PLACE LABEL HERE
MYELOGRAM POST PROCEDURE
ORDERS
The following orders will be implemented. Orders with a “q” are choices and are NOT implemented unless checked.
DIAGNOSIS: ______
1. Admit: Physician initials _____ admit to Inpatient for ______(reason for admit)
Physician initials _____ place in Observation for ______(reason for OBV)
Physician initials _____ place in Outpatient status
2. Unit: q ICU q IMCU/PCU q Telemetry Floor q Any Floor Telemetry q Any Floor (No Telemetry)
3. Consults: ______
4. Seizure precautions until am
5. Diet: resume previous orders and force po fluids
6. Activity:
· Minimize ( 30 min at time for the next 24 hrs) being in an erect weight bearing (standing) or flat (supine) position to reduce chances of post spinal puncture headache. Preferable position is head elevated in reclining chair or bed.
· Bathroom privileges with assistance allowed.
PRN MEDICATIONS:
7. Nausea: Tigan (trimethobenzamide) 200 mg IM q 6 hrs prn
Do not use Phenergan (promethazine) for 24 hours post Myelogram
8. Restricted medications: do not administer the following medications for 24 hours:
· Other phenothiazine derivatives; e.g., Compazine (prochlorperazine), Phenergan (promethazine), and Thorazine (chlorpromazine)
· Tricyclic antidepressants; e.g. Sinequan (doxepin), Tofranil (imipramine), and Elavil (amitriptyline)
· Central nervous system stimulants
ADDITIONAL ORDERS:
______
______
______
______
Date Time Physician Signature PID Number
*1-727* FORM 1-727 REV. 11/2011 Send copy to pharmacy______(initials)
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