1.
ALLERGIES/REACTIONS:
\
2.
3.
4.
STATUS:
NUTRITION:
ACTIVITY:
5.
LAB:
6.
VITAL SIGNS:
Per recovery room guidelines
Every 1 hour times 4, every 4 hours times 6, then every 8 hours
Other
Call MD if Temp greater than 100.4° Fahrenheit / 38.5° Centigrade, pulse less than 60 or greater than 120, blood
pressure less than 90 or greater than 160 systolic, if urine output less than 120ml in 4 hours
MEDICATIONS:
7.
INPATIENT
Diet as tolerated
Dangle in 0-6 hours
Out of bed in 6-12 hours, then ambulate at least 2 times per shift
CBC
Rhophylac IV or IM IF INDICATED BY RhoImmune Globulin Workup (RHIG WKUP)
† INTRASPINAL ANALGESIA GIVEN: Anesthesia 24-hour Post-Cesarean Section Intraspinal Analgesia
Orders Supercede All Analgesia Orders for 24 Hours
† GENERAL ANESTHESIA GIVEN: Analgesia Orders Below Are Effective Immediately Post-op
See PCA order sheet
Discontinue PCA at
0500 tomorrow
time/date
See 24- Hour Post-Cesarean Section Interspinal Analgesia Orders
Analgesia: [NOTE: Number only those medications desired. The nurse will select #1 as the first medication to
be given. If ineffective, #2 will be used next, and then #3, #4, etc. Number IV/IM Meds and Oral Meds
separately. If orders chosen are not numbered, the nurse will contact the prescriber for clarification.]
IV/IM Analgesia:
Hydromorphone (Dilaudid)
mg IV every 1 hour PRN pain or
mg IM
every 3 hours PRN pain. (NOTE: 1 mg hydromorphone = 7 mg morphine. Usual starting dose for
hydromorphone is 0.2 – 0.6 mg in opiate naïve patients. Patients with prior opiate exposure may
tolerate higher initial doses.)
Oral Analgesia: (When pain is under control and patient tolerating oral intake, trial oral pain medications. If oral
medications ineffective, continue IV medications and retry oral medications in 6 hours.)
Oxycodone 5 mg with acetaminophen 325 mg (Percocet 5/325) 1-2 tablets PO every 4 hours PRN pain
Hydrocodone 5 mg with acetaminophen 500 mg (Vicodin 5/500) 1-2 tablets PO every 4 hours PRN pain
Oral Medications for Fever, Cramping or Mild Discomfort:
Ibuprofen 400 mg 1-2 tablets PO every 6 hours PRN pain, fever or cramping
Acetaminophen (Tylenol) 325 mg 1-2 tablets PO every 4 hours PRN mild discomfort, fever or cramping
LIMIT THE TOTAL DOSE OF ALL ACETAMINOPHEN CONTAINING PRODUCTS TO 4000MG PER DAY
Break Through Pain:
If above oral medications are ineffective after 1 hour minimum, use
Oxycodone 5 mg 1-2 tablets PO every 3 hours PRN pain
Physician Initial:
PATIENT INFORMATION
Page 1 of 2
(08/11/09)
Revision O
PHYSICIAN ORDERS
CESAREAN SECTION POST-OP
7.
MEDICATIONS: (Continued)
Simethicone (Mylicon) 80 mg chewable tablet. Chew and swallow 1 tablet 1 hour after eating, four times daily
PRN gas pains.
Stool softener: docusate sodium (Colace) 100 mg PO twice daily, hold for diarrhea
Bisacodyl (Dulcolax) suppository 10 mg every day PRN constipation (post-op day # 1 or 2)
Promethazine (Phenergan) 25 mg IV every 3-4 hours PRN nausea/vomiting
Metoclopramide (Reglan) 10 mg IV/PO every 6 hours PRN nausea/vomiting
MMR (Measles, Mumps, Rubella) vaccine if indicated
† Lanolin PRN - tender nipples (per nursing discretion)
Other
8.
If flow is excessive:
A. Follow protocol for PPH
B. Notify provider
C. † Misoprostol (Cytotec) 1,000 mcg
† rectally † orally
D. … Methergine 0.2mg IM times 1, then 0.2mg PO every 4 hours times 6 doses, then 0.2mg PO every
6 hours times 4 doses. Contraindicated For Hypertension.
Nicotine Replacement Protocol per Nicotine Replacement order
Provide smoking cessation information and document on education record
6 Nursing to complete Nurse Initiated Vaccine Assessment Order
9.
10.
11.
12.
IV FLUIDS: Follow current IV with
Saline lock when tolerating oral intake
Discontinue IV when tolerating oral intake
13.
TREATMENT:
6 Continue sequential compression device until patient ambulatory
Retention catheter to straight drainage. Discontinue retention catheter 6-12 hours after surgery
OR
Straight cath every 4-6 hours PRN inability to void
Incentive spirometry every 2 hours times 24 hours after surgery
May shower post-op day #
Discontinue dressing post-op day #
Remove staples post-op day #
Lactation consult per nursing discretion
Abdominal binder
Patient may be discharged after discharge criteria are met
at
ml/hour
NOTE: These orders should be reviewed by the attending physician, appropriately modified for the individual
patient, dated, timed and signed below.
DATE
TIME
PHYSICIAN’S SIGNATURE
Another brand of drug, identical in form and content, may be dispensed unless checked.
PATIENT INFORMATION
Page 2 of 2
(08/11/09) 573
Revision O
PHYSICIAN ORDERS
CESAREAN SECTION POST-OP