Unique Plan Description: Epidural Protocol-JE
Plan Selection Display: Epidural Protocol-JE
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2011-11-29 14:35:28
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-07-13 02:04:27
Available at all facilities: No

Epidural Protocol-JE
Admit/Discharge/Transfer
	Transfer
		T;N
			Comment: to floor with oxygen
Vital Signs
	BP, Pulse and Respirations
		Q1H, 12, hr
		T;N+720, Q4H-Sch minus Q12 Start of Shift, until 24 hours post epidural
	Temperature
		Q4H-Sch minus Q12 Start of Shift, until 24 hours post epidural
IV Solutions
	fentaNYL 2 mcg/mL-bupivacaine 1/8% NS 250 mL
		Bag Volume = 250 mL, Epidural, EPIDURAL
			Comment: EPIDURAL RATE  ___ml/hr.  fentanyl conc:  2 mcg/mL.  Change Every 24 Hours.
	fentaNYL 4 mcg/mL-bupivacaine 1/8% NS 250 mL
		Bag Volume = 250 mL, Epidural, EPIDURAL
			Comment: EPIDURAL RATE  ___ml/hr.  fentanyl conc:  4 mcg/mL.  Change Every 24 Hours.
Medications
	HYDROmorphone 20 mcg/mL-bupivacaine 1/8% 250 mL
		Bag Volume = 250 mL, EPIDURAL
			Comment: EPIDURAL RATE  ___ml/hr.  HYDROmorphone conc:  20 mcg/mL.  Change Every 24 Hours.
	Reglan
		10 mg, Injection, IV PUSH, Q6H, PRN, nausea and/or vomiting
	ondansetron
		4 mg, Injection, IV Push, Q24H, PRN for nausea and/or vomiting
	nalbuphine
		2.5 mg, Injection, IV PUSH, Q4H, PRN, itching
		5 mg, Injection, IV PUSH, Q4H, PRN, itching
	Benadryl
		25 mg, Injection, IV PUSH, Q6H, PRN, itching
		50 mg, Injection, IV PUSH, Q6H, PRN, itching
		25 mg, Capsule, BY MOUTH, Q6H, PRN, itching
		50 mg, Capsule, BY MOUTH, Q6H, PRN, itching
	Narcan
		0.4 mg, Injection, IV PUSH, Q5MIN, PRN, see comment
			Comment: STAT if respirations less than 8 per minute, then call anesthesia.
	sodium chloride 0.9% flush injectable soln
		10 mL, Syringe, IV PUSH, BID
		10 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush
Patient Care
	Notify Anesthesia if:
		Marked change in sedation or CMS status | Persistent pain | Persistent side effect despite treatment | Respiratory rate less than 10 | Systolic BP less than 90 mmHG
	Foley Catheter
		Foley
	Epidural Assessment
		Q1H-Sch minus Q12 Start of Shift, 12, hr
		T;N+720, Q2H-Sch minus Q12 Start of Shift, 12, hr
		T;N+1440, Q4H-Sch minus Q12 Start of Shift
			Comment: until 24 hours post epidural
	IV-Maintain
		for 12 hours after last dose of epidural narcotic
	No Opioids
		Without notifying anesthesia first
	No Anticoagulants/antiplatelets/thrombolytics
		Refer to Anticoagulation Guidelines for Neuraxial Procedures.
	No Sedatives
		Without notifying anesthesia first
Therapies
	Oxygen Set Up-MH/JE
		Stat, Orders per Respiratory Protocol
	Oxygen Therapy
		Via Nasal Cannula, Titrate->Keep Sats>/= to 92%, Orders per Respiratory Protocol, Constant Indicator

*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