Card Open Heart POD1 POD3 Plan Post Op Day 1

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1 Day 1 PHYSICIAN S Weight Allergies Admit/Discharge/Transfer Transfer Patient Transfer to: Floor, Pt Status: Inpatient (LOS > 2 midnights) Vital Signs q2h, POD 1 Vital Signs q2h for 24 hours then per unit standards. Daily Weight Ambulate Patient Ambulate in Room, POD1 Short Distances as tolerated. POD2 Ambulate TID. POD3 Ambulate QID and PRN ft. **Modify Existing Pacemaker Settings Order or Cancel/DC Existing Pacemaker Settings Order Prior to Placing New Order Below** Bedside Pacemaker Settings Mode: DDD, Rate: 90, 10 ma, 0.5 mv, 10 ma, 2.0 mv, 170 msec, Continue for 72 hours Discontinue Gastric Tube DC Nasogastric NG, DC when Pt. extubated. Discontinue Arterial Line D/C on POD #1 at 0600 if CI >2 and Urine Output >0.5 ml/kg/hr. Apply pressure x 10 minutes. Leave pressure dressing for 8 hrs and then DC. Discontinue PA Catheter (Discontinue Swan Ganz) D/C on POD #1 at 0600 if CI >2 and Urine Output >0.5 ml/kg/hr. Apply pressure x 10 minutes. Leave pressure dressing for 8 hrs and then DC. Wound Care by Nursing Sterile Dressing, Cover/Pack with Island, Located: Chest Incision, Change q12h, Cleanse with chlorhexidine with each change. DO NOT rinse. May discontinue dressing upon discharge from hospital. Wound Care by Nursing Cover/Pack with 4x4 Gauze, Secure with Hypafix Tape Located: Leg Incision, Change q12h, Clean with chlorhexidine with each change. DO NOT rinse. May discontinue dressing upon discharge from hospital. Communication Notify Provider of VS Parameters (Notify Provider if VS) SpO2 < 92 Dietary Advance Diet as Tolerated Advance Diet To: Clear Liquid Diet, Clear Liquid post NG removal. Clear Liquid Diet Page: 1 Card Open Heart POD1 POD3 Plan Version: 2 Effective on: 11/10/13

2 Day 1 PHYSICIAN S Dietary Supplements Supplement: Ensure Clinical Strength, With All Meals Supplement: Glucerna, With All Meals ADA Diet Adult AHA Diet Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. amiodarone 200 mg, PO, tab, BID rosuvastatin 10 mg, PO, tab, Nightly Other Medications potassium chloride 20 meq, PO, tab sa, TID, PRN other To keep K+ > or = 4.0 Mmol/L clonidine (clonidine 0.1 mg/24 hr transdermal film, extended release) 0.1 mg/day, transdermal, adh patch, ONE TIME 0.1 mg/day, transdermal, adh patch, Every week clonidine (clonidine 0.2 mg/24 hr transdermal film, extended release) 0.2 mg/day, transdermal, adh patch, ONE TIME 0.2 mg/day, transdermal, adh patch, Every week clonidine (clonidine 0.3 mg/24 hr transdermal film, extended release) 0.3 mg/day, transdermal, adh patch, ONE TIME 0.3 mg/day, transdermal, adh patch, Every week Respiratory Respiratory Care Plan Protocol Oxygen Therapy Via: Nasal cannula, Keep sats greater than %: 92, POD3 If O3 Sat >92% may wean to room air. IS Instruct Instruct patient use of IS times every 1 hour while awake 6am until 11pm Page: 2 Card Open Heart POD1 POD3 Plan Version: 2 Effective on: 11/10/13

3 Day 1 Post Op Day 2 PHYSICIAN S Discontinue Urinary Catheter (Discontinue Foley) **Document Reason to Maintain Foley Below** Do NOT DC Foley Critically Ill or Unstable Pt. Requires Prolonged Immobilization Discontinue Chest Tube Located: Pleural Chest Tubes, DC if no air leak and get chest x ray 1 hour after removal Discontinue Chest Tube Located: Mediastinal Chest Tubes Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. bumetanide mg, IVPush, inj, ONE TIME Give after removal of Foley warfarin 1 mg, PO, tab, QPM 2 mg, PO, tab, QPM 2.5 mg, PO, tab, QPM 3 mg, PO, tab, QPM 4 mg, PO, tab, QPM 5 mg, PO, tab, QPM 6 mg, PO, tab, QPM 7.5 mg, PO, tab, QPM 10 mg, PO, tab, QPM furosemide 20 mg, PO, tab, Daily 40 mg, PO, tab, Daily potassium chloride 10 meq, PO, tab sa, Daily 20 meq, PO, tab sa, Daily 40 meq, PO, tab sa, Daily Use metoprolol (Lopresser) 25 mg PO BID for LVEF > 35% Use metoprolol (Lopresser) 12.5 mg PO BID for LVEF < 36% metoprolol 25 mg, PO, tab, BID For LVEF >35% HOLD for SBP <100 or HR <50bpm 12.5 mg, PO, tab, BID For LVEF < 36% HOLD for SBP <100 or HR <50bpm Consults/Referrals Page: 3 Card Open Heart POD1 POD3 Plan Version: 2 Effective on: 11/10/13

4 Day 1 Post Op Day 2 PHYSICIAN S Social Services for Assessment and Eval Discharge Planning Page: 4 Card Open Heart POD1 POD3 Plan Version: 2 Effective on: 11/10/13

5 Day 2 PHYSICIAN S Discontinue Urinary Catheter (Discontinue Foley) **Document Reason to Maintain Foley Below** Do NOT DC Foley Critically Ill or Unstable Pt. Requires Prolonged Immobilization Discontinue Chest Tube Located: Pleural Chest Tubes, DC if no air leak and get chest x ray 1 hour after removal Discontinue Chest Tube Located: Mediastinal Chest Tubes Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. bumetanide mg, IVPush, inj, ONE TIME Give after removal of Foley warfarin 1 mg, PO, tab, QPM 2 mg, PO, tab, QPM 2.5 mg, PO, tab, QPM 3 mg, PO, tab, QPM 4 mg, PO, tab, QPM 5 mg, PO, tab, QPM 6 mg, PO, tab, QPM 7.5 mg, PO, tab, QPM 10 mg, PO, tab, QPM furosemide 20 mg, PO, tab, Daily 40 mg, PO, tab, Daily potassium chloride 10 meq, PO, tab sa, Daily 20 meq, PO, tab sa, Daily 40 meq, PO, tab sa, Daily Use metoprolol (Lopresser) 25 mg PO BID for LVEF > 35% Use metoprolol (Lopresser) 12.5 mg PO BID for LVEF < 36% metoprolol 25 mg, PO, tab, BID For LVEF >35% HOLD for SBP <100 or HR <50bpm 12.5 mg, PO, tab, BID For LVEF < 36% HOLD for SBP <100 or HR <50bpm Consults/Referrals Page: 5 Card Open Heart POD1 POD3 Plan Version: 2 Effective on: 11/10/13

6 Day 2 PHYSICIAN S Social Services for Assessment and Eval Discharge Planning Page: 6 Card Open Heart POD1 POD3 Plan Version: 2 Effective on: 11/10/13

7 Day 2 Post Op Day 3 PHYSICIAN S Discontinue Pacemaker Wires Discontinue Central Line Convert IV to INT Page: 7 Card Open Heart POD1 POD3 Plan Version: 2 Effective on: 11/10/13

8 Day 3 PHYSICIAN S Discontinue Pacemaker Wires Discontinue Central Line Convert IV to INT Page: 8 Card Open Heart POD1 POD3 Plan Version: 2 Effective on: 11/10/13

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