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OP - Cosyntropin Stimulation Test Delegation Protocol - Pediatric Diagnostics - Supplemental [6378]

OP - Cosyntropin Stimulation Test Delegation Protocol - Pediatric Diagnostics - Supplemental [6378] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, HOD, Diagnostics/Sedation


OP - Cosyntropin Stimulation Test Delegation Protocol - Pediatric Diagnostics -
Supplemental [6378]
Imaging Preparatory and Recovery Orders –
Pediatric –AFCH Diagnostic Imaging and
Therapeutic
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/?path=/content/delegationpractice-
protocols/ambulatory-delegation-protocols/name-
97359-en.cckm
All Stimulation Test Patients
Premedications for Needle Insertion [126859]
Lidocaine [152737]
lidocaine (LMX) 4% topical dressing kit [66882] Topical, EVERY 1 HOUR PRN, prior to needle
sticks to reduce pain. See "LMX Use Instructions"
order in Active Orders report or the Admin
Instructions for application details
FOR PATIENTS 5 Kg OR LESS: Do NOT apply to
area greater than 100 square centimeters.
(maximum 1 g/site; maximum 1 site per hour, 6
times per day).
FOR PATIENTS 5.1-10 Kg: Do NOT apply to area
greater than 100 square centimeters. (maximum 1
g/site; maximum 2 sites per hour, 6 times per day).
FOR PATIENTS GREATER THAN 10 Kg: Do NOT
apply to area greater than 200 square centimeters.
(maximum 2.5 g/site; maximum 4 sites per hour, 6
times per day).
For patients less than 1 year old do NOT leave on
longer than 1 hour. For patients 1 year or older do
NOT leave on longer than 2 hours
Peds Diagnostic
LMX Use Instructions for Premedication Prior to
Needle Insertion [NURCOM0095]
Peds Diagnostic
Stimulation Test Orders
Cosyntropin Stimulation Test [221117]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Starting today, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed? Yes
Peds Diagnostic
sodium chloride flush 0.9% 10 mL injection
[785055]
Flush, PRN Starting today For 8 Hours, flush/line
care, Peds Diagnostic
Vital Signs - Baseline [NURMON0013] ONCE, Starting today For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Obtain once prior to test., Peds Diagnostic
cosyntropin in sodium chloride 0.9%
(CORTROSYN) injection [755006]
1 mcg, Intravenous, ONCE For 1 Doses, for 2
Minutes, Peds Diagnostic
Nursing Communication [NURCOM0022] ONCE, Obtain baseline lab tests if indicated by MD
staff. Orders will be placed within encounter., Peds
Diagnostic
Page 1 of 2
Printed by STRAKA, KEVIN F [KFS1] at 5/31/2017 4:20:47 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2017CCKM@uwhealth.org

ACTH [XACTH] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw 45 minutes post cosyntropin, Peds Diagnostic
CORTISOL [CORT] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw 45 minutes post cosyntropin, Peds Diagnostic
ACTH [XACTH] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Peds Diagnostic
CORTISOL [CORT] NEXT 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?
Peds Diagnostic
Page 2 of 2
Printed by STRAKA, KEVIN F [KFS1] at 5/31/2017 4:20:47 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org