Methadone 40mg PO

SCDs

• • While in bed

ABG

• • On arrival to unit

Consult

• • nutrition

Delirium screening

• • Once per shift

Labs

• • CBC, BMP, Mg, Ca2+, Coags @ 6 hrs after OR, earlier if needed

Implement standarized transfusion algorithm

Initiate A-fib Prevention Amiodarone protocol

• • If CI >2 L/min/m2 for 3 consecutive hours

  • Amiodarone 150 mg IV bolus over 10 min followed by:

  • Amiodarone 1.0 mg/min IV infusion x 6 hrs, then 0.5 mg/min x 18 hrs

  • When infusion complete, D/C IV

  • Then Amiodarone 400 mg PO BID with meals x 5 days

Diet:

• • once extubated-clear liquids and

  • advance to cardiac carb control diet

  • protein supplementation 3x/day

Activity:

• • OOB to chair

Flutter Valve (when extubated)

• • Q1-2hrs 30x while awake

Mulitmodal Analgesia

• • Acetaminophen 1g PO Q 8 hrs (Not ordered as "while awake")

  • Oxycodone 5 mg PO Q4 hrs PRN

  • Oxycodone 10 mg Q4 hrs PRN

  • Tramadol 50-100 mg PO Q8 hrs PRN

Bowel regimen

• • Colace 100mg PO QHS

Amiodarone protocol

• • Amiodarone 400mg PO BID x5 days w/meals

IVF

• • D/C when tolerating PO intake

Activity:

• • Ambulate 3-4x/daily

  • OOB to Chair if not ambulating or sleeping

Diet

• • Cardiac Carb control

  • Protein supplementation 3x/day

Multimodal Analgesia:

• • Acetaminophen 1g PO Q8 hrs (Not ordered as "while awake")

  • Gabapentin 300 mg PO TID

  • Oxycodone 5-10mg PO Q4 hrs PRN

  • Tramadol 50-100 mg PO Q8 hrs PRN

Bowel Regimen

• • Lactulose solution 20 gram/30ml PO daily prn

  • Dulcolax suppository 10mg PRN (start POD #1)

  • Colace capsule 100mg PO every HS (start POD #1)

  • Lactulose 20 gram/30ml x 1 on POD #2 (hold if BM in last 24hr)

  • Dulcolax 10mg PO daily (start POD #3) OR suppository 10mg if unable to take PO’s

Continue Amiodarone protocol from CVRU to 5D

• • Amiodarone 400mg PO BID x5 days w/meals

Diet:

• • Cardiac carb control diet immediately

  • Protein supplementation 3x/day

Activity:

• • Ambulate 3-4x/daily

  • OOB to Chair if not ambulating or sleeping

Incentive spirometry

• • 5-10x/hr while awake

IVF

• • D/C if tolerating PO intake

  • If IVF needed, balanced crystalloid (LR) preferred over 0.9% NS

VTE prophylaxis

• • SCD usage while in bed or chair until discharge

Foley

• • D/C on or before POD 1

Multimodal-non-opioid analgesics as first line

• • Acetaminophen 1g PO Q8 hrs (Not ordered as "while awake")

  • Gabapentin 300 mg PO TID

  • Oxycodone 5-10mg PO Q4 hrs PRN

  • Tramadol 50-100 mg PO Q8 hrs PRN

Bowel regimen:

• • Lactulose solution 20 gram/30ml PO daily prn

  • Dulcolax suppository 10mg daily x 2 days (start POD #1)

  • Colace capsule 100mg PO every HS (start POD #1)

  • Lactulose 20 gram/30ml x 1 on POD #2 (hold if BM in last 24hr)

  • Dulcolax 10mg PO daily (start POD #3) OR suppository 10mg if unable to take PO’s

Glycemic control

Consult

• • case management if needed