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Re: Subject: Section on demand From: Dr Eberhard Lisse (el@lisse.NA) Thu Apr 27 00:53:24 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Elrod, Darryl G Maj 48 MDOS/SGOBO: "Re: Subject: Section on demand" Previous message: Dr Eberhard Lisse: "Re: Celebrity Birth" In reply to: Richard Chudacoff, MD: "Re: Subject: Section on demand" Next in thread: Richard Chudacoff, MD: "Re: Subject: Section on demand" Reply: Richard Chudacoff, MD: "Re: Subject: Section on demand" My Standing Orders: D0 (elective, ie 08:00 cases): Nil Per Os Close Observation Plasmalyte B (ie Ringer's) 1L 8 hrly ivi with 20 IU Oxytocin in each Metoclopramid 10 mg 6-8 hrly ivi/imi if required Morphine 10 mg or Pethidine 100 mg ivi/imi if required tomorrow: 08:00 Sips of Water, Catheter out 10:00 Drip down 12:00 Free Fluids 17:00 Full Diet (if Spinal: 24 hour bed rest, then/otherwise...) ...mobilize aggressively as tolerated 1 Amp Anti-D imi if mother Rhesus negative (and infant Rhesus positive) D1 Mypradol 1 tab 8 hrly if required (or a NSAID of doctor's choice) D2 get ready D3 Discharge. In out of hour cases, we vary the hours. I could discharge earlier, but the Medical Aid funds do not complain (they even permit a further day most of the time without written motivation), and the patients prefer to stay. Occasionally one wants to leave on day 2 and that's not a problem if the infrastructure and support is there. And, by the way, there is no such diagnosis as: STATUS (post C/S) :-)-O greetings, el on 4/26/06 10:04 PM Richard Chudacoff, MD said the following: > You are out of date.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 Next message: Elrod, Darryl G Maj 48 MDOS/SGOBO: "Re: Subject: Section on demand" Previous message: Dr Eberhard Lisse: "Re: Celebrity Birth" In reply to: Richard Chudacoff, MD: "Re: Subject: Section on demand" Next in thread: Richard Chudacoff, MD: "Re: Subject: Section on demand" Reply: Richard Chudacoff, MD: "Re: Subject: Section on demand"

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