DOCTOR’S ORDER SHEET

DRUG ALLERGIES:

POST-OP ROBOTIC/LAPAROSCOPIC HYSTERECTOMY ORDERS - PATIENT IDENTIFICATION ROOM NO.

CLINICAL PATHWAY

DATE

/

TIME

/ ORDERS FOR MEDICATION, DIET AND TREATMENTS
1. To PACU, then admit to post op unit when stable.
If transported on O2, continue per PACU orders.
2. Routine vital signs.
3. Follow present IV with RL at 125 ml/hr. If need for IV restart, may use 1% Lidocaine (Xylocaine)
at site. Discontinue IV upon discharge or in AM when tolerating fluids and temp less than 100°F.
4. Saline Lock IV on arrival to unit
5. Diet as tolerated.
6. Shower prn after IV discontinued.
7. Ambulate as tolerated.
8. Intake and output until voiding.
9. Maintain indwelling catheter to gravity.
Remove Foley in AM (unless otherwise ordered)
Remove foley on admit to unit
Remove vag pack in AM.(as applicable)
Remove foley catheter and vag pack (if applicable) @ ______.
10. Assess bladder volume prn using bladder scanner. In & Out cath X 3 if unable to void.
11. Incentive Spirometry every 1-2 hours while awake until discharge
12. For DVT prophylaxis, refer to DVT Prophylaxis Clinical Pathway Orders for the Surgical Patient.

13. Flu Vaccine if indicated.

14. Discharge when patient meets discharge criteria for surgical outpatients.

Notify M.D. if unable to discharge or if does not meet discharge criteria within 23 hours.

SURGERY POST-OP PRN ORDERS PAIN

Mild Pain: Ibuprofen 600 mg po every 6 hours prn pain.
Moderate Pain: Percocet 1 – 2 tabs po every 3 hours prn pain. If reaches maximum
Acetaminophen limit of 4 gms in 24 hours, give Oxycodone (OxyIR) 5 – 10 mg every 3
hours prn pain. If allergic to Percocet, give HYDROmorphONE (Dilaudid) 2 mg po every 3
hours prn pain.
Severe Pain: MorphINE 5 mg IV Push every 2 hours prn pain. If allergic to MorphINE:
HYDROmorphONE (Dilaudid) 0.5 mg IV Push every 2 hours prn pain. If no IV access, give
MorphINE 10 mg IM every 4 hours prn pain.
OTHER PRN MEDICATIONS
1. Nausea: Ondansetron (Zofran) 4 mg IV Push every 4 hours prn
If Zofran not effective in 30 minutes, give -
Promethazine (Phenergan) 25 mg IM/po every 3 hours prn.
Ondansetron (Zofran) 4 mg tab po every 4hours prn
2. Itching: Diphenhydramine (Benadryl) 50 mg po every 4 hours prn.
3. Acetaminophen (Tylenol) 650 mg po every 4 hours prn pain or temp greater than 101°F. (If
giving Percocet, total Acetaminophen not to exceed 4 gms in 24 hours.)
4. Fleets enema every day prn constipation. (May begin post-op day one.)

5. Bisacodyl (Dulcolax) 10 mg suppository rectally bid prn gas pain.

6. Zolpidem (Ambien) 5 mg po at bedtime prn sleep.

7. Simethicone 80 mg po every 6 hours prn gas.

(Total Acetaminophen not to exceed 4 gms in 24 hrs. 1 Percocet contains Oxycodone 5 mg and Acetaminophen 325 mg)

RESUME HOME MEDS: as listed (include start date)

03/2015 POST-OP ROBOTIC/LAPAROSCOPIC HYSTERECTOMY ORDERS - CLINICAL PATHWAY