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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Anesthesiology

Anesthesiology - Pediatric - Preoperative [2520]

Anesthesiology - Pediatric - Preoperative [2520] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Anesthesiology


Anesthesiology - Pediatric - Preoperative [2520]
Patient Care Orders
Respiratory [81193]
Oxygen Therapy - Nasal Cannula [RT0032] CONTINUOUS, Starting today, Routine
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%):
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen?
Pre-Op Day Of Procedure
Oxygen Therapy - Non-Rebreather [RT0032] CONTINUOUS, Routine
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%):
O2 Delivery Device: Non-rebreather mask
Attempt to Wean Off Oxygen?
Pre-Op Day Of Procedure
Non-categorized Patient Care Orders [81194]
Glucose, POC [IPGLUCOSE] ONCE, Starting today For 1 Occurrences, Routine,
Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia management
and monitoring as indicated in the Hypoglycemia
Management (Adult) panel.
If Conditional, What Condition?
Pre-Op Day Of Procedure
Contingency Parameters [148251]
Notify Provider [NURCOM0001] Provider to Notify:
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): 400
If blood glucose < (mg/dL): 40
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other:
Medications
Analgesics - Opioid (Single Response) [81197]
HYDROmorphone PF (DILAUDID) injection -
NOTE: Suggested dose 0.015 mg/kg (Maximum
0.2 mg/dose) [800120]
0.015 mg/kg, Intravenous, ONCE For 1 Doses
NOTE: Suggested dose 0.015 mg/kg (Maximum 0.2
mg/dose)
Pre-Op Day Of Procedure
MORPHine PF injection - NOTE: Suggested dose
0.05 mg/kg (Maximum 4 mg/dose) [800122]
0.05 mg/kg, Intravenous, ONCE For 1 Doses
NOTE: Suggested dose 0.05 mg/kg (Maximum 4
mg/dose)
Pre-Op Day Of Procedure
Page 1 of 5
Printed by STRAKA, KEVIN F [KFS1] at 8/8/2017 10:33:23 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

oxycodone tab [45976] 5-10 mg, Oral, ONCE PRN For 1 Doses, pain,
Moderate to Severe Pain, Pre-Op Day Of Procedure
oxycodone 5 MG/5ML soln - NOTE - Suggested
dose 0.05 mg/kg/dose (Maximum 5 mg) [45975]
Oral, ONCE PRN For 1 Doses, pain, Moderate to
Severe Pain, Pre-Op Day Of Procedure
Analgesics - Non-opioid [111215]
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - NOTE: Suggested dose 15 mg/kg
(Maximum 1000 mg/dose) [800005]
15 mg/kg, Oral, ON CALL For 1 Doses
Administer {arrival/on-call:2000140}
NOTE: Suggested dose 15 mg/kg (Maximum 1000
mg/dose)
Pre-Op Day Of Procedure
acetaMINOPHEN (TYLENOL) tab - NOTE:
Sugested dose 15 mg/kg (Maximum 1000
mg/dose) [34149]
Oral, ON CALL For 1 Doses
Administer {arrival/on-call:2000140}
NOTE: Sugested dose 15 mg/kg (Maximum 1000
mg/dose)
Pre-Op Day Of Procedure
acetaMINOPHEN (TYLENOL) disintegrating tab -
NOTE: Sugested dose 15 mg/kg [64412]
Oral, ON CALL For 1 Doses
Administer {arrival/on-call:2000140}
NOTE: Sugested dose 15 mg/kg (Maximum 1000
mg/dose)
Pre-Op Day Of Procedure
ibuprofen (MOTRIN) 100 mg/5 mL susp - NOTE:
Suggested dose 10 mg/kg (Maximum 400
mg/dose) [45376]
10 mg/kg, Oral, ON CALL For 1 Doses
Administer {arrival/on-call:2000140}
Pre-Op Day Of Procedure
ibuprofen (MOTRIN) tab - NOTE: Suggested dose
10 mg/kg (Maximum 400 mg/dose) [38353]
Oral, ON CALL For 1 Doses
Administer {arrival/on-call:2000140}
NOTE: Suggested dose 10 mg/kg (Maximum 400
mg/dose)
gabapentin (NEURONTIN) soln - Note:
Recommended Dose = 10-15 mg/kg Maximum
Dose = 900 mg [65814]
Oral, ONCE For 1 Doses
gabapentin (NEURONTIN) cap - NOTE:
Recommended Dose = 10-15 mg/kg Maximum
Dose = 900 mg [54258]
200 mg, Oral
Sedatives [81202]
midazolam (VERSED) syrup - NOTE: Suggested
dose 0.5 mg/kg (Maximum 20 mg/dose) [60487]
0.5 mg/kg, Oral, ON CALL For 1 Doses
Administer {arrival/on-call:2000140}
NOTE: Suggested dose 0.5 mg/kg (Maximum 20
mg/dose)
Pre-Op Day Of Procedure
diazepam (VALIUM) tab - NOTE: Suggested dose
0.2-0.3 mg/kg (Maximum 10 mg/dose) [36679]
Oral, ONCE For 1 Doses, Pre-Op Day Of Procedure
Anti-emetics [81196]
diphenhydramine (BENADRYL) injection [800106] 1 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op
Day Of Procedure
meclizine (ANTIVERT) tab [47269] 25 mg, Oral, ONCE For 1 Doses, Pre-Op Day Of
Procedure
metoclopramide (REGLAN) injection [800059] 0.15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op
Day Of Procedure
ondansetron (ZOFRAN) injection [800202] 0.1 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op
Day Of Procedure
ranitidine (ZANTAC) injection [800075] 1 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op
Day Of Procedure
scopolamine (TRANSDERM-SCOP) 1
MG/3DAYS 72hr patch - NOTE: Do NOT order for
patients less than 12 years [166671]
1 patch, Transdermal, ONCE For 1 Doses
Apply patch to dry, hairless area of skin behind the ear
NOTE: Do NOT order for patients less than 12 years
Pre-Op Day Of Procedure
Infusions [153864]
Page 2 of 5
Printed by STRAKA, KEVIN F [KFS1] at 8/8/2017 10:33:23 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

Tranexamic Acid [201353]
tranexamic acid (CYKLOKAPRON) 20 MG/ML
bolus injection [760357]
30 mg/kg, Intravenous, ONCE For 1 Doses, IntraOp
tranexamic acid (CYKLOKAPRON) 3,000 mg in
sodium chloride 0.9 % 150 mL infusion [700607]
10 mg/kg/hr, Intravenous, CONTINUOUS
Administer a loading dose of 30 mg/kg, then
continuous infusion of 10 mg/kg/hr until skin closure
IntraOp
Insulin [81200]
insulin regular (human) 100 units/mL vial [45422] Subcutaneous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
Premedication for Needle Insertion [84316]
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
Pre-Op Day Of Procedure
LMX Use Instructions for Premedication Prior to
Needle Insertion [NURCOM0095]
Pre-Op Day Of Procedure
Respiratory [81201]
albuterol HFA 90 mcg/act inhaler [53730] Inhalation, ONCE For 1 Doses, Pre-Op Day Of
Procedure
albuterol neb soln (3 mL) [800248] 2.5 mg, Nebulization, ONCE For 1 Doses, Pre-Op Day
Of Procedure
glycopyrrolate (ROBINUL) injection - NOTE:
Suggested dose 4 mcg/kg (Maximum 0.1
mg/dose) [37960]
4 mcg/kg, Intravenous, ONCE For 1 Doses
NOTE: Suggested dose 4 mcg/kg (Maximum 0.1
mg/dose)
Pre-Op Day Of Procedure
ipratropium (ATROVENT) neb soln [47883] 500 mcg, Nebulization, ONCE For 1 Doses, Pre-Op
Day Of Procedure
ipratropium-albuterol (DUO-NEB) 0.5-2.5 mg/3
mL neb soln [67220]
3 mL, Nebulization, ONCE For 1 Doses, Pre-Op Day
Of Procedure
oxymetazoline (AFRIN) 0.05% nasal spray
[40671]
1 spray, Nostril (Each), EVERY 10 MINUTES For 3
Doses, Pre-Op Day Of Procedure
Self-administer Medications [81204]
Note: Self Administered Medication Program
Documentation [950000]
ONCE For 1 Doses
Patient may self-administer and use own supply of the
following medications: ***
Pre-Op Day Of Procedure
Laboratory
Page 3 of 5
Printed by STRAKA, KEVIN F [KFS1] at 8/8/2017 10:33:23 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

Labs [81206]
POTASSIUM [K] STAT - RN COLLECT, Starting today 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
CREATININE [CRET] STAT - RN COLLECT, Starting today 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
PLATELET COUNT [PLT] STAT - RN COLLECT, Starting today 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
PTT [PTT] STAT - RN COLLECT, Starting today 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
TYPE AND SCREEN [HCTS] STAT - RN COLLECT, Starting today 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., Pre-Op Day Of Procedure
Pregnancy Test [83802]
surgery is pelvic, renal, pregnancy test if female between menarche & menopause and any of: (1) Obtain
intercourse, (3) patient missed menses, (4) patient says abdominal, (2) patient had unprotected -or intra
pregnant. she "could" be
HCG, QUALITATIVE, URINE [UPREG] STAT - RN COLLECT, Starting today 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
HCG, QUALITATIVE, BLOOD [SPREG] 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?
Pre-Op Day Of Procedure
Diagnostic Tests and Imaging
Studies [81208]
ECG - 12 Lead (PEDS) [EKG0014] ONCE, Starting today For 1 Occurrences, Routine
Reason for exam:
Page 4 of 5
Printed by STRAKA, KEVIN F [KFS1] at 8/8/2017 10:33:23 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

X-RAY CHEST PA & LAT VIEWS [R71020] ONCE-RAD NEXT AVAILABLE, Starting today 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?
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
Pre-Op Day Of Procedure
Page 5 of 5
Printed by STRAKA, KEVIN F [KFS1] at 8/8/2017 10:33:23 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org