Re: Subject: Section on demand
From: Dr. Ainsworth (ainsron@sbcglobal.net)
Wed Apr 26 16:16:08 2006
My orders are similar, however the pain management orders for the first
24 hours are handled by anesthesia, because of intrathecal precautions.
Suits me fine, if there is a need for additional meds during the middle
of the night, they get the call, not me.
At Wed, 26 Apr 2006, Richard Chudacoff, MD wrote:
>
>You are out of date. Here is a sample of my c-section orders. In fact, the
>new hospital I joined now has incorporated them into their standard post op
>orders. I find these orders give patients the autonomy to make decisions
>that most patients loose when admitted to the hospital. Also, they make far
>less work for the nursing staff. Most of my 7AM sections eat dinner the
>night of surgery. Most of my repeat c-sections leave the hospital 36 hours
>post-op because the want to leave.
>
>--
>
>1. DIAGNOSIS: STATUS-POST C-SECTION
>
>2. VITAL SIGNS PER ROUTINE PACU AND POST-PARTUM UNIT
>
>3. ACTIVITY:
>
>o BED REST
>
>o OUT OF BED TO CHAIR BY 10 HOURS POST-OP
>
>o THEN AMBULATE AS TOLERATED
>
>o CALL MD IF UNABLE TO GET OOB
>
>4. IF BREAST FEEDING, MASSE CREAM AND BREAST PUMP PRN
>
>5. DIET:
>
>* NPO
>
>* WHEN OUT OF BED TO CHAIR: ADVANCE TO ICE CHIPS
>
>* WHEN AMBULATING TO NURSES STATION: ADVANCE TO COFFEE, TEA OR COKE
>
>* ADVANCE AS TOLERATED IF TOLERATES COFFEE, TEA OR COKE
>
>6. IV: D5LR @ cc/ hr WITH 20 U PITOCIN
>IN FIRST BAG, D/C WHEN TOLERATING PO AND AMBULATING
>
>7. FOLEY TO GRAVITY. STRICT I/O WHILE FOLEY IN PLACE. CALL MD IF URINE
>OUTPUT IS LESS THAN 60 cc/2 hours. REMOVE FOLEY WHEN PATIENT AMBULATING
>
>8. LABS: Hgb/Hct @ 6 AM PP DAY #1
>
>9. MEDICATIONS:
>
>1. TORADOL IV Q 6 HOURS, D/C WHEN
>TOLERATING PO
>
>2. DEMEROL mg IV Q 4 HOURS PRN, D/C WHEN
>TOLERATING PO
>
>3. MORPHINE SULFATE mg IV Q 4
>HOURS PRN, D/C WHEN TOLERATING PO
>
>4. PHENERGAN mg IV Q 4 HOURS PRN D/C WHEN
>TOLERATING PO
>
>5. MOTRIN mg PO Q 6 HOUR FOR 24 HOURS,
>WHEN TOLERATING PO
>
>6. TYLENOL #3 PO Q 4 HOURS PRN WHEN TOLERATING
>PO
>
>7. LORTAB mg PO Q 4 HOURS PRN WHEN
>TOLERATING PO, IF ALLERGIC TO CODEINE
>
>8. TYLENOL mg PO Q 4 HOURS PRN WHEN
>TOLERATING PO
>
>9. DARVOCET N100 PO Q 4 HOURS PRN WHEN
>TOLERATING PO
>
>10. MYLICON MG PO Q AC/HS PRN WHEN TOLERATING
>PO
>
>11. MYLANTA CC PO Q AC/HS PRN WHEN TOLERATING
>PO
>
>12.
>
>13.
>
>10. RHOGAM 300 ug IM IF MOTHER IS Rh NEGATIVE AND BABY IS Rh POSITIVE
>
>11. OKAY TO SHOWER ONCE DRESSING IS REMOVED
>
>Richard Chudacoff, MD, FACOG
>
> _____
>
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>Stmidwife@aol.com
>Sent: Tuesday, April 25, 2006 3:43 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Subject: Section on demand
>
>Wow she sounds like she would have been a perfect homebirth candidate. I
>don't even encourage my clients to be up and around that fast much less in a
>movie theater with their baby.
>
>Sue
>
>In a message dated 4/25/06 9:25:09 A.M. Pacific Daylight Time,
>ob-gyn-l@obgyn.net writes:
>
>Agreed. My non-researched experience is that healthy patients with a
>good attitude and an elective cesarean almost always do extremely well
>post-op (short and long-term). For example, I found my wife wandering
>around the hospital cafeteria in street clothes on post-op day 1.5 after
>her first cesarean, and we went to a movie on post-op day 2.5 after her
>
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