Unique Plan Description: Cards Same Day Discharge Radial Post PCI
Plan Selection Display: Cards Same Day Discharge Radial Post PCI
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-20 11:42:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-12-11 12:56:10
Available at all facilities: No

Cards Same Day Discharge Radial Post PCI
Admit/Discharge/Transfer
	Admit to Observation Status
		T;N
	Discharge Conditional
		Conditions to be met: after bedrest complete, and arterial insertion site is stable with ambulation
			Comment: no post procedure angina, hematoma, ambulated 300 feet or has returned to baseline, observed minimum of 6 hours once on the unit, absence of site complications, voiding without difficulty, tolerating oral foods and liquids, post procedure EKG remains unchanged.
Vital Signs
	Vital Signs
		T;N, Routine post op
			Comment: Incision/drain assessment and vascular assessment with each vital signs check
Activity
	Bedrest
		1, hr
			Comment: Elevate affected hand on pillow
		2, hr
			Comment: Elevate affected hand on pillow
		4, hr
			Comment: Elevate affected hand on pillow
		6, hr
			Comment: Elevate affected hand on pillow
	Elevate head of bed
		Elevate head of bed 45 degrees
	Ambulate
		T;N
			Comment: after bedrest discontinued
	Discharge Activity
		No lifting more than 10 pounds for 48 hours, Driving Restrictions: No driving for 24 hours.
Diet
	Cardiac Diet
		T;N
	NPO
		T;N
Laboratory
	hs Troponin I - FH
		Timed, Q8H, 2 Dose(s)/Time(s), spec type = Blood
	Myoglobin
		Timed, Q8H, 2 Dose(s)/Time(s), spec type = Blood
Diagnostic Tests
	ECG
		T;N, Stat, Indication: Post Cardiac Procedure
IV Solutions
	Sodium Chloride 0.9%
		1,000 mL, IV, 75 ml/hr
Medications
	aspirin
		324 mg, Tablet-Chew, BY MOUTH, DAILY
		Option One:(NOTE)*
		81 mg, Tablet-Chew, BY MOUTH, DAILY, T+1; 0900
	Plavix
		75 mg, Tab, BY MOUTH, DAILY, T+1;0900
			Comment: Verify patient received loading dose of Plavix in the Cath Lab before starting maintenance dose.  Notify Cardiologist if patient has not received loading dose.
		Option Two:(NOTE)*
	aspirin
		81 mg, Tablet-Chew, By Mouth, DAILY, T+1; 0900
	Brilinta (ticagrelor)
		180 mg, Tab, By Mouth, Once, NOW
		90 mg, Tab, By Mouth, Q12H, T;N+720
		Option Three: ONLY AVAILABLE AT MH, MFH and JE(NOTE)*
	Effient
		60 mg, Tab, By Mouth, Once, NOW
			Comment: if not previously loaded
		For patients >/= 60kg(NOTE)*
	aspirin
		81 mg, Tablet-Chew, By Mouth, DAILY, T+1; 0900
	Effient
		10 mg, Tab, BY MOUTH, DAILY, T+1;0900
			Comment: Verify patient received loading dose of Effient or Plavix before starting maintenance dose the next day. Use not recommended in patients age 75 or older (UNLESS history of diabetes or MI).  Contraindicated in patients with active bleeding or history of stroke or TIA.
		For patients <60kg(NOTE)*
	aspirin
		81 mg, Tablet-Chew, By Mouth, DAILY, T+1; 0900
	Effient
		5 mg, Tab, By Mouth, DAILY, T+1;0900
			Comment: Verify patient received loading dose of Effient or Plavix before starting maintenance dose the next day. Use not recommended in patients age 75 or older (UNLESS history of diabetes or MI).  Contraindicated in patients with active bleeding or history of stroke or TIA.
	morphine  IV
		2 mg, Syringe, IV Push, Q15MIN, PRN, pain-mild
	Nitrostat
		0.4 mg, Tab, SUBLINGUAL, Q5MIN, PRN, chest pain
	Tylenol
		650 mg, Tab, BY MOUTH, Q4H, PRN, pain-mild
			Comment: for or temperature > 100.6 degrees F.
	lisinopril
		5 mg, Tab, BY MOUTH, DAILY
			Comment: Do not give if SBP <100
	Lopressor
		25 mg, Tab, BY MOUTH, BID
			Comment: Do not give if SBP <100 and HR < 55
	Lipitor
		80 mg, Tab, BY MOUTH, QHS
	Xanax
		0.25 mg, Tab, BY MOUTH, TID, PRN, anxiety
Patient Care
	Resuscitation Status
		T;N, Full Code
		T;N, No Code
	Cardiac Telemetry Monitoring
		T;N, Telemetry Indications: ACS/Arrhythmia/QTc
			Comment: Continuously
	Straight Catheter
		Straight, Insert, unable to void
	Foley Catheter
		T;N
			Comment: Remove foley when off bedrest
	Notify MD
		T;N, if urine output less than 200 ml per 2 hours OR if site bleeding, decreased/absent distal pulses
	Order ECG
		Stat if chest pain or chest pain equivalent, ST segment changes, and notify MD
	Bladder Scan
		T;N, unable to void
	No BPs
		T;N, Affected arm
	Notify MD
		T;N, Cardiologist if affected extremity becomes cool, numb, excessive swelling or bleeding.
	Incision/Dressing Care
		T;N
			Comment: When hemostatic compression device removed, place transparent dressing over puncture site.  Instruct pt to remove in 24 hours.
	Patient Education
		T;N, Instructions: No Driving for 24 hours. Limited use of affected hand for 48 hours. No lifting > 10 lbs with affected limb for 48 hours. No dishwashing for 48 hours.
		T;N, Instructions: Must have responsible adult to stay with patient for 24 hours after discharge.
	Limb Alert
		No lab draws or IV access to affected limb for 48 hours
	Hemostatic Compression Device
		T;N
			Comment: 1 hour (if no intervention) OR 2 hours (if PCI) after compression device application, withdraw 2ml of air. Repeat every 15minutes. If bleeding observed, re-inflate 2ml of air and recheck in 30 min.
	Discharge Incisional, Wound, Stoma Care
		Remove transparent dressing from wrist in 24 hours. Gently clean site with mild soap and water, pat dry
	Discharge Instructions Other
		Instructions: Do not submerge hand in bathtub, dishwater, swimming pools or other water sources for 48 hours. Avoid flexing at the wrist such as hammering, playing tennis, or swing objects. It is ok to shower
		Instructions: If bleeding occurs at site of procedure, apply firm pressure for at least 10 minutes or until bleeding subsides. Call the physician if bleeding continues.
	Discharge Symptoms to Report
		Instructions: Chest pain, blood in urine, black or tarry stools or any other kind of bleeding., loss of sensation, redness, swelling, coldness, a bluish color or drainage in the hand used for the procedure.
			Comment: Signs of infection include redness, swelling or fever greater than 100.4
Therapies
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID
			Comment: Keep O2 sat monitor on thumb/index finger of affected hand. Notify MD if SaO2 drops below 90% continuously.
Consults/Follow-up
	Consult Cardiac Rehab: Outpatient
		Indications Angioplasty/stent
	Consult Cardiac Rehab: Inpatient
		Indications Angioplasty/stent
	Smoking Cessation Education
		T;N
	Smoking Cessation Education RT (FH)
		T;N

Oxygen Protocol
Therapies
Respiratory Therapy
	Oxygen Therapy
		T;N
	Pulse Oximetry Spot Check RT
		T;N, BID
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID

Peripheral Lock - Access
Medications

	sodium chloride 0.9% flush injectable soln
		10 mL Syringe IV PUSH BID
		10 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush
	lidocaine 1% injectable solution (MH/WH/FH)
		0.1 mL, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start
	sodium chloride bacteriostatic 0.9% injectable soln
		0.1 mL, Injection, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start, use if patient has lidocaine allergy.
	Sodium Chloride 0.9% IVPB Flush
		25 mL, IVPB, Q1H, PRN, IV line flush, 5 min(s)
			Comment: Use if medication not compatible with primary line or there is no primary line;  infuse 25mL.
Patient Care
	Peripheral Lock-Insert
		T;N

hs Troponin T - MH/WH/JE
Laboratory
	hs Troponin T - MH/WH/JE
		Stat, spec type = Blood
		T;N+120, Timed, spec type = Blood
		T;N+360, Timed, spec type = Blood

hs Troponin I - FH (Stat and 2hr and 6hr)
	hs Troponin I - FH
		T;N, Stat, spec type = Blood
		T;N+120, Timed, spec type = Blood
		T;N+360, Timed, spec type = Blood

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase