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****(Please select all applicable orders)****
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1. VS q5 minutes for first 30 minutes, then q15 minutes for 30 minutes until Aldrete score of 8 or above.
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2. Oxygen
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Oxygen (other)
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3. IV Fluids
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IV Fluids (other)
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4. Medications
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a. Pain
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Dilaudid __ mg IV
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Frequency (q ____ mins)
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up to ___ mg
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Demerol ___ mg IV PRN
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Frequency (q ____ mins)
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up to ___ mg
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Percocet ____ tabs PO
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Tylenol ___ mg PO
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Vicodin __ tabs PO
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Norco ___ tabs PO
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Other
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b. Nausea
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Phenergan __ mg IV given over 5 minutes mixed in NS
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Reglan __ mg IV
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may repeat x ___
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Zofran __ mg IV
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Other:
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c. Other
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Hydralazine ____ tabs
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PO x ____ tabs
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for _____
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Other:
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5. Ambulation
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Other:
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6. Suction PRN
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7. Diet
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8. Discharge from PACU when patient seen by MD or anesthesia and has Aldrete of 8 or more
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Notify Anesthesia of any problems/complications
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Anesthesia Signature
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Anesthesia Signature - Date/Time
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RN Signature
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RN Signature - Date/Time
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