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201606170

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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Ambulatory,ENT

OP - Otolaryngologic Surgery - Pediatric - Postoperative [3321]

OP - Otolaryngologic Surgery - Pediatric - Postoperative [3321] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, ENT


OP - Otolaryngologic Surgery - Pediatric - Postoperative [3321]
PostOp/Phase II
Medications - Scheduled - NOTE: Order All THREE if ordering from this group [92555]
Scheduled
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - NOTE: Suggested dose 15 mg/kg
(Maximum 650 mg/dose) [800005]
15 mg/kg, Oral, EVERY 6 HOURS For 8 Doses
NOTE: Suggested dose 15 mg/kg (Maximum 650 mg/dose)
PACU
acetaMINOPHEN (TYLENOL) suppository - NOTE:
Suggested dose 15 mg/kg (Maximum 650 mg/dose)
[43994]
Rectal, EVERY 6 HOURS PRN For 8 Doses, pain/fever,
unable to tolerate scheduled oral acetaminophen / ibuprofen
Continue until discharged or 8 doses administered
NOTE: Suggested dose 15 mg/kg (Maximum 650 mg/dose)
PACU
ibuprofen (MOTRIN) 100 mg/5 mL susp - NOTE:
Suggested dose 10 mg/kg (maximum 600 mg/dose)
[45376]
10 mg/kg, Oral, EVERY 6 HOURS For 8 Doses
NOTE: Suggested dose 10 mg/kg (maximum 600 mg/dose)
PACU
Medications - Analgesics - Liquids [124301]
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - NOTE: Suggested dose 15 mg/kg
(Maximum 650 mg/dose) [800005]
15 mg/kg, Oral, EVERY 4 HOURS PRN, pain/fever, For mild
to moderate pain. Give with ibuprofen.
NOTE: Suggested dose 15 mg/kg (Maximum 650 mg/dose)
Post-Op/Phase II
oxycodone soln - NOTE: Suggested dose 0.1
mg/kg/dose (Maximum 5 mg/dose) [45975]
0.1 mg/kg, Oral, EVERY 4 HOURS PRN, pain, For severe
pain.
NOTE: Suggested dose 0.1 mg/kg/dose (Maximum 5
mg/dose)
Post-Op/Phase II
ibuprofen (MOTRIN) 100 mg/5 mL susp - NOTE:
Suggested dose 10 mg/kg (Maximum 600 mg/dose)
[45376]
10 mg/kg, Oral, EVERY 6 HOURS PRN, pain, For mild to
moderate pain. Give with acetaminophen.
NOTE: Suggested dose 10 mg/kg (Maximum 600 mg/dose)
Post-Op/Phase II
Medications - Non-opioid - Tablets [124302]
acetaMINOPHEN (TYLENOL) tab - NOTE: Suggested
dose 15 mg/kg (Maximum 650 mg/dose) [34149]
Oral, EVERY 4 HOURS PRN, pain, For mild pain or
mulitmodal therapy. May give with ibuprofen.
NOTE: Suggested dose 15 mg/kg (Maximum 650 mg/dose)
Post-Op/Phase II
acetaMINOPHEN (TYLENOL) disintegrating tab -
NOTE: Suggested dose 15 mg/kg (Maximum 650
mg/dose) [64412]
Oral, EVERY 4 HOURS PRN, pain, For mild pain or
multimodal therapy if unable to swallow tablets. May give with
ibuprofen.
NOTE: Suggested dose 15 mg/kg (Maximum 650 mg/dose)
Post-Op/Phase II
ibuprofen (MOTRIN) tab - NOTE: Do not order for
patients less than 6 months old Suggested dose 10
mg/kg (Maximum 600 mg/dose) [38353]
Oral, EVERY 6 HOURS PRN, pain, For mild pain or
multimodal therapy. May give with acetaminophen.
NOTE: Do not order for patients less than 6 months old
Suggested dose 10 mg/kg (Maximum 600 mg/dose)
Post-Op/Phase II
Medications - Opioid - Tablet (Single Response) [203772]
hydrocodone-acetaMINOPHEN (NORCO) 5-325 mg per
tab RANGE - NOTE: Suggested dose 0.05-0.15 mg/kg
hydrocodone (Maximum 10 mg hydrocodone/dose)
[750021]
1-2 tab, Oral, EVERY 4 HOURS PRN, pain, For severe pain
NOTE: Suggested dose 0.05-0.15 mg/kg hydrocodone
(Maximum 10 mg hydrocodone/dose)
Post-Op/Phase II
oxycodone-acetaminophen (PERCOCET) 5-325 mg per
tab RANGE - NOTE: Suggested dose 0.05-0.15 mg/kg
oxycodone (Maximum 10 mg oxycodone/dose) [750033]
1-2 tab, Oral, EVERY 4 HOURS PRN, pain, For severe pain
NOTE: Suggested dose 0.05-0.15 mg/kg oxycodone
(Maximum 10 mg oxycodone/dose)
Post-Op/Phase II
Medications - Analgesics - Suppositories [93651]
acetaMINOPHEN (TYLENOL) suppository - NOTE:
Suggested dose 15 mg/kg (Maximum 650 mg/dose)
Rectal, EVERY 4 HOURS PRN, pain/fever, For mild pain or
multimodal therapy if unable to take orally.
Page 1 of 6
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[43994] NOTE: Suggested dose 15 mg/kg (Maximum 650 mg/dose)
Post-Op/Phase II
Sucrose for Oral Analgesia [110668]
sucrose (SWEET-EASE) 24% buccal soln [794009] Oral, PRN, pain, mild pain or potentially painful procedures.
See Admin Instructions, Post-Op/Phase II
Non-Categorized Patient Care Orders [92811]
Length of time to observe patient prior to discharge
[NURCOM0022]
ONCE For 1 Occurrences, Observe patient for *** hours prior
to discharge, Post-Op/Phase II
Prior to Discharge [92767]
Patient Must Be Seen by Attending Prior to Discharge
[NURMON0083]
ONCE, Starting today For 1 Occurrences, Routine, Post-
Op/Phase II
Patient Must Be Seen by Resident Prior to Discharge
[NURMON0082]
ONCE, Starting today For 1 Occurrences, Routine, Post-
Op/Phase II
Outpatient Discharge Orders
Medications - Scheduled - NOTE: Order BOTH if ordering from this group [143393]
.
acetaMINOPHEN alcohol free (TYLENOL) 160 mg/5 mL
susp - NOTE: Suggested dose 15 mg/kg (Maximum 650
mg/dose) [43991]
15 mg/kg, 1 Bottle, 0, starting 5/27/16, Normal, Phase II
Discharge
ibuprofen (MOTRIN) susp - NOTE: Suggested dose 10
mg/kg (maximum 600 mg/dose) [45376]
10 mg/kg, 1 Bottle, 0, starting 5/27/16, Normal, Phase II
Discharge
Medications-Prescriptions-Oxycodone (Single Response) [124303]
oxycodone soln - 50 mL - NOTE: Order for age 2-4 yrs
(12-15 kg) [45975]
0.1 mg/kg, 50 mL, 0, starting 5/27/16, Normal, Phase II
Discharge
oxycodone soln - 75 mL - NOTE: Order for age 5-8 yrs
(16-25 kg) [45975]
0.1 mg/kg, 75 mL, 0, starting 5/27/16, Normal, Phase II
Discharge
oxycodone soln - 100 mL - NOTE: Order for age 9-12
yrs (26-40 kg) [45975]
0.1 mg/kg, 100 mL, 0, starting 5/27/16, Normal, Phase II
Discharge
oxycodone soln - 150 mL - NOTE: Order for age 13-15
yrs (41-55 kg) [45975]
0.1 mg/kg, 150 mL, 0, starting 5/27/16, Normal, Phase II
Discharge
oxycodone soln - 200 mL - NOTE: Order for age greater
than 15 yrs (greater than 55 kg) [45975]
0.1 mg/kg, 200 mL, 0, starting 5/27/16, Normal, Phase II
Discharge
Medications - Prescriptions - Analgesics - Liquids [124304]
acetaMINOPHEN alcohol free (TYLENOL) 160 mg/5 mL
susp - q4h prn - NOTE: Suggested dose 15 mg/kg
(Maximum 650 mg/dose) [43991]
15 mg/kg, 1 Bottle, 0, starting 5/27/16, Normal, Phase II
Discharge
hydrocodone-acetaMINOPHEN (LORTAB) 7.5 mg/325
mg/15 mL soln - NOTE: Suggested dose 0.05-0.15 mg
(0.1-0.3 mL)/kg hydrocodone (Maximum 5 mg
hydrocodone/dose) [74885]
0, starting 5/27/16, Normal
oxycodone 5 MG/5ML soln - NOTE: Suggested dose
0.05-0.15 mg/kg oxycodone (Maximum 5 mg/dose)
[45975]
0.1 mg/kg, 0, starting 5/27/16, Normal, Phase II Discharge
ibuprofen (MOTRIN) 100 mg/5mL susp - q6-8h prn -
NOTE: Suggested dose 10 mg/kg (Maximum 2400
mg/day) [45376]
10 mg/kg, 1 Bottle, 0, starting 5/27/16, Normal, Phase II
Discharge
Medications - Prescriptions - Analgesics - Tablets (Single Response) [124305]
acetaMINOPHEN (TYLENOL) 325 mg tab - q4h prn -
NOTE: Suggested dose 15 mg/kg (Maximum 650
mg/dose) [34149]
100 tab, 0, starting 5/27/16, Normal, Phase II Discharge
hydrocodone-acetaMINOPHEN (NORCO) 5-325 mg per
tab - q4h prn - NOTE: Suggested dose 0.05-0.15 mg/kg
hydrocodone (Maximum 10 mg hydrocodone/dose)
[71425]
40 tab, 0, starting 5/27/16, Normal, Phase II Discharge
oxycodone-acetaminophen (PERCOCET) 5-325 mg per
tab - q4h prn - NOTE: Suggested dose 0.05-0.15 mg/kg
40 tab, 0, starting 5/27/16, Normal, Phase II Discharge
Page 2 of 6
Printed by LIND, JANNA S [JSL237] at 5/27/2016 2:21:35 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2016CCKM@uwhealth.org

oxycodone (Maximum 10 mg oxycodone/dose) [40668]
ibuprofen (MOTRIN) 200 mg tab - q6-8h prn - NOTE:
Suggested dose 10 mg/kg (Maximum 2400 mg/day) Do
not order for patients < 6 months old. [38353]
100 tab, 0, starting 5/27/16, Normal, Phase II Discharge
Medications - Prescriptions - Analgesics - Suppositories (Single Response) [93680]
acetaMINOPHEN (TYLENOL) 80 mg suppository - q4h
prn [43994]
80 mg, 20 suppository, 0, starting 5/27/16, Normal, Phase II
Discharge
acetaMINOPHEN (TYLENOL) 120 mg suppository - q4h
prn [34151]
120 mg, 20 suppository, 0, starting 5/27/16, Normal, Phase II
Discharge
acetaMINOPHEN (TYLENOL) 325 mg suppository - q4h
prn [34152]
325 mg, 20 suppository, 0, starting 5/27/16, Normal, Phase II
Discharge
acetaMINOPHEN (TYLENOL) 650 mg suppository - q4h
prn [34153]
650 mg, 20 suppository, 0, starting 5/27/16, Normal, Phase II
Discharge
Medications - Prescriptions - Anti-infectives [89234]
amoxicillin (AMOXIL) 125 mg/5 mL susp - 2x/d -5d -
NOTE - Recommended dose is 12.5 - 22.5 mg/kg every
12 hours (Maximum dose: 875 mg/dose) [34526]
0, starting 5/27/16 until 6/6/16, Normal, Phase II Discharge
amoxicillin (AMOXIL) 250 mg/5 mL susp - 2x/d 5d -
NOTE: Recommended dose is 12.5 - 22.5 mg/kg every
12 hours (Maximum dose: 875 mg/dose) [34527]
0, starting 5/27/16 until 6/1/16, Normal, Phase II Discharge
amoxicillin (AMOXIL) 250 mg chew tab - 2x/d 7d -
NOTE: Recommended dose is 12.5 - 22.5 mg/kg every
12 hours (Maximum dose: 875 mg/dose) [34525]
14 tab, 0, starting 5/27/16 until 6/3/16, Normal, Phase II
Discharge
amoxicillin (AMOXIL) 250 mg cap - 2x/d 7d - NOTE:
Recommended dose is 12.5 - 22.5 mg/kg every 12
hours (Maximum dose: 875 mg/dose) [34523]
14 cap, 0, starting 5/27/16 until 6/3/16, Normal, Phase II
Discharge
amoxicillin (AMOXIL) 500 mg cap - 2x/d 7d - NOTE:
Recommended dose is 12.5 - 22.5 mg/kg every 12
hours (Maximum dose: 875 mg/dose) [34524]
14 cap, 0, starting 5/27/16 until 6/3/16, Normal, Phase II
Discharge
amoxicillin-clavulanate (AUGMENTIN) 125-31.25
MG/5ML SUSR - 5 mL 2/xd 7d - NOTE: Recommended
dose: For patients weighing <40 kg: 12.5 mg/kg twice
daily. For patients >= 40 kg: 500 mg twice daily.
(Maximum single dose: 875 mg) [44144]
70 mL, 0, starting 5/27/16 until 6/3/16, Normal, Phase II
Discharge
Amoxicillin-Pot Clavulanate (AUGMENTIN) 250-62.5
MG/5ML SUSR - 5 mL 2x/d 7d - Note: Recommended
dose: For patients weighing <40 kg: 12.5 mg/kg twice
daily. For patients >= 40 kg: 500 mg twice daily.
(Maximum single dose: 875 mg) [44145]
70 mL, 0, starting 5/27/16 until 6/3/16, Normal, Phase II
Discharge
amoxicillin-clavulanate (AUGMENTIN) 400-57 MG/5ML
SUSR - 5 mL 2x/d 7d - NOTE - Recommended dose:
For patients weighing <40 kg: 12.5 mg/kg twice daily.
For patients >= 40 kg: 500 mg twice daily. (Maximum
single dose: 875 mg amoxicillin) [70055]
70 mL, 0, starting 5/27/16, Normal
amoxicillin-clavulanate (AUGMENTIN) 400-57 MG
CHEW - 2x/d 7d - NOTE: Recommended dose: For
patients weighing <40 kg: 12.5 mg/kg twice daily. For
patients >= 40 kg: 500 mg twice daily. (Maximum single
dose: 875 mg) [70051]
14 tab, 0, starting 5/27/16 until 6/3/16, Normal, Phase II
Discharge
amoxicillin-clavulanate (AUGMENTIN) 875-125 mg per
tab - 2x/d 7d [70053]
1 tab, 14 tab, 0, starting 5/27/16 until 6/3/16, Normal, Phase II
Discharge
azithromycin (ZITHROMAX) 100 MG/5ML SUSR -
NOTE: Z-Pak Suggested dose 10 mg/kg on day 1, then
5 mg/kg daily (Maximum 500 mg/dose) [51546]
0, starting 5/27/16, Normal, Phase II Discharge
azithromycin (ZITHROMAX) 250 mg tab - Z-Pak [57023] 6 tab, 0, starting 5/27/16, Normal, Phase II Discharge
Medications - Prescriptions - Otic [124308]
ciprofloxacin-dexamethasone (CIPRODEX) 0.3-0.1%
otic susp - 3drp 3x/d [73602]
3 drop, 10 mL, 0, starting 5/27/16 until 5/30/16, Normal,
Phase II Discharge
ciprofloxacin (CETRAXAL) 0.2 % otic soln - 5 drp 2x/d- 5 drop, 14 each, 0, starting 5/27/16 until 6/3/16, Normal,
Page 3 of 6
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Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
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7d [136381] Phase II Discharge
ofloxacin (OCUFLOX) 0.3 % ophthalmic soln - 3drp
3x/d-3d [55774]
3 drop, 5 mL, 0, starting 5/27/16 until 5/30/16, Normal, Phase
II Discharge
Medications - Prescriptions - Anti-emetics [124307]
ondansetron (ZOFRAN ODT) 4 MG disintegrating tab
[64224]
4 mg, 10 tab, , starting 5/27/16, Normal
For insurance reasons may change to 4 mg/5 mL soln
Phase II Discharge
promethazine (PHENERGAN) 12.5 mg tab - q8h prn #5
- NOTE: For patients 2 years or older. Suggested dose
0.25-1 mg/kg (Maximum 25 mg/dose) [41416]
12.5 mg, 5 tab, 0, starting 5/27/16, Normal, Phase II
Discharge
promethazine (PHENERGAN) 25 mg tab - NOTE: For
patients 2 years or older. Suggested dose 0.25-1 mg/kg
(Maximum 25 mg/dose) [41417]
25 mg, 5 tab, 0, starting 5/27/16, Normal, Phase II Discharge
promethazine (PHENERGAN) 12.5 mg rectal
suppository - q8h prn #5 - NOTE: For patients 2 years or
older. Suggested dose 0.25-1 mg/kg (Maximum 25
mg/dose) [46328]
12.5 mg, 5 suppository, 0, starting 5/27/16 until 6/26/16,
Normal, Phase II Discharge
promethazine (PHENERGAN) 25 mg rectal suppository -
NOTE: For patients 2 years or older. Suggested dose
0.25-1 mg/kg (Maximum 25 mg/dose) [46329]
25 mg, 5 suppository, 0, starting 5/27/16 until 6/1/16, Normal,
Phase II Discharge
promethazine (PHENERGAN) 6.25 MG/5ML syrup -
NOTE: For patients 2 years or older. Suggested dose
0.25 mg/kg (Maximum 25 mg/dose) [41415]
0.25 mg/kg, 0, starting 5/27/16, Normal, Phase II Discharge
Medication Instructions [124306]
No NSAIDs (ibuprofen, motrin, advil, aspirin, naproxen
etc) for 4 days after surgery [NURCOM0022]
Routine
No NSAIDs (ibuprofen, motrin, advil, aspirin, naproxen
etc) for 7 days after surgery [NURCOM0022]
Routine
Maximum acetaminophen dose per 24 hours
[NURCOM0022]
Routine, No more than 4 grams acetaminophen per 24 hours
for adults or 15mg/kg per dose for peds <40 kg
Activity/Return to Work [92348]
Activity [NURACT0008] Routine
Discharge Activity:
May return to work/school in *** days.
No lifting greater than *** pounds for *** days.
No driving while taking pain medications (for patients old
enough to drive)
Activity - No Restrictions [NURACT0008] Routine
Discharge Activity: Up As Tolerated
No activity restrictions
Activity - Up As Tolerated [NURACT0008] Routine
Discharge Activity: Up As Tolerated
Nutrition [89050]
Soft Diet [NUT0006] Routine
Diet: Other (Comment Required)
Soft diet for 7 days.
Soft Diet [NUT8888] Routine
General:
Diet Modifications: Palate Soft
Other Diet Modifications:
Soft diet for 7 days.
General Diet (No Diet Restrictions) [NUT0006] Routine
Diet: General Diet Without Restrictions
Genereal Diet (No Diet Restrictions) [NUT8888] Routine
General: General (No Modifications)
Diet Modifications:
Other Diet Modifications:
Clear Liquid Diet [NUT0006] Routine
Diet: Clear Liquid Diet
Page 4 of 6
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Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2016CCKM@uwhealth.org

Clear liquid diet for 7 days.
Clear Liquid Diet [NUT8888] Routine
General:
Diet Modifications:
Other Diet Modifications: -
Solid Consistency:
Liquid Consistency:
Liquid: Clear Liquid
Esophagectomy:
Fat Controlled:
Fiber:
Fluid Restriction:
Heart Healthy:
Metabolic:
Renal:
Sodium Controlled:
NPO:
Clear liquid diet for 7 days.
Wound Care [92350]
Leave Original Surgical Dressing On [NURWND0018] Routine, For *** days.
Leave Original Surgical Dressing on Until MD Follow-Up
[NURWND0018]
Routine
Keep Incision Completely Dry [NURWND0018] Routine, For *** days.
Keep Incision Completely Dry Until MD Follow-Up
[NURWND0018]
Routine
No Nose Blowing [NURWND0018] Routine, For *** days.
No Nose Blowing Until MD Follow-Up [NURWND0018] Routine
Cough and Sneeze with Mouth Open [NURWND0018] Routine, For *** days.
Cough and Sneeze with Mouth Open Until MD Follow-
Up [NURWND0018]
Routine
Keep Soapy Water out of Ears [NURWND0018] Routine
Keep Ear Dry [NURWND0018] Routine, Keep *** ear(s) completely dry for *** days.
Keep Ear Dry Until MD Follow-Up [NURWND0018] Routine, Keep *** ear(s) completely dry until MD follow-up.
Do Not Scrub Incision [NURWND0018] Routine
Remove Mastoid Dressing (Hours) [NURWND0018] Routine, In *** hours.
Change Cottonball as Needed [NURWND0018] Routine
Wound Care [NURWND0018] Routine
Contingency Parameters [92812]
Notify Provider [NURCOM0001] Routine, For questions or problems contact the Pediatric
Otolaryngology Clinic at (608) 265-7760 during business
hours. After hours or on weekends call (608) 263-6400 and
ask for the Otolaryngology resident on call.
Follow-Up Instructions
Follow-Up Appointments [89052]
Patient to Schedule Appointment with Otolaryngology
[NURCOM0056]
Routine
Purpose: Post-op Evaluation
With whom: Otolaryngology
For when:
If Otolaryngology and Audiology Follow-Up Needed, Order Both [89053]
Patient to Schedule Appointment with Otolaryngology
[NURCOM0056]
Routine
Purpose: Post-op Evaluation
With whom: Otolaryngology
For when:
To be scheduled with Audiology Follow-Up.
Patient to Schedule Appointment with Audiology
[NURCOM0056]
Routine
Purpose: For audiogram
With whom: Audiology
Page 5 of 6
Printed by LIND, JANNA S [JSL237] at 5/27/2016 2:21:35 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2016CCKM@uwhealth.org

For when:
To be scheduled with Otolaryngology Follow-Up.
If Otolaryngology and Voice/Speech Follow-Up Needed, Order Both [89054]
Patient to Schedule Appointment with Otolaryngology
[NURCOM0056]
Routine
Purpose: Post-op Evaluation
With whom: Otolaryngology
For when:
To be scheduled with Voice/Speech Follow-Up.
Patient to Schedule Appointment with Voice/Speech
[NURCOM0056]
Routine
Purpose: Post-op Evaluation
With whom: Voice or Speech
For when:
To be scheduled with Otolaryngology Follow-Up.
Otolaryngology Clinic Telephone Follow-Up [93591]
Otolaryngology Clinic to Phone Patient for Follow-Up
[NURCOM0026]
Routine
Reason for Appointment: Post-op Evaluation
When do you want appointment: Per clinic
Which Clinic or Specialty:
Which Provider (Optional): Clinic to call patient
Page 6 of 6
Printed by LIND, JANNA S [JSL237] at 5/27/2016 2:21:35 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2016CCKM@uwhealth.org