1) st essen Preop Anesthesia (SANPREOP) Vital Signs - Preprocedure & Vital signs (VS) baseline Nursing Orders @ Consent: confirm completion --Anesthesia @ POC: Glucose the morning of surgery on ail patients with a history of diabetes Warming blanket (Bair Hugger) If Indicated Nursing med instructions: may give all oral medications ac regularly scheduled _patiant may use their own inhaler; sand to O.R. with patiant Notify anesthesia if: missed beta-blocker dose prophylactic antibiotic given greater than 1 hour before incision blood sugar less than 80 mg/dL or greater than 200 mg/dL. @ SBP greater than 160 mmHg @ temperature less than 36 C (96.8 F) within 30 minutes prior to anesthesia or temperature greater Urari 38.6 C (101.5 F) Respiratory Pulse oximetry with vitals 1D Pulse oximetry continuous D_ Oxygen therapy by nasal cannula at 2 L/min if Sp02 is less than 92% and then titrate to maintain SpOZ of at least 92%; may increase to 6 L/min Diet NPO 12 NPO after midnight except for medication with a sip of water 1D. Clear liquid diet before 06:00 if surgery scheduled from 12 noon and beyond NPO guidelines (ASA recommendations): Source DZ hrs before surgery - clear liquids (water, fruit juice with no pulp, clear carbonated beverages, tea, coffee - with or without sugar) 0 4 hrs before surgery - breast milk, if applicable (If on proton pump inhibitor may have this diet up to 6 hrs before surgery) 1 G hrs before surgery - infant formula, if applicable; simple carbohydrates (crackers, toast with jelly but no butter/jams/preserves, cereal without milk; fruit juice with some pulp (If on proton pump inhibitor may have this dist up to & hrs before surgery) 1 8 hours before surgery - proteins (meat, nuts), fats (Fried foods, dairy, peanut butter, chocolate); complex carbohydrates (cookies, sweet rolls, pop-tarts, aranola bars) Laboratory Urine pregnancy last on al female patients, menses lo menopause, unless Uocurented hysterectomy or tubel ligetion (document test results or refusal to be tested) CBC w differential Protime (PT / INR) Basic metabolic prof (MP) Type and screen Type and crossmatch 2 units Fi tcoone {AN AN 8 oooooDiagnostic Tests D CVEKG 12 lead IV Fluids. @ Waceess 2 1V: saline lock Sodium Chloride 0.9% D150 mililiter/hour intravenously D_10 mililiter/hour intravenously Lactated Ringers 1D 150 miliiter/hour intravenously 1D 10 mililiter/hour intravenously Medications ‘dexamethasone (DECADRON) 1D 4 milligram intravenous push once ondansetron (70FRAN) 1D 4 milligram intravenous push once scopolamine 1.5 mg 72 hr transderm patch (TRANSDERM-SCOP) 1D 1 patch trensdermally once and remove 24 hours after surgery metoclopramide (REGLAN) B10 milligram intravenous push once 1D 10 milligram orally once femotidine (PLPCID) 20 milligram intravenously once 1D 20 milligram orally once sodium citrate /citric acid (BICITRA) D_30 milliliter orally once mecizine (ANTIVERT) 1B_25 milligram orally once droperidol (INAPSINE) 0.625 miligram intravenous push once midazolam (VERSED) ‘D1 milligram intravenous push once and may repeat x1 hydrocortisone (SOLU-CORTEF) 11 100 milligram intravenous push once metoprolol (LOPRESSOR) DS milligram intravenously over 5 minutes (in surgery staging area) hold for HR less than 60 or SBP less than 100 albuterol (PROVENTIL) 2 puff inhaled once if history of asthma and/or current smoker - DO NOT GIVE if patient has taken a bronchodilator that morning lbuterol-ipratropium 2.5 mg-0.5 mg/3 mL soln for inhalation (DUONEB) ‘D 3niilliter by nebulizer once (send to OR with patient) atropine 1D 0.4 milligram intramuscularly once DATE TIME © 2012, Zynx Health Incorporated Page 2 of 2