POST OPEN HEART PATIENTS

Perform Pt. Assessment Bid

Keep SpO2 > 90%
Follow one or more pathways

No distress; Weak Cough or poor Documented Patients with home New onset of
BBS Clear secreation clearance. atelecatasis and SpO2 medicines. wheezes.
< 90% on 6 LPM n/c Not in acute distress
Begin I.S.and PEP
within 2 Hours. Sx Q4 – Q6 & prn.
Suction one time Follow home
Pg 2
drug schedule.
Pt. achieves min. of 500cc and/or Therapy effective
demonstrates good technique with PEP Therapy effective

No No No
Yes
Yes

Access sedation, pain and Theravest or

anxiety management. BiPAP Tx Q4 and
CPT Qid & prn. as tolerated at noc.
Suction Q4 – 6
and prn Therapy effective
Therapy effective Therapy effective

Yes No
NO YES YES NO

Continue I.S.& Suction Bid & Q4prn.

Initiate BiPAP Continue flutter Notify Dr. flutter Q2 w/a Notify Physician
Tx. Q4 and noc & I.S. Q2 w/a.
as toleracted
 New onset of Wheezes

Respiratory Distress No Respiratory Distress

No Respiratory Distress YES COPD or RAD Hx
No COPD or RAD Hx

Obtain ABG.
Consider CHF. Albuterol 2-4P or neb
Albuterol. 4P or 2.5mg neb. 2.5mg .
May repeat in 10-20 Albuterol 2-4P May repeat once in
minutes, max 3 doses. or neb 2.5 mg 10-20 minutes.
Notify Physician

Therapy effective
Lasix Distress Albuterol or
effective continues Albuterol & Therapy effective
lasix effective
Yes
No
No
COPD or Inititate BiPAP protocol Yes
RAD Hx for respiratory distress.

COPD or
RAD Hx Assume Fluid Overload. Albuterol 2-4P or neb
No Yes Notify physician. 2.5mg Q4 and Q2prn.
Albuterol 2-4P or neb 2.5mg Spiriva 1 puff QD
Q4WA & Q2prn. Advair 220 1 puff Bid
I.S & flutter Q2 W/A I.S & flutter Q2 W/A
Albuterol 2-4P or neb 2.5 Yes No
mg Q4WA & Q2prn

Albuterol 2-4P or neb
2.5mg Q4 and Q2prn.
Continue flutter
& I.S. Q2 w/a. Spiriva 1 puff QD
Advair 220 1 puff Bid
I.S & flutter Q2 W/A
Albuterol 2.5mg neb or
2-4P Q4 & Q2Prn
I.S & flutter Q2 W/A
Notify Physician
Assume fluid overload.
Flutter & I.S. Q2 w/a.
Albuterol 2-4P or 2.5mg
neb Q4prn