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UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,GI/Renal

IP - Colonoscopy - Adult - Preprocedure [1038]

IP - Colonoscopy - Adult - Preprocedure [1038] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, GI/Renal


IP - Colonoscopy - Adult - Preprocedure [1038]
for Adult Patients OnlyIntended
Patient Care Orders
Procedure Order [20638]
Colonoscopy [GI0002] ONCE, Starting today For 1 Occurrences, Routine
Reason for Exam:
Nutrition [103145]
NPO for Procedure - Hold Diet [DIE0007] EFFECTIVE MIDNIGHT, Starting today For 1
Occurrences, Routine
NPO For Which Procedure? Colonoscopy
Modifiers: NPO EXCEPT MEDICATIONS
Hold Nasogastric Tube Feeding After Midnight
[NURDIE0013]
ONCE, Starting today For 1 Occurrences
Respiratory [14034]
Oxygen On Call to Procedure (Include
CPAP/BIPAP if Applicable) [RT0073]
ONCE, Starting today For 1 Occurrences, Routine
Contingency Parameters [14035]
Notify GI Fellow On Call [NURCOM0001] Provider to Notify: Other (Comment)
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg):
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: International Normalized Ratio (INR) is greater
than 1.4,Platelet count less than 50,000/microliter,If
patient has taken aspirin within the last 7 days,
clopidogrel (PLAVIX) within the last 7 days,
unfractionated heparin within the last 8 hours, low
molecular weight heparin within the last 12 hours,
warfarin (COUMADIN) within the last 5 days, or
nonsteroidal anti-inflammatory drugs within the last 7
days.
Intravenous Therapy
IV Fluids [13075]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
sodium chloride 0.9% infusion [64367] at 125 mL/hr, Intravenous, CONTINUOUS
IV fluids for endoscopy procedure ONLY. Please
discontinue order once procedure is complete.
Nursing Communication - IV fluids for endoscopy
procedure ONLY. Please discontinue order once
procedure is complete. [NURCOM0022]
ONCE For 1 Occurrences
Medications - Preprocedure
Page 1 of 2
Printed by O'BRIEN, RYLEY P [RPO249] at 12/15/2016 9:33:52 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

Bowel Preparation [13076]
G.I. lavage (GOLYTELY) soln [103976] 4 L, Oral, ONCE For 1 Doses
Administer 240 mL every 10 minutes until 4 liters
have been consumed. Complete 4 hours before
colonoscopy.
G.I. lavage (GOLYTELY) soln - NOTE: Split prep
[103976]
2 L, Oral, 2 X DAILY For 2 Doses
Administer the evening before and morning of
colonoscopy. Complete 4 hours before colonoscopy
Communication [213400]
No barium within 24 hours of colonoscopy
[NURCOM0022]
ONCE For 1 Occurrences
Laboratory
Draw Day of Procedure [14045]
CBC WITH DIFFERENTIAL [CBC] NEXT DRAW For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw on Day of Procedure
PROTHROMBIN TIME/INR [PT] NEXT DRAW For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw on Day of Procedure
Page 2 of 2
Printed by O'BRIEN, RYLEY P [RPO249] at 12/15/2016 9:33:52 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org