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ED – Bronchiolitis – Pediatric [5798]

ED – Bronchiolitis – Pediatric [5798]- Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - Bronchiolitis - Pediatric [5798]
Isolation Status
Respiratory Isolation [109204]
Contact/Droplet Isolation - Respiratory Infection -
Acute, Infant/Child [ISO0342]
What is the Reason for Isolation?
Separate order must be placed for isolation cart.
Laboratory
Labs [198587]
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?
Intravenous Therapy
admissionNG tube placement if clinically dehydrated on Consider
Premedication for Needle Insertion [30232]
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
LMX Use Instructions for Premedication Prior to
Needle Insertion [NURCOM0095]
Details
IV Fluids [199293]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
dextrose 5%-NaCl 0.45% infusion [51613] Intravenous, CONTINUOUS
sodium chloride 0.9% BOLUS - NOTE:
Suggested dose 10-20 mL/kg [730003]
Intravenous
NOTE: Suggested dose 10-20 mL/kg
Medications
Acetaminophen and Ibuprofen/Antipyretics (Single Response) [199294]
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - NOTE: Suggested dose 10-15
mg/kg (Maximum 650 mg/dose) [800005]
15 mg/kg, Oral, EVERY 4 HOURS PRN, pain/fever,
mild pain, multimodal therapy, first line agent
NOTE: Suggested dose 10-15 mg/kg (Maximum 650
mg/dose)
Page 1 of 3
Printed by STRAKA, KEVIN F [KFS1] at 11/28/2017 11:11:34 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

acetaMINOPHEN (TYLENOL) suppository -
NOTE:Suggested dose 10-15 mg/kg/dose
(Maximum 650 mg/dose) [43994]
Rectal, EVERY 4 HOURS PRN, pain/fever, mild pain,
multimodal therapy, first line agent
NOTE: Suggested dose 10-15 mg/kg/dose (Maximum
650 mg/dose)
ibuprofen (MOTRIN) susp - (Maximum dose =
400 mg) [45376]
10 mg/kg, Oral, EVERY 8 HOURS PRN, pain, mild
pain, multimodal therapy, first line agent
Ibuprofen/Antipyretics [199292]
ibuprofen (MOTRIN) susp - NOTE: Suggested
dose 4 mg/kg (Maximum dose = 400 mg) [45376]
4 mg/kg, Oral, EVERY 8 HOURS PRN, pain, mild
pain, multimodal therapy, first line agent
Non-Categorized (Single Response) [199295]
sodium chloride (SALINE) 0.65 % nasal spray
[41865]
1 spray, Nostril (Each), EVERY 1 HOUR PRN, and as
needed during severe respiratory distress
Patient Care Orders
Vital Signs [199289]
Vital Signs [NURMON0013] SEE COMMENTS, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 1 Hour and as needed during severe respiratory
distress
Activity [109207]
Activity [NURACT0008] CONTINUOUS, Starting today, 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:
Nutrition [198590]
NPO Except Medications [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Pediatric
Diet Type: NPO
NPO Diet: NPO except Medications
Bedside Meal Instructions:
Room Service Class:
Breast Feeding Mom [DIE0008] Please Provide Tray for Breast Feeding Mom: Yes
Routine, CONTINUOUS, Starting today
Respiratory [199290]
Pulse Oximetry [NURMON0009] SEE COMMENTS, Starting today, Routine, Every 1
hour and as needed during severe respiratory distress
Respiratory Care Protocol - Bronchiolitis [RT0067] Routine
Nasal Cannula or Oxygen Therapy (Single Response) [218740]
Pediatric Bronchiolitis High Flow Nasal Cannula
(HFNC) Management- Emergency Dept./General
Care
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/respiratory/related/name-
113133-en.cckm
Page 2 of 3
Printed by STRAKA, KEVIN F [KFS1] at 11/28/2017 11:11:34 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Oxygen Therapy [RT0032] CONTINUOUS, 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? Yes
Initiate oxygen therapy for SpO2 consistency less than
or equal to 90%. Titrate oxygen by 1/4 L to keep SpO2
between 91-94%. Discontinue for oxygen saturation
greater than or equal to 94%.
High Flow Nasal Cannula [RT0071] CONTINUOUS, Routine
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%): 90 (and flow)
Attempt to Wean Off Oxygen?
Non-Categorized Patient Care Orders [199291]
Supply - Little Sucker [SUP0001] Details
Bronchiolitis Management Without Inhaled
Medications [NURCOM0022]
ONCE, a) RN Assess and record using Bronchiolitis
Scoring Tool (WARM) with Intermittent Vitals
b) Perform Nasal Suction
c) RN Reassess and Record Using WARM tool when
patient calm
Page 3 of 3
Printed by STRAKA, KEVIN F [KFS1] at 11/28/2017 11:11:34 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org