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IP – Heart and Vascular Care Center – Femoral Approach – Adult – Postoperative [1562]

IP – Heart and Vascular Care Center – Femoral Approach – Adult – Postoperative [1562] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Cardiology/CT Surgery


IP - Heart & Vascular Care Center - Femoral Approach - Adult - Postprocedure
[1562]
for Adult Patients OnlyIntended
For Carotid Stent or Carotid Endarterectomy Postoperative orders use order set:
[5433]Postprocedure -Adult -Carotid Endarterectomy/Stent -IP
Patient Care Orders
Vital Signs [21639]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, 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 4, then every 4 hours
times 2, then every 8 hours.
Patient Monitoring [21640]
Monitor Entry Site [NURMON0060] SEE COMMENTS, Starting today, Site: Femoral
Artery
Location: {right, left, bilaterally:4001510}
Monitor entry site for hematoma or new bleeding
every 15 minutes times 4, then every 30 minutes
times 4, then every hour times 4, then every 4 hours
times 2, then every 8 hours. Keep entry site clean
and dry for 24 hours postprocedure. Apply direct
pressure to procedure site for hematoma or persistent
bleeding. Remove dressing 24 hours postprocedure.
High Risk Entry Site [NURCOM0022] CONTINUOUS, Pain in the flank, back, or abdomen
may indicate internal bleeding. Notify Cardiology
Fellow.
For bleeding, oozing, swelling, or hematoma at
entry site [NURCOM0022]
CONTINUOUS, For bleeding, oozing, swelling, or
hematoma at entry site
-Apply direct manual pressure
-Notify Cardiology Fellow
-Do not apply sandbag
Monitor Pedal Pulses [NURMON0060] SEE COMMENTS, Starting today, Site: pedal pulses
Location: {right, left, bilaterally:4001510}
Monitor entry site for hematoma or new bleeding
every hour prior to sheath removal. After sheath
removal, every 15 minutes times 4, then every 30
minutes times 4, then every hour times 4, then every
4 hours times 2, then every 8 hours.
ACTIVATED CLOTTING TIME, POC
[HCACTPOC]
SEE COMMENTS, Starting today, Routine
If Conditional, What Condition?
Monitor Activated Clotting Time (ACT) every hour
starting at *** (time/date) until activated clotting time
(ACT) is equal or less than 160 seconds.
Cardiac Rhythm Monitoring - Adult
[NURMON0010]
ONCE, Routine
Notify Provider: Symptomatic Change in
Rhythm,Serious Arrhythmia
Functional Cardiac Defibrillator Present:
Page 1 of 8
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Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 07/2016CCKM@uwhealth.org

Activity - Manual [83593]
Prior to Sheath Removal - Bedrest/Logroll
[NURACT0011]
CONTINUOUS, Starting today For Until specified,
Prior to Sheath Removal - Bedrest/Logroll. Patient
may roll to affected side for comfort, keeping the
affected leg extended
Prior to Sheath Removal - Elevate Head Of Bed
Less Than 30 Degrees [NURACT0002]
Equal to (degrees):
Greater than (degrees):
Less than (degrees): 30
Other options:
Routine, CONTINUOUS, Starting today, Prior to
Sheath Removal - elevate head of bed less than 30
degrees
Post Sheath Removal - Activity Progression
[NURACT0011]
CONTINUOUS, Starting today For Until specified,
Post Sheath Removal - bedrest during femoral
compression device application. Roll to affected side
for comfort with affected leg extended, starting 1 hour
post sheath removal. Ambulate with assistance,
starting *** hours post-sheath removal.
Post Sheath Removal - Elevate Head Of Bed
Equal to 45 Degrees [NURACT0002]
Equal to (degrees): 45
Greater than (degrees):
Less than (degrees):
Other options:
Routine, CONTINUOUS, Starting today, Post Sheath
Removal - elevate head of bed equal to 45 degrees
starting *** hours post sheath removal
Activity - Closure Device [83597]
Post Sheath Removal - Activity Progression
[NURACT0011]
CONTINUOUS, Starting today For Until specified,
Post Sheath Removal - bedrest during femoral
compression device application. Roll to affected side
for comfort with affected leg extended, starting 1 hour
post sheath removal. Ambulate with assistance,
starting *** hours post-sheath removal if there is no
hematoma.
Post Sheath Removal - Elevate Head Of Bed
Equal to 45 Degrees [NURACT0002]
Equal to (degrees): 45
Greater than (degrees):
Less than (degrees):
Other options:
Routine, CONTINUOUS, Starting today, Post Sheath
Removal - elevate head of bed equal to 45 degrees
starting *** hours post sheath removal
Nutrition [83598]
Cardiac Diet [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Heart Healthy
Heart Healthy Options: Custom
Sodium: NAS (2400 mg)
Fat: Low Saturated Fat/Low Cholesterol
Fluid Restriction Total mLs/24H (IV/PO):
Caffeine: Low Caffeine
Bedside Meal Instructions:
Room Service Class:
Page 2 of 8
Printed by LIND, JANNA S [JSL237] at 7/28/2016 9:06:54 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 07/2016CCKM@uwhealth.org

General Diet [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: General (no Modifications)
Bedside Meal Instructions:
Room Service Class:
Diabetes Meal Plan [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Diabetes
Bedside Meal Instructions:
Room Service Class:
Encourage Fluids [NURDIE0006] CONTINUOUS, Starting today, Routine
Restrict Fluids - Must Indicate Restriction
[NUT9999]
EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Fluid Restriction
Fluid Restriction Total mLs/24H (IV/PO):
Bedside Meal Instructions:
Room Service Class:
Diet - Mediterranean/DASH [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Heart Healthy
Heart Healthy Options: DASH
Bedside Meal Instructions:
Room Service Class:
Femoral Compression System [21644]
Femoral Compression System [NURTAD0048] CONTINUOUS, Starting today, Routine, Maintain
dome pressure at *** mmHg for *** minutes, then
wean dome pressure by *** mmHg every *** minutes
until 0 mmHg is reached. If hemostasis is achieved,
discontinue device at *** (date/time). If hematoma or
persistent bleeding, apply direct pressure to site.
Reapply femoral compression device (FEMOSTOP)
at *** mmHg for *** minutes, then wean dome
pressure by *** mmHg every *** minutes until 0
mmHg is reached.
Contingency Parameters [21646]
Page 3 of 8
Printed by LIND, JANNA S [JSL237] at 7/28/2016 9:06:54 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 07/2016CCKM@uwhealth.org

Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 160
If systolic blood pressure < (mmHg): 90
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm): 110
If heart rate < (bpm): 50
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: Platelet count decreases by more than 100
K/uL of baseline value or falls below 100K/uL,Chest
pain/ rhythm change.,Bleeding, oozing, swelling, or
hematoma at entry site,Sheath removal needed for
activated clotting time (ACT) equal or less than 160
seconds,Change in neurovascular exam at affected
extremity including pain, cool, cold to touch,
numbness, or tingling.
Discharge Instructions
Discharge Instructions [206936]
Post Femoral Cath [132326]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
Activity restriction - For 1 week or until the wound
has healed:
- Do not lift more than 10 pounds
- No vigorous activity or straining
- Do not sit in a bathtub, hot tub, or go into a
swimming pool.
Activity recommendations - Walking on a flat
surface for exercise is preferred for the first week
after your procedure.
Page 4 of 8
Printed by LIND, JANNA S [JSL237] at 7/28/2016 9:06:54 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 07/2016CCKM@uwhealth.org

Symptom Management [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After
Hospital Care Plan., Routine, What to expect:
Soreness or tenderness at the site that may last 1
week; Bruising at the site that may take 2-3 weeks
to go away; A small lump (dime to quarter size)
which may last up to 6 weeks.
For MINOR pain: You may take acetaminophen
(Tylenol®) 325 mg tablets every 4-6 hours; You
may place an ice pack or warm pack over the site
for 20 minutes every 2 hours. Gently wipe the site
after you remove the pack if it is wet.
For angina: If your heart symptoms return (chest,
arm, neck pain or pressure, sweatiness, or
breathlessness), sit or lie down. If prescribed, take
nitroglycerin as directed. If the symptoms have not
gone away within 15 minutes, call 911.
Wound Care [NURWND0015] Routine, You may shower after 24 hours. Remove
the bandage over the incision before showering.
For the next 3 days, gently clean the site using
soap and water while in the shower. Dry
thoroughly. Do not rub the site. You may apply an
antibacterial ointment. Do not use lotions or
powders in the area. Cover the site with a bandage.
Make sure to cover the entire area. A square
adhesive Band-Aid works well. Keep the site clean
and dry to prevent infection. If the bandage
becomes wet, remove it and replace it with a new
one. Inspect the site daily for redness, swelling, or
drainage.
Page 5 of 8
Printed by LIND, JANNA S [JSL237] at 7/28/2016 9:06:54 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 07/2016CCKM@uwhealth.org

When to Call Your Doctor [NURCOM0079] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After
Hospital Care Plan.
You should include specific instructions on when
and who to call.
You should include actual provider names (i.e. not
'PCP').
You should NOT include the discharging unit as a
contact., Routine, - If bleeding or sudden swelling
should occur at the site, apply direct pressure. If
the bleeding does not stop after 10 minutes of
placing constant pressure on the site, call 911 for
emergency help. Keep pressure on the site until
help arrives.
- If your extremity becomes numb, cold, or turns
blue, call 911 for emergency help.
- If you have severe pain or notice any signs of
infection including: Redness, swelling, or drainage
at the site/Prolonged pain/Fever over 100.4°F for
two readings taken a few hours apart or have any
other questions/concerns, call the UW Health Heart
and Vascular Clinic at (608) 263-1530 (Monday -
Friday, 8am - 5pm). After hours, nights, weekends,
and holidays, this same number is answered by the
message center. Ask for the cardiology fellow on
call. Give the operator your full name and phone
number with the area code. The doctor will call you
back. If you live out of the area, please call 1-800-
323-8942.
Intravenous Therapy
IV Fluids [97936]
sodium chloride 0.9% infusion [64367] at 100 mL/hr, Intravenous, CONTINUOUS
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Starting today, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Begin after IV discontinued
Infusion Agent
Eptifibatide - Normal Renal Function [21544]
50 mL/min/1.73 m2 or greaterofGFR For serum creatinine less than 2 mg/dL or
eptifibatide (INTEGRILIN) 75 mg in 100 mL
infusion - NOTE: Minimum infusion time 12
hours, maximum infusion time 18-24 hours.
(maximum 15 mg/hr) [59379]
2 mcg/kg/min, Intravenous, CONTINUOUS
Stop infusion at *** (date/time)
For serum creatinine less than 2 mg/dL or GFR of 50
mL/min/1.73 m2 or greater the recommended dose is
2 mcg/kg/min (maximum 15 mg/hr). Minimum
infusion time 12 hours, maximum infusion time 18-24
hours
Eptifibatide - Renal Impairment [21612]
m249 mL/min/1.73 -4 mg/dL or GFR 20-serum creatinine 2 For
eptifibatide (INTEGRILIN) 75 mg in 100 mL
infusion - NOTE: Minimum infusion time 12
hours, maximum infusion time 18-24 hours.
(maximum 7.5 mg/hr) [59379]
1 mcg/kg/min, Intravenous, CONTINUOUS
Stop infusion at *** (date/time)
For serum creatinine 2 - 4 mg/dL or GFR 20-49
mL/min/1.73 m2 the recommended dose is 1
mcg/kg/min (maximum 7.5mg/hr). Minimum infusion
time 12 hours, maximum infusion time 18-24 hours.
Page 6 of 8
Printed by LIND, JANNA S [JSL237] at 7/28/2016 9:06:54 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 07/2016CCKM@uwhealth.org

Medications
Medications [21545]
aspirin chew tab [720014] 81 mg, Oral, 1 X DAILY
aspirin chew tab [720014] 162 mg, Oral, 1 X DAILY
clopidogrel (PLAVIX) tab [58345] 75 mg, Oral, 1 X DAILY
clopidogrel (PLAVIX) tab [58345] 150 mg, Oral, 1 X DAILY For 7 Doses
clopidogrel (PLAVIX) tab [58345] 300 mg, Oral, ONCE For 1 Doses
clopidogrel (PLAVIX) tab [58345] 600 mg, Oral, ONCE For 1 Doses
NOTE: Discontinue low molecular weight
heparins (LMWH) dalteparin (FRAGMIN),
enoxaparin (LOVENOX), fondaparinux
(ARIXTRA) [950018]
ONCE For 1 Doses
NOTE: Discontinue low molecular weight heparins
(LMWH) dalteparin (FRAGMIN), enoxaparin
(LOVENOX), fondaparinux (ARIXTRA)
Note: Discontinue heparin [950018] ONCE For 1 Doses
Discontinue heparin
atorvastatin (LIPITOR) tab [720017] 40 mg, Oral, 1 X DAILY (HS)
atorvastatin (LIPITOR) tab [720017] 80 mg, Oral, 1 X DAILY (HS)
rosuvastatin (CRESTOR) tab [73638] 20 mg, Oral, 1 X DAILY (HS)
rosuvastatin (CRESTOR) tab [73638] 40 mg, Oral, 1 X DAILY (HS)
Laboratory
For Patients on Eptifibatide (INTEGRILIN) [21647]
PLATELET COUNT [PLT] CONDITIONAL - RN COLLECT, Starting today,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw 4 hours after
eptifibatide (INTEGRILIN) bolus administration
Now and Every 6 Hours Times 3 or Until Peak [21648]
TROPONIN [GM2447] EVERY 6 HOURS, Starting today For 3 Occurrences,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Now and every 6
hours times 3 or until peak
Postprocedure Day 1 [21649]
CREATININE [CRET] NEXT AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
POTASSIUM [K] NEXT AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
HEMATOCRIT [HCT] NEXT AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PLATELET COUNT [PLT] NEXT AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Diagnostic Tests and Imaging
Studies [124399]
Page 7 of 8
Printed by LIND, JANNA S [JSL237] at 7/28/2016 9:06:54 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 07/2016CCKM@uwhealth.org

ECG - 12 Lead WITHOUT Rhythm-
Postprocedure Evaluation [EKG0008]
ONCE, Starting tomorrow at 7:00 AM For 1
Occurrences, Routine
Reason for exam: OTHER (COMMENT)
ECG - 12 Lead WITHOUT Rhythm- PRN for
Chest Pain [EKG0008]
PRN, Starting today, STAT
Reason for exam: CHEST PAIN
Consults
Consults [135721]
Order Consult Cardiac Rehab for the following Indications:
1. Diagnosis of clinically stable angina pectoris
2. Percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention
(PCI) within last 6 months, acute myocardial infarction (AMI) within last 12 months
3. Heart valve repair/replacement within last 6 months
4. CABG within last 12 months
5. Heart or heart-lung transplant within last 12 months
Consult Cardiac Rehab/Preventive Cardiology
(Inpatient) [CON0010]
ONCE, Starting today For 1 Occurrences, Routine
Reason for consult:
Can this consult be done via video?
Page 8 of 8
Printed by LIND, JANNA S [JSL237] at 7/28/2016 9:06:54 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 07/2016CCKM@uwhealth.org