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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Delegation/Practice Protocols,Inpatient Delegation Protocols,Related

Cardiac Transplant - Adult - Postoperative

Cardiac Transplant - Adult - Postoperative - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Inpatient Delegation Protocols, Related


IP - Cardiac Transplant - Adult - Postoperative [2849]
Intended for Adult Patients Only
Admission Status
Admission Status [95591]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor: B4/5
Service:
Rationale for LOS greater than 2 midnights:
Post-Op/Phase II
Venous Thromboembolism (VTE) Prophylaxis
VTE Prophylaxis (Single Response) [144115]
Caprini VTE Risk Assessment URL: https://uconnect.wisc.edu/servlet/Satellite?
cid=1126666624583&pagename=B_EXTRANET_UWH_HOME%
2FFlexMemberFile%2FLoad_File&c=FlexMemberFile
High VTE Risk with Low Bleed Risk [130117]
enoxaparin (LOVENOX) injection [800040] 40 mg, Subcutaneous, EVERY 24 HOURS
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 12 HOURS
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 8 HOURS Starting
tomorrow at 6:00 AM
Begin Postoperative Day 1
Sequential Compression Device (SCD) / Foot Pump
[EQP0023]
CONTINUOUS, Starting today, Routine
Left/Right/Bilateral? Bilateral
Type: Knee High
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Starting today, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
High VTE Risk with High Bleed Risk (Single Response)
[129757]
Sequential Compression Device (SCD) / Foot Pump
[EQP0023]
CONTINUOUS, Starting today, Routine
Left/Right/Bilateral? Bilateral
Type: Knee High
Post-Op/Phase II
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Starting today, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
Post-Op/Phase II
No VTE Prophylaxis [130084]
VTE Prophylaxis - Reason Not Ordered [COR0008] ONCE, Starting today, Routine
Reason Not Ordered:
Patient Care Orders
Vital Signs [88587]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 15 minutes until similar readings are recorded 4
consecutive times, then every 30 minutes., Post-Op/Phase II
Check Peripheral Pulse [NURMON0008] EVERY 4 HOURS, Starting today, Routine
Method:
Pulse Side:
Pulse Location:
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Post-Op/Phase II
Patient Monitoring [88588]
Refer to Policy 1.14 for Pulmonary Artery Catheter
Insertion, Maintenance, Blood Drawing and
Discontinuation [NURMON0060]
CONTINUOUS, Starting today For Until specified, Refer to
Policy 1.14 - Pulmonary Artery Catheter (Pulmonary Artery
Catheter (Swan Ganz)): Insertion, Maintenance, Blood
Drawing, and Discontinuation (Adult Only), Post-Op/Phase II
Refer to Policy 1.11 for Arterial Catheter Insertion,
Maintenance, Blood Drawing, and Discontinuation
[NURMON0060]
CONTINUOUS, Starting today For Until specified, Refer to
Policy 1.11 for Arterial Catheter Insertion, Maintenance, Blood
Drawing, and Discontinuation (Adults & Pediatrics), Post-
Op/Phase II
Measure Blood Pressure [NURMON0019] CONTINUOUS, Starting today, Routine
BP Source: Invasive
BP Location:
BP Position:
BP Restrictions:
Post-Op/Phase II
Measure Hemodynamic Parameters [NURMON0023] CONTINUOUS, Starting today, Routine
Pulmonary Artery Systolic Pressure (mmHg): Q1 Hour
Pulmonary Artery Diastolic Pressure (mmHg): Q1 Hour
Pulmonary Artery Mean Pressure (mmHg):
Pulmonary Artery Wedge Pressure (mmHg):
Central Venous Pressure (mmHg): Q1 Hour
Central Venous Pressure (mmH2O):
Cardiac Output: Q4 Hours
Cardiac Output Method:
Cardiac Index: Q4 Hours
Systemic Vascular Resistance: Q4 Hours
Pulmonary Vascular Resistance: Q4 Hours
Pulmonary Vascular Resistance Index:
Stroke Volume (mL/beat):
Stroke Volume Index:
Systemic Vascular Resistance Index:
Left Cardiac Work Index:
Right Cardiac Work Index:
Left Ventricular Stroke Work Index:
Right Ventricular Stroke Work Index:
Pulmonary Capillary Wedge Pressure (mmHg):
Measure with FloTrac? No
And as needed starting on arrival to unit, Post-Op/Phase II
Assess Neurologic Status [NURMON0006] EVERY 2 HOURS, Starting today, Routine, Every 2 hours
until fully awake starting on arrival to unit., Post-Op/Phase II
Cardiac Rhythm Monitoring - Adult [NURMON0010] CONTINUOUS, Starting today, Routine
Notify Provider: Symptomatic Change in Rhythm
Functional Cardiac Defibrillator Present:
Activity [87683]
Activity Bedrest While Intubated [NURACT0008] SEE COMMENTS, Starting today For 1 Weeks, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST: strict bedrest
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Increase activity to dangle once patient is extubated., Post-
Op/Phase II
Elevate Head Of Bed Unless Chest Is Open Equal to (degrees): 30
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


[NURACT0002] Greater than (degrees):
Less than (degrees):
Other options:
Routine, CONTINUOUS, Starting today, Post-Op/Phase II
High Fowler's Position During Weaning [NURACT0011] CONTINUOUS, Starting today, Post-Op/Phase II
Dangle With Leg Extension Exercises After Extubation
[NURACT0008]
CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE: 3x daily
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Once extubated, increase activity to dangle., Post-Op/Phase
II
Activity Chair [NURACT0008] CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE:
CHAIR: 3x daily
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
To chair if tolerate dangling, Post-Op/Phase II
Activity Ambulate [NURACT0008] CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE: 4x daily
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Once pulmonary catheter is removed, Post-Op/Phase II
Reposition Patient [NURACT0005] Type:
Routine, SEE COMMENTS, Starting today, Every 2 hours.,
Post-Op/Phase II
Sternal Precautions [PRECAU0010] CONTINUOUS, Starting today, Routine, Post-Op/Phase II
Nutrition [88590]
NPO [NUT0001] EFFECTIVE NOW, Starting tomorrow, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question 25):
STRICT NPO
Liquids & Modified Consistency (If Dysphagia Protocol see
questions 21-24):
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat:
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


Sodium:
Potassium:
Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO): 2,000
Research:
Metabolic:
Other Modifiers:
Infant Nutrition (Select product and calories per ounce):
Infant Formula (Calories per Ounce):
Dysphagia Protocol:
Dysphagia Protocol-Modified Consistency (Also select
Dysphagia Protocol Liquid Consistency and Dysphagia
Protocol-Supervision):
Dysphagia Protocol-Liquid Consistency:
Dysphagia Protocol-Supervision:
Tube Feeding (Use Tube Feeding Order Set to indicate order
detail):
Tube Feeding Management:
Room Service Class:
Until extubated., Post-Op/Phase II
Respiratory [88591]
Pulse Oximetry [NURMON0009] CONTINUOUS, Starting today, Routine, Post-Op/Phase II
Mechanical Ventilation - Adult [117146]
Provide Manual Resuscitator at Bedside [RT0039] CONTINUOUS, Starting today, Routine, Post-Op/Phase II
Mechanical Ventilation [RT0028] CONTINUOUS, Starting today, Routine
Ventilator Management:
Mode:
Set Rate/Min:
Tidal Volume (mL) (6-8 mL/kg of Ideal Body Weight):
PEEP (cmH2O):
FiO2 (%):
Pressure Support:
Pressure Control:
Wean: Per Cardiothoracic Surgery Protocol
P High (cmH20):
P Low (cmH20):
T High (sec):
T Low (sec):
Refer to Cardiac Surgery, Transplant, and VAD Early
Extubation Algorithm, Post-Op/Phase II
chlorhexidine (PERIDEX) 0.12 % soln MULTIDOSE
[792004]
15 mL, Mouth/Throat, 2 X DAILY Starting today
Use to swab oral cavity. D/C when patient no longer on
ventilation.
Post-Op/Phase II
Respiratory - Post Extubation [88592]
Respiratory Therapy per Protocol [RT0035] CONTINUOUS, Starting today, Routine
Protocol Type:
Post Extubation, Post-Op/Phase II
Oxygen Therapy [RT0032] CONTINUOUS, Starting today, Routine
FiO2 (%):
Liter Flow:
Titrate oxygen to maintain O2 sat at (%): 92
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen? Yes
Post Extubation, Post-Op/Phase II
Incentive Spirometry [NURTRT0018] EVERY 1 HOUR, Starting today, Routine, Every hour while
awake, every 4 hours while asleep post extubation, Post-
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


Op/Phase II
Nasogastric/Orogastric Tube Care [88593]
NG Tube Placement - Adult [120994]
Insert and Maintain Nasogastric Tube [NURTAD0014] CONTINUOUS, Starting today, Routine
Options: Low, Continuous Suction
Flush with:
Flush Frequency:
Clamp NG Tube:
Check Residual:
Does this need to be inserted/placed?
Device Status:
Confirm placement prior to use. Discontinue when
extubated and tolerating oral fluids.
Refer to Policy 2.20 Enteral Tubes Used for Instillation of
Fluids, Medications, or Feeding, Post-Op/Phase II
lidocaine-oxymetazoline 4%-0.05% (ADULT) nasal
spray [785081]
2 spray, Nasal, ONCE For 1 Doses
For numbing prior to feeding tube insertion.
Slowly spray the chosen nostril once, if required may
repeat x1 in opposite nostril. Angle toward back of throat
spraying the anterior nostril and wait 30-60 seconds
before introducing more local anesthetic into the nostril.
Caution: Entire bottle should not be used for insertion of
tube. Discard excess solution when procedure completed.
X-RAY ABDOMEN AP VIEW (KUB) [R74000] CONDITIONAL, Starting today For 1 Days, Routine
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms?
What specific question(s) would you like answered by this
exam? Evaluate nasogastric tube placement
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where?
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
If Conditional, What Condition? Evaluate nasogastric tube
placement. The location of nasogastric tube should be
confirmed prior to the instillation of fluids, medications, or
feedings. Refer to Policy 2.20 Enteral Tubes Used for
Instillation of Fluids, Medications, or Feeding
OG Tube Placement - Adult [120995]
Insert and Maintain Orogastric Tube [NURTAD0015] CONTINUOUS, Starting today, Routine
Options: Low, Intermittent Suction
Flush with:
Flush Frequency:
Check Residual:
Does this need to be inserted/placed?
Device Status: Ready For Use
Refer to Policy 2.20 Enteral Tubes Used for Instillation of
Fluids, Medications, or Feeding.
Confirm placement prior to use. Discontinue when
extubated and tolerating oral fluids., Post-Op/Phase II
X-RAY ABDOMEN AP VIEW (KUB) [R74000] CONDITIONAL, Starting today For 3 Days, Routine
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms? Orogastric tube placement
What specific question(s) would you like answered by this
exam? Evaluate orogastric tube placement
Relevant recent/past history? Cardiac Surgery
Is patient pregnant?
If being performed remotely, where?
Last patient weight?
Transport Method: Floor Determined/Entered
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


If Conditional, What Condition? Evaluate orogastric tube
placement. The location of orogastric tube should be
confirmed prior to the instillation of fluids, medications, or
feedings. Refer to Policy 2.20 Enteral Tubes Used for
Instillation of Fluids, Medications, or Feeding
Post-Op/Phase II
Wound/Procedure Site Care [88594]
Maintain Chest Tube [NURTAD0001] CONTINUOUS, Starting today, Routine
Location: Mediastinal
Position: Anterior
Drainage Options: -20 cm wall suction
Site Assessment Frequency: SEE COMMENTS
Care Frequency: EVERY 24 HOURS
Wash With: Chlorhexidine Sponge
Primary Dressing: Gauze
Secondary Dressing: Other (Comment)
Location applies to all chest tubes. Assess site every 1 hour
times 4, then every 2 hours., Post-Op/Phase II
Wound Care [NURWND0015] CONTINUOUS, Starting today, Routine
Wound Type: Closed - Incision
Wound Site: Chest
Wound Location: Other (Comment)
Assess Frequency: EVERY 24 HOURS
Care Frequency: 1X DAILY
Wash With: Other (Comment)
Irrigate/Rinse With:
Apply (Must also enter separate medication order to obtain
drug):
Primary Dressing: Gauze
Secondary Dressing: Other (Comment)
Sterile technique if chest tube in, clean technique if chest tube
out., Post-Op/Phase II
Wound Care [NURWND0015] CONTINUOUS, Starting today, Routine
Wound Type: Open
Wound Site: Chest
Wound Location:
Assess Frequency: EVERY 8 HOURS
Care Frequency:
Wash With:
Irrigate/Rinse With:
Apply (Must also enter separate medication order to obtain
drug):
Primary Dressing: Other (Comment)
Secondary Dressing:
Provider to perform dressing change if patient's chest is still
open.
Intake and Output [88595]
Measure Intake And Output [NURMON0005] SEE COMMENTS, Starting today, Routine, Every 15 minutes
times 4, then every 30 minutes times 4, then every hour.,
Post-Op/Phase II
Temporary Pacemaker Epicardial Settings (Single Response) [88596]
Epicardial Pacemaker Settings (ADULT) [NURTRT0077] ON, Starting today, Routine, Post-Op/Phase II
Non-Categorized Patient Care Orders [88597]
Refer to "Insulin Infusion - Adult - Supplemental" Order Set for Patients on Insulin Infusion
Refer to "Diabetes Management - Adult - Supplemental" Order Sets for all Glucose Monitoring and Insulin Therapy
Strict Handwashing per Precautions for
Immunocompromised Patients [NURCOM0022]
CONTINUOUS, Starting today, Precautions for
Immunocompromised Patients Policy 13.06., Post-Op/Phase
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


II
No Live Plants or Flowers [NURCOM0022] SEE COMMENTS, Starting today, No live plants or flowers in
patient's room or at nurses station., Post-Op/Phase II
Must Wear Duckbill mask (PCM 2000) [NURCOM0022] CONTINUOUS, Starting today, Patients must wear properly
fitting duckbill mask (PCM 2000) when leaving HEPA flitered
unit., Post-Op/Phase II
Measure Weight [NURMON0015] 1X DAILY, Starting today, Routine
Weigh With?
Weigh when?
Post-Op/Phase II
Insert and Maintain Urinary Catheter [NURELM0013] CONTINUOUS, Starting today, Routine
Type: Indwelling Single Lumen
Indication for Placement: Postoperative Requirements of
Specific Procedure
Initiate Urinary Catheter Removal Protocol? (NP/PA Must
Select "No"): Yes
Details: To Dependent Drainage
Irrigate With:
Irrigation Frequency:
Does this need to be inserted/placed?
Post-Op/Phase II
Use Warm Air Blanket [NURTRT0027] CONDITIONAL, Starting today For Until specified, Routine,
Warming blanket immediately postoperative for temperature
less than 36.0 degrees Celsius., Post-Op/Phase II
Apply Cool Compress to Affected Area [NURTRT0003] SEE COMMENTS, Starting today For Until specified, Routine
Site: Affected Area
Cooling blanket for temperature greater than 38.6 degrees
Celsius., Post-Op/Phase II
Notify Primary Service to Place Diabetes Management
Service Consult Order if Patient Has A Single Blood
Glucose Result Greater Than 180 milligrams per
deciliter within 24 hours of anesthesia end time.
[NURCOM0022]
CONTINUOUS, Starting today
Initiate B4/5 Insulin Infusion Protocol [NURMON0062] CONTINUOUS, Starting today, Routine
Glucose, POC [IPGLUCOSE] EVERY 2 HOURS, Starting today For 24 Hours, Routine
If Conditional, What Condition? Draw until patient begins on
clear liquids.
Draw until patient begins on clear liquids.
Glucose, POC [IPGLUCOSE] BEFORE MEALS AND BEDTIME, Starting today For 24
Occurrences, Routine
If Conditional, What Condition? If patient eating or drinking.
If patient eating or drinking., Post-Op/Phase II
Contingency Parameters [88598]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): ***
If systolic blood pressure < (mmHg): ***
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C): 38.5
If temperature < (C):
If heart rate > (bpm): ***
If heart rate < (bpm): 80
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%): 90
If urine output < (mL): 30 milliliters/hour
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


Other: Rhythm changes and/or arrhythmias
Post-Op/Phase II
Notify Attending Transplant Cardiologist
[NURCOM0001]
Provider to Notify: Other (Comment)
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg):
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: White blood cell count less than 3K/uL.
Post-Op/Phase II
Cardiac Arrest/Change In Rhythm
Resuscitation Orders [100026]
Resuscitation Progression - Ventricular
Fibrillation/Pulseless Ventricular Tachycardia
(Witnessed) [NURVENT0018]
CONTINUOUS, Starting today, Routine, Post-Op/Phase II
Resuscitation Progression - Asystole/Severe
Bradycardia [NURVENT0019]
CONTINUOUS, Starting today, Routine, Post-Op/Phase II
Resuscitation Progression - Pulseless Electrical Activity
[NURVENT0020]
CONTINUOUS, Starting today, Routine, Post-Op/Phase II
Intravenous Therapy
IV Fluids [88600]
dextrose 5%-NaCl 0.2% infusion [51615] at 5 mL/hr, Intravenous, CONTINUOUS
Per central venous pressure port
Post-Op/Phase II
CMV Status
CMV Status - Donor (Single Response) [96089]
Note: Donor CMV Status Pending - Pharmacy to confirm
donor status [950018]
CONTINUOUS, Post-Op/Phase II
Note: Donor is CMV Positive [950018] ONCE For 1 Doses, Post-Op/Phase II
Note: Donor is CMV Negative [950018] ONCE For 1 Doses, Post-Op/Phase II
CMV Status - Recipient (Single Response) [96090]
Note: Recipient is CMV Positive [950018] ONCE For 1 Doses, Post-Op/Phase II
Note: Recipient is CMV Negative [950018] ONCE For 1 Doses, Post-Op/Phase II
Medications - Immunosuppressants
Calcineurin Inhibitors/Purine Synthesis Inhibitors [88602]
tacrolimus susp [780140] 1 mg, Oral, EVERY 12 HOURS
Pharmacy to order tacrolimus (GENERIC) cap 1 mg orally
every 12 hours when patient tolerating oral intake
Post-Op/Phase II
mycophenolate mofetil (CELLCEPT) susp CUSTOM
[780105]
1,500 mg, Oral, 2 X DAILY (AT MEALTIME)
Pharmacy to order mycophenolate sodium (MYFORTIC)
1080 mg orally 2 X daily when patient tolerating oral intake.
Post-Op/Phase II
mycophenolate sodium (MYFORTIC) EC tab [75184] 720 mg, Oral, 2 X DAILY (AT MEALTIME), Post-Op/Phase II
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Steroid Taper - Intravenous [88603]
methylprednisolone sodium succ. (SOLU-MEDROL)
intraVENOUS [800058]
250 mg, Intravenous, ONCE For 1 Doses
Give 8 hours after arrival in Cardiothoracic ICU
Post-Op/Phase II
methylprednisolone sodium succ. (SOLU-MEDROL)
intraVENOUS [800058]
125 mg, Intravenous, ONCE Starting tomorrow For 1 Doses,
Post-Op/Phase II
methylprednisolone sodium succ. (SOLU-MEDROL)
intraVENOUS [800058]
72 mg, Intravenous, ONCE Starting 2/1/14 For 1 Doses, Post-
Op/Phase II
methylprednisolone sodium succ. (SOLU-MEDROL)
intraVENOUS [800058]
56 mg, Intravenous, ONCE Starting 2/2/14 For 1 Doses, Post-
Op/Phase II
methylprednisolone sodium succ. (SOLU-MEDROL)
intraVENOUS [800058]
48 mg, Intravenous, 1 X DAILY Starting 2/3/14, Post-
Op/Phase II
Note: Discontinue methylprednisolone and begin
prednisone at an equivalent dose when patient tolerating
oral medications. [950018]
1 X DAILY Starting 2/1/14
Discontinue methylprednisolone and begin prednisone at an
equivalent dose when patient tolerating oral medications.
Post-Op/Phase II
Steroid Taper - Oral [88604]
prednisone (DELTASONE) tab [41277] 90 mg, Oral, ONCE Starting 2/1/14 For 1 Doses
Give in place of methylprednisolone when tolerating oral
medications.
Post-Op/Phase II
prednisone (DELTASONE) tab [41277] 70 mg, Oral, ONCE Starting 2/2/14 For 1 Doses
Give in place of methylprednisolone when tolerating oral
medications.
Post-Op/Phase II
prednisone (DELTASONE) tab [41277] 30 mg, Oral, 2 X DAILY (AT MEALTIME) Starting 2/3/14
Give in place of methylprednisolone when tolerating oral
medications.
Post-Op/Phase II
Note: Do NOT lower prednisone dose below 60 mg prior
to obtaining first biopsy result [950018]
1 X DAILY
Do NOT lower prednisone dose below 60 mg prior to
obtaining first biopsy result
Post-Op/Phase II
Medications - General
Analgesics - Combination (Single Response) [88606]
acetaMINOPHEN-codeine (TYLENOL #3) 300-30 mg
per tab RANGE [750004]
1-2 tab, Oral, EVERY 4 HOURS PRN, pain, Post-Op/Phase II
hydrocodone-acetaMINOPHEN (NORCO) 5-325 mg per
tab RANGE [750021]
1-2 tab, Oral, EVERY 4 HOURS PRN, pain, Post-Op/Phase II
oxycodone-acetaminophen (PERCOCET) 5-325 mg per
tab RANGE [750033]
1-2 tab, Oral, EVERY 4 HOURS PRN, pain, Post-Op/Phase II
Analgesics - Opioid [88607]
MORPHine PF injection RANGE [750057] 1-4 mg, Intravenous, EVERY 2 HOURS PRN, pain, for 4
Minutes, Post-Op/Phase II
Analgesics - Non-opioid [88608]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, EVERY 4 HOURS PRN, pain, pain or
temperature greater than 38.5 degrees Celsius, Post-
Op/Phase II
acetaMINOPHEN (TYLENOL) suppository [43994] 650 mg, Rectal, EVERY 4 HOURS PRN, pain/fever, pain or
temperature greater than 38.5 degrees Celcius, Post-
Op/Phase II
Anti-emetics [88609]
ondansetron (ZOFRAN) injection [142579] 4 mg, Intravenous, EVERY 24 HOURS PRN,
nausea/vomiting, Post-Op/Phase II
Bowel Management [144116]
senna-docusate (SENOKOT-S) 8.6-50 mg per tab
[60530]
2 tab, Oral, 2 X DAILY Starting tomorrow
Hold for loose stool or suspected obstruction. Use rescue
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therapy after first 48hrs if inadequate response to scheduled
bowel management.
Post-Op/Phase II
polyethylene glycol (MIRALAX) oral powder [61353] 17 g, Oral, 1 X DAILY PRN Starting tomorrow, constipation
Hold for loose stool or suspected obstruction. Use as first line
rescue therapy if inadequate response to scheduled bowel
management.
Post-Op/Phase II
bisacodyl (DULCOLAX) rectal suppository [35231] 10 mg, Rectal, 1 X DAILY PRN Starting tomorrow,
constipation
Hold for loose stool. Use as second line rescue therapy if no
response to first line rescue therapy within 24 hours and
notify Primary Team.
Post-Op/Phase II
Anti-anxiety [88611]
midazolam (VERSED) injection RANGE [750056] 1-2 mg, Intravenous, EVERY 6 HOURS PRN, agitation or
anxiety while on ventilator, Post-Op/Phase II
Hypnotics (Single Response) [111644]
zolpidem (AMBIEN) tab [46913] 5 mg, Oral, 1 X DAILY (HS) PRN, sleep
Offer only after failure of non-pharmacologic interventions
(see IPOC supplemental Sleep/Rest Disturbance Adult)
Post-Op/Phase II
temazepam (RESTORIL) cap [46696] 15 mg, Oral, 1 X DAILY (HS) PRN, sleep
Offer only after failure of non-pharmacologic interventions
(see IPOC supplemental Sleep/Rest Disturbance Adult)
Post-Op/Phase II
Anti-infectives (Single Response) [144476]
Patients who are 40-159 kg [141444]
cefuroxime (ZINACEF) intraVENOUS [800030] 1.5 g, Intravenous, EVERY 12 HOURS For 3 Doses, Post-
Op/Phase II
vancomycin (VANCOCIN) intraVENOUS [800084] 10 mg/kg, Intravenous, EVERY 8 HOURS For 5 Doses,
Post-Op/Phase II
Patients who are 160 kg or greater [141445]
cefuroxime (ZINACEF) intraVENOUS [800030] 3 g, Intravenous, EVERY 12 HOURS For 3 Doses, Post-
Op/Phase II
vancomycin (VANCOCIN) intraVENOUS [800084] 10 mg/kg, Intravenous, EVERY 8 HOURS For 5 Doses,
Post-Op/Phase II
Candida Prophylaxis [88613]
nystatin (MYCOSTATIN) susp [40456] 5 mL, Swish & Swallow, 4 X DAILY
Discontinue when tolerating oral medications
Post-Op/Phase II
clotrimazole (MYCELEX) troche [111248] 10 mg, Oral, 4 X DAILY
Suck and swallow. Begin when tolerating oral medications
Post-Op/Phase II
PJP Prophylaxis [88614]
sulfamethoxazole-trimethoprim (BACTRIM DS) 800-160
mg per tab [42455]
1 tab, Oral, 1 X DAILY Starting 2/3/14, Post-Op/Phase II
Donor OR Recipient CMV Positive [88615]
ganciclovir (CYTOVENE) bag [700206] 5 mg/kg, Intravenous, EVERY 12 HOURS For 6 Days, Post-
Op/Phase II
valganciclovir (VALCYTE) tab [66847] 900 mg, Oral, 1 X DAILY Starting 2/6/14, Post-Op/Phase II
Donor AND Recipient Both CMV Negative [88616]
acyclovir (ZOVIRAX) tab [44027] 400 mg, Oral, 2 X DAILY
Begin when tolerating oral medications
Post-Op/Phase II
Gastric [88617]
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ranitidine (ZANTAC) injection [800075] 50 mg, Intravenous, EVERY 8 HOURS, Post-Op/Phase II
Potassium Supplementation (Single Response) [87535]
potassium chloride 20 mEq/ 100 mL bag [46255] 20 mEq, Intravenous, PRN, potassium supplementation - See
Admin Instructions
For serum potassium 3.8 - 4.0 mmol/L give 20 mEq x1
For serum potassium 3.5 - 3.7 mmol/L give 20 mEq x2
For serum potassium 3.2 - 3.4 mmol/L give 20 mEq x3
for 60 Minutes, Post-Op/Phase II
potassium chloride 10 mEq/100 mL bag - NOTE: Renal
dosing [46253]
10 mEq, Intravenous, PRN, potassium supplementation - See
Administration Instructions
For serum potassium 3.5 - 3.9 mmol/L give 10 mEq x1
For serum potassium 3.2 - 3.4 mmol/L give 10 mEq x2
for 60 Minutes
NOTE: Renal dosing
Post-Op/Phase II
Magnesium Supplementation (Single Response) [87536]
Magnesium Supplemental Scale [950039] PRN - NOTIFY PHARMACY WHEN NEEDED, magnesium
supplementation - See Administation Instructions
For serum magnesium 1.6-1.9 mg/dL give 0.05 g/kg IV x1
over 12 hours
For serum magnesium 1.0-1.5 mg/dL give 0.1 g/kg IV x1 over
24 hours
For serum magnesium less than 1 mg/dL give 0.15 g/kg IV x1
over 24 hours
Post-Op/Phase II
Magnesium Supplemental Scale - NOTE: Order for
RENAL Dosing [950039]
PRN - NOTIFY PHARMACY WHEN NEEDED, magnesium
supplementation - See Administation Instructions
For serum magnesium 1.6-1.9 mg/dL give 0.025 g/kg IV x1
over 12 hours
For serum magnesium 1.0-1.5 mg/dL give 0.05 g/kg IV x1
over 24 hours
For serum magnesium less than 1 mg/dL give 0.075 g/kg IV
x1 over 24 hours
NOTE: Order for RENAL Dosing
Post-Op/Phase II
Flushes [88620]
sodium chloride 0.9% flush 10 mL injection [785055] 10 mL, Intravenous, EVERY 8 HOURS PRN, flush/line care
Flush every saline lock port with 10 mL/port for each line.
Post-Op/Phase II
sodium chloride 0.9% infusion [64367] at 4 mL/hr, Intravenous, CONTINUOUS
Give per intraflow for arterial line, central venous and distal
swan port
Post-Op/Phase II
Vasoactive Agents [88621]
DOPamine (INTROPIN) 800 mg in dextrose 5% 250 mL
infusion [50506]
2 mcg/kg/min, Intravenous, Post-Op/Phase II
norepinephrine (LEVOPHED) infusion [700247] Intravenous, Post-Op/Phase II
vasopressin (PITRESSIN) 100 units in dextrose 5% 250
mL infusion (SEPTIC SHOCK) [700291]
0.04-0.06 Units/min, Intravenous, Post-Op/Phase II
epINEPHrine infusion [700197] Intravenous, Post-Op/Phase II
milrinone (PRIMACOR) 20 mg in dextrose 5% 100 mL
infusion [158103]
Intravenous
Do NOT wean unless approved by attending surgeon
Post-Op/Phase II
DOBUTamine (DOBUTREX) 1000mg in dextrose 5%
250 mL infusion [51747]
Intravenous
Do NOT wean unless approved by attending surgeon
Post-Op/Phase II
isoproterenol (ISUPEL) infusion [700221] Intravenous, Post-Op/Phase II
Laboratory
Page 11 of 19
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


Immediately Postoperative [88624]
HEMATOCRIT [HCT] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Immediately postoperative, Post-Op/Phase II
PLATELET COUNT [PLT] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Immediately postoperative, Post-Op/Phase II
PROTHROMBIN TIME/INR [PT] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Immediately postoperative, Post-Op/Phase II
PTT [PTT] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Immediately postoperative, Post-Op/Phase II
ELECTROLYTES [LYTE] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Immediately postoperative, Post-Op/Phase II
GLUCOSE [GLU] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Immediately postoperative, Post-Op/Phase II
BUN [BUN] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Immediately postoperative, Post-Op/Phase II
CREATININE [CRET] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Immediately postoperative, Post-Op/Phase II
BLOOD GASES AND O2 SATURATION [HCBGASOS] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
Indicate FIO2:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Immediately postoperative, Post-Op/Phase II
BLOOD GASES AND O2 SATURATION - Venous
[HCBGASOS]
STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
Indicate FIO2:
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If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Immediately postoperative, Post-Op/Phase II
4 Hours Postoperative [88625]
HEMATOCRIT [HCT] CONDITIONAL - RN COLLECT, Starting today For 1 Days,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Draw 4 hours postoperative.
Post-Op/Phase II
POTASSIUM [K] CONDITIONAL - RN COLLECT, Starting today For 1 Hours,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Draw 4 hours postoperative.
Post-Op/Phase II
BLOOD GASES AND O2 SATURATION [HCBGASOS] CONDITIONAL - RN COLLECT, Starting today For 1 Days,
Routine
If source is OTHER, indicate here:
Indicate FIO2:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Draw 4 hours postoperative.
Post-Op/Phase II
Postoperative Day 1 [88626]
CBC WITHOUT DIFFERENTIAL [HEMO] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
PROTHROMBIN TIME/INR [PT] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
PTT [PTT] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
ELECTROLYTES [LYTE] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
GLUCOSE [GLU] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
BUN [BUN] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
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previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
CREATININE [CRET] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
MAGNESIUM [MAG] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
CALCIUM [CA] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
PHOSPHATE [PHOS] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
GGT [GGT] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
LD, TOTAL [LDH] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
PREALBUMIN [XPRALB] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
AST/SGOT [AST] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
ALT/SGPT [ALT] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
ALKALINE PHOSPHATASE [ALKP] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
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previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
BILIRUBIN, TOTAL [TBIL] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
ALBUMIN [ALB] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
BLOOD GASES AND O2 SATURATION [HCBGASOS] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
Indicate FIO2:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
BLOOD GASES AND O2 SATURATION - Venous
[HCBGASOS]
SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
Indicate FIO2:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
TACROLIMUS [HCTAC] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 7:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
Daily - Beginning Postoperative Day 2 [95597]
TACROLIMUS [HCTAC] NEXT AM, Starting 2/1/14 at 7:00 AM For 6 Days, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
CREATININE [CRET] NEXT AM, Starting 2/1/14 at 5:00 AM For 6 Days, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
CBC WITHOUT DIFFERENTIAL [HEMO] NEXT AM, Starting 2/1/14 at 5:00 AM For 6 Days, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
ELECTROLYTES [LYTE] NEXT AM, Starting 2/1/14 at 5:00 AM For 6 Days, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
BUN [BUN] NEXT AM, Starting 2/1/14 at 5:00 AM For 6 Days, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
Page 15 of 19
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If Conditional, What Condition?
Post-Op/Phase II
MAGNESIUM [MAG] NEXT AM, Starting 2/1/14 at 5:00 AM For 6 Days, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
Conditional Labs [88627]
POTASSIUM [K] CONDITIONAL - RN COLLECT, Starting today For 4 Days,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Once, 1 hour after
intravenous supplementation (as needed if on diuretics).
Post-Op/Phase II
MAGNESIUM [MAG] CONDITIONAL - RN COLLECT, Starting today For 4 Days,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Once, 1 hour after
intravenous supplementation (as needed if on diuretics).
Post-Op/Phase II
HEMATOCRIT [HCT] CONDITIONAL - RN COLLECT, Starting today For 4 Days,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Once, 1 hour after packed red
blood cell infusion.
Post-Op/Phase II
PROTHROMBIN TIME/INR [PT] CONDITIONAL - RN COLLECT, Starting today For 4 Days,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Once, 1 hour after plasma
infusion.
Post-Op/Phase II
PTT [PTT] CONDITIONAL - RN COLLECT, Starting today For 4 Days,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Once, 1 hour after plasma
infusion.
Post-Op/Phase II
BLOOD GASES AND O2 SATURATION [HCBGASOS] CONDITIONAL - RN COLLECT, Starting today For 4 Days,
STAT
If source is OTHER, indicate here:
Indicate FIO2:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? After vent changes or for
changes in respiratory status
Post-Op/Phase II
CALCIUM [CA] CONDITIONAL - RN COLLECT, Starting today For 4 Days,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Once, 1 hour after
intravenous supplement
Post-Op/Phase II
Page 16 of 19
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GLUCOSE [GLU] CONDITIONAL - RN COLLECT, Starting today For 7 Days,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Draw if blood glucose is <40
or >400 mg/dL
Draw if blood glucose is <40 or >400 mg/dL, Post-Op/Phase
II
Once, for Temperature Greater than 38.5 degrees Celsius After First 24 Hours [88628]
URINALYSIS WITH MICROSCOPY [UA] CONDITIONAL - RN COLLECT, Starting today For 4 Days,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Once, for temperature greater
than 38.5 degrees Celsius after first 24 hours.
Post-Op/Phase II
CULTURE, BLOOD, BACTERIA AND YEAST [GM4045] CONDITIONAL - RN COLLECT, Starting today For 4 Days,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Once, for temperature greater
than 38.5 degrees Celsius after first 24 hours.
All Lines/Peripheral, Post-Op/Phase II
CULTURE, BLOOD, BACTERIA AND YEAST [GM4045] CONDITIONAL - RN COLLECT, Starting today For 4 Days,
Routine
If Conditional, What Condition? Once, for temperature greater
than 38.5 degrees Celsius after first 24 hours.
All Lines/Peripheral, Post-Op/Phase II
CULTURE, SPUTUM WITH GRAM STAIN [HCSPUCS] CONDITIONAL - RN COLLECT, Starting today For 4 Days,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Once, for temperature greater
than 38.5 degrees Celsius after first 24 hours.
Expectorated/Endotracheal Tube, Post-Op/Phase II
CULTURE, URINE [URC] CONDITIONAL - RN COLLECT, Starting today For 4 Days,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Once, for temperature greater
than 38.5 degrees Celsius after first 24 hours.
Indwelling Catheter, Post-Op/Phase II
Diagnostic Tests and Imaging
Chest X-Ray Orders [88636]
X-RAY CHEST AP VIEW [R71010] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms? Assess ETT placement
What specific question(s) would you like answered by this
exam? Assess ETT placement
Relevant recent/past history? Status Post Cardiac Transplant
Is patient pregnant?
If being performed remotely, where? Bedside
Transport Method: Floor Determined/Entered
On admission to Cardiothoracic ICU., Post-Op/Phase II
X-RAY CHEST AP VIEW - Day 1 [R71010] ONCE-RAD NEXT AVAILABLE, Starting tomorrow For 1
Occurrences, Routine
Current signs and symptoms? Assess for pleural effusion
What specific question(s) would you like answered by this
exam? Assess for pleural effusion
Page 17 of 19
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Relevant recent/past history? Status Post Cardiac Transplant
Is patient pregnant?
If being performed remotely, where? Bedside
Transport Method: Floor Determined/Entered
Post-Op/Phase II
X-RAY CHEST AP VIEW - Day 2 [R71010] ONCE-RAD NEXT AVAILABLE, Starting 2/1/14 For 1
Occurrences, Routine
Current signs and symptoms? Assess for pleural effusion
What specific question(s) would you like answered by this
exam? Assess for pleural effusion
Relevant recent/past history? Status Post Cardiac Transplant
Is patient pregnant?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Post-Op/Phase II
X-RAY CHEST AP VIEW - Day 3 [R71010] ONCE-RAD NEXT AVAILABLE, Starting 2/2/14 For 1
Occurrences, Routine
Current signs and symptoms? Assess for pleural effusion
What specific question(s) would you like answered by this
exam? Assess for pleural effusion
Relevant recent/past history? Status Post Cardiac Transplant
Is patient pregnant?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Post-Op/Phase II
ECG Orders [88637]
ECG - 12 Lead Without Rhythm [EKG0008] ONCE, Starting today For 1 Occurrences, Routine
Reason for exam: OTHER (COMMENT)
On arrival to CTICU (unless 100% paced)., Post-Op/Phase II
Echocardiogram [88638]
Transthoracic Resting Echocardiogram [ECH0003] ONCE, Starting 2/6/14 For 1 Occurrences, Routine
Reason for exam: HEART OR LUNG TRANSPLANT
Do you want Agitated Bubble Study?
Is patient mechanically ventilated? No
Is patient ICU status? No
Does patient need continuous monitoring? Yes
On day of first biopsy post transplant., Post-Op/Phase II
Consults
Consults [88640]
Consult Diabetes Management Service (Inpatient)
[CON0022]
ONCE, Starting today
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis): History of diabetes
Post-Op/Phase II
Consult Nutrition (Inpatient) [CON0043] ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult:
Delegate to Initiate and Manage Tube Feeding:
Delegate to Initiate Feeding Tube Placement Order Set:
Delegate to Manage Diet Order/Supplement Order:
Delegate to Dysphagia Diet Order Progression:
Post-Op/Phase II
Consult Occupational Therapy (Inpatient) Eval and Treat
[CON0046]
ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult: Mobility/ADL Training
Post-Op/Phase II
Consult Physical Therapy (Inpatient) Eval and Treat
[CON0061]
ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult: Mobility/ADL Training
Post-Op/Phase II
Consult Cardiac Rehab/Preventive Cardiology ONCE, Starting today For 1 Occurrences, Routine
Page 18 of 19
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


(Inpatient) [CON0010] Reason for consult: Other (Comment)
Initiate cardiac transplant activity protocol., Post-Op/Phase II
Consult Social Work (Inpatient) [CON0076] ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult: OTHER
Post-Op/Phase II
Consult Swallow Therapy (Inpatient) [CON0079] ONCE, Starting today, Routine
Reason for Consult: EVALUATE AND TREAT PATIENT
May the Speech Pathologist and Registered Dietician place
diet orders on your behalf?
Evaluation after intubation of *** days., Post-Op/Phase II
BestPractice
No Hospital Problems have yet been identified [107363]
Specify Hospital Problem(s) [COR0018] Post-Op/Phase II
Page 19 of 19
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