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201611319

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ED - CLINICAL DECISION UNIT - ASTHMA-COPD - ADULT [5762]

ED - CLINICAL DECISION UNIT - ASTHMA-COPD - ADULT [5762] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - Clinical Decision Unit - Asthma/COPD - Adult [5762]
Inclusion Criteria for this Order Set:
- Patient with dyspnea that is secondary to asthma/COPD
- Mild to moderate wheezing
- Fair to good air exchange
Exclusion Criteria for this Order Set:
- Respiratory rate > 40
- Impending respiratory fatigue/failure
- Pulse Oximetry < 90 on room air
- Need for continuous nebulizer treatments, positive pressure ventilation, or heliox
- Abnormal mentation
Prior to Observation Admission:
- Nebulized albuterol 5 mg x 3
- Ipratropium 0.5 mg x 3
- Steroid administration (choose ONE either: 60 mg prednisone by mouth OR 125 mg
methylprednisolone sodium succinate intravenous
- Magnesium sulfate 2mg, intravenous
Admission Status
Admissioni Status [211667]
Admit to CDU (ED Observation) [ADT0019] Patient Class: Observation
Accommodation Code, if IMC request, please enter
Comments in field to the right: OSS/OBS
Will the patient require special placement due to
ISOLATION Precautions?
Is the patient currently a Department of Corrections
(DOC) Inmate?
Is a nursing assessment for CONSTANT
OBSERVATION recommended?
Is the patient currently a resident of CWC or Mendota
Mental Health (MMHI)?
Will the patient go directly to the OR from the ED?
Could this patient have ACS/MI?
Does the patient require CARDIAC MONITORING for
transport?
Admitting Provider?
Attending Provider?
CDU Protocol: Asthma/COPD
Family History:
Expected Treatment/Procedures:
Medications
Bronchodilator [211656]
albuterol 2.5 mg/0.5 mL neb soln [34315] 2.5 mg, Nebulization, EVERY 2 HOURS PRN,
dyspnea
albuterol neb soln (3 mL) [800248] 2.5 mg, Nebulization, RT 4 X DAILY
Anticholinergics (Single Response) [214545]
ipratropium (ATROVENT) 0.02 % neb soln
[47883]
500 mcg, Nebulization, EVERY 4 HOURS PRN,
dyspnea
ipratropium (ATROVENT) 0.02 % neb soln
[47883]
500 mcg, Nebulization, RT 4 X DAILY
Corticosteriods (CHOOSE ONE) (Single Response) [211670]
methylprednisolone sodium succ. (SOLU-
MEDROL) intraVENOUS [800058]
20 mg, Intravenous, EVERY 12 HOURS
Page 1 of 3
Printed by STRAKA, KEVIN F [KFS1] at 11/13/2016 7:43:57 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

prednisone (DELTASONE) tab [41277] 20 mg, Oral, 2 X DAILY (AT MEALTIME)
Patient Care Orders
Vital Signs [211114]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every *** Hours, STAT
Activity [212530]
Activity [NURACT0008] CONTINUOUS, Routine
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:
Nutrition [211116]
Diet - Custom [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Room Service Class:
Diet Type: Diet Modifications
Diet Modifications:
Bedside Meal Instructions:
Diet - General [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: General (no Modifications)
Bedside Meal Instructions:
Room Service Class:
Diet - NPO Except Medications [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: NPO
NPO: NPO except Medications
Bedside Meal Instructions:
Room Service Class:
Diet - Adult Renal [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Renal
Sodium:
Potassium:
Phosphorus:
Fluid Restriction Total mLs/24H (IV/PO):
Protein:
Bedside Meal Instructions:
Room Service Class:
Respiratory [211669]
Respiratory Therapy per Protocol [RT0035] CONTINUOUS, Routine
Protocol Type:
Page 2 of 3
Printed by STRAKA, KEVIN F [KFS1] at 11/13/2016 7:43:57 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2016CCKM@uwhealth.org

Cardio-Respiratory Monitor - Adult
[NURMON0061]
CONTINUOUS, Routine
Pulse Oximetry [NURMON0009] CONTINUOUS, Routine
Contingency Parameters [211118]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 180
If systolic blood pressure < (mmHg): 100
If diastolic blood pressure > (mmHg): 95
If diastolic blood pressure < (mmHg): 60
If temperature > (C): 38
If temperature < (C): 36
If heart rate > (bpm): 120
If heart rate < (bpm): 50
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): 300
If blood glucose < (mg/dL): 80
If pain score >:
Pulse Oximetry < (%): 92
If urine output < (mL):
Other:
Consults [211361]
Consult Respiratory Therapy (Inpatient)
[CON0071]
ONCE For 1 Occurrences, Routine
Reason for Consult:
Can this consult be done via video?
Disposition Criteria
Home [211674]
Disposition Criteria - Home [NURCOM0022] CONTINUOUS, 1. Resolution of shortness of
breath/wheezing/bronchospasm (return to baseline).
- PEFR > 70% predicted (or 70% of personal best) -
if reliable. Predicted = [30 x age] + 30
2. Ambulating comfortably while maintaining oxygen
saturation > 90% on room air or home oxygen (or
return to baseline).
Hospital [211675]
Disposition Criteria - Hospital [NURCOM0022] CONTINUOUS, 1. Deterioration of condition.
2. Continued symptoms without improvement after 23
hours observation.
- PEFR < 70% of predicted (if reliable).
Page 3 of 3
Printed by STRAKA, KEVIN F [KFS1] at 11/13/2016 7:43:57 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2016CCKM@uwhealth.org