Postoperative Orders - Total Knee Replacement

Patient Name: sdfasdfasdf
MR #: sdfaasdfasdf
Pre-operative Diagnosis: Osteoarthritis
Post-operative Diagnosis: Osteoarthritis
Procedure: Right total knee replacement
Date: 1/30/2000
Time: 10:53:2

1. AP and lateral xray R L knee(in recovery room)
2. Admit to the Orthopaedic Floor
3. Advance diet as tolerated
4. Labs: H&H q am x 3, daily PT
5. Vital signs & NVC q 4 hrs x 24 hrs then routine (8 am & 8 pm)
6. Activity: WBATPWBTDWBNWB
7. Consults:

Physical Therapy (total knee protocol)
Occupational Therapy (ADL's)
Respiratory Therapy (for atelectasis prophylaxis)
Managed Care (discharge planning, consider transfer to Rehab or transitional care unit on third postoperative day)
Rehab consult
Other:
 8. Incentive spirometry q 2 hrs while awake, RT instruct x 1
9. Intake and Output: Hemovac
10. Adjustable bedside commode, box of 4x4s, 2 inch tape, ABD at bedside, overhead frame and trapeze, eggcrate mattress.
11. CPM 0-30 degrees in recovery room, advance as tolerated
12. Overhead frame and trapeze
13. Foley catheter, remove on 2nd postop day, unless patient has an epidural for pain control. Remove Foley catheter within 4 hrs. after epidural catheter is removed. In an out catheterization, prn.
14. IV: D5W 1/2 NS @ 100 cc/hr. Decrease to TKO on first postop day if tolerating PO fluids well. D/C IV on third postop day.
15. MSO4 PCA, 1 mg/cc concentration, 1 mg/hr basal, 1 cc intermittent, 10 min lockout
16. MSO4 4-6 mg IM q 4-6 hrs prn severe pain
17. Vicodin 1-2 tabs po q4 hrs prn pain
18. Tylenol #3 1-2 tabs po q4 hrs prn pain
19. Tylenol 1-2 tabs po q4 hrs prn
20. Docusate sodium 100 mg po bid
21. Promethazine 12.5 mg IM q 4 hrs prn nausea.
22. Diphenhydramine 25 - 50 mg po qhs prn insomnia
23. Acetaminophen 650 mg po prn temp greater than 101 or HA
24. Coumadin 10 mg po today, page MD for daily dose
25. Ancef 1 gm IV q8 hrs x three doses