Post Biopsy Orders

PLACE LABEL HERE POST BIOPSY ORDERS

The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked. Initial all handwritten order modifications and the bottom of each page when indicated (multipage).

1. Do you expect that the patient’s condition will require a hospital stay that will cross two midnights (includes the time spent in outpatient- ED, surgery, OBS) and the patient has medical necessity for an inpatient admission? 2.  Yes, admit as inpatient, proceed to # 2 No, place in observation No, outpatient, DC home 3. If admitted as inpatient, Inpatient Physician Certification: Diagnosis: ______Level of Care:  Critical  Intermediate  Acute Care Location/Specialty Unit Preference ______4.  Telemetry: If patient Medical/Surgical, must complete form # 36084 5.  Isolation:  Contact  Droplet  Airborne For: ______6. Consults: ______7. Assessments: Vital signs q 15 min x 2, then q 30 min x 4, then q hr x 3 Check for bleeding or hematoma at biopsy site at same intervals 8. Diagnostics: Chest x-ray PA & LAT, CXR (upright), reason______ now  in ______hrs Portable, PCXR reason______ now  in ______hrs PA/AP only Chest - Stretcher reason______ now  in ______hrs 9. Diet:  May resume previous diet as tolerated 10. Activity:  Bedrest, pressure at biopsy site x 30 min, then ad lib for ____ hrs with assistance  Bedrest for ______hrs

MEDICATIONS 11. IVF:  Normal saline ______ml/hr IV x ______hrs 12. Mild Pain, Temp >100.5F, HA:  Tylenol (acetaminophen) 650 mg po or PR q 4 hrs prn 13. Moderate Pain:  Norco (HYDROcodone/acetaminophen) 5/325 mg or 10/325mg 1 tab po q 4 hrs prn. DC if Percocet ordered. OR  Percocet (oxyCODONE/acetaminophen) 5/325 mg or 10/325 mg 1 tab po q 4 hrs prn. DC if Norco ordered. 14. Severe Pain (Begin when Epidural or PCA has been discontinued)  Morphine 1-2 mg IV q 3 hrs prn, DC if CrCl < 30. Hold for excessive sedation. DC if Dilaudid ordered. OR  Dilaudid (HYDROmorphone) 0.25-0.5 mg IV q 3 hrs prn. If CrCl < 30, dose at 0.25 mg. Hold for excessive sedation. DC if Morphine ordered. 15. Nausea/Vomiting:  Zofran (ondansetron) 4 mg IV or po q 6 hrs prn

ADDITIONAL ORDERS: ______

______Date Time Physician Signature PID Number

*1-1352* FORM 1-1352 REV. 09/2016 WHITE: Medical Record CANARY: Pharmacy Page 1 of 1