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OP - Cardiac CatheterizationElectrophysiology Lab - Pediatric Diagnostics - Postprocedure [4624]

OP - Cardiac CatheterizationElectrophysiology Lab - Pediatric Diagnostics - Postprocedure [4624] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, HOD, Diagnostics/Sedation


OP - Cardiac Catheterization/Electrophysiology Lab - Pediatric Diagnostics - Postprocedure
[4624]
Patient Care Orders
Vitals [127987]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today For Until specified, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 15 minutes times 4, then every 30 minutes times 4,
then every hour times 2, then every 4 hours., Peds Diagnostic
Patient Monitoring [126480]
Cardio-Respiratory Monitor - Pediatric - With Rhythm
[139419]
Cardio-Respiratory Monitor - Pediatric - With Rhythm
[NURMON0014]
CONTINUOUS, Routine, Most pediatric patients do NOT
require rhythm analysis. Please complete the Notify
Provider order below, including specification for apnea >
*** seconds. If indicated, order pulse oximetry separately.
Device Present:
Device Mode:
Device Low Rate Limit (BPM):
Notify Provider: Symptomatic Change in Rhythm,Serious
Arrhythmia
Peds Diagnostic
Notify [NURCOM0001] Provider to Notify: Provider
Notify based on:
Notify provider for apnea > 20 seconds, Peds Diagnostic
Activity [126481]
Bedrest with Extremity Straight [NURACT0008] CONTINUOUS, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST: other (comment)
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Bedrest with extremity straight: {right, left, bilateral:3200103},
Peds Diagnostic
Ad Lib [NURACT0008] CONTINUOUS, Routine
AD LIB: ad lib
AMBULATE:
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Peds Diagnostic
Elevate Head of Bed - Less than 30 degrees
[NURACT0002]
Equal to (degrees):
Greater than (degrees):
Less than (degrees): 30
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Other options: At all times
Routine, CONTINUOUS, Peds Diagnostic
Nutrition [126482]
NPO Except Medications [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question 25): NPO
EXCEPT MEDICATIONS
Liquids & Modified Consistency (If Dysphagia Protocol see
questions 21-24):
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat:
Sodium:
Potassium:
Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO):
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:
Peds Diagnostic
General Diet [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet: GENERAL;
Diabetic Diet:
NPO (If patient receiving tube feeding see question 25):
Liquids & Modified Consistency (If Dysphagia Protocol see
questions 21-24):
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat:
Sodium:
Potassium:
Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO):
Research:
Metabolic:
Other Modifiers:
Infant Nutrition (Select product and calories per ounce):
Infant Formula (Calories per Ounce):
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison

 

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:
Peds Diagnostic
Clear Liquid Diet [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question 25):
Liquids & Modified Consistency (If Dysphagia Protocol see
questions 21-24): CLEAR LIQUID;
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat:
Sodium:
Potassium:
Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO):
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:
Peds Diagnostic
Respiratory Therapy [126485]
Pulse Oximetry [NURMON0009] CONTINUOUS, Routine, Peds Diagnostic
Wound/Procedure Site Care [126483]
Wound Care [NURWND0015] CONTINUOUS, Routine
Wound Type: Puncture
Wound Site: Leg
Wound Location:
Assess Frequency: SEE COMMENTS
Care Frequency:
Wash With:
Irrigate/Rinse With:
Apply (Must also enter separate medication order to obtain
drug):
Primary Dressing:
Secondary Dressing:
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison

 

Assess procedure site/access site dressing for bleeding
and/or swelling every 15 minutes times 4, then every 30
minutes times 4, then every hour times 2, then every 4 hours.,
Peds Diagnostic
Neurovascular Checks [126484]
Neurovascular Checks [NURMON0045] SEE COMMENTS, Routine, Every 15 minutes times 4, then
every 30 minutes time 4, then every hour times 2, then every
4 hours., Peds Diagnostic
Non-Categorized Patient Care Orders [127939]
Discharge Criteria [NURCOM0022] SEE COMMENTS, Patient may be discharged *** hours after
procedure complete and the following discharge criteria are
met: Patient is able to ambulate with no bleeding, tolerating
sips of clear liquids with no emesis, and has voided., Peds
Diagnostic
Transport patient to car in wheel chair. [NURCOM0022] SEE COMMENTS, Transport patient to car in wheel chair.,
Peds Diagnostic
Contingency Parameters for Patients Less than 7 Months of Age [126488]
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):
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: Patient develops nausea or vomiting.
Peds Diagnostic
Contingency Parameters for Patients 7 Months to 3 Years of Age [126490]
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):
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: Patient develops nausea or vomiting.
Peds Diagnostic
Contingency Parameters for Patients 3 to 7 Years of Age [126500]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg):
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison

 

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: Patient develops nausea or vomiting.
Peds Diagnostic
Contingency Parameters for Patients 7 to 11 Years of Age [126501]
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):
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: Patient develops nausea or vomiting.
Peds Diagnostic
Contingency Parameters for Patients 11 Years of Age and Older [126502]
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):
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: Patient develops nausea or vomiting.
Peds Diagnostic
IV Fluids
IV Fluids (Single Response) [126403]
dextrose 5%-NaCl 0.45% infusion [51613] Intravenous, CONTINUOUS, Peds Diagnostic
dextrose 5%-NaCl 0.2% infusion [51615] Intravenous, CONTINUOUS, Peds Diagnostic
lactated ringers infusion [38890] Intravenous, CONTINUOUS, Peds Diagnostic
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison

 

Medications
Analgesics (Single Response) [126404]
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - Note: Suggested dose 10-15 mg/kg/dose
(Maximum 650 mg/dose) [800005]
Oral, EVERY 4 HOURS PRN, pain/fever
Note: Suggested dose 10-15 mg/kg/dose (Maximum 650
mg/dose)
Peds Diagnostic
acetaMINOPHEN (TYLENOL) suppository - Note:
Suggested dose 10-15 mg/kg/dose (Maximum 650
mg/dose) [43994]
Rectal, EVERY 4 HOURS PRN, pain
Note: Suggested dose 10-15 mg/kg/dose (Maximum 650
mg/dose)
Peds Diagnostic
acetaMINOPHEN (TYLENOL) tab RANGE - Note:
Suggested dose 10-15 mg/kg/dose (Maximum 650
mg/dose) [750000]
325-650 mg, Oral, EVERY 4 HOURS PRN, pain
Note: Suggested dose 10-15 mg/kg/dose (Maximum 650
mg/dose)
Peds Diagnostic
Sedatives [144068]
dexmedetomidine (PRECEDEX) 200 mcg/50 mL
infusion [700431]
Intravenous, Post-Op/Phase II
Anti-infectives
First Line (Single Response) [112541]
cefazolin (ANCEF) intraVENOUS [800000] 30 mg/kg, Intravenous, EVERY 8 HOURS For 2 Doses, Post-
Op/Phase II
cefuroxime (ZINACEF) intraVENOUS [800030] 50 mg/kg, Intravenous, EVERY 8 HOURS For 2 Doses, Post-
Op/Phase II
cefdinir (OMNICEF) 250 MG/5ML susp [104063] 14 mg/kg, Oral, EVERY 24 HOURS For 1 Doses, Post-
Op/Phase II
Patients with MRSA (Single Response) [144010]
Cefazolin - Vancomycin (Maximum Dose 2 grams)
[191197]
cefazolin (ANCEF) intraVENOUS [800000] 30 mg/kg, Intravenous, EVERY 8 HOURS For 2 Doses,
Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS [800084] 15 mg/kg, Intravenous, EVERY 6 HOURS For 3 Doses,
Post-Op/Phase II
Cefuroxime - Vancomycin (Maximum Dose 2 grams)
[191200]
cefuroxime (ZINACEF) intraVENOUS [800030] 50 mg/kg, Intravenous, EVERY 8 HOURS For 2 Doses,
Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS [800084] 15 mg/kg, Intravenous, EVERY 6 HOURS For 3 Doses,
Post-Op/Phase II
Cefdinir - Vancomycin (Maximum Dose 2 grams)
[191203]
cefdinir (OMNICEF) 250 MG/5ML susp [104063] Details
vancomycin (VANCOCIN) intraVENOUS [800084] 15 mg/kg, Intravenous, EVERY 6 HOURS For 3 Doses,
Post-Op/Phase II
Patients with Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies and MRSA positive (Single
Response) [144086]
vancomycin (VANCOCIN) intraVENOUS [800084] 15 mg/kg, Intravenous, EVERY 6 HOURS For 3 Doses
Patients with Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies and MRSA negative (Single
Response) [144013]
clindamycin (CLEOCIN) intraVENOUS [800033] 10 mg/kg, Intravenous, EVERY 8 HOURS For 2 Doses, Post-
Op/Phase II
Diagnostic Tests and Imaging
Studies [126503]
X-Ray Chest AP View Bedside [R71010] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms?
What specific question(s) would you like answered by this
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison

 

exam?
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where? Bedside
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
Peds Diagnostic
Transthoracic Resting Echocardiogram (PEDS)
[ECH0012]
ONCE For 1 Occurrences, Routine
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
To whom can we send the results of the study? (include
clinician and location):
Do you want Agitated Bubble Study?
Last patient height? (will auto pull in value and date in
comment):
Last patient weight? (will auto pull in value and date in
comment):
Peds Diagnostic
ECG - 12 Lead (PEDS) [EKG0014] ONCE, Routine
Reason for exam:
Peds Diagnostic
Holter Monitor - 24/48 Hour Monitor (Peds) [EKG0027] ONCE For 1 Occurrences, Routine
Reason for exam:
Length of monitoring: 24 HOURS
Peds Diagnostic
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison