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/clinical/cckm-tools/content/order-sets/hod/radiation-oncology/name-97780-en.cckm

20180119

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100

UWHC,UWMF,

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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,HOD,Radiation Oncology

RAD ONC - High-Dose Rate Intracavitary Radiation (HDR-ICR) - Adult [4559]

RAD ONC - High-Dose Rate Intracavitary Radiation (HDR-ICR) - Adult [4559] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, HOD, Radiation Oncology


RAD ONC - High-Dose Rate Intracavitary Radiation (HDR-ICR) - Adult [4559]
for Adult Patients OnlyIntended
Preprocedure
Non-Categorized Patient Care Orders [124050]
Have Patient Change Into Hospital Gown (No
Underwear) [NURCOM0022]
ONCE For 1 Occurrences, Pre-Op Day Of Procedure
Instruct Patient that Radiation Oncology
Physicians Will Meet With Patient in Treatment
Area Before Procedure to Address Any Last
Minute Questions/Concerns [NURCOM0022]
ONCE, Pre-Op Day Of Procedure
GLUCOSE, POC [HCMGLUC] ONCE, Routine
If Conditional, What Condition?
Pre-Op Day Of Procedure
Port per Protocol [NURCOM0022] ONCE, Pre-Op Day Of Procedure
Contingency Parameters [122705]
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:
Notify Anesthesiologist, Pre-Op Day Of Procedure
Laboratory [195563]
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?
Pre-Op Day Of Procedure
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?
Pre-Op Day Of Procedure
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?
Pre-Op Day Of Procedure
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?
Pre-Op Day Of Procedure
Page 1 of 3
Printed by STRAKA, KEVIN F [KFS1] at 1/19/2018 11:16:40 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

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?
Pre-Op Day Of Procedure
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?
Pre-Op Day Of Procedure
ABSOLUTE NEUTROPHIL COUNT [HCANC] 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?
Pre-Op Day Of Procedure
MAGNESIUM [MAG] 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?
Pre-Op Day Of Procedure
Premedications for Needle Insertion [242893]
Use lidocaine topical dressing kit for stable patient, no lidocaine allergies, have at least 30
minutes time prior to needing to use IV
Sodium chloride (bacteriostatic) 0.9% intradermal: Useful for patients requiring urgent IV
access; onset is immediate.
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Pre-Op Day Of Procedure
lidocaine (LMX) 4% topical dressing kit [66882] Topical, EVERY 1 HOUR PRN, peripheral line
insertion - see Admin Instructions
Do NOT apply to area greater than 200 square
centimeters (maximum 2.5 g/site; maximum 4 sites
per hour, 6 times per day). Do NOT leave on longer
than 2 hours. Use for stable patient, no allergies to
lidocaine, with at least 30 minutes time prior to IV use
Pre-Op Day Of Procedure
sodium chloride (bacteriostatic) 0.9 % injection
[50585]
0.05-0.1 mL, Intradermal, PRN, peripheral line
insertion - see Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge
needle to inject solution and create a wheal. Wait 30
seconds to 1 minute then insert IV catheter into center
of wheal. Use if IV is needed within 30 minutes.
Pre-Op Day Of Procedure
PACU
Non-categorized Patient Care Orders (Single Response) [124028]
Leave foley catheter in place and on discharge
[NURCOM0022]
ONCE, PACU
Leave nephrostomy tube in place and on
discharge [NURCOM0022]
ONCE, PACU
Discontinue Urinary Catheter [NURELM0069] ONCE For 1 Occurrences, Routine, Discontinue foley
catheter prior to transfer to Phase 2 recovery, PACU
Post-Op/Phase II Recovery
Non-Categorized Patient Care Orders [124031]
Page 2 of 3
Printed by STRAKA, KEVIN F [KFS1] at 1/19/2018 11:16:40 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Discharge Patient [ADT0004] Disposition:
Discharge Date: 1/19/2018
Discontinue IV when taking adequate oral
[NURCOM0022]
ONCE, Post-Op/Phase II
Contact Radiation Oncology Prior to Discharge
[NURMON0083]
ONCE For 1 Occurrences, Routine, Contact *** in
Radiation Oncology prior to discharge, Post-Op/Phase
II
Medications [124034]
acetaMINOPHEN (TYLENOL) tab RANGE
[750000]
325-650 mg, Oral, EVERY 4 HOURS PRN, pain/fever,
Post-Op/Phase II
oxycodone-acetaMINOPHEN (PERCOCET)
5-325 MG per tab RANGE [750033]
1-2 tab, Oral, EVERY 4 HOURS PRN, pain, Post-
Op/Phase II
Outpatient Discharge Orders
Reason for Hospitalization [134797]
Why You Were Hospitalized [NURCOM0073] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, You were hospitalized for radiation
therapy for your cancer.
Activity [124037]
May Resume Normal Activity as Tolerated
[NURACT0008]
Routine
Discharge Activity: Other (Comment)
May resume normal activity as tolerated, Phase II
Discharge
Nutrition [124038]
Resume Normal Diet as Tolerated [NUT8888] Routine
General: General (No Modifications)
Diet Modifications:
Other Diet Modifications:
Resume Normal Diet as Tolerated
Medication Instructions [123596]
Resume Home Medications [NURCOM0066] Routine, Resume home medications immediately
Contingency Parameters [122709]
Contact Radiation Oncology [NURCOM0001] Routine, Contact Radiation Oncologist on call at (608)
263-8500 if problems arise after discharge
Page 3 of 3
Printed by STRAKA, KEVIN F [KFS1] at 1/19/2018 11:16:40 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org