UNIVERSITY OF CALIFORNIA, DAVIS MEDICAL CENTER SACRAMENTO, CALIFORNIA

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ENT ADMISSION ORDERS TO TOWER 7 MSICU Attending: Fellow: Resident: Diagnosis: Surgery: Isolation: Allergies: (Food & Med.) Respiratory Settings: FiO2 SIMV TV PS PEEP. O2 Therapy L, %, NP Mask Cupula Heated mist Cool mist Wean from ventilator to keep SaO2 >92%, ph >7.32 & RR <30 Line Care: A-line Swan-Ganz IV Fluid: Activity: Head of bed at 30 degrees. Bed rest X 24h. Then OOB q shift & prn when hemodynamically stable. NPO: NG to int. wall suction X 24h then clamp. DO NOT REPOSITION Secure w/tape. TED/SCD. (May D/C when ambulating.) Medications: ASA 325mg NG/PO daily Docusate 100 mg NG/PO q 12h. Famotidine 20 mg IV/NG/PO q 12h. MVI 1 amp IV/NG/PO daily X 7 day. Folate 1 mg IV/NG/PO daily X 7 day. Thiamine 100 mg IV/NG/PO daily X 7 day. Lacrilube OU q hs. Artificial tears q 2h while awake. A1951-1 (09-04) OTOLARYNGOLOGY HEAD AND NECK SURGERY PHYSICIANS ORDERS PAGE 1 OF 4- MR02/94323

MEDICATIONS: See antibiotics sheet. PRN MEDICATIONS: PCA per Anesthesia Pain Service. Lorazapam 1-2 mg IV q 2-4h prn agitation. Morphine Sulfate 2-6 mg IV q 1-2h prn pain. Acetominophen with Codeine elixir 15-30 ml q 4-6h prn pain. Acetominophen 650 mg NG/PR q 6h prn T >38.5º C. Diphenhydramine 25-50 mg IV/NG q 6h prn itching. Metaclopramide 10 mg IV q 4h prn nausea/vomiting. Phenergan 12.5 mg-25 mg IV q 6h prn nausea/vomiting. MOM 15-60 ml po daily prn No BM (use first) Ducolax supp. PR prn No BM (if no result with MOM) Fleets Enema daily prn No BM (if no result with above) K series: Call H.O. for K < 3.0 or > 5.5. (Redraw post coverage) K < 3.9 give 10 meq KCl IV X 3. K < 3.5 give 10 meq KCl IV X 4. Magnesium series: (Redraw post coverage) Mg < 1.8 give 1 Gm MgSO4 IV Mg < 1.5 give 2 Gm MgSO4 IV Calcium series: (Redraw post coverage) Calcium Gluconate 1amp IV for ion Ca <. LABS AND X-RAY: Chest X-Ray in AM X 1 and in RR. CBC, BMP, Ca, Mg & Phos. q AM X 3 days and in RR. CMP q Monday and Thursday ABG prn A1951-2 (09-04) OTOLARYNGOLOGY HEAD AND NECK SURGERY PHYSICIANS ORDERS PAGE 2 OF 4- MR02/94323

ROUTINE CARE: Strict intake and output. Foley to gravity drain. Weight daily. Vital signs per ICU routine. Call HO SBP<180>80;DBP<90;T>38.5 C; HR<50 >110; RR>25; UO<30ml hr; SaO2<92% WOUND CARE: Wound care with H2O2 followed by NS wash to remove crusts. q 6h & prn Apply Bacitracin ointment q 12h X 2 days then D/C. JP drains to bulb suction. (If bulb not holding suction switch to low wall suction) Record drains separately. Strip drains q 1-2h for patency. (tape tubing securely to skin) STSG thigh donor site. Change Aquacell daily and prn breakthrough drainage. Use Hydrogel when No drainage daily and prn FLAP CARE: Type: Check capillary refill q 1h X 24h Then q 4h. (call HO for) Any change in flap/reconstruction capillary refill. Fluid collection under flap. Air leak around drain insertion site. Unusual drainage from drain (including frothy) Incision becomes red, develops pustules, is edematous or dehiscent Refer to free flap order sheet. AIRWAY CARE: Routine laryngectomy/tracheostomy care q 8h and prn. Instill.9 NS pillows q 1-2h. Deflate cuff when off vent unless on aspiration precautions. Routine laryngectomy care q 8h and prn. Instill.9 NS pillows q 1-2h. A1951-3 (09-04) OTOLARYNGOLOGY HEAD AND NECK SURGERY PHYSICIANS ORDERS PAGE 3 OF 4- MR02/94323

ORAL CARE: ½ st.h202 &.9 NS or Peridex q 4h. Do not suction or clean directly over internal oral suture lines. Consults: Anesthesia Pain Service. (MD to call.) Critical Care Medicine. (MD to call.) ENT Speech Pathology. Call 734-2786 (voice mail) Nutrition. Physical Therapy. IV Therapy for PICC line insertion. 1. 0800-1600 call 4-5379 2. Nights & weekends call 4-3732 (voice mail). Transfusion Orders: Call HO Hgb < or Hct < for transfusion orders. Premedicate with: a) Acetominophen 650mg NG/PR x 1. b) Diphenhydramine 50mg IV/NG x 1. Nursing and Patient Education: MPER for total laryngectomy/partial laryngectomy. MPER for oral-facial cancer Advance Directive. Attending Physicians Name: PI# Beeper. Ordering Physicians Name: PI# Beeper. A1951-4 (09-04) OTOLARYNGOLOGY HEAD AND NECK SURGERY PHYSICIANS ORDERS PAGE 4 OF 4- MR02/94323

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