/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/order-sets/,/clinical/cckm-tools/content/order-sets/hod/,/clinical/cckm-tools/content/order-sets/hod/diagnosticssedation/,

/clinical/cckm-tools/content/order-sets/hod/diagnosticssedation/name-123245-en.cckm

201712345

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,HOD,Diagnostics/Sedation

OP - Sickle Cell Disease - Pediatric Diagnostics - Supplemental [6624]

OP - Sickle Cell Disease - Pediatric Diagnostics - Supplemental [6624] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, HOD, Diagnostics/Sedation


OP - Sickle Cell Disease - Pediatric Diagnostics - Supplemental [6624]
Intravenous Therapy
Premedications for Needle Insertion [236809]
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
LMX Use Instructions for Premedication Prior to
Needle Insertion [NURCOM0095]
Details
IV Fluids [236810]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Peds Diagnostic
sodium chloride 0.9% BOLUS [730003] 20 mL/kg, Intravenous, ONCE For 1 Doses, Peds
Diagnostic
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L
infusion - NOTE: Suggested rate 1 x maintenance
[44910]
Intravenous, CONTINUOUS, Peds Diagnostic
sodium chloride 0.9% infusion - NOTE:
Suggested rate 1 x maintenance [730003]
Intravenous, CONTINUOUS, Peds Diagnostic
Medications
Flushes [237461]
Vortex Ports [NURCOM0001] Location:
Notify based on:
RNs may perform care for Vortex® vascular access
devices when used for blood draws or medication
administration (no apheresis), according to Nursing
Patient Care Policy and Procedure 1.56AP, Central
Vascular Access Device Use, Maintenance and
Removal (Adult & Pediatric). Refer to the section on
implanted ports., Peds Diagnostic
sodium chloride 0.9% flush 10 mL injection
[785055]
Flush, PRN, flush/line care
Flush per UW Health Flushing/Locking of Venous
Access Devices - Adult/Pediatric -
Inpatient/Ambulatory Clinical Practice Guideline.
Peds Diagnostic
Page 1 of 6
Printed by WILLIAMS, HEATHER R [HRS0] at 12/8/2017 11:23:02 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

heparin lock flush 10 UNIT/ML injection [75031] 1-150 units, Flush, PRN, flush/line care
Flush per UW Health Flushing/Locking of Venous
Access Devices - Adult/Pediatric -
Inpatient/Ambulatory Clinical Practice Guideline.
Peds Diagnostic
heparin lock flush 100 units/mL 5 mL injection
[64978]
500 units, Flush, PRN, flush/line care
For implanted port maintenance lock or de-accessing
port only
Peds Diagnostic
Analgesics - Acetaminophen [236812]
acetaMINOPHEN (TYLENOL) disintegrating tab -
Maximum Dose = 650 mg - Suggested Dose 15
mg/kg/dose [64412]
Oral, EVERY 6 HOURS PRN, pain/fever, mild to
moderate pain, Peds Diagnostic
acetaMINOPHEN (TYLENOL) tab - Maximum
Dose = 650 mg - Suggested Dose 15 mg/kg/dose
[34149]
Oral, EVERY 6 HOURS PRN, pain, mild to moderate
pain, Peds Diagnostic
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - Maximum Dose = 650 mg [800005]
15 mg/kg, Oral, EVERY 6 HOURS PRN, pain/fever,
mild to moderate pain, Peds Diagnostic
acetaMINOPHEN (TYLENOL) suppository -
Maximum Dose = 650 mg - Suggested Dose 15
mg/kg/dose [43994]
Rectal, EVERY 6 HOURS PRN, pain/fever, mild to
moderate pain, Peds Diagnostic
Analgesics - NSAIDS - Oral [237455]
ibuprofen (MOTRIN) susp - NOTE: suggested
dose 10 mg/kg/dose with (MAX dose= 600
mg/dose), mild to moderate pain [45376]
Oral, ONCE PRN For 1 Doses, pain, mild to moderate
pain
DO NOT order if using ketorolac
Peds Diagnostic
ibuprofen (MOTRIN) tab - NOTE: suggested dose
10 mg/kg/dose with MAX dose= 600 mg/dose,
mild to moderate pain [38353]
Oral, ONCE PRN For 1 Doses, pain
DO NOT order if using ketorolac
Peds Diagnostic
Analgesics - NSAIDS - Intravenous [237456]
ketOROLAC (TORADOL) injection [800050] 0.5 mg/kg, Intravenous, ONCE PRN For 5 Days
DO NOT order if using oral ibuprofen
Peds Diagnostic
Analgesics - Opioids - INTRANASAL [237457]
FENTanyl PF 100 MCG/2ML intraNASAL soln
(MAX dose of 100 mcg/dose) [785209]
1.5 mcg/kg, Nasal, ONCE PRN For 1 Doses, severe
pain
for use if no IV access
Peds Diagnostic
Analgesics - Opioids - ORAL [237458]
oxycodone 5 MG/5ML soln RANGE (MAX dose
10 mg per dose) [750031]
0.1-0.2 mg/kg, Oral, ONCE PRN For 1 Doses, pain,
severe pain, Peds Diagnostic
oxycodone tab RANGE - NOTE: suggested dose
0.1-0.2 mg/kg (MAX dose 10 mg per dose),
[750032]
Oral, ONCE PRN For 1 Doses, pain, severe pain,
Peds Diagnostic
Analgesics - Opioids - INTRAVENOUS [237459]
disease is reassessing initial loading dose, recommended acute pain control in sickle cell After
at 50% of IV opioid loading dose PRNpain at least every 20 minutes and repeating dosing
FENTanyl PF injection (MAX dose 100 mcg/dose)
[800187]
1 mcg/kg, Intravenous, EVERY 20 MINUTES PRN,
severe pain
After initial loading dose, recommended acute pain
control in sickle cell disease is reassessing pain at
least every 20 minutes and repeating dosing at 50% of
IV opioid loading dose PRN
Peds Diagnostic
Page 2 of 6
Printed by WILLIAMS, HEATHER R [HRS0] at 12/8/2017 11:23:02 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

MORPHine PF injection RANGE (MAX dose= 10
mg/dose) [750057]
0.1-0.15 mg/kg, Intravenous, EVERY 20 MINUTES
PRN, pain, severe pain
After initial loading dose, recommended acute pain
control in sickle cell disease is reassessing pain at
least every 20 minutes and repeating dosing at 50% of
IV opioid loading dose PRN
for 4 Minutes, Peds Diagnostic
HYDROmorphone PF (DILAUDID) injection
RANGE (MAX dose= 2 mg/dose) [750050]
0.02-0.03 mg/kg, Intravenous, EVERY 20 MINUTES
PRN, severe pain
After initial loading dose, recommended acute pain
control in sickle cell disease is reassessing pain at
least every 20 minutes and repeating dosing at 50% of
IV opioid loading dose PRN
for 3 Minutes, Peds Diagnostic
Anti-infectives [236813]
ceftriaxone (ROCEPHIN) intraVENOUS -
Maximum Dose = 2 g [800027]
50 mg/kg, Intravenous, ONCE For 1 Doses, Peds
Diagnostic
azithromycin (ZITHROMAX) 200 MG/5ML susp
(MAX dose= 500 mg/dose) [51547]
10 mg/kg, Oral, ONCE For 1 Doses, Peds Diagnostic
Anti-emetics (Single Response) [236815]
ondansetron (ZOFRAN) injection (Maximum Dose
= 4 mg) [800202]
0.1 mg/kg, Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting, Peds Diagnostic
ondansetron (ZOFRAN) soln (Maximum Dose = 4
mg) [54843]
0.1 mg/kg, Oral, ONCE PRN For 1 Doses,
nausea/vomiting, Peds Diagnostic
Bowel Management [237460]
bisacodyl (DULCOLAX) rectal suppository
[35231]
10 mg, Rectal, ONCE For 1 Doses, Peds Diagnostic
glycerin (PEDIATRIC) rectal suppository - NOTE:
order for children LESS than or equal to 12 years
of age [153728]
1 suppository, Rectal, ONCE For 1 Doses, Peds
Diagnostic
glycerin (ADULT) rectal suppository - NOTE:
order for children GREATER than 12 years of age
[106612]
1 suppository, Rectal, ONCE For 1 Doses, Peds
Diagnostic
phosphate (FLEET PEDIATRIC) enema - NOTE:
order for children 2-11 years of age [37522]
1 enema, Rectal, ONCE For 1 Doses, Peds
Diagnostic
phosphate (FLEET) enema - NOTE: order for
children12 years of age and older [37517]
1 enema, Rectal, ONCE For 1 Doses, Peds
Diagnostic
Laboratory
Laboratory [236816]
CBC WITHOUT DIFFERENTIAL [HEMO] STAT 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
RETICULOCYTE COUNT [RET] STAT 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 3 of 6
Printed by WILLIAMS, HEATHER R [HRS0] at 12/8/2017 11:23:02 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

TYPE AND SCREEN [HCTS] STAT For 1 Occurrences, Routine, As good clinical
practice and for patient safety, the Transfusion Service
will automatically crossmatch 2 packed RBCs on all
patients with antibodies to ensure blood would be
available in the event it is needed. If you would like to
opt out of this automatic order for this patient please
contact the UWHC Blood Bank at (608) 263-8367 or
The American Center Lab at (608) 234-6600 as
appropriate., Peds Diagnostic
FERRITIN [FER] STAT 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
SODIUM [NA] STAT 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
POTASSIUM [K] STAT 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
CHLORIDE [CL] STAT 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
CARBON DIOXIDE [CO2] STAT 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
GLUCOSE [GLU] STAT 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
BUN [BUN] STAT 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
CREATININE [CRET] STAT 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
CALCIUM [CA] STAT 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 4 of 6
Printed by WILLIAMS, HEATHER R [HRS0] at 12/8/2017 11:23:02 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

BILIRUBIN, TOTAL [TBIL] STAT 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
ALKALINE PHOSPHATASE [ALKP] STAT 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
AST/SGOT [AST] STAT 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
ALT/SGPT [ALT] STAT 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
ALBUMIN [ALB] STAT 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
PROTEIN, TOTAL [TP] STAT 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
HEMOGLOBINOPATHY EVALUATION
[XHGBEV]
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
Laboratory - additional labs if FEVER present [236824]
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
STAT For 1 Occurrences, Routine, For optimum
diagnosis of sepsis, sample 3-4 sites only on the first
day of a septic episode. Cultures on subsequent days
are of minimal diagnostic value. Culture detects
bacteria, Candida and Cryptococcus. If filamentous
fungi are suspected see Culture, Blood, Filamentous
Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
URINALYSIS, NO MICROSCOPY, POC
[HCDIPSCR]
STAT For 1 Occurrences, Routine
If Conditional, What Condition?
CULTURE, URINE [URC] STAT For 1 Occurrences, Routine
Does patient have an indwelling urinary catheter?
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Diagnostic Tests and Imaging
Imaging [236825]
Page 5 of 6
Printed by WILLIAMS, HEATHER R [HRS0] at 12/8/2017 11:23:02 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

X-RAY CHEST PA & LAT VIEWS [R71020] ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
Routine
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history? sickle cell disease
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
Peds Diagnostic
X-RAY ABDOMEN AP VIEW (KUB) [R74000] ONCE-RAD NEXT AVAILABLE, Routine
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history? sickle cell disease
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
Peds Diagnostic
Patient Care Orders
Patient Care Orders [236827]
Vital Signs [NURMON0013] EVERY 1 HOUR, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Peds Diagnostic
Pulse Oximetry [NURMON0009] SEE COMMENTS, Routine, Spot check with vital
signs and/or PRN for increased respiratory distress
and/or respiratory depression, Peds Diagnostic
Diet - Custom [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Pediatric
Diet Type: General (no Modifications)
Bedside Meal Instructions:
Room Service Class:
Peds Diagnostic
Page 6 of 6
Printed by WILLIAMS, HEATHER R [HRS0] at 12/8/2017 11:23:02 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org