Gabapentin Research Pain Study for Ortho Total Knee Replacement Post-Op Plan - PACU Ortho Phase

Transcription

1 Total Knee Replacement Post-Op Plan - PACU Ortho Phase Diagnosis Weight Allergies Admit/Discharge/Transfer Patient Status Requested Location: 3W, Pt Status: Inpatient (LOS > 2 midnights) Patient Condition Acuity Level Floor Status Acuity Level Critical Acuity Level Intermediate Patient Care Apply Cold Therapy Device POC Hemoglobin and Hematocrit (istat Hgb and Hct) STAT POC Chem 8 (istat Chem 8) STAT POC Blood Sugar Check Communication Code Status Code Status: Full Code Code Status: DNR/AND (Allow Natural Death) Code Status: Care Limitation Laboratory CBC STAT, Comment: Pt in PACU Basic Metabolic Panel STAT, Comment: Pt in PACU Diagnostic Tests DX Knee 1or 2 vws (Left) STAT, Portable, Other (specify below), Post-op. Pt in PACU DX Knee 1or 2 vws (Right) STAT, Portable, Other (specify below), Post-op. Pt in PACU Order Taken by Signature: Page: 1 Total Knee Replacement Post-Op Version: Plan7 Effective on: 04/27/16 Page 1 of 15

2 Pt. Arrives to Room Patient Care Vital Signs Per Unit Standards Perform Neurovascular Checks To: Operative Extremity, Check every 30 minutes x 2 then with Vital Signs q30min Strict Intake and Output Per Unit Standards q1h q2h q4h q12h Urinary Catheter Care Patient Activity Assist as Needed, Daily Foot Pumping exercises x 10 every 30 minutes until night time Set Up for Overhead Trapeze and Frame Continuous Passive Motion Device CPM to Left Knee, initial application In PACU If on Bed, run for 1/2-4 hrs, frequency 1-3 x day, start at 0-45 degrees, increase by 5-10 degrees, speed: Medium, Turn off knee flexion on bed with bed flat. Patient does not have to sleep in CPM. CPM to Right Knee, initial application In PACU If on Bed, run for 1/2-4 hrs, frequency 1-3 x day, start at 0-45 degrees, increase by 5-10 degrees, speed: Medium, Turn off knee flexion on bed with bed flat. Patient does not have to sleep in CPM. CPM to Bilateral Knees, initial application In PACU If on Bed, run for 1/2-4 hrs, frequency 1-3 x day, start at 0-45 degrees, increase by 5-10 degrees, speed: Medium, Turn off knee flexion on bed with bed flat. Patient does not have to sleep in C Activity Precautions Knee Immobolizer When Out of Bed, with femoral nerve block Bed pillow between knees Abduction pillow between knees Wound Care by Nursing Reinforce dressing, Cover/Pack with ABD Pad, Secure with Hypafix Tape Located: Operative Knee, Change PRN Reinforce dressing, Cover/Pack with ABD Pad, Secure with Hypafix Tape Located: Operative Knee, Change PRN, Monitor drain output Every Shift LLE Weight Bearing Activity Weight Bearing as Tolerated Partial Weight Bearing Touch Down Weight Bearing Non Weight Bearing Order Taken by Signature: Page: 2 Total Knee Replacement Post-Op Version: Plan7 Effective on: 04/27/16 Page 2 of 15

3 Pt. Arrives to Room RLE Weight Bearing Activity Weight Bearing as Tolerated Partial Weight Bearing Touch Down Weight Bearing Non Weight Bearing Elevate Extremity Other, Elevate legs while out of bed Left Lower Extremity (LLE) Right Lower Extremity (RLE) Convert IV to INT When tolerating PO Communication Notify Provider/Primary Team of Pt Admit Notify: PCP, Upon Arrival to Unit Notify Provider of VS Parameters Notify Provider (Misc) Notify Nurse (DO NOT USE FOR MEDS) Dietary Oral Diet Clear Liquid Diet Full Liquid Diet Regular Diet AHA Diet Clear Liquid Diet, Advance as tolerated to Regular Clear Liquid Diet, Advance as tolerated to 1600 Calorie ADA Clear Liquid Diet, Advance as tolerated to 1800 Calorie ADA Clear Liquid Diet, Advance as tolerated to AHA ADA Diet 1800 Calories, AHA 1600 Calories, AHA 1800 Calories 1600 Calories NPO Diet NPO NPO, Except Meds NPO, Except Ice Chips NPO, Except Meds, Except Ice Chips IV Solutions LR (Lactated Ringer s) IV, 75 ml/hr IV, 100 ml/hr IV, 125 ml/hr IV, 150 ml/hr IV, 200 ml/hr Order Taken by Signature: Page: 3 Total Knee Replacement Post-Op Version: Plan7 Effective on: 04/27/16 Page 3 of 15

4 Pt. Arrives to Room D5 1/2 NS + 20 meq KCl/L IV, 75 ml/hr IV, 100 ml/hr IV, 125 ml/hr IV, 150 ml/hr IV, 200 ml/hr 1/2 NS IV, 75 ml/hr IV, 100 ml/hr IV, 125 ml/hr IV, 150 ml/hr IV, 200 ml/hr NS (Normal Saline) IV, 75 ml/hr IV, 100 ml/hr IV, 125 ml/hr IV, 150 ml/hr IV, 200 ml/hr D5 1/2 NS IV, 75 ml/hr IV, 100 ml/hr IV, 125 ml/hr IV, 150 ml/hr IV, 200 ml/hr Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. aspirin 81 mg, PO, tab ec, Daily Antibiotics cefazolin 1 g, IVPB, ivpb, q6h, x 3 dose, Infuse over 30 min 2 g, IVPB, ivpb, q6h, x 3 dose, Infuse over 60 min clindamycin 600 mg, IVPB, ivpb, q6h, x 3 dose, Infuse over 30 min 900 mg, IVPB, ivpb, q6h, x 3 dose, Infuse over 30 min vancomycin 15 mg/kg, IVPB, ivpb, q12h, Infuse over 90 min, Pharmacy to dose Dose may be rounded if appropriate. 15 mg/kg, IVPB, ivpb, q12h, Infuse over 90 min Dose may be rounded if appropriate. Pain Study Analgesics investigational drug (Ortho Pain Study Gabapentin or Placebo) 300 mg, cap, PO, q8h, x 3 days Start within 8 hours of Pre-Op dose. acetaminophen 1,000 mg, IVPB, inj, q6h, x 4 dose Do not exceed 4000 mg of acetaminophen per day from all sources. HYDROcodone-acetaminophen (HYDROcodone-acetaminophen 7.5 mg-325 mg oral tablet) 1 tab, PO, tab, q4h, PRN pain-mild, Pain Scale: 1-5 Start after 24 hrs post op. Do not exceed 4g/day of acetaminophen. 2 tab, PO, tab, q4h, PRN pain-moderate, Pain Scale: 5-7 Start after 24 hrs post op. Do not exceed 4g/day of acetaminophen. Order Taken by Signature: Page: 4 Total Knee Replacement Post-Op Version: Plan7 Effective on: 04/27/16 Page 4 of 15

5 Pt. Arrives to Room tramadol 50 mg, PO, tab, q6h, PRN pain, x 24 hr HYDROmorphone 1.5 mg, IVPush, inj, q2h, PRN pain-severe, Pain Scale: 7-10 ***Slow IV Push*** Use if morphine ineffective or contraindicated. 1 mg, IVPush, inj, q2h, PRN pain-severe, Pain Scale: 7-10 ***Slow IV Push*** Use if morphine ineffective or contraindicated. 0.5 mg, IVPush, inj, q2h, PRN pain-severe, Pain Scale: 7-10 ***Slow IV Push*** Use if morphine ineffective or contraindicated. Gastrointestinal Agents docusate 100 mg, PO, cap, Nightly, PRN constipation *****IF docusate is contraindicated or ineffective after 12 hours, USE bisacodyl if ordered***** *****IF docusate is contraindicated or ineffective after 12 hours, USE bisacodyl***** bisacodyl 10 mg, rectally, supp, Daily, PRN constipation *****IF bisacodyl is contraindicated or ineffective after 6 hours, USE Fleet Enema if ordered***** *****IF bisacodyl is contraindicated or ineffective after 6 hours, USE Fleet Enema***** sodium biphosphate-sodium phosphate (Fleet Enema) 1 ea, rectally, enema, Daily, PRN constipation Antihistamines diphenhydramine 25 mg, IVPush, q6h, PRN itching *****IF diphenhydramine PO is ineffective or patient is NPO, USE diphenhydramine inj***** Antiemetics ondansetron 4 mg, IVPush, soln, q4h, PRN nausea/vomiting Use if promethazine ineffective or contraindicated. Laboratory CBC Next Day in AM, T+1;0300 CBC with Differential Next Day in AM, T+1;0300 Prothrombin Time with INR Next Day in AM, T+1;0300 PTT Next Day in AM, T+1;0300 Order Taken by Signature: Page: 5 Total Knee Replacement Post-Op Version: Plan7 Effective on: 04/27/16 Page 5 of 15

6 Pt. Arrives to Room Basic Metabolic Panel Next Day in AM, T+1;0300 Comprehensive Metabolic Panel Next Day in AM, T+1;0300 Respiratory Oxygen Therapy Via: Nasal cannula, Keep sats greater than: 92% IS Instruct Physical Medicine and Rehab Consult PT Mobility for Eval & Treat Consult Occ Therapy for Eval & Treat T+1;N, ADL s Consults/Referrals Social Services for Assessment and Eval Disharge Planning Social Services for DME for Home (Durable Medical Equipment for Home) Bedside Commode Walker for Home Use Shower Chair Home CPM Social Services for Home Health Care Home Physical Therapy Home Care Nurse Home Wound Care...Additional Orders Order Taken by Signature: Page: 6 Total Knee Replacement Post-Op Version: Plan7 Effective on: 04/27/16 Page 6 of 15

7 Pt. Arrives to Room - VTE Prophylaxis Plan Patient Care VTE Guidelines See Reference Text for Guidelines ***If VTE Pharmacologic Prophylaxis not given, choose the Contraindications for VTE below and complete reason contraindi cated*** Contraindications VTE Active/high risk for bleeding Treatment not indicated Patient or caregiver refused Other anticoagulant ordered Anticipated procedure within 24 hours Intolerance to all VTE chemoprophylaxis Apply Elastic Stockings Apply to: Bilateral Lower Extremities, Length: Knee High Apply to: Left Lower Extremity (LLE), Length: Knee High Apply to: Right Lower Extremity (RLE), Length: Knee High Apply to: Bilateral Lower Extremities, Length: Thigh High Apply to: Left Lower Extremity (LLE), Length: Thigh High Apply to: Right Lower Extremity (RLE), Length: Thigh High Apply Sequential Compression Device Apply to Bilateral Lower Extremities Apply to Left Lower Extremity (LLE) Apply to Right Lower Extremity (RLE) Apply Pedal Pump Apply to Bilateral Feet Apply to Left Foot Apply to Right Foot Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. ***Recommended Trauma Dose = 30 mg, subcut, q12h*** ***Recommended Dose for Morbidly Obese Patients = 40 mg, subcut, q12h*** enoxaparin 40 mg, subcut, syringe, q24h 30 mg, subcut, syringe, q12h 30 mg, subcut, syringe, q24h, For CrCl less than 30 ml/min 40 mg, subcut, syringe, q12h, For BMI greater than 39 heparin 5,000 units, subcut, inj, q12h 5,000 units, subcut, inj, q8h fondaparinux 2.5 mg, subcut, syringe, q24h rivaroxaban 10 mg, PO, tab, In PM 20 mg, PO, tab, In PM warfarin 5 mg, PO, tab, QPM aspirin 81 mg, PO, tab chew, Daily 325 mg, PO, tab, Daily Order Taken by Signature: Page: 7 Total Knee Replacement Post-Op Version: Plan7 Effective on: 04/27/16 Page 7 of 15

8 Pt. Arrives to Room - Sliding Scale Insulin Regular Plan Patient Care POC Blood Sugar Check Per Sliding Scale Insulin Frequency AC & HS AC & HS 3 days TID BID q12h q6h q6h 24 hr q4h q2h Sliding Scale Insulin Regular Guidelines Follow SSI Regular Reference Text Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. insulin regular (Low Dose Insulin Regular Sliding Scale) 0-10 units, subcut, inj, AC & nightly, PRN glucose levels - see parameters Low Dose Insulin Regular Sliding Scale mg/dl - 2 units subcut mg/dl - 3 units subcut mg/dl - 4 units subcut mg/dl - 6 units subcut mg/dl - 8 units subcut If blood glucose is greater than 400 mg/dl, administer 10 units subcut, notify provider, and repeat POC blood sugar check in units, subcut, inj, BID, PRN glucose levels - see parameters Low Dose Insulin Regular Sliding Scale mg/dl - 2 units subcut mg/dl - 3 units subcut mg/dl - 4 units subcut mg/dl - 6 units subcut mg/dl - 8 units subcut If blood glucose is greater than 400 mg/dl, administer 10 units subcut, notify provider, and repeat POC blood sugar check in units, subcut, inj, TID, PRN glucose levels - see parameters Low Dose Insulin Regular Sliding Scale mg/dl - 2 units subcut mg/dl - 3 units subcut mg/dl - 4 units subcut mg/dl - 6 units subcut mg/dl - 8 units subcut If blood glucose is greater than 400 mg/dl, administer 10 units subcut, notify provider, and repeat POC blood sugar check in 1 Continued on next page... Order Taken by Signature: Page: 8 Total Knee Replacement Post-Op Version: Plan7 Effective on: 04/27/16 Page 8 of 15

9 Pt. Arrives to Room - Sliding Scale Insulin Regular Plan 0-10 units, subcut, inj, q6h, PRN glucose levels - see parameters Low Dose Insulin Regular Sliding Scale mg/dl - 2 units subcut mg/dl - 3 units subcut mg/dl - 4 units subcut mg/dl - 6 units subcut mg/dl - 8 units subcut If blood glucose is greater than 400 mg/dl, administer 10 units subcut, notify provider, and repeat POC blood sugar check in units, subcut, inj, q4h, PRN glucose levels - see parameters Low Dose Insulin Regular Sliding Scale mg/dl - 2 units subcut mg/dl - 3 units subcut mg/dl - 4 units subcut mg/dl - 6 units subcut mg/dl - 8 units subcut If blood glucose is greater than 400 mg/dl, administer 10 units subcut, notify provider, and repeat POC blood sugar check in units, subcut, inj, q2h, PRN glucose levels - see parameters Low Dose Insulin Regular Sliding Scale mg/dl - 2 units subcut mg/dl - 3 units subcut mg/dl - 4 units subcut mg/dl - 6 units subcut mg/dl - 8 units subcut If blood glucose is greater than 400 mg/dl, administer 10 units subcut, notify provider, and repeat POC blood sugar check in 1 Order Taken by Signature: Page: 9 Total Knee Replacement Post-Op Version: Plan7 Effective on: 04/27/16 Page 9 of 15

10 Pt. Arrives to Room - Sliding Scale Insulin Regular Plan insulin regular (Moderate Dose Insulin Regular Sliding Scale) 0-12 units, subcut, inj, AC & nightly, PRN glucose levels - see parameters Moderate Dose Insulin Regular Sliding Scale mg/dl - 3 units subcut mg/dl - 4 units subcut mg/dl - 6 units subcut mg/dl - 8 units subcut mg/dl - 10 units subcut If blood glucose is greater than 400 mg/dl, administer 12 units subcut, notify provider, and repeat POC blood sugar check in units, subcut, inj, BID, PRN glucose levels - see parameters Moderate Dose Insulin Regular Sliding Scale mg/dl - 3 units subcut mg/dl - 4 units subcut mg/dl - 6 units subcut mg/dl - 8 units subcut mg/dl - 10 units subcut If blood glucose is greater than 400 mg/dl, administer 12 units subcut, notify provider, and repeat POC blood sugar check in units, subcut, inj, TID, PRN glucose levels - see parameters Moderate Dose Insulin Regular Sliding Scale mg/dl - 3 units subcut mg/dl - 4 units subcut mg/dl - 6 units subcut mg/dl - 8 units subcut mg/dl - 10 units subcut If blood glucose is greater than 400 mg/dl, administer 12 units subcut, notify provider, and repeat POC blood sugar check in units, subcut, inj, q6h, PRN glucose levels - see parameters Moderate Dose Insulin Regular Sliding Scale mg/dl - 3 units subcut mg/dl - 4 units subcut mg/dl - 6 units subcut mg/dl - 8 units subcut mg/dl - 10 units subcut If blood glucose is greater than 400 mg/dl, administer 12 units subcut, notify provider, and repeat POC blood sugar check in 1 Continued on next page... Order Taken by Signature: Page: 10 Total Knee Replacement Post-Op Version: Plan7 Effective on: 04/27/16 Page 10 of 15

11 Pt. Arrives to Room - Sliding Scale Insulin Regular Plan 0-12 units, subcut, inj, q4h, PRN glucose levels - see parameters Moderate Dose Insulin Regular Sliding Scale mg/dl - 3 units subcut mg/dl - 4 units subcut mg/dl - 6 units subcut mg/dl - 8 units subcut mg/dl - 10 units subcut If blood glucose is greater than 400 mg/dl, administer 12 units subcut, notify provider, and repeat POC blood sugar check in units, subcut, inj, q2h, PRN glucose levels - see parameters Moderate Dose Insulin Regular Sliding Scale mg/dl - 3 units subcut mg/dl - 4 units subcut mg/dl - 6 units subcut mg/dl - 8 units subcut mg/dl - 10 units subcut If blood glucose is greater than 400 mg/dl, administer 12 units subcut, notify provider, and repeat POC blood sugar check in 1 insulin regular (High Dose Insulin Regular Sliding Scale) 0-14 units, subcut, inj, AC & nightly, PRN glucose levels - see parameters High Dose Insulin Regular Sliding Scale mg/dl - 4 units subcut mg/dl - 6 units subcut mg/dl - 8 units subcut mg/dl - 10 units subcut mg/dl - 12 units subcut If blood glucose is greater than 400 mg/dl, administer 14 units subcut, notify provider, and repeat POC blood sugar check in units, subcut, inj, BID, PRN glucose levels - see parameters High Dose Insulin Regular Sliding Scale mg/dl - 4 units subcut mg/dl - 6 units subcut mg/dl - 8 units subcut mg/dl - 10 units subcut mg/dl - 12 units subcut If blood glucose is greater than 400 mg/dl, administer 14 units subcut, notify provider, and repeat POC blood sugar check in 1 Order Taken Continued by Signature: on next page... Page: 11 Total Knee Replacement Post-Op Version: Plan7 Effective on: 04/27/16 Page 11 of 15

12 Pt. Arrives to Room - Sliding Scale Insulin Regular Plan 0-14 units, subcut, inj, TID, PRN glucose levels - see parameters High Dose Insulin Regular Sliding Scale mg/dl - 4 units subcut mg/dl - 6 units subcut mg/dl - 8 units subcut mg/dl - 10 units subcut mg/dl - 12 units subcut If blood glucose is greater than 400 mg/dl, administer 14 units subcut, notify provider, and repeat POC blood sugar check in units, subcut, inj, q6h, PRN glucose levels - see parameters High Dose Insulin Regular Sliding Scale mg/dl - 4 units subcut mg/dl - 6 units subcut mg/dl - 8 units subcut mg/dl - 10 units subcut mg/dl - 12 units subcut If blood glucose is greater than 400 mg/dl, administer 14 units subcut, notify provider, and repeat POC blood sugar check in units, subcut, inj, q4h, PRN glucose levels - see parameters High Dose Insulin Regular Sliding Scale mg/dl - 4 units subcut mg/dl - 6 units subcut mg/dl - 8 units subcut mg/dl - 10 units subcut mg/dl - 12 units subcut If blood glucose is greater than 400 mg/dl, administer 14 units subcut, notify provider, and repeat POC blood sugar check in units, subcut, inj, q2h, PRN glucose levels - see parameters High Dose Insulin Regular Sliding Scale mg/dl - 4 units subcut mg/dl - 6 units subcut mg/dl - 8 units subcut mg/dl - 10 units subcut mg/dl - 12 units subcut If blood glucose is greater than 400 mg/dl, administer 14 units subcut, notify provider, and repeat POC blood sugar check in 1 Continued on next page... Order Taken by Signature: Page: 12 Total Knee Replacement Post-Op Version: Plan7 Effective on: 04/27/16 Page 12 of 15

13 Pt. Arrives to Room - Sliding Scale Insulin Regular Plan insulin regular (Blank Insulin Sliding Scale) See Comments, subcut, inj, PRN glucose levels - see parameters If blood glucose is less than mg/dl, initiate hypoglycemia guidelines and notify provider mg/dl - units mg/dl - units subcut mg/dl - units subcut mg/dl - units subcut mg/dl - units subcut mg/dl - units subcut If blood glucose is greater than 400 mg/dl, administer units subcut, notify provider, and repeat POC blood sugar check in 1 hour. Continue to repeat units subcut and POC blood sugar checks every 1 hour until blood glucose is less than 300 mg/dl, then HYPOglycemia Guidelines HYPOglycemia Guidelines ***See Reference Text*** glucose 15 g, PO, gel, as needed, PRN glucose levels - see parameters Use if patient is symptomatic and able to swallow. See hypoglycemia guidelines. glucose (D50) 25 g, IVPush, syringe, as needed, PRN glucose levels - see parameters Use if patient is symptomatic and unable to swallow / NPO with IV access. See hypoglycemia guidelines. glucagon 1 mg, IM, inj, as needed, PRN glucose levels - see parameters Use if patient is symptomatic and unable to swallow / NPO WITHOUT IV access. See hypoglycemia guidelines. Order Taken by Signature: Page: 13 Total Knee Replacement Post-Op Version: Plan7 Effective on: 04/27/16 Page 13 of 15

14 Pt. Arrives to Room - PCA Med Plan IV Solutions ***CAUTION*** Ordering a continuous rate (Basal Dose), should be reserved for opioid tolerant patients who require high dose therapy. ***DOSING NOTES***: 1. Initial doses are for opioid naive patients. Chronic pain patients may require higher doses. 2. Decrease initial starting dose by 25-30% in patients > 65 yrs, or patients with renal, hepatic, or pulmonary impairment. 3. Hydromorphone and fentanyl are recommended for patients with renal impairment or those intolerant of morphine. 4. Avoid meperidine use in patients > 65 yrs, renal impairment, seizure disorders, MAO inhibitors, or duration > 72 hrs. Reserve meperidine use for patients intolerant to all other opioids. morphine (morphine 30 mg/30 ml PCA) Start date/time T;N Dose (mg) = 1, Lock-out Interval (min) = 8, 4-hour Limit (mg) = 20, Start date/time T;N Dose (mg) = 1, Lock-out Interval (min) = 10, 4-hour Limit (mg) = 20, Start date/time T;N Dose (mg) = 2, Lock-out Interval (min) = 10, 4-hour Limit (mg) = 40, Start date/time T;N HYDROmorphone (HYDROmorphone 6 mg/30 ml PCA) Start date/time T;N Dose (mg) = 0.1, Lock-out Interval (min) = 10, 4-hour Limit (mg) = 2, Start date/time T;N Dose (mg) = 0.2, Lock-out Interval (min) = 10, 4-hour Limit (mg) = 4, Start date/time T;N Dose (mg) = 0.3, Lock-out Interval (min) = 10, 4-hour Limit (mg) = 6, Start date/time T;N fentanyl (fentanyl 300 mcg/30 ml PCA) Start date/time T;N Dose (mcg) = 10, Lock-out Interval (min) = 10, 4-hour Limit (mcg) = 100, Start date/time T;N Dose (mcg) = 10, Lock-out Interval (min) = 10, 4-hour Limit (mcg) = 150, Start date/time T;N Dose (mcg) = 10, Lock-out Interval (min) = 10, 4-hour Limit (mcg) = 200, Start date/time T;N If no IV Fluid is currently infusing, start 0.9% sodium chloride at KVO for duration of PCA NS (Normal Saline) 1,000 ml final vol, IV, KVO Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. ACUTE MANAGEMENT OF RESPIRATORY DEPRESSION If respiratory rate is less than 10 breaths/min or patient is unresponsive 1. Stop PCA Pump 2. Dilute naloxone (Narcan) 0.4 mg / 1 ml in 9 ml NS and administer 0.1 mg (2.5 ml) by IVP every 2-3 minutes until respiratory rate is greater than 10 breaths/min. 3. Notify Physician naloxone (naloxone 0.4 mg/ml injectable solution) 0.1 mg, IVPush, inj, q2min, PRN bradypnea Dilute in 0.4 mg in 9 ml NS and administer 0.1 mg (2.5 ml) every 2-3 minutes until respiratory rate is greater than 10 breaths/ min. Respiratory Order Taken by Signature: Page: 14 Total Knee Replacement Post-Op Version: Plan7 Effective on: 04/27/16 Page 14 of 15

15 Pt. Arrives to Room - PCA Med Plan Continuous Pulse Oximetry Order Taken by Signature: Page: 15 Total Knee Replacement Post-Op Version: Plan7 Effective on: 04/27/16 Page 15 of 15