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IP - Appendectomy - Perforated - Laparoscopic - Pediatric - Postoperative [2963]

IP - Appendectomy - Perforated - Laparoscopic - Pediatric - Postoperative [2963] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, General Surgery


IP - Appendectomy - Perforated - Laparoscopic - Pediatric - Postoperative [2963]
Admission Status
Level of Care (Single Response) [187485]
*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.
Isolation Status
If patient requires Isolation, please search for isolation in the additional orders section below.
Patient Care Orders
Vital Signs [88770]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 1 hour times 2, then every 2 hours times 2,
then every 4 hours., Post-Op/Phase II
Patient Monitoring [88771]
Cardio-Respiratory Monitor - Pediatric - Without
Rhythm [139420]
Cardio-Respiratory Monitor - Pediatric - Without
Rhythm [NURMON0074]
CONTINUOUS, Routine, 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:
Post-Op/Phase II
Notify [NURCOM0001] CONTINUOUS
Provider to Notify: Provider
Notify based on:
Notify provider for apnea > 20 seconds, Post-
Op/Phase II
Activity [88772]
Turn Patient [NURACT0011] SEE COMMENTS, Starting today For Until specified,
Turn patient every 2 hours on Operative Day., Post-
Op/Phase II
Page 1 of 7
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2017CCKM@uwhealth.org

Ambulate At Least 3 Times Daily [NURACT0008] CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE: 3x daily
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
Ad Lib [NURACT0008] CONTINUOUS, 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 [88774]
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:
Post-Op/Phase II
Clear Liquid Diet [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Pediatric
Diet Type: Diet Modifications
Diet Modifications: Liquid
Liquid: Clear Liquid
No Red or Purple Dye:
Liquid Thickness: Thin
Bedside Meal Instructions:
Room Service Class:
Post-Op/Phase II
General Diet [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Pediatric
Diet Type: General (no Modifications)
Bedside Meal Instructions:
Room Service Class:
Post-Op/Phase II
Respiratory [91374]
Pulse Oximetry [NURMON0009] CONTINUOUS, Starting today, Routine, Post-
Op/Phase II
Cough And Deep Breathe [NURTRT0019] EVERY 1 HOUR, Starting today, Routine, While
awake., Post-Op/Phase II
Incentive Spirometry [NURTRT0018] EVERY 1 HOUR, Starting today, Routine, While
awake., Post-Op/Phase II
Blow Bubbles [NURTRT0047] EVERY 1 HOUR, Starting today, Routine, While
awake., Post-Op/Phase II
Page 2 of 7
Printed by STRAKA, KEVIN F [KFS1] at 5/30/2017 4:35:18 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2017CCKM@uwhealth.org

Intake and Output [88775]
Measure Intake And Output [NURMON0005] EVERY 4 HOURS, Starting today, Routine, Post-
Op/Phase II
Non-Categorized Patient Care Orders [91429]
Measure Weight [NURMON0015] 1X DAILY, Starting today, Routine
Weigh With?
Weigh when?
Post-Op/Phase II
Measure Weight - On Admission
[NURMON0015]
ONCE, Starting today For 1 Occurrences, Routine
Weigh With?
Weigh when?
Post-Op/Phase II
Measure Height - On Admission [NURMON0052] ONCE For 1 Occurrences, Routine, Post-Op/Phase II
Maintain Nasogastric Tube [NURTAD0014] CONTINUOUS, Routine
Options:
Flush with:
Flush Frequency:
Clamp NG Tube:
Check Residual:
Does this need to be inserted/placed?
Device Status:
Post-Op/Phase II
Maintain Urinary Catheter [NURELM0013] CONTINUOUS, Routine, To discontinue this order,
enter a new order for "Discontinue Urinary Catheter".
To modify this order, enter a new order for "Maintain
Urinary Catheter" and make the necessary changes
in the new order.
Type:
Indication for Placement:
Details: To Dependent Drainage
Does this need to be inserted/placed?
Post-Op/Phase II
Maintain Drain [NURTAD0003] CONTINUOUS, Starting today, Routine
Type: Closed Suction (Jackson-Pratt)
Site:
Location:
Drainage Options:
Irrigate Frequency:
Irrigate With:
Irrigant Volume (mL):
Strip:
Strip For:
Dressing Change Frequency:
Dressing Type:
Empty three times per day and as needed., Post-
Op/Phase II
Contingency Parameters for Patients 11 Years and Older [135349]
Page 3 of 7
Printed by STRAKA, KEVIN F [KFS1] at 5/30/2017 4:35:18 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2017CCKM@uwhealth.org

Notify Provider [NURCOM0001] CONTINUOUS
Provider to Notify: Provider
If systolic blood pressure > (mmHg): 140
If systolic blood pressure < (mmHg): 100
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C): 38.5
If temperature < (C):
If heart rate > (bpm): 110
If heart rate < (bpm): 60
If respiratory rate >: 22
If respiratory rate <: 12
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%): 93
If urine output < (mL):
Other:
Post-Op/Phase II
Intravenous Therapy
IV Fluids - NOTE: Suggested dose 4 mL/kg/hr for first 10 kg; 2 mL/kg/hr for next 10 kg; 1 mL/kg/hr for
every kg greater than 20 kg [91383]
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L
infusion [44910]
Intravenous, CONTINUOUS, Post-Op/Phase II
Premedication for Needle Insertion [84317]
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
Post-Op/Phase II
LMX Use Instructions for Premedication Prior to
Needle Insertion [NURCOM0095]
Post-Op/Phase II
Medications - Anti-infectives
First Line [224582]
Ceftriaxone and metRONIDazole [224586]
ceftriaxone (ROCEPHIN) intraVENOUS -
Maximim Dose = 1 g [800027]
50 mg/kg, Intravenous, EVERY 24 HOURS, Post-
Op/Phase II
metRONIDazole (FLAGYL) intraVENOUS -
Maxumum Dose = 1 g [800062]
30 mg/kg, Intravenous, EVERY 24 HOURS, Post-
Op/Phase II
Page 4 of 7
Printed by STRAKA, KEVIN F [KFS1] at 5/30/2017 4:35:18 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2017CCKM@uwhealth.org

MRSA/Documented History Of MRSA [224587]
Cefoxitin and Vancomycin [224590]
cefoxitin (MEFOXIN) intraVENOUS - Maximum
Dose = 2 grams [800022]
40 mg/kg, Intravenous, EVERY 6 HOURS, Post-
Op/Phase II
vancomycin (VANCOCIN) intraVENOUS -
Maximum Dose = 2 grams [800084]
15 mg/kg, Intravenous, EVERY 6 HOURS, Post-
Op/Phase II
Patient with Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergties Who Are
MRSA negative [224613]
Ciprofloxacin - MeTRONIDazole [224616]
ciprofloxacin (CIPRO) intraVENOUS - Maximum
Dose = 400 mg [800031]
10 mg/kg, Intravenous, EVERY 8 HOURS, Post-
Op/Phase II
metRONIDazole (FLAGYL) intraVENOUS -
Maximum Dose = 1 g [800062]
30 mg/kg, Intravenous, EVERY 24 HOURS, Post-
Op/Phase II
MRSA and Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies [224617]
Ciprofloxacin - MetRONIDazole - Vancomycin
[224620]
ciprofloxacin (CIPRO) intraVENOUS - Maximum
Dose = 400 mg [800031]
10 mg/kg, Intravenous, EVERY 8 HOURS, Post-
Op/Phase II
metRONIDazole (FLAGYL) intraVENOUS -
Maximum Dose = 1 gram [800062]
30 mg/kg, Intravenous, EVERY 24 HOURS, Post-
Op/Phase II
vancomycin (VANCOCIN) intraVENOUS -
Maximum Dose - 2 grams [800084]
15 mg/kg, Intravenous, EVERY 6 HOURS, Post-
Op/Phase II
Medications - General
Analgesics - Acetaminophen - Scheduled (Single Response) [131815]
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - NOTE: Suggested dose 15 mg/kg
(Maximum 650 mg/dose) [800005]
15 mg/kg, Oral, EVERY 6 HOURS For 72 Hours,
Post-Op/Phase II
acetaMINOPHEN (TYLENOL) tab [34149] Oral, EVERY 6 HOURS For 72 Hours, Post-
Op/Phase II
acetaMINOPHEN (TYLENOL) suppository -
NOTE: Suggested dose 20 mg/kg. Must order in
whole suppository size (maximum 650 mg/dose)
[43994]
Rectal
Use if unable to tolerate oral medications
No more than 4 grams acetaminophen per 24 hours
for adults or 15mg/kg per dose for peds <40kg.
Post-Op/Phase II
Analgesics - NSAID - Scheduled (Single Response) [187906]
ketOROLAC (TORADOL) injection - NOTE:
Suggested dose 0.5 mg/kg (Maximum 15
mg/dose) [800050]
0.5 mg/kg, Intravenous, EVERY 6 HOURS For 72
Hours, Post-Op/Phase II
ibuprofen (MOTRIN) susp - NOTE: Suggested
dose 10 mg/kg (Maximum 600 mg/dose) [45376]
10 mg/kg, Oral, EVERY 6 HOURS For 72 Hours,
Post-Op/Phase II
Analgesics - Acetaminophen - PRN (Starting in 72 hours) (Single Response) [187907]
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - NOTE: Suggested dose 15 mg/kg
(Maximum 650 mg/dose) [800005]
15 mg/kg, Oral, EVERY 4 HOURS PRN Starting
6/2/17, pain, Mild pain or multimodal therapy., Post-
Op/Phase II
acetaMINOPHEN (TYLENOL) tab - NOTE:
Suggested dose 15 mg/kg (maximum 650
mg/dose) [34149]
Oral, EVERY 4 HOURS PRN Starting 6/2/17, pain,
Mild pain or multimodal therapy, Post-Op/Phase II
Page 5 of 7
Printed by STRAKA, KEVIN F [KFS1] at 5/30/2017 4:35:18 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2017CCKM@uwhealth.org

acetaMINOPHEN (TYLENOL) suppository -
NOTE: Suggested dose 20 mg/kg. Must order in
whole suppository size (Maximum 650 mg/dose)
[43994]
Rectal, EVERY 6 HOURS PRN Starting 6/2/17, pain,
Mild pain or multimodal therapy
Use if unable to tolerate oral medications
No more than 4 grams acetaminophen per 24 hours
for adults or 15mg/kg per dose for peds <40kg.
Post-Op/Phase II
Analgesics - NSAID - PRN (Starting in 72 hours) (Single Response) [224578]
ibuprofen (MOTRIN) susp - NOTE: Suggested
dose 10 mg/kg (Maximum 600 mg/dose) [45376]
10 mg/kg, Oral, EVERY 6 HOURS PRN Starting
6/2/17, pain, Mild to Moderate Pain or Multimodal
therapy, Post-Op/Phase II
ibuprofen (MOTRIN) tab - NOTE: Suggested
dose 10 mg/kg (Maximum 600 mg/dose) [38353]
Oral, EVERY 6 HOURS PRN Starting 6/2/17, pain,
Mild to Moderate Pain or Multimodal Therapy, Post-
Op/Phase II
Analgesics - Opioids (Oral) - PRN (Single Response) [187909]
oxycodone 5 MG/5ML soln RANGE – (Maximum
20 mg/dose) [750031]
0.1-0.2 mg/kg, Oral, EVERY 4 HOURS PRN, pain,
Moderate/Severe Pain, Post-Op/Phase II
oxycodone tab RANGE – NOTE: Suggested
dose 0.1-0.2 mg/kg (Maximum 20mg/dose)
[750032]
Oral, EVERY 4 HOURS PRN, pain, Moderate/Severe
Pain, Post-Op/Phase II
Analgesics - Opioids (Intravenous) - PRN (Single Response) [187910]
morphine PF injection – NOTE: suggested dose
0.05 – 0.1 mg/kg (Maximum 2 mg/dose) [800122]
0.05-0.1 mg/kg, Intravenous, EVERY 2 HOURS PRN,
pain, Moderate/Severe Pain and unable to take oral
opioid
Use if unable to tolerate oral medications
Post-Op/Phase II
HYDROmorphone PF (DILAUDID) injection -
NOTE: suggested dose 0.01-0.02 mg/kg
(Maximum 0.4 mg/dose) [800120]
0.01-0.02 mg/kg, Intravenous, EVERY 2 HOURS
PRN, pain, Moderate/Severe Pain and unable to take
oral opioid
Use if unable to tolerate oral medications
Post-Op/Phase II
Bowel Management (Single Response) [131817]
docusate sodium (COLACE) cap [36859] 100 mg, Oral, 2 X DAILY, Post-Op/Phase II
polyethylene glycol (MIRALAX) oral packet -
NOTE: for patients less than 10 kg [61829]
3.4 g, Oral, 1 X DAILY, Post-Op/Phase II
polyethylene glycol (MIRALAX) oral packet -
NOTE: For patients 10 - 25 kg [61829]
8.5 g, Oral, 1 X DAILY
Dissolve in 4 ounces of water
NOTE: For patients less than 25 kg
Post-Op/Phase II
polyethylene glycol (MIRALAX) oral packet -
NOTE: For patients 25 kg or greater [61829]
17 g, Oral, 1 X DAILY
Dissolve in 8 ounces of water
NOTE: For patients 25 kg or greater
Post-Op/Phase II
Anti-emetics [88788]
ondansetron (ZOFRAN) injection - NOTE:
Suggested dose 0.1 mg/kg (Maximum 4
mg/dose) [800202]
0.1 mg/kg, Intravenous, EVERY 6 HOURS PRN,
nausea/vomiting
NOTE: Suggested dose 0.1 mg/kg (Maximum 4
mg/dose)
Post-Op/Phase II
Consults
Consults [188411]
Consult Case Management (Inpatient)
[CON0013]
ONCE For 1 Occurrences, Routine
Reason for Consult:
Can this consult be done via video?
Post-Op/Phase II
Page 6 of 7
Printed by STRAKA, KEVIN F [KFS1] at 5/30/2017 4:35:18 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2017CCKM@uwhealth.org

Consult Pediatric Anesthesia Pain Service
[CON0166]
ONCE, Routine
Reason for Consult:
Can this consult be done via video?
Post-Op/Phase II
Page 7 of 7
Printed by STRAKA, KEVIN F [KFS1] at 5/30/2017 4:35:18 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2017CCKM@uwhealth.org