01442_acutepain_management

01442_acutepain_management - SCANNED TO PHARMACY STAT...

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Unformatted text preview: SCANNED TO PHARMACY STAT MEDICATION NEURAXIAL ANALGESIA ORDERS: 1. Patient received Epidural Intrathecal ____________________________________________________ (drug and dose) at _______________________ (time) on ____________________ (date) 2. Injection orders: __________________________________________________________________________________________ (RN cannot administer bolus injections of local anesthetic or Clonidine) 3. Infusion: Run the following infusion at _________mL/hour Opioid_______________________________ (drug/dose) Local anesthetic ________________________ (drug/conc.) Clonidine ___________________ (dose) Note: Do not abruptly stop Clonidine. Titrate downward following MD order. 4. For breakthrough pain: ____________________________________________________________________________________ 5. Discontinue all previous orders for sedatives/narcotics, including sleeping pills. 6. Follow Neuraxial Analgesia protocol. 7. If patient has been or is being anticoagulated, do neurologic exam of lower extremities Q _________ while neuraxial analgesia orders are in effect. 8. ALL OPIOIDS OR SEDATIVES MUST BE ORDERED BY THE ANESTHESIOLOGIST WHILE EPIDURAL CATHETER IS IN PLACE, WHILE THE PATIENT IS UNDER THE EFFECT OR FOR ______________HOURS. PCA ORDERS: Patient is opioid experienced. Notify Pharmacy if higher concentration needed. _______ Meperidine 10 mg/mL. Give no more than 600 mg in 24 Medication: ________ Morphine sulfate 1mg/mL hours. Discontinue after 24 hours. Call physician for further orders prior to stopping medication. _______ Hydromorphone 0.2 mg/mL ________ Fentanyl 10 mcg/mL 1. Initiate PCA orders at ____________________________________ (time, date). 2. Dose: (Patient Controlled) _______________________________ mL. 3. Delay: (Dose Interval Lockout) ____________________________ minutes. 4. Basal Rate: (Continuous Background Infusion) ______________ mL/hr. 5. One Hour Limit: (Maximum amount/hour) ________________mL = _____________ mg/mcg. 6. Bolus: (if additional dose is required for analgesia, a nurse may bolus the patient with) ________ mL Q ________ hour PRN. 7. Stop Basal Rate after ____________ hours. 8. Discontinue PCA ____________________ 9. Discontinue all previous orders for sedatives/narcotics, including sleeping pills. 10. Follow PCA Protocol RELATED ORDERS: 1. Oxygen: O2 __________________ L/min by nasal cannula. Continue until _____________________________________________ 2. Respiratory depression: For respirations less than 8/min, give O2 10 L/min or ______ L/min O2 by mask, give Naloxone 0.2 mg IV STAT, call physician STAT. For respirations 8-10, arouse patient, give O2 10 L/min or ______ L/min O2 by mask, and call physician. 3. Nausea/Vomiting: 4 mg or ______mg IV. MR x 1 PRN once in 24 hours. If second dose not effective, use alternate antiemetic. ______ Ondansetron ______ Metoclopramide 10 mg or _______ mg IV Q 4 hours PRN, MR x 1 in 30 min. ______ Other: ___________________________________________________________________________________________ 4. Pruritis: 25 mg or _______mg IV Q 4 hours PRN, MR x 1 in 20 minutes. ______ Diphenhydramine 0.1 mg or ______mg IV PRN, May repeat Q 10 minutes PRN. ______ Naloxone 5 mg or _______mg IV PRN, MR up to 15 mg/hour or ______ mg/hour PRN. ______ Nalbuphine 5. Pulse oximeter checks Q _______ hours until _________. Continuous until ________________. Call physician for O2 Sat under _____________% sustained. 6. Related orders are to be discontinued when the above Neuraxial Analgesia or PCA orders expire. 7. Additional Orders: _______________________________________________________________________________________ Contact Dr_______________________________________ Phone____________________ Pager ______________________ Physician Signature___________________________________________ Date___________________ Time_____________ Authorization for therapeutic substitution is given unless checked here Patient Identification Sutter Medical Center, Sacramento A Sutter Health Affiliate Acute Pain Management Orders 01442 (12/17/08) ORDERS ...
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