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IP – Heart and Vascular Care Center – Adult – Preprocedure [1567]

IP – Heart and Vascular Care Center – Adult – Preprocedure [1567] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Cardiology/CT Surgery


IP - Heart & Vascular Care Center - Adult - Preprocedure [1567]
Patient Care Orders
Vital Signs [22369]
Vital Signs [NURMON0013] ONCE, Starting today For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location: Bilateral Arms
BP Position:
BP Restrictions:
On admission
Patient Monitoring [22371]
Glucose, POC - On Admission [IPGLUCOSE] ONCE, Starting today For 1 Occurrences, Routine
If Conditional, What Condition?
On admission.
Glucose, POC - As Needed [IPGLUCOSE] AS NEEDED FOR SIGNS AND SYMPTOMS OF
HYPOGLYCEMIA, Starting today For 1 Occurrences, Routine
If Conditional, What Condition?
Glucose, POC [IPGLUCOSE] BEFORE MEALS AND BEDTIME, Starting today, Routine
If Conditional, What Condition?
Nutrition [22372]
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:
Respiratory [22373]
Pulse Oximetry [NURMON0009] ONCE, Starting today For 1 Occurrences, Routine, On
admission
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


Intake and Output [22374]
Void On Call to Cath Lab [NURELM0022] CONTINUOUS, Starting today, Routine
Non-Categorized Patient Care Orders [22376]
Measure Height [NURMON0052] ONCE, Starting today For 1 Occurrences, Routine, On
admission.
Measure Weight [NURMON0015] ONCE, Starting today For 1 Occurrences, Routine
Weigh With?
Weigh when?
On admission.
Contingency Parameters [22377]
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): 400
If blood glucose < (mg/dL): 40
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: Chest pain/rhythm change
Intravenous Therapy
Premedications for Needle Insertion [106310]
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 within 1 minute.
Choice of medication should be based on patient’s previous experience/preference, history of lidocaine allergy and ease
of access.
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
lidocaine (XYLOCAINE) 1% injection [39034] 0.1-0.4 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. Choice of medication should be
based on patient’s previous experience/preference, history of
lidocaine allergy and ease of access
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. Choice of medication should be
based on patient’s previous experience/preference, history of
lidocaine allergy and ease of access
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


IV Fluids [22876]
sodium chloride 0.9% infusion [64367] Intravenous, CONTINUOUS
sodium chloride 0.45% infusion [42187] Intravenous, CONTINUOUS
Insert and Maintain Peripheral IV - Left Upper Extremity
[NURVAD0013]
CONTINUOUS, Starting today For Until specified, Routine
Peripheral IV Device:
Peripheral IV Location:
Peripheral IV Size:
Peripheral IV Status:
Does this need to be inserted/placed?
Insert and Maintain Peripheral IV - Right Upper
Extremity [NURVAD0013]
CONTINUOUS, Starting today For Until specified, Routine
Peripheral IV Device:
Peripheral IV Location:
Peripheral IV Size:
Peripheral IV Status:
Does this need to be inserted/placed?
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Starting today For Until specified, Routine
Peripheral IV Device:
Peripheral IV Location:
Peripheral IV Size:
Peripheral IV Status:
Does this need to be inserted/placed?
Second Line
Medications - Preprocedure
Preprocedure [152816]
prednisone (DELTASONE) tab [41277] 50 mg, Oral, ON CALL For 1 Doses
Give on arrival in Heart and Vascular Care Center
hydrocortisone sod suc in sodium chloride 0.9% injection
[800189]
200 mg, Intravenous, ON CALL For 1 Doses
Give on arrival in Heart and Vascular Care Center
diphenhydramine (BENADRYL) cap [36791] 25 mg, Oral, ON CALL For 1 Doses
Give on arrival in Heart and Vascular Care Center
diphenhydramine (BENADRYL) cap [36791] 50 mg, Oral, ON CALL For 1 Doses
Give on arrival in Heart and Vascular Care Center
diphenhydramine (BENADRYL) injection [800106] 25 mg, Intravenous, ON CALL For 1 Doses
Give on arrival in Heart and Vascular Care Center
diphenhydramine (BENADRYL) injection [800106] 50 mg, Intravenous, ON CALL For 1 Doses
Give on arrival in Heart and Vascular Care Center
ranitidine (ZANTAC) tab [720131] 150 mg, Oral, ON CALL For 1 Doses
Give on arrival in Heart and Vascular Care Center.
Supplemental Orders
Refer to:Contrast Induced Nephropathy Prophylaxis - Adult - Supplemental Order Set
Contrast Induced Nephropathy Prophylaxis - Heart Failure/Fluid Overload Risk - Supplemental Order Set
Laboratory
Labs [22379]
CBC WITHOUT DIFFERENTIAL [HEMO] NEXT DRAW, 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?
ELECTROLYTES [LYTE] NEXT DRAW, 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?
BUN [BUN] NEXT DRAW, 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?
CREATININE [CRET] NEXT DRAW, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


If Conditional, What Condition?
GLUCOSE [GLU] NEXT DRAW, 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?
PROTHROMBIN TIME/INR [PT] NEXT DRAW, 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?
PTT [PTT] NEXT DRAW, 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?
HEMOGLOBIN A1C [HA1C] NEXT DRAW, 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?
Administer test if not done within the past 60 days
HCG, QUALITATIVE, URINE [UPREG] ONCE, 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?
ALT/SGPT [ALT] NEXT DRAW, 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?
AST/SGOT [AST] NEXT DRAW, 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?
LIPID PANEL [LIPID] NEXT DRAW, Starting today For 1 Occurrences, Routine,
Test includes Cholesterol, Total; HDL Cholesterol;
Triglyceride; LDL cholesterol, calculated; and non-HDL
cholesterol.
Patient must fast for 12-14 hours and be heparin free for 48
hours prior to specimen collection. The patient can only have
water or black coffee during the fasting period.
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
If the patient has not fasted for the required time, then
consider orders for total cholesterol and HDL instead of lipid
panel.
PROTEIN, URINE [UTPR] ONCE, 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?
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL - RN COLLECT, STAT
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Stat every time blood glucose
monitoring (bedside) is less than 40 or greater than 400
mg/dL.
Diagnostic Testing
Cardiology [22380]
ECG - 12 Lead - Pre-Operative [EKG0008] ONCE, Starting today For 1 Occurrences, Routine
Reason for exam: PRE-OPERATIVE
ECG - 12 Lead - PRN for Chest Pain and Arrhythmias PRN, Starting today, Routine
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


[EKG0008] Reason for exam: CHEST PAIN
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority