The following orders will be implemented. Orders with a “  ” are choices and are NOT implemented unless checked.
Initial all handwritten order modifications and the bottom of each page when indicated (multipage).
PREOP MEDICATIONS:
1.  Versed (midazolam) 0.5 mg/kg po x 1 dose in preop (max dose 15 mg). Administer 30 min prior to scheduled OR time.
2.  Demerol (meperidine) 1 mg/kg po x 1 dose in preop (max dose 100 mg). Administer 30 min prior to scheduled OR time.
3.  Albuterol neb 2.5 mg inhaled x 1 dose in preop
4.  Cuvposa (glycopyrrolate) 0.04 mg/kg po x 1 dose in preop (max dose 2 mg)
5.  Zofran (ondansetron) 0.15 mg/kg IV x 1 dose prn nausea/vomiting (max dose 4 mg)
INTRAOP MEDICATIONS:
6.  Acetaminophen 30 mg/kg per rectum x 1 dose on call to OR (ok to round dose, max dose 1,000 mg).
POSTOP NURSING CARE:
7. Pediatric Post Op Nursing Care
Monitoring per Care for Patients in Phase I (6604-01) and Care of Patients in Phase 2 (6604-02)
Apply oxygen via face shield or non rebreather mask at 100% FiO
2
and titrate down to RA maintaining O
2 sat ≥ 90%
Call Anesthesia for uncontrolled pain or respiratory distress.
Patient to remain in PACU setting for 30 min after last narcotic dose.
When Phase I discharge criteria met, transfer to Phase II and reunite patient with parent.
When Phase 2 discharge criteria met, transfer observation patient to floor or discharge per surgeon’s orders.
POSTOP MEDICATIONS:
8. Severe pain:  Morphine 0.1 mg/kg IV in divided doses q 5 min prn (max dose 4 mg) or  Dilaudid (HYDROmorphone) 0.015 mg/kg IV in divided doses q 5 min prn (max dose 0.5 mg)
9. Moderate pain:  Toradol (ketorolac) 0.5 mg/kg IV X 1 dose prn (max dose 30 mg)
10. Mild pain:  Hycet (HYDROcodone 7.5 mg/acetaminophen 325 mg in 15 ml) 0.1 mg/kg po x 1 dose prn (max dose 15 ml)
 or  Roxicodone (oxyCODONE 5 mg/5 ml) 0.1 mg/kg po x 1 dose prn (max dose 10 mg)
11. Nausea/vomiting:  Zofran (ondansetron) 0.15 mg/kg IV x 1 dose prn (max dose 4 mg). Ok to give Zofran post-op even if patient had pre-op Zofran dose. However, wait 4 hrs before any additional dosing.
ADDITIONAL ORDERS:
______________________________________________________________________________________________
______________
Date
____________
Time
_________________________________
Physician Signature
___________
PID Number
Copy to pharmacy
*1-38522*
FORM 1-38522 INITIATED 06/2015 Page 1 of 1