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ED - Possible Neutropenic Fever - Pediatric [5552]

ED - Possible Neutropenic Fever - Pediatric [5552] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - Possible Neutropenic Fever - Pediatric [5552]
Management of Fever and Neutropenia - Pediatric
- Inpatient/Ambulatory/Emergency Department -
Clinical Practice Guideline
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/oncology/name-116777-
en.cckm
Laboratory
Labs [195375]
CBC WITH DIFFERENTIAL [CBC] STAT - RN COLLECT, 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?
URINALYSIS WITH MICROSCOPY [UA] STAT - RN COLLECT, 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?
Do NOT catheterize patient unless directed by
provider
CULTURE, URINE [URC] STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
Does patient have an indwelling urinary catheter?
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Do NOT catheterize patient unless directed by
provider
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
STAT - RN COLLECT For 1 Occurrences, Routine,
For optimum diagnosis of sepsis, sample 3-4 sites
only on the first day of a septic episode. Cultures on
subsequent days are of minimal diagnostic value.
Culture detects bacteria, Candida and Cryptococcus.
If filamentous fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
Place additional orders as needed for multiple
lines/lumens
Labs [195578]
CBC WITH DIFFERENTIAL [CBC] STAT - RN COLLECT, 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?
URINALYSIS WITH MICROSCOPY [UA] STAT - RN COLLECT, 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?
Do NOT catheterize patient unless directed by
provider
Page 1 of 4
Printed by STRAKA, KEVIN F [KFS1] at 9/21/2017 12:43:21 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org

CULTURE, URINE [URC] STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
Does patient have an indwelling urinary catheter?
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Do NOT catheterize patient unless directed by
provider
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
STAT - RN COLLECT For 1 Occurrences, Routine,
For optimum diagnosis of sepsis, sample 3-4 sites
only on the first day of a septic episode. Cultures on
subsequent days are of minimal diagnostic value.
Culture detects bacteria, Candida and Cryptococcus.
If filamentous fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
Place additional orders as needed for multiple
lines/lumens
Additional Labs [195579]
BASIC METABOLIC PANEL [BMET] STAT - RN COLLECT, Starting today For 1
Occurrences, Routine, Test includes Sodium;
Potassium; Chloride; Carbon Dioxide, Total; Anion
Gap; Glucose; BUN; Creatinine; and Calcium.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
LACTATE [GM2255] STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Diagnostic Tests and Imaging
General Radiology [196357]
X-RAY CHEST AP VIEW [R71010] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Current signs and symptoms? Suspected Sepsis
What specific question(s) would you like answered by
this exam? Suspected Sepsis
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Intravenous Therapy
Venous Access and Flushes [196358]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed? Yes
Maintain Central Venous Access [NURVAD0023] CONTINUOUS, Routine
Device Status: Ready For Use
Page 2 of 4
Printed by STRAKA, KEVIN F [KFS1] at 9/21/2017 12:43:21 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

lidocaine (LMX) 4% topical dressing kit [66882] Topical, EVERY 1 HOUR PRN, apply 20 to 30
minutes prior to needle insertion - see Admin
Instructions
For children less than10 kg - Do NOT apply to area
larger than 100 square centimeters.
For children 10 kg or greater - Do NOT apply to area
larger than 200 square centimeters.
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
sodium chloride 0.9% flush 10 mL injection
[785055]
Flush, PRN, flush/line care, Flush per VAD guidelines
heparin lock flush 10 UNIT/ML injection [75031] 1-150 units, Flush, PRN, flush/line care
IV Fluids [195378]
sodium chloride 0.9% IV BOLUS [730003] 20 mL/kg, Intravenous, ONCE For 1 Doses
Medications
Anti-infectives (Single Response) [195564]
Management of Fever and Neutropenia - Pediatric
- Inpatient/Ambulatory/Emergency Department -
Clinical Practice Guideline
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/oncology/name-116777-
en.cckm
ceftriaxone (ROCEPHIN) intraVENOUS - NOTE:
Order for clinically stable patients regardless of
ANC [800027]
50 mg/kg, Intravenous, ONCE For 1 Doses
Give first dose STATafter blood cultures are obtained.
Do NOT wait for results of CBC or obtaining urine
specimen to administer antibiotics.
Ordering MD please notify pharmacy of STAT
antibiotic request. Maximum Dose = 2000 mg
Cefepime - Vancomycin - NOTE: Order for
clinically unstable patients regardless of ANC
[232801]
cefepime (MAXIPIME) intraVENOUS [800016] 50 mg/kg, Intravenous, ONCE For 1 Doses
Give first dose STAT after blood cultures are
obtained. Do NOT wait for results of CBC or
obtaining urine specimen to administer antibiotics.
Ordering MD, please notify pharmacy of STAT
antibiotic request. Maximum Dose = 2000 mg
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, ONCE For 1 Doses
Give first dose STAT after blood cultures are
obtained. Do NOT wait for results of CBC or
obtaining urine specimen to administer antibiotics.
Ordering MD, please notify pharmacy of STAT
antibiotic request. Maximum Dose = 2000 mg
Patients with IgE mediated allergy or severe
reaction to beta-lactam antibiotics [232804]
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, ONCE For 1 Doses
Give first dose STAT after blood cultures are
obtained. Do NOT wait for results of CBC or
obtaining urine specimen to administer antibiotics.
Ordering MD, please notify pharmacy of STAT
antibiotic request. Maximum Dose = 2000 mg
aztreonam (AZACTAM) intraVENOUS [800013] 30 mg/kg, Intravenous, ONCE For 1 Doses
Give first dose STAT after blood cultures are
obtained. Do NOT wait for results of CBC or
obtaining urine specimen to administer antibiotics.
Ordering MD please notify pharmacy of STAT
antibiotic request. Maximum Dose = 2000 mg
Page 3 of 4
Printed by STRAKA, KEVIN F [KFS1] at 9/21/2017 12:43:21 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

meropenem (MERREM) intravenous - NOTE:
Order for patients with history of multidrug-
resistant organisms Suggested dose 20
mg/kg/dose (Maximum Dose 1 g/dose) [800055]
20 mg/kg, Intravenous, ONCE For 1 Doses
Administer after blood cultures are obtained and within
1 hour of admission. Ordering MD please notify
pharmacy of STAT antibiotic request. Please use last
weight obtained within 30 days for dosing. NOTE:
Give first dose STAT - suggested dose 20 mg/kg/dose
(Maximum Dose 1 g/dose)
Patient Care Orders
Vital Signs [195580]
Vital Signs [NURMON0013] EVERY 15 MINUTES, STAT
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Respiratory [195568]
Pulse Oximetry [NURMON0009] CONTINUOUS, Routine
Isolation Status
Isolation [197765]
Isolation - Protective Precautions - Panel
[116356]
Protective Precautions [ISO0001] CONTINUOUS
Reason for Protective Precautions: Other
Protective - Positive Pressure Room
[NURCOM0109]
CONTINUOUS
Page 4 of 4
Printed by STRAKA, KEVIN F [KFS1] at 9/21/2017 12:43:21 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org