Post-OP Orders

• Depending on hospital and service, “check box” preprinted order sheets may be available and will be located in the chart
  • ask the resident to show you how to properly fill them out

PEARL each of the consultants have their own preferential post-op regimens (activity, drains, dressing changes, post-op XRs, etc.), therefore always ask the specifics when working with a new surgical team

Use the DAVIID format

• DIET: sips ? DAT (diet as tolerated)

• ACTIVITY: AAT (activity as tolerated) with ROM restrictions & weight bearing status
  • (TWB – touch weight bearing, NWB – non-weight bearing, etc.)

• VITALS: VSR (vital signs routine i.e. q4h x 48hrs.), CSM q4h (colour, sensory & motor – indicate the limb)

• IV FLUIDS: IV RL 100-125cc/hr. (adult)
  • IV NS 100-125cc/hr. (diabetic adult)
  • IV NS using 4:2:1 rule (pediatric pts.)
  • D/C WDW (discontinue when pt. drinking well)

• INVESTIGATIONS: XR of post-operative site in the PACU & POD #__
  • Electrolytes, creatinine POD # __
  • CBC POD # __, Daily INR __

• DRUGS: refer to commonly ordered medications for exceptions and complete list
  • Analgesia: Morphine 0.5-4 mg IV q4h prn in PACU
    • Morphine 2-10 mg IM/SC q4h prn
    • Percocet I-II po q4h prn
    • Acetaminophen 325-975 mg po q6h prn
  • Anti-emetic: Gravol 25-50 mg po/IM/IV q4h prn
    • Maxeran 10 mg po/IM/IV q6h prn
  • Antibiotics: Cefazolin (Ancef) 1 gm IV q8h x 3 doses
    • Vancomycin 500 mg IV q12h x 2 doses
  • Prophylaxis: Fragmin 5000 IU SC od starting POD #1
  • Precedent: look in pt.’s chart to reorder their current meds (adjust accordingly)
  • Other: Sedation – Ativan 1-2mg po qhs prn
    • Diabetics – Sliding Scale
    • Bowel – Senna 1-2 tablets po bid prn
      • MOM 30mL po bid prn
      • Bisacodyl supp. 10mg PR qam prn
      • Fleet enema PR prn

ADDITIONAL ORDERS:

• D/C drain if <50mL q12h and by 24hrs. post-op
• PT/OT to see
• If patient is an outpatient, D/C when stable and alert
• F/U in # clinic in __ weeks