Unique Plan Description: OB Hyperemesis
Plan Selection Display: OB Hyperemesis
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-02-13 14:35:15
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-08-17 12:20:42
Available at all facilities: No

OB Hyperemesis
Admit/Discharge/Transfer
	Admit to Observation Status
		T;N
Vital Signs
	Vital Signs
		T;N, Q4H-Sch
	Weight
		T;N, DAILY
Diet
	NPO
		T;N
			Comment: Advance to Hyperemesis diet when 4 hours without vomiting
Laboratory
	CBC with Diff
		T;N, Stat, spec type = Blood
	Prealbumin
		T;N, Stat, spec type = Blood
	UA (Culture if Positive)
		Nurse Collect, T;N, Stat, Stat, spec type = Urine
			Comment: clean catch
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
	Beta-HCG Quantitative - Pregnancy
		T;N, Stat, spec type = Blood
	Hepatic Function Panel
		T;N, Stat, spec type = Blood
	Thyroid Panel
		T;N, Stat, spec type = Blood
	Amylase Level
		T;N, Stat, spec type = Blood
	Lipase Level
		T;N, Stat, spec type = Blood
Diagnostic Tests
Radiology
	US OB Limited
		Indication Hyperemesis, T;N, Routine, Pregnancy
	US Abd Limited
		Indication pancreas, T;N, Routine, Findings/Abnormal
		Indication galbladder, T;N, Routine, Findings/Abnormal
IV Solutions

	pyridoxine 100 mg/MVI-12 10 mL/D5LR 1000 mL
		1,000 mL, IV, 250 ml/hr
			Comment: Initial bag and one bag daily
		100 mg, EVERY BAG
		10 mL, DAILY
	ondansetron 24 mg/Lactated Ringers 500 mL
		24 mg, EVERY BAG
		500 mL, IV, 21 ml/hr
Medications
	Pepcid
		20 mg, Injection, IV PUSH, Q12H
		20 mg, Tab, BY MOUTH, Q12H
	ondansetron
		4 mg, Injection, IV Push, Q6H, PRN for nausea
		8 mg, Injection, IV Push, Q6H, PRN for nausea
	Unisom
		25 mg, Tab, By Mouth, QHS
		12.5 mg, Tab, By Mouth, Q6H, PRN, nausea
	Vitamin B6
		50 mg, Tab, By Mouth, BID
	Tylenol
		325 mg, Tab, BY MOUTH, Q6H, PRN, pain-mild
		650 mg, Tab, BY MOUTH, Q6H, PRN, pain-moderate
Patient Care
	Resuscitation Status
		T;N, Full Code
		T;N, No Code
	Notify MD
		T;N, before starting third liter of IV fluid for rate/fluid adjustment
	Urine Ketones-POC
		T;N, Q8H-Sch
	Fetal Heart Rate
		T;N, DAILY
			Comment: if greater than 12 weeks gestation
Consults/Follow-up
	Consult Dietitian
		T;N, Regarding: Recommend nutrition intervention
			Comment: Hyperemesis
	Consult Perinatologist
		Reason for Referral: Hyperemesis

Nausea Protocol EKM
Medications
	ondansetron
		4 mg, Injection, IV PUSH, Q24H, PRN for nausea and/or vomiting
			Comment: Administer for nausea if not previously administered by anesthesia, PACU, or ED and unable to take oral meds.
		4 mg, Injection, IV PUSH, Q6H, PRN for nausea and/or vomiting
			Comment: Administer for nausea if not previously administered by anesthesia, PACU, or ED and unable to take oral meds.
		4 mg, Tablet-Disintegrating, By Mouth, Q6H, PRN for nausea and/or vomiting
			Comment: Administer for nausea if not previously administered by anesthesia, PACU, or ED
		Select either promethazine or prochlorperazine orders:(NOTE)*
	prochlorperazine
		10 mg, Injection, IV PUSH, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures
		25 mg, Suppository, RECTALLY, BID, PRN, nausea
			Comment: Give if ondansetron ineffective and if no history of seizures, give if IV access not available
	Phenergan (JE)
		25 mg, Tab, By Mouth, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures
		25 mg, Suppository, RECTALLY, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures, give if IV access not available
	Phenergan (MH/WH)
		25 mg, Tab, By Mouth, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
		25 mg, Suppository, RECTALLY, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
		6.25 mg, Injection, IM-Intramuscular, Q6H, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds
	Phenergan (FH)
		25 mg, Tab, By Mouth, BID, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
		25 mg, Suppository, RECTALLY, BID, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
		12 mg, INT, IVPB, Q6H, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
	Benadryl
		12.5 mg, Injection, IV PUSH, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron and phenothiazine ineffective
	Ativan
		1 mg, Tab, BY MOUTH, Q8H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, phenothiazine, or other anti-nausea medications ineffective
		1 mg, Injection, IV PUSH, Q8H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, phenothiazine, or other anti-nausea medications ineffective
	Reglan
		10 mg, Injection, IV PUSH, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, phenothiazine, or other anti-nausea medications ineffective; avoid in patients > 65yo
		10 mg, Injection, IM-Intramuscular, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, phenothiazine, or other anti-nausea medications ineffective; avoid in patients > 65yo

*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