 Phlebotomy Round
- CBC (no diff), Type and Screen
|
| Discharge Planning |
- Assess home health and transportation needs
- Evaluate for DME needs and coordinate with case management
- Provide family with post-operative education
- Review and initiate home exercise program
|