Three-year-old C.E. is admitted to the Emergency Department (ED) fast track clinic. Her mother tells    the nurse that C.E. has had a low-grade fever for 2 days and is complaining of ear pain and a sore     throat. Mrs. E. states that C.E.’s appetite has been “off,” but she has been drinking and using the bath- room as usual. Mrs. E. takes C.E. to an ENT specialist. It is determined that her enlarged tonsils might be contributing to the frequent throat and ear infections, and a tonsil and adenoidectomy (T&A) is scheduled. She will be admitted postoperatively for 24-hour observation. After the surgery, the postoperative nurse receives C.E. to the short-stay unit from the post-anesthesia care unit (PACU). C.E. is awake and alert, bilateral breath sounds are clear, and her oxygen saturation is 98% on room air. She has tolerated sips of clear fluids, and her parents are with her. 8.           Which of these orders would you expect to see in her postoperative orders? (Select all that apply, and discuss the rationales for your choices.) a.           Vital signs q4h b.           Clear liquids. Advance to regular toddler diet. c.            Methylprednisolone (Solu-Medrol) 2.3 mg IV q8h ´ 3 doses d.           Acetaminophen (Tylenol) (120 mg) with codeine (12.5 mg) 5 mL PO q6h prn for pain e.           Home prescription for amoxicillin (Amoxil) 120 mg PO q8h f.            Maintain peripheral IV with D51⁄2 NS at 50 mL/hr until taking PO well and then saline lock g.           Aggressively gargle and swish with water after eating or drinking.

Based on the postoperative status of C.E. and the routine interventions following tonsil and adenoidectomy (T&A) surgery, the expected postoperative orders for C.E. would include the following:

a. Vital signs q4h: This order is expected as monitoring vital signs is crucial in assessing the patient’s postoperative condition. It allows healthcare providers to identify any potential complications such as fever, changes in blood pressure, or abnormal heart rate. Regular monitoring of vital signs enables early detection and intervention if necessary.

b. Clear liquids. Advance to regular toddler diet: Initially, after T&A surgery, it is common practice to start with clear liquids and gradually progress to a regular diet as tolerated by the patient. Clear fluids are easily digestible and reduce the risk of aspiration or irritation to the surgical site. As the patient demonstrates the ability to tolerate clear fluids without any complications, the diet can be advanced to regular toddler foods.

c. Methylprednisolone (Solu-Medrol) 2.3 mg IV q8h ´ 3 doses: Methylprednisolone is a steroid medication that can help reduce inflammation and swelling. Given that C.E. has undergone a T&A surgery, which involves the removal of enlarged tonsils, there may be some postoperative inflammation in the throat and surrounding tissues. Administering a short course of steroids can help minimize postoperative edema and promote faster healing.

d. Acetaminophen (Tylenol) (120 mg) with codeine (12.5 mg) 5 mL PO q6h prn for pain: Pain management is an important aspect of postoperative care. T&A surgery can cause discomfort and pain, especially during swallowing and eating. The combination of acetaminophen with codeine provides effective pain relief for mild to moderate pain. It should be administered as needed to maintain the patient’s comfort level.

e. Home prescription for amoxicillin (Amoxil) 120 mg PO q8h: After T&A surgery, there is an increased risk of infection due to the surgical site. To prevent postoperative infections, prophylactic antibiotics such as amoxicillin may be prescribed. This prescription allows for a continued course of antibiotics once the patient is discharged from the hospital, ensuring appropriate treatment and reducing the risk of complications.

f. Maintain peripheral IV with D5 1/2 NS at 50 mL/hr until taking PO well and then saline lock: It is common practice to maintain intravenous (IV) access postoperatively until the patient is able to tolerate oral intake well. This ensures that fluid and medication administration can be continued if necessary. Once the patient demonstrates adequate oral intake, the IV line can be changed to a saline lock, which allows for easy access if needed but without continuous fluid administration.

g. Aggressively gargle and swish with water after eating or drinking: This order aims to reduce the risk of infection and promote healing at the surgical site. Gargling and swishing with water after eating or drinking helps to flush out any debris or bacteria that may accumulate in the throat. This practice can help prevent infection and ensure proper hygiene of the surgical site.

In summary, the expected postoperative orders for C.E. following T&A surgery would include monitoring vital signs, advancing diet from clear liquids to regular toddler diet, administering steroids for inflammation, managing pain with a combination of acetaminophen and codeine, prescribing prophylactic antibiotics, maintaining IV access until oral intake is well-tolerated, and recommending aggressive gargling and swishing with water for hygiene purposes. These interventions aim to ensure optimal postoperative recovery and reduce the risk of complications.