ICU MANAGEMENT:
- Identify patient as ERAS
- Hand Off
Confirm with CRNA ALL medications given intra-op for safety precautions and to ensure no double dosing occurs
- Pulse oximetry
Continuous x24 hrs
- Multimodal, non-opioid analgesics as first line:
Acetaminophen 1 g PO Q8 (if dosing meets 3g/24hr limit, contact pharmacy to reschedule; do not skip dose)
Ofirmev 1 g IV (15mg/kg) Q8 if not taking PO
NO for right lobe resection
Gabapentin 300 mg PO QHS starting POD 0
Celebrex 200 mg PO Q12
Oxycodone 5-10 mg PO Q4 PRN pain <7
IV opioids for severe breakthrough pain (VPS β₯7)
***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***
- Alvimopan (Entereg) 12 mg PO Q12-start POD 0
Know dosing criteria before administering
RN must be educated on dosing criteria before being able to administer
- VTE per MD order
- IVF
Balanced crystalloid (LR) per MD order
- GDFT
**Continue: SV optimization protocol
- Incentive spirometry
10x/hr while awake
- Diet
POD 0: Clears
POD 1: Advance to GI soft diet
Document all PO liquid and solid intake in Dimensions-please document type of diet being consumed
- Foley
Removal POD 1 evening
Male patients, foley remains in place until 6 hrs after epidural discontinuation)
- Ambulation
DOCUMENT in Dimensions as "Ambulation in Hall" NOT "Up Ad Lib"
POD 0: Out of bed to chair
POD 1: Ambulate 2-3x in hallway
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
- Glycemic control
FSBS <200
- Consults
Nutrition Consult β to follow through discharge
Wound nurse POD 0 if necessary