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/clinical/cckm-tools/content/order-sets/hod/diagnosticssedation/name-97797-en.cckm

201711317

page

100

UWHC,UWMF,

Tools,

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

OP - Renal Biopsy - Pediatric - Preprocedure [4720]

OP - Renal Biopsy - Pediatric - Preprocedure [4720] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, HOD, Diagnostics/Sedation


OP - Renal Biopsy - Pediatric - Preprocedure [4720]
Isolation
Isolation Status [127391]
Isolation - Contact - Multidrug Resistant
Organism [235756]
Contact Isolation - MDRO (MDR) [ISO0334] CONTINUOUS
What is the Reason for Isolation? MDR
Peds Diagnostic
Isolation Cart [EQP0016] CONTINUOUS, Routine, Peds Diagnostic
Isolation - Contact - Extensively Resistant
Organism (XDR) [235757]
Contact Isolation - MDRO (XDR) [ISO0334] CONTINUOUS
What is the Reason for Isolation? XDR
Peds Diagnostic
Isolation Cart [EQP0016] CONTINUOUS, Routine, Peds Diagnostic
Enhanced Contact Isolation - CDIFF [ISO0348] What is the reason for isolation? CDIFF
Separate order must be placed for isolation cart., Peds
Diagnostic
Contact Isolation - MDRO (MRSA) [ISO0334] CONTINUOUS
What is the Reason for Isolation? MRSA
Separate order must be placed for isolation cart., Peds
Diagnostic
Contact Isolation - MDRO (VRE) [ISO0334] CONTINUOUS
What is the Reason for Isolation? VRE
Separate order must be placed for isolation cart., Peds
Diagnostic
Isolation - Protective Precautions [235759]
Protective Precautions [ISO0349] What is the Reason for Isolation?
Peds Diagnostic
Isolation Cart [EQP0016] CONTINUOUS, Routine, Peds Diagnostic
Airborne Isolation - Confirmed/Suspected
Pulmonary TB [ISO0325]
Separate order must be placed for isolation cart., Peds
Diagnostic
Patient Care Orders
Nutrition [127929]
Diet - NPO Except Medications [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Pediatric
Diet Type: NPO
NPO Diet: NPO except Medications
Bedside Meal Instructions:
Room Service Class:
NPO except medications for 4 hours post-biopsy until
hematocrit is back. Call Provider on-call for Diet Order
update., Peds Diagnostic
Vital Signs [127539]
Vital Signs [NURMON0013] ONCE For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Peds Diagnostic
Patient Monitoring [127540]
Page 1 of 9
Printed by STRAKA, KEVIN F [KFS1] at 10/23/2017 5:31:06 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

Measure Weight Upon Admission
[NURMON0015]
ONCE For 1 Occurrences, Routine
Weigh With?
Weigh when?
Upon Admisson, Peds Diagnostic
Measure Height Upon Admission [NURMON0052] ONCE For 1 Occurrences, Routine, Upon Admission,
Peds Diagnostic
Intravenous Therapy
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
IV Fluids [127373]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed? Yes
Peds Diagnostic
sodium chloride 0.9 % infusion [64367] at 125 mL/hr, Intravenous, CONTINUOUS, Peds
Diagnostic
dextrose 5%-NaCl 0.2% infusion [51615] at 125 mL/hr, Intravenous, CONTINUOUS, Peds
Diagnostic
dextrose 5%-NaCl 0.2% with KCl 20 mEq/L
infusion [44909]
at 125 mL/hr, Intravenous, CONTINUOUS, Peds
Diagnostic
dextrose 5%-NaCl 0.45% infusion [51613] Intravenous, CONTINUOUS, Peds Diagnostic
Blood Bank
Test [126476]
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
Laboratory
Laboratory [127393]
Page 2 of 9
Printed by STRAKA, KEVIN F [KFS1] at 10/23/2017 5:31:06 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

CBC WITH DIFFERENTIAL [CBC] 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
ELECTROLYTES [LYTE] 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
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
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
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
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
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
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
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
GGT [GGT] 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 9
Printed by STRAKA, KEVIN F [KFS1] at 10/23/2017 5:31:06 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

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
LIPID PANEL [LIPID] STAT For 1 Occurrences, Routine, Test includes
Cholesterol, Total; HDL Cholesterol; Triglyceride; LDL
cholesterol, calculated; and non-HDL cholesterol.
Patient must fast for a minimum of 10 hours and be
heparin free for 48 hours prior to specimen collection.
The patient can only have water during the fasting
period.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Peds Diagnostic
PHOSPHATE [PHOS] 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
URINALYSIS WITH MICROSCOPY [UA] 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/CREATININE RATIO, URINE
[HCUPCRC]
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
PROTHROMBIN TIME/INR [PT] 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
PTT [PTT] 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
CYCLOSPORINE [XCYCA] 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
TACROLIMUS LEVEL [HCTAC] 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
MYCOPHENOLATE [HCMPA] 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 9
Printed by STRAKA, KEVIN F [KFS1] at 10/23/2017 5:31:06 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

SURGICAL PATHOLOGY [HCPATHS] STAT For 1 Occurrences, Routine, This order is to be
used for fresh or formalin-fixed (for gross and micro
evaluation) tissues.
Slides and/or paraffin-embedded blocks coming from
outside institutions needing second opinion pathology
review should be ordered as Surgical Pathology
Consult [HCPATHSP].
Specimen Source Description:
Number of containers:
Clinical Diagnosis/Reason for Procedure:
Other pertinent information:
Frozen section call back number:
Type of Procedure:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Peds Diagnostic
Laboratory - Transplant [127394]
PTH [HCPTHIN] 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 5 of 9
Printed by STRAKA, KEVIN F [KFS1] at 10/23/2017 5:31:06 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

VITAMIN D, 25-HYDROXY BY HPLC [HCLCD25] STAT For 1 Occurrences, Routine, Screening for
Vitamin D deficiency is not covered by Medicare. If
this is the reason for the test, please advise the patient
of non-coverage via the ABN process. Coverage is
allowed in some other circumstances. If one of these
diagnoses is appropriate for your patient, please
associate the corresponding code with this order.
252.00 (ICD-9); E21.3 (ICD-10) Hyperparathyroidism,
unspecified
252.01 (ICD-9); E21.0 (ICD-10) Primary
Hyperparathyroidism
252.02 (ICD-9); E21.1 (ICD-10) Secondary
Hyperparathyroidism, Non-Renal
252.08 (ICD-9); E21.2 (ICD-10) Other
Hyperparathyroidism
252.1 (ICD-9); E20.9 (ICD-10) Hypoparathyroidism
268.0 (ICD-9); E55.0 (ICD-10) Rickets Active
268.2 (ICD-9); M83.9 (ICD-10) Osteomalacia
Unspecified
268.9 (ICD-9); E55.9 (ICD-10) Established Vitamin D
Deficiency (monitoring efficacy of replacement
therapy)
275.3 (ICD-9); E83.30 (ICD-10) Disorders of
Phosphorus Metabolism
275.41 (ICD-9); E83.51 (ICD-10) Hypocalcemia
275.42 (ICD-9); E83.52 (ICD-10) Hypercalcemia
585.3 (ICD-9); N18.3 (ICD-10) Chronic Kidney
Disease, Stage III (Moderate)
585.4 (ICD-9); N18.4 (ICD-10) Chronic Kidney
Disease, Stage IV (Severe)
585.5 (ICD-9); N18.5 (ICD-10) Chronic Kidney
Disease, Stage V
585.6 (ICD-9); N18.6 (ICD-10) End Stage Renal
Disease
588.81 (ICD-9); N25.81 (ICD-10) Secondary
Hyperparathyroidism (of Renal Origin)
733.00 (ICD-9); M81.0 (ICD-10) Osteoporosis
Unspecified
733.01 (ICD-9); M81.0 (ICD-10) Senile Osteoporosis
Page 6 of 9
Printed by STRAKA, KEVIN F [KFS1] at 10/23/2017 5:31:06 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

733.02 (ICD-9); M81.8 (ICD-10) Idiopathic
Osteoporosis
733.03 (ICD-9); M81.8 (ICD-10) Disuse Osteoporosis
733.09 (ICD-9); M81.8 (ICD-10) Other Osteoporosis
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Peds Diagnostic
BK VIRUS, QUANTITATIVE BY PCR
[HCBKVPCR]
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
BK VIRUS, QUANTITATIVE BY PCR, URINE
[HCBKPCR]
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
CMV QUANTITATIVE BY PCR [HCCMVDNA] 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
EBV QUANTITATIVE BY PCR [HCEBVPCR] 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
MYCOPHENOLATE [HCMPA] 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
SIROLIMUS [HCSIRO] 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
HLA CLASS I DONOR SPECIFIC AB BY
LUMINEX [HCDSA1B]
STAT For 1 Occurrences, Routine
Indicate organ for transplant:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Peds Diagnostic
HLA CLASS II DONOR SPECIFIC AB BY
LUMINEX [HCDSA2B]
STAT For 1 Occurrences, Routine
Indicate organ for transplant:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Peds Diagnostic
Page 7 of 9
Printed by STRAKA, KEVIN F [KFS1] at 10/23/2017 5:31:06 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

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?
Peds Diagnostic
Laboratory - Native Kidney [127395]
ANA SCREEN WITH TITER IF POSITIVE [ANAT] 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
ANCA [ANCA] 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
C3 [XC3] 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
C4 [XC4] 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
ESR [ESR] 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
C REACTIVE PROTEIN [CRPN] 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
DNA AB, DOUBLE STRANDED [DNA] STAT For 1 Occurrences, Routine, Order only if ANA
is positive.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Peds Diagnostic
ENA AB [HCENA] STAT For 1 Occurrences, Routine, Order only if ANA
is positive.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Peds Diagnostic
HISTONE AB, IGG [HCHISTON] 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
Diagnostic Tests and Imaging
Pathology [126571]
Page 8 of 9
Printed by STRAKA, KEVIN F [KFS1] at 10/23/2017 5:31:06 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

US DEEP DOPPLER [R93975] Status: Future, Expires: 12/23/2018, Normal, Routine
BIOPSY ULTRASOUND GUIDED [R76942] Status: Future, Expires: 9/23/2018, Normal, Routine
Page 9 of 9
Printed by STRAKA, KEVIN F [KFS1] at 10/23/2017 5:31:06 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org