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IP – Circumcision – Neonatal – Supplemental [5184]

IP – Circumcision – Neonatal – Supplemental [5184] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Neonatal


SmartSet: IP - CIRCUMCISION - NEONATAL - SUPPLEMENTAL (ID:5184)
General Information
Display name: IP - Circumcision - Neonatal - Supplemental
Type: General
Merge priority:
Version comment:
Content source:
Synonyms: 1. NICU
2. .NICU
3. .NEONATE
SmartSet notes:
Description:
Web information: Title URL
1.
Questionnaire:
Configuration
Patient Care Orders
Non-Categorized Patient Care Orders
Nursing Communication ONCE, Apply Vaseline to circumcision with every diaper
change until discharge. Evaluate circumcision site at 30
minutes, then PRN.
Contingency Parameters
Notify 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 < (%):
Page 1 of 2
Printed by STRAKA, KEVIN F [KFS1] at 3/21/2016 3:11:15 PM
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority
 

If urine output < (mL):
Other: If excessive bleeding from circumcision site persists.
Medications
General Medications
lidocaine 1 % vial 0.1-0.4 mL, Intradermal, ONCE For 1 Doses
sucrose (SWEET-EASE) 24% buccal soln Buccal, ONCE For 1 Doses
lidocaine (LMX) 4% topical dressing kit Topical, ONCE For 1 Doses
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension
Oral, ONCE For 1 Doses
silver nitrate-potassium nitrate 75-25 % swab Topical
Apply to circumcision site.
bacitracin-polymyxin b (POLYSPORIN) 500-10000
UNIT/GM ointment
Topical, EVERY 3 HOURS PRN For 48 Hours, Circumcision
Care
Apply to the circumcision site with every diaper change for 48
hours after the procedure.
Criteria
Suggestions: UWIP C LOGIN DEPT IPPED NEONATAL INTENSIVE CARE[3001764]
Filter: UWIP ORDER SET RESTRICTOR - IP AND PEDS - NOT IP DC[3000404]
Restrict SmartSet:
Settings
Discontinue action:
Deselect sections for
Pended/Held orders:
Pended/Held orders display:
Release date: Use System Definitions Setting
Disallow user override:
Page 2 of 2
Printed by STRAKA, KEVIN F [KFS1] at 3/21/2016 3:11:15 PM
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority