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/clinical/cckm-tools/content/order-sets/inpatient/cardiologyct-surgery/name-98430-en.cckm

201606170

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100

UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Cardiology/CT Surgery

IP – Implantable Cardiac Device - Pediatric – Postprocedure [5746]

IP – Implantable Cardiac Device - Pediatric – Postprocedure [5746] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Cardiology/CT Surgery


IP - Implantable Cardiac Device - Pediatric - Postprocedure [5746]
Admission Status
Level of Care (Single Response) [186484]
*An admit patient order has already been written, but the level of care at which the patient should be placed still needs to
be identified.
Place Patient on General Care [ADT0018] General Care, has already been signed. This order will
ensure that the patient is placed at the appropriate level of
care.
Place Patient on Intermediate Care (IMC) [ADT0018] Intermediate Care, has already been signed. This order will
ensure that the patient is placed at the appropriate level of
care.
Place Patient on Intensive Care (ICU) [ADT0018] Intensive Care, has already been signed. This order will
ensure that the patient is placed at the appropriate level of
care.
Admit to Inpatient (Single Response) [188296]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service:
I certify that an inpatient stay is medically necessary
because of either an anticipated LOS >2 midnights,
complexity and/or severity of illness, an inpatient-only
surgery, or a previously-authorized inpatient stay.
Rationale listed below. Yes
C - CLEAR DIAGNOSIS:
E - EVALUATIONS PLANNED:
R - RESULTS EXPECTED:
T - TREATMENTS ORDERED:
Admit to Observation (Single Response) [188297]
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Admit to Outpatient Short Stay (Single Response)
[188298]
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Admission Status (Single Response) [191022]
Admit To Inpatient Status [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service:
I certify that an inpatient stay is medically necessary because
of either an anticipated LOS >2 midnights, complexity and/or
severity of illness, an inpatient-only surgery, or a previously-
authorized inpatient stay. Rationale listed below. Yes
C - CLEAR DIAGNOSIS:
E - EVALUATIONS PLANNED:
R - RESULTS EXPECTED:
T - TREATMENTS ORDERED:
Post-Op/Phase II
Admit To Observation Status [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


Post-Op/Phase II
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admission Status (Single Response) [191024]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service:
I certify that an inpatient stay is medically necessary because
of either an anticipated LOS >2 midnights, complexity and/or
severity of illness, an inpatient-only surgery, or a previously-
authorized inpatient stay. Rationale listed below. Yes
C - CLEAR DIAGNOSIS:
E - EVALUATIONS PLANNED:
R - RESULTS EXPECTED:
T - TREATMENTS ORDERED:
Post-Op/Phase II
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Patient Care Orders
Vital Signs [191047]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today For Until specified, 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 2, then every 4 hours., Post-Op/Phase
II
Patient Monitoring [191048]
Cardio-Respiratory Monitor - Pediatric - With Rhythm
[139419]
Cardio-Respiratory Monitor - Pediatric - With Rhythm
[NURMON0014]
CONTINUOUS, Routine, Most pediatric patients do NOT
require rhythm analysis. Please complete the Notify
Provider order below, including specification for apnea >
*** seconds. If indicated, order pulse oximetry separately.
Device Present:
Device Mode:
Device Low Rate Limit (BPM):
Notify Provider: Symptomatic Change in Rhythm,Serious
Arrhythmia
Post-Op/Phase II
Notify [NURCOM0001] Provider to Notify: Provider
Notify based on:
Notify provider for apnea > 20 seconds, Post-Op/Phase II
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


Activity [189080]
Ad Lib [NURACT0008] CONTINUOUS, Starting today For Until specified, Routine
AD LIB: ad lib
AMBULATE:
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Post-Op/Phase II
Activity - Upper Left Extremity Weight Bearing
[NURACT0008]
CONTINUOUS, Starting today For Until specified, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING: Non weight
bearing
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Post-Op/Phase II
Activity - Upper Right Extremity Weight Bearing
[NURACT0008]
CONTINUOUS, Starting today For Until specified, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING: Non
weight bearing
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Post-Op/Phase II
Apply Arm Sling [NURTRT0001] CONTINUOUS, Starting today For Until specified, Routine, If
ordering a Shoulder Immobilizer - Adult, please contact the
cast room technician at 265-0746.
Type: Simple Sling - Pediatric (Snoopy)
Left/Right/Bilateral?
Wearing schedule:
Post-Op/Phase II
Nutrition [189091]
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:
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


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):
Room Service Class:
Post-Op/Phase II
General Diet [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet: GENERAL;
Diabetic Diet:
NPO (If patient receiving tube feeding see question 25):
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):
Room Service Class:
Post-Op/Phase II
Clear Liquid Diet [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question 25):
Liquids & Modified Consistency (If Dysphagia Protocol see
questions 21-24): CLEAR LIQUID;
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


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):
Room Service Class:
Post-Op/Phase II
Wound Care/Procedure Site Care [189097]
Wound Care [NURWND0015] CONTINUOUS, Starting today For Until specified, Routine
Wound Type: Closed - Incision
Wound Site: Chest
Wound Location:
Assess Frequency: SEE COMMENTS
Care Frequency:
Wash With:
Irrigate/Rinse With:
Apply (Must also enter separate medication order to obtain
drug):
Primary Dressing:
Secondary Dressing:
Assess for bleeding every 15 minutes times 4, then every 30
minutes times 4, then every hour times 2, then every 4 hours.,
Post-Op/Phase II
Notify Pediatric Cardiology [189099]
Notify Pediatric Cardiology [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): 38
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 < (%): 92
If urine output < (mL):
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


Other: Patient develops nausea or vomiting.
Notify Pediatric Cardiology, Post-Op/Phase II
Intravenous Therapy
IV Fluids (Single Response) [191029]
dextrose 5%-NaCl 0.45% infusion [51613] Intravenous, CONTINUOUS, Post-Op/Phase II
lactated ringers infusion [38890] Intravenous, CONTINUOUS, Post-Op/Phase II
Anti-infectives
First Line [189243]
Cefazolin and Cephalexin [189245]
cefazolin (ANCEF) intraVENOUS [800000] 30 mg/kg, Intravenous, EVERY 8 HOURS For 3 Doses,
Post-Op/Phase II
cephalexin (KEFLEX) 250 MG/5ML susp [44596] 10 mg/kg, Oral, 3 X DAILY (AT MEALTIME) Starting
tomorrow For 3 Doses
Start when intravenous cefazolin therapy is completed.
Post-Op/Phase II
Patients with MRSA (Single Response) [144010]
Cefazolin - Vancomycin (Maximum Dose 2 grams)
[191197]
cefazolin (ANCEF) intraVENOUS [800000] 30 mg/kg, Intravenous, EVERY 8 HOURS For 2 Doses,
Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS [800084] 15 mg/kg, Intravenous, EVERY 6 HOURS For 3 Doses,
Post-Op/Phase II
Cefuroxime - Vancomycin (Maximum Dose 2 grams)
[191200]
cefuroxime (ZINACEF) intraVENOUS [800030] 50 mg/kg, Intravenous, EVERY 8 HOURS For 2 Doses,
Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS [800084] 15 mg/kg, Intravenous, EVERY 6 HOURS For 3 Doses,
Post-Op/Phase II
Cefdinir - Vancomycin (Maximum Dose 2 grams)
[191203]
cefdinir (OMNICEF) 250 MG/5ML susp [104063] Details
vancomycin (VANCOCIN) intraVENOUS [800084] 15 mg/kg, Intravenous, EVERY 6 HOURS For 3 Doses,
Post-Op/Phase II
Patients with Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies (Single Response) [189256]
vancomycin (VANCOCIN) intraVENOUS [800084] 15 mg/kg, Intravenous, EVERY 6 HOURS For 7 Doses, Post-
Op/Phase II
Medications - Postprocedure
Non-Opioid Analgesics (Single Response) [189241]
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - NOTE: Suggested dose 10-15 mg/kg/dose
(Maximum 650 mg/dose) [800005]
Oral, EVERY 4 HOURS PRN, pain/fever
NOTE: Suggested dose 10-15 mg/kg/dose (Maximum 650
mg/dose)
Post-Op/Phase II
acetaMINOPHEN (TYLENOL) suppository - NOTE:
Suggested dose 10-15 mg/kg/dose (Maximum 650
mg/dose) [43994]
Rectal, EVERY 4 HOURS PRN, pain
NOTE: Suggested dose 10-15 mg/kg (Maximum 650
mg/dose)
Post-Op/Phase II
acetaMINOPHEN 325 mg (TYLENOL) tab RANGE
[750000]
325-650 mg, Oral, EVERY 4 HOURS PRN, pain, Post-
Op/Phase II
Opioid Analgesics (Single Response) [189242]
oxycodone 5 MG/5ML soln RANGE - NOTE: Maximum
Dose = 10 mg [750031]
0.05-0.15 mg/kg, Oral, EVERY 3 HOURS PRN, pain, Severe
Pain, Post-Op/Phase II
oxycodone tab RANGE - NOTE: Suggested Dose 0.05-
0.15 mg/kg Maximum Dose = 10 mg [750032]
Oral, EVERY 3 HOURS PRN, pain, Severe Pain, Post-
Op/Phase II
Diagnostic Tests and Imaging
Studies [189101]
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


X-Ray Chest AP View Bedside [R71010] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
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? AFCH PACU
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
Post-Op/Phase II
X-RAY CHEST PA & LAT VIEWS [R71020] ONCE-ON SPECIFIC DATE, Starting tomorrow at 8:00 AM
For 1 Occurrences, Routine
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms? Post device implant
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
ARMS NOT TO BE RAISED ABOVE SHOULDER LEVEL.
Please complete by 10:00 a.m., Post-Op/Phase II
ECG - 12 Lead [EKG0008] ONCE, Starting today For 1 Occurrences, Routine
Reason for exam: OTHER (COMMENT)
Post Device Implant, Post-Op/Phase II
Holter Monitor - 24/48 Hour Monitor (Peds) [EKG0027] ONCE, Starting today For 1 Occurrences, Routine
Reason for exam:
Length of monitoring: 24 HOURS
Post-Op/Phase II
BestPractice
No Hospital Problems Have Yet Been Identified [191025]
Specify Hospital Problem(s) [COR0018] You will be prompted to specify a hospital problem on
signing., Post-Op/Phase II
Consults
Consults [189102]
Pacemaker/ICD/Loop Recorder (Peds) [CARD0018] ONCE, Starting tomorrow For 1 Occurrences, Routine,
Consults are performed Monday-Friday 0730-1700. For after
hours, weekends and holidays, contact the Pediatric
Cardiologist on call.
Reason for consult: Post-op
Specify programming changes (if needed):
Type of device:
Device company:
Post-Op/Phase II
Follow Up Appointments
Follow Up Appointments [189105]
Schedule Appointment [NURCOM0026] Reason for Appointment: Wound Check
When do you want appointment: 1 week
Which Clinic or Specialty:
Which Provider (Optional):
Post-Op/Phase II
Schedule Appointment [NURCOM0026] Reason for Appointment: Device Check
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


When do you want appointment: 6-8 Weeks
Which Clinic or Specialty:
Which Provider (Optional):
Post-Op/Phase II
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority