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/clinical/cckm-tools/content/order-sets/inpatient/hospital-wide/name-98243-en.cckm

20170376

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Hospital-wide

IP - Thoracentesis - Bedside - Adult - Pre/Postprocedure [2471]

IP - Thoracentesis - Bedside - Adult - Pre/Postprocedure [2471] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


IP - Thoracentesis - Bedside - Adult - Pre/Postprocedure [2471]
for Adult Patients OnlyIntended
Thoracentesis - The New England Journal of
Medicine 2006;355:e16 (October 12, 2006)
URL: http://content.nejm.org/cgi/reprint/355/15/e16.pdf
Patient Care Orders - Preprocedure
Vital Signs [80303]
Vital Signs [NURMON0013] ONCE, Starting today For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Prior to procedure.
Non-Categorized Patient Care Orders [80307]
Confirm Signed Consent on Chart
[NURCOM0022]
ONCE, Starting today For 1 Occurrences
THORACENTESIS (PERFORMED BY BEDSIDE
PROCEDURE SERVICE) [NWIP0011]
ONCE
Reason for Exam:
Side:
Diagnostic, Therapeutic or Both:
Provider Call-back Number:
To be performed at bedside.
THORACENTESIS W GUIDANCE
(PERFORMED IN INTERVENTIONAL
RADIOLOGY) [R76942AH]
ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Is this Diagnostic, Therapeutic, or Both?
Radiology Specialty Area: ULTRASOUND
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
For Scheduling purposes, is the patient
claustrophobic or require any form of sedation? Note:
ordering provider is responsible for prescribing oral
anxiolytic or ordering sedation services.
Is patient on anticoagulation therapy? If yes, specify
coagulation disorder and current medications in
comments box at bottom.
Transport Method: Floor Determined/Entered
To be performed at bedside.
Medications - Preprocedure
Preprocedure Medications [148238]
lidocaine 1 % vial [39034] ONCE For 1 Doses
Laboratory - Preprocedure
Laboratory [80273]
Page 1 of 5
Printed by O'BRIEN, RYLEY P [RPO249] at 3/16/2017 3:23:41 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2017CCKM@uwhealth.org

PROTHROMBIN TIME/INR [PT] NEXT DRAW, 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?
HEMATOCRIT [HCT] NEXT DRAW, 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?
PLATELET COUNT [PLT] NEXT DRAW, 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?
Patient Care Orders - Postprocedure
Vital Signs [80312]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Once after procedure and as needed.
Activity [80296]
Bed Rest for 1 Hour, Then Ad Lib
[NURACT0008]
CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST: other (comment)
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
For 1 hour, then ad lib.
Site Care [80316]
Inspect Puncture Site [NURWND0018] SEE COMMENTS, Starting today, Once after
procedure, then every 8 hours times 24 hours.
Cleanse Site with Alcohol and Apply 4x4 Gauze
to Puncture Site [NURWND0018]
SEE COMMENTS, Starting today, Once after
procedure and as needed.
Contingency Parameters [80317]
Page 2 of 5
Printed by O'BRIEN, RYLEY P [RPO249] at 3/16/2017 3:23:41 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

Notify Provider [NURCOM0001] CONTINUOUS
Provider to Notify: Provider
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: Breath sounds are absent or decreased from
baseline assessment,Newly developed cough or
hemoptysis,Tracheal deviation,Pain not controlled
with ordered analgesics or ordered interventions
Laboratory - Postprocedure - Common Pleural Fluid Labs
Laboratory [80802]
Nursing Communication - Lab [NURCOM0055] ONCE, Starting today For 1 Occurrences, Routine,
Peritoneal fluid specimens to be labeled STAT &
immediately handcarried to the lab. Follow Policy
#5.06 Acceptance Policy for Specimen Identification.
Routine - Pleural Fluid Tube 1 [80823]
GLUCOSE, PLEURAL FLUID [HCPLGLUC] ONCE, 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?
Routine - Pleural Fluid Tube 2 [80824]
CELL COUNT, PLEURAL FLUID [HCPLCC] ONCE, 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?
Routine - Pleural Fluid Tube 3 [80825]
PH, PLEURAL FLUID [HCPLPH] ONCE, 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?
Routine - Simultaneous Draw - Pleural Fluid [80826]
LD, TOTAL, PLEURAL FLUID [HCPLLD] ONCE, 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?
PROTEIN, PLEURAL FLUID [HCPLEUP] ONCE, 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?
Routine - Other - Pleural Fluid [148318]
Page 3 of 5
Printed by O'BRIEN, RYLEY P [RPO249] at 3/16/2017 3:23:41 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

CULTURE, BODY FLUID, AER WITH GRAM
STAIN [HCBFC]
ONCE, Starting today For 1 Occurrences, Routine,
For peritoneal, pericardial, pleural, synovial and
dialysate fluids order Culture, Body Fluid, Aer/Ana
with Gram stain and use blood culture bottles.
Indicate source if other:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
CULTURE, BODY FLUID, AER/ANA WITH
GRAM STAIN [HCWABF]
ONCE, Starting today For 1 Occurrences, Routine,
UWHC Only: Use blood culture bottles for peritoneal,
pericardial, pleural, synovial and dialysate fluids.
Indicate source if other:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Laboratory - Postprocedure - Optional Pleural Fluid Labs
Optional - Pleural Fluid [80828]
AMYLASE, PLEURAL FLUID [HCPLAMYL] ONCE, 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?
AFB SMEAR AND CULTURE [130496]
AFB SMEAR [AFBSMR] ONCE For 1 Occurrences, Routine
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
AFB CULTURE [AFBCX] ONCE For 1 Occurrences, Routine, Smear and
culture should be ordered for diagnostic specimens.
M. avium complex PCR is performed on the first
smear positive respiratory specimen from patients
not previously diagosed with tuberculosis.
Susceptibility testing is performed automatically on
all initial M. tuberculosis isolates. Susceptibility
testing for some non-tuberculous mycobacteria is
available.
The initial M. tuberculosis isolate from each patient
is also genotyped as part of the CDC Universal
Genotyping Program.
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
Isolation - Airborne - TB-Pulmonary
Confirmed/Suspect [ISO0003]
CONTINUOUS
Isolation - Airborne - Negative Pressure Room
[NURCOM0108]
CONTINUOUS
ADENOSINE DEAMINASE, PLEURAL FLUID
[HCADEPLEU]
ONCE, 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?
CHOLESTEROL, PLEURAL FLUID
[HCPLCHOL]
ONCE, 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?
Page 4 of 5
Printed by O'BRIEN, RYLEY P [RPO249] at 3/16/2017 3:23:41 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

CREATININE, PLEURAL FLUID [HCPLCRET] ONCE, 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?
CULTURE, FUNGAL, WITH SMEAR
[HCFCULTS]
ONCE, Starting today For 1 Occurrences, Routine,
Smears not routinely performed on CSF. If CSF,
order Culture, Fungal.
Indicate source if other:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
CYTOLOGY, NON-GYN [HCPATHM] ONCE, Starting today For 1 Occurrences, Routine,
For any questions please refer to U-Connect Test
Directory or contact UWHC Cytology at (608)263-
3205.
Specimen Source Description/Laterality:
Clinical History:
Is Lipid Laden Macrophage Index requested?
HEMATOCRIT, BODY FLUID [GM1840] ONCE, 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?
TRIGLYCERIDE, PLEURAL FLUID [HCPLTRIG] ONCE, 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?
UREA, PLEURAL FLUID [HCPLUREA] ONCE, 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?
Diagnostic Tests and Imaging - Postprocedure
Radiology [80318]
X-RAY CHEST PA & LAT VIEWS [R71020] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Radiology Specialty Area:
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
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
Page 5 of 5
Printed by O'BRIEN, RYLEY P [RPO249] at 3/16/2017 3:23:41 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org