Unique Plan Description: HN Onc Parathyroid Post-Op EKM
Plan Selection Display: HN Onc Parathyroid Post-Op
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2019-11-04 12:38:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-04-09 13:39:45
Available at all facilities: Yes

HN Onc Parathyroid Post-Op EKM
Admit/Discharge/Transfer
	Discharge Conditional
		T;N
			Comment: May discharge 2 hours after arrival to floor.  Notify MD with PTH Level.
	Discharge
		T;N
			Comment: from Phase II
	Admit to Observation Status
		T;N
Vital Signs
	Vital Signs
		Routine Post Op
Activity
	Up in Chair
		T;N
	Ambulate
		T;N
	Elevate head of bed
		Elevate head of bed 30 degrees
	Discharge Activity
		Avoid lifting more than 20 pounds for the first week then gradually increase to normal activity.  Resume full activities at 2-3 weeks. Very important to ambulate (walk around) same day as surgery and routinely thereafter., Bathing Activities: May shower 2
Diet
	Clear Liquid Diet
		T;N, Advance as Tolerated
	Discharge Diet
		T;N, Diet as tolerated. Ice chips or Popsicles for sore throat as needed.
Laboratory
	Intact PTH
		T;N, Stat, spec type = Blood
IV Solutions
	Discontinue IV Fluids
		When taking adequate PO
			Comment: and discontinue lock prior to discharge.
Medications
	ibuprofen
		400 mg, Tab, By Mouth, Once, T;N+360
			Comment: Give 6 hours after preop NSAID x once only. Only received half dose of meloxicam prior to surgery.
		600 mg, Tab, By Mouth, Q6H, for see comment, T;N+900, duration: 48 hr
			Comment: Okay to hold the dose at nighttime if sleeping. Alternate with acetaminophen.  Do not give if systolic blood pressure is < 90mm Hg or if serum creatinine is greater than 1.5mg/dL (or creatinine clearance < 50mL/min)
	acetaminophen
		1,000 mg, Tab, By Mouth, Q6H, T;N+360, duration: 48 hr
			Comment: Okay to hold the dose at nighttime if sleeping. Alternate with ibuprofen.
	ondansetron
		4 mg, Injection, IV Push, Q4H, PRN for nausea
	promethazine oral tablet
		25 mg, Tab, BY MOUTH, Q4H, PRN for nausea
	VTE Advisor
		General surgery
		Prescriptions(NOTE)*
	Citracal Maximum + D oral tablet
		2 TAB, By Mouth, BID, # 28 TAB, 0 Refill(s)
	Rocaltrol 0.25 mcg oral capsule
		1 CAP, By Mouth, TID, # 30 TAB, 0 Refill(s)
Patient Care
	Resuscitation Status
		Full Code
		No Code
	Incision/Dressing Care
		Cleanse with normal saline, BID
			Comment: Cleanse incisions with normal saline, apply antibiotic ointment and change
	Wound Drain
		Connect to compressed suction
	Record Output
		T;N, Bulb suction, Q4H-Sch, 48, hr
			Comment: Strip JP and record output
		T;N, Bulb suction, Q12H-End of Shift
			Comment: Strip JP and record output
	Discharge Instructions Other
		T;N, Instructions: If you experience numbness or tingling around the lips or of the finger tips or muscle cramping, take 2-3 TUMS and if it does not resolve, call the doctor.
	Discharge Incisional, Wound, Stoma Care
		May apply ice to neck for 20 minutes on, 20 minutes off as needed for pain for 48 hours and then as needed.
	Discharge Symptoms to Report
		Instructions: Call immediately for difficulty swallowing, change in voice, increasing neck swelling, difficulty breathing, muscle cramps or severe pain.
	Notify MD
		T;N, Head and Neck Surgery House Officer for bleeding, temp >101.5 or <96.0, SBP >160 or <90, DBP >110 or <50, RR >30 or < 10, Oxygen sat <92%, UO <100ml/4hr
	Cold Therapy
		Ice bag, Incision
			Comment: immediately in PACU, and then on for 20 min, off for 20 min for 3 Days
Therapies
	Consult Physical Therapy, Evaluate and Treat
		Reason to See: Range of Motion
			Comment: to shoulder.
Consults/Follow-up
	Consult Social Work
		Home Health Care

*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