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

IP – Bowel Clean Out – Pediatric – Admission [4365]

IP – Bowel Clean Out – Pediatric – Admission [4365] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, GI/Renal


IP - Bowel Clean Out - Pediatric - Admission [4365]
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.
Admit to Inpatient (Single Response) [188296]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service:
I certify that an inpatient stay is medically necessary
because of either an anticipated LOS >2 midnights,
complexity and/or severity of illness, an inpatient-only
surgery, or a previously-authorized inpatient stay.
Rationale listed below. Yes
C - CLEAR DIAGNOSIS:
E - EVALUATIONS PLANNED:
R - RESULTS EXPECTED:
T - TREATMENTS ORDERED:
Post-Op/Phase II
Admit to Observation (Single Response) [188297]
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admit to Outpatient Short Stay (Single Response)
[188298]
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admission Status (Single Response) [82665]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service:
I certify that an inpatient stay is medically necessary because
of either an anticipated LOS >2 midnights, complexity and/or
severity of illness, an inpatient-only surgery, or a previously-
authorized inpatient stay. Rationale listed below. Yes
C - CLEAR DIAGNOSIS:
E - EVALUATIONS PLANNED:
R - RESULTS EXPECTED:
T - TREATMENTS ORDERED:
Post-Op/Phase II
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
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Service:
Post-Op/Phase II
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admission Status (Single Response) [20869]
Admit To Inpatient Status [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service:
I certify that an inpatient stay is medically necessary because
of either an anticipated LOS >2 midnights, complexity and/or
severity of illness, an inpatient-only surgery, or a previously-
authorized inpatient stay. Rationale listed below. Yes
C - CLEAR DIAGNOSIS:
E - EVALUATIONS PLANNED:
R - RESULTS EXPECTED:
T - TREATMENTS ORDERED:
Post-Op/Phase II
Admit To Observation Status [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Patient Care Orders
Vital Signs [19751]
Vital Signs [NURMON0013] EVERY 8 HOURS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Activity [19752]
Ad Lib [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 [116281]
Diet - Strict NPO [NUT0001] EFFECTIVE _____, Starting today, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question 25):
STRICT NPO
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Liquids & Modified Consistency (If Dysphagia Protocol see
questions 21-24):
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):
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:
Diet - General [NUT0001] EFFECTIVE _____, Starting today, Routine
General Diet: GENERAL;
Diabetic Diet:
NPO (If patient receiving tube feeding see question 25):
Liquids & Modified Consistency (If Dysphagia Protocol see
questions 21-24):
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):
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:
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Room Service Class:
Diet - 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):
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:
Non-Categorized Patient Care Orders [116445]
Measure Weight [NURMON0015] ONCE, Starting today For 1 Occurrences, Routine
Weigh With?
Weigh when?
Measure Intake And Output [NURMON0005] EVERY 8 HOURS, Starting today, Routine
NG Tube Placement - Pediatric [121658]
Insert and 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:
Recommendations for flush quantity:
For patients < 30 kg, use 1mL of fluid per 1 kg.
For patients >30 kg, 30 mLs of fluid should be sufficient.
In general, consider the amount of fluid needed to clear the
tube and patient’s fluid status before determining flush
quantity.
lidocaine-oxymetazoline 3%-0.01% (PEDS) nasal spray
[785104]
Nasal, ONCE For 1 Doses
For numbing prior to feeding tube insertion. Slowly spray
the chosen nostril once, if required may repeat x1 in
opposite nostril. Angle toward back of throat spraying the
anterior nostril and wait 30-60 seconds before introducing
more local anesthetic into the nostril. Caution: Entire bottle
should not be used for insertion of tube. Discard excess
solution when procedure completed.
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X-RAY ABDOMEN AP VIEW (KUB) [R74000] CONDITIONAL For 3 Days, Routine
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms?
What specific question(s) would you like answered by this
exam? Evaluate nasogastric tube placement
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where?
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
If Conditional, What Condition? Evaluate nasogastric tube
placement. The location of nasogastric tube should be
confirmed prior to the instillation of fluids, medications, or
feedings. Refer to Policy 2.20 Enteral Tubes Used for
Instillation of Fluids, Medications, or Feeding
Contingency Parameters [116283]
Notify Provider [NURCOM0001] Provider to Notify: Other (Comment)
Notify based on: Other
Other: Stop bowel prep if persistent emesis, abdominal
distention or respiratory distress.,If bowel effluent not clear
after completion of bowel prep
Intravenous Therapy
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 (Single Response) [194227]
dextrose 5%-NaCl 0.45% infusion [51613] Intravenous, CONTINUOUS
dextrose 5%-NaCl 0.9% infusion [51641] Intravenous, CONTINUOUS
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L infusion
[44910]
Intravenous, CONTINUOUS
dextrose 5%- NaCl 0.9% with KCl 20 mEq/L infusion
[44904]
Intravenous, CONTINUOUS
Medications
Metoclopramide (REGLAN) - Prior to Bowel Prep (Single Response) [116007]
metoclopramide (REGLAN) soln - NOTE: Order for
patients less than 6 years Maximum Dose = 10 mg
[800224]
0.1 mg/kg, Oral, ONCE PRN For 1 Doses, GI motility
Maximum Dose = 10 mg
NOTE: Order for patients less than 6 years
metoclopramide (REGLAN) soln - NOTE: For children 6-
13 years suggested dose 2.5 or 5 mg Maximum dose =
Oral, ONCE PRN For 1 Doses, GI motility
Maximum Dose = 10 mg
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10 mg [800224] NOTE: For children 6-13 years suggested dose 2.5 or 5 mg
metoclopramide (REGLAN) soln - NOTE: Order for
patients 14 years or older Maximum Dose = 10 mg
[800224]
10 mg, Oral, ONCE PRN For 1 Doses, GI motility
Maximum Dose = 10 mg
NOTE: Order for patients 14 years or older
Bowel Prep [116222]
G.I. lavage (GOLYTELY) 236 G soln [103976] Oral, ONCE For 1 Doses
Administer GI Lavage at 20 mL/kg/hr (Maximum 1 liter/hr)
until bowel effluent is clear. Start at half goal rate. Advance to
goal rate within one hour.
polyethylene glycol (MIRALAX) oral powder [61353] Oral, ONCE For 1 Doses
Enemas (Single Response) [116223]
Sodium chloride 0.9% Enema [NURTRT0048] ONCE, Starting today For 1 Occurrences, Sodium chloride
0.9% enema 10 mL/kg (Maximum 500 mL) rectally until clear.
Administer at beginning of cleanse
Saline Enema [NURELM0048] ONCE For 1 Occurrences, Routine
Duration:
Administer at beginning of cleanse
bisacodyl (DULCOLAX) rectal suppository [35231] 10 mg, Rectal, ONCE For 1 Doses
Administer at beginning of cleanse
mineral oil (FLEET OIL) enema [39712] 135 mL, Rectal, ONCE For 1 Doses
Administer at beginning of cleanse
phosphate (FLEET PEDIATRIC) enema [37522] 1 enema, Rectal, ONCE For 1 Doses
Administer at beginning of cleanse
phosphate (FLEET) enema [37517] 1 enema, Rectal, ONCE For 1 Doses
Administer at beginning of cleanse
Anti-emetics [117812]
ondansetron (ZOFRAN) tab [45939] Oral, EVERY 8 HOURS PRN, nausea/vomiting
ondansetron (ZOFRAN) soln [54843] Oral
Diagnostic Tests and Imaging
Imaging [116284]
X-RAY ABDOMEN AP VIEW (KUB) [R74000] ONCE-RAD NEXT AVAILABLE For 1 Occurrences, Routine
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms? Constipation
What specific question(s) would you like answered by this
exam? Effectiveness of cleanout
Relevant recent/past history? Constipation
Is patient pregnant?
If being performed remotely, where? Other
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
Complete post cleanout
Consults
Consults [116285]
Consult Peds GI midlevel provider [CON0093] ONCE
Intent:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis): Teaching on Constipation
Follow-Up
Follow-Up [150035]
Follow-Up with Peds GI MLP 2 Weeks after Discharge
[NURCOM0026]
Reason for Appointment: Follow-up
When do you want appointment: 2 weeks
Which Clinic or Specialty: GI Peds Mid Level Provider
Which Provider (Optional): Mid Level Provider
Follow-up with Peds GI MLP 2 weeks after discharge
BestPractice
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No Hospital Problems have yet been identified. [107035]
Specify Hospital Problem(s) [COR0018] You will be prompted to specify a hospital problem on
signing., Post-Op/Phase II
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