/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/order-sets/,/clinical/cckm-tools/content/order-sets/inpatient/,/clinical/cckm-tools/content/order-sets/inpatient/general-surgery/,

/clinical/cckm-tools/content/order-sets/inpatient/general-surgery/name-98317-en.cckm

201606170

page

100

UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,General Surgery

IP - Central Venous Catheter Placement - Pediatric - Postoperative [2852]

IP - Central Venous Catheter Placement - Pediatric - Postoperative [2852] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, General Surgery


IP - Central Venous Catheter Placement - Pediatric - Postoperative [2852]
Admission Status
Admission Status [95525]

Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Isolation Status

If patient requires Isolation, please search for isolation in the additional orders section below.
Patient Care Orders
Vital Signs [88715]

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

Pediatric Early Warning Signs [NURMON0060] SEE COMMENTS, Starting today, Every 4 hours, Post-Op/Phase
II
Patient Monitoring [88716]

Cardio-Respiratory Monitor [NURMON0061] CONTINUOUS, Starting today, Routine, Post-Op/Phase II
Activity [88717]

Ambulate [NURACT0008] CONTINUOUS, Starting today For Until specified, 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
Nutrition [88718]

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;
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):
Page 1 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 4/29/2013 11:08:51 AM
Copyright © 2013 University of Wisconsin Hospital and Clinics Authority


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):
Tube Feeding Management:
Room Service Class:
Post-Op/Phase II
Respiratory [88719]

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
Intake and Output [88720]

Measure Intake And Output [NURMON0005] EVERY 8 HOURS, Starting today, Routine, Post-Op/Phase II
Non-Categorized Patient Care Orders [88721]

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, Starting today For 1 Occurrences, Routine, Post-
Op/Phase II
Contingency Parameters for Patients 3 through 6 Years Old [135347]

Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 118
If systolic blood pressure < (mmHg): 87
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C): 38.5
If temperature < (C):
If heart rate > (bpm): 140
If heart rate < (bpm): 75
If respiratory rate >: 30
If respiratory rate <: 18
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 [88728]

dextrose 5%-NaCl 0.2% with KCl 20 mEq/L infusion [44909] Intravenous, CONTINUOUS, Post-Op/Phase II

dextrose 5%-NaCl 0.45% with KCl 20 mEq/L infusion
[44910]
Intravenous, CONTINUOUS, Post-Op/Phase II
Medications - General
Analgesics - Scheduled [131811]
Page 2 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 4/29/2013 11:08:51 AM
Copyright © 2013 University of Wisconsin Hospital and Clinics Authority



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) suppository - NOTE:
Suggested dose 20 mg/kg. Must order in whole suppository
size (Maximum 650 mg/dose) [43994]
Rectal, 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

ketOROLAC (TORODOL) 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) [780067]
10 mg/kg, Oral, EVERY 6 HOURS For 72 Hours, Post-Op/Phase
II
Analgesics - PRN - Starting in 72 hours [131812]

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 5/2/13, pain
Administer for mild pain
Maximum 5 doses/day
Post-Op/Phase II

acetaMINOPHEN (TYLENOL) suppository - NOTE:
Suggested dose 20 mg/kg (Maximum 650 mg/dose) [43994]
Rectal, EVERY 4 HOURS PRN Starting 5/2/13, pain
Administer for mild pain
Maximum 5 doses/day
Post-Op/Phase II

ibuprofen (MOTRIN) susp - NOTE: Suggested dose 10
mg/kg (Maximum 600 mg/dose) [780067]
10 mg, Oral, EVERY 6 HOURS PRN Starting 5/2/13, pain
Administer for mild to moderate pain or multimodal therapy
Post-Op/Phase II
Analgesics - PRN [132478]

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, pain
Administer for mild pain
Maximum 5 doses/day
Post-Op/Phase II

acetaMINOPHEN (TYLENOL) suppository - NOTE:
Suggested dose 20 mg/kg (Maximum 650 mg/dose) [43994]
Rectal, EVERY 4 HOURS PRN, pain
Administer for mild pain
Maximum 5 doses/day
Post-Op/Phase II

oxycodone soln RANGE - (Maximum 20 mg/dose) [750031] 0.1-0.2 mg/kg, Oral, EVERY 3 HOURS PRN, pain
Administer for severe pain
Post-Op/Phase II

oxycodone tab RANGE - NOTE: Suggested dose 0.1 - 0.2
mg/kg (Maximum 20 mg/dose) [750032]
Oral, EVERY 3 HOURS PRN, pain
Administer for severe pain
Post-Op/Phase II

ibuprofen (MOTRIN) tab - NOTE: Suggested dose 10 mg/kg
(Maximum 600 mg/dose) [38353]
Oral, EVERY 6 HOURS PRN, pain
Administer for mild to moderate pain or multimodal therapy
Post-Op/Phase II

ibuprofen (MOTRIN) susp - NOTE: Suggested dose 10
mg/kg (Maximum 600 mg/dose) [780067]
10 mg, Oral, EVERY 6 HOURS PRN, pain
Administer for mild to moderate pain or multimodal therapy
Post-Op/Phase II

MORPHine PF injection - NOTE: suggested dose 0.05 - 0.1
mg/kg (Maximum 2 mg/dose) [750057]
0.05-0.1 mg/kg, Intravenous, EVERY 2 HOURS PRN, pain
Administer if unable to take PO.
for 4 Minutes, Post-Op/Phase II

HYDROmorphone PF (DILAUDID) injection - NOTE:
suggested dose 0.01 - 0.02 mg/kg (Maximum 0.4 mg/dose)
[750050]
0.01-0.02 mg/kg, Intravenous, EVERY 2 HOURS PRN, pain
Administer if unable to take PO.
for 3 Minutes, Post-Op/Phase II
Anti-emetics [87756]

ondansetron (ZOFRAN) injection - NOTE: Suggested dose
0.1 mg/kg/dose (Maximum 4 mg/dose) [760183]
0.1 mg/kg, Intravenous, EVERY 24 HOURS PRN,
nausea/vomiting, for 3 Minutes
NOTE: Suggested dose 0.1 mg/kg (Maximum 4 mg/dose)
Post-Op/Phase II
Diagnostic Tests
Obtain in PACU [88734]

X-RAY CHEST AP VIEW [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?:
Page 3 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 4/29/2013 11:08:51 AM
Copyright © 2013 University of Wisconsin Hospital and Clinics Authority


Rule out pheumothorax
Relevant recent/past history?:
Is patient pregnant?:
If being performed remotely, where?:
Transport Method: Floor Determined/Entered
Post-Op/Phase II
BestPractice


No Hospital Problems have yet been identified [107363]

Specify Hospital Problem(s) [COR0018] Post-Op/Phase II
Consults
Consults [131894]

Consult Case Management (Inpatient) [CON0013] ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult:
Post-Op/Phase II
Page 4 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 4/29/2013 11:08:51 AM
Copyright © 2013 University of Wisconsin Hospital and Clinics Authority