NURSING UNIT
- Identify patient as ERAS
- Multimodal, non-opioid analgesics as first line
Acetaminophen 1g PO q8 (if dosing meets 3g/24hr limit, contact pharmacy to reschedule; do not skip dose)
Gabapentin elixir 300 mg PO qhs
Toradol 15 mg IV q6
IV opioid for breakthrough pain ***dose accordingly with pain score***
Transition to oral opioids when diet tolerated
Ensure appropriate medication given for patient's current pain score (take "Patient's Stated Pain Goal" into account too). ERAS Goal is to limit opioids
***If any of the multimodal medications are not ordered or not ordered correctly, contact surgeon ASAP for correction***
- SCD
usage until discharge
- Diet
Diet advancement protocol using bariatric clear liquids including clear protein and/or bariatric full liquids 30 cc @ 6 hr, 60 cc @ 8hr, 90cc @10 hr
- Nutrition Consult
**stress adequate hydration**
- HOB
elevated 30 degrees at all times
- AMBULATION
**Document in Dimensions as "Ambulation in Hall" NOT "Up ad lib"**
Ambulate 4 times daily starting immediately- DOCUMENT IN DIMENSIONS
OOB at least 6 hours daily, in addition to walks
If patient is unable to ambulate due to fatigue, nausea, or refuses, please make note on Activity flowsheet. If patient does refuse, remind them they were educated on this prior to surgery, benefits of ambulation and risk of not ambulating
- IVF
Minimize to less than 1L/POD 0-1
Then KVO vs 75cc/hr thereafter
Need parameters for continuing IVF
- VTE prophylaxis
- Ulcer prophylaxis
With PPI QD
- Atelectasis prophylaxis
With IS
Mobilization
Albuterol nebs?
- Maintain euglycemia
Via standard SSI order set
- Defined Discharge Criteria
Discussed Preoperative and from POD 1
Reinforce expectations β discussed regularly among patient, RN staff, family
Discharge instructions per Bariatric RN Navigator
Anticipate Discharge needs
HHN for PT
Bariatric equipment
Follow-up appts, staple removal, nutrition
Laxative prn constipation
Gasx prn gas pain