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201709263

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IP - Neuroendovascular - IV Digital Subtraction Angiogram (DSA) - Adult - Preprocedure [6360]

IP - Neuroendovascular - IV Digital Subtraction Angiogram (DSA) - Adult - Preprocedure [6360] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Neurosciences


IP - Neuroendovascular - IV Digital Subtraction Angiogram (DSA) - Adult -
Preprocedure [6360]
for Adult Patients OnlyIntended
Patient Care Orders
Vital Signs [224023]
Vital Signs [NURMON0013] ONCE, Starting tomorrow For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Patient Monitoring [224025]
Assess Neurologic Status [NURMON0006] ONCE, Starting tomorrow For 1 Occurrences, Routine
Nutrition [224030]
NPO Except Medications [NUT9999] EFFECTIVE MIDNIGHT, Starting tomorrow, Routine
Patient Type: Adult
Diet Type: NPO
NPO: NPO except Medications
Bedside Meal Instructions:
Room Service Class:
Non-Categorized Patient Care Orders [224031]
Measure Weight For Dose Calculations
[NURMON0054]
ONCE, Starting tomorrow For 1 Occurrences, Routine,
Standing weight preferred.
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Starting tomorrow, Routine
Peripheral IV Size: 18 Gauge (Must be placed in right
antecubital)
Does this need to be inserted/placed? Yes
Must be placed in right antecubital.
Check and document patency, tubing change, site
assessment, and dressing change per policy.
Hypoglycemia Management [22627]
BOTH orders when ordering. Select
Glucose, POC [IPGLUCOSE] ONCE, Starting tomorrow For 1 Occurrences, Routine,
Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia management
and monitoring as indicated in the Hypoglycemia
Management (Adult) panel.
If Conditional, What Condition?
On arrival to Angio Suite.
Hypoglycemia Management (Adult) [191576]
Glucose, POC [IPGLUCOSE] AS NEEDED FOR SIGNS AND SYMPTOMS OF
HYPOGLYCEMIA, Starting tomorrow For Until
specified, Routine, Glucose, POC should always be
ordered in conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
Page 1 of 6
Printed by O'BRIEN, RYLEY P [RPO249] at 9/18/2017 8:52:04 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org

Glucose, POC [IPGLUCOSE] AFTER PROVIDING HYPOGLYCEMIA
TREATMENT, Starting tomorrow For Until specified,
Routine, Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
Per hypoglycemia treatment algorithm Recheck
glucose 15 minutes after providing treatment until
glucose is greater than or equal to 70 mg/dL. If
patient has been critically low (i.e., glucose less than
40 mg/dL), recheck glucose after 1 hour to ensure
glucose remains greater than or equal to 70mg/dL.
After resolution of mild hypoglycemia (i.e., glucose
40-69 mg/dL), consider rechecking after 1 hour if
patient has signs/symptoms of hypoglycemia or is at
risk for a subsequent hypoglycemic event (e.g.,
previously administered insulin still active, altered
renal status, altered mental status, NPO or
interrupted nutrition, or any other condition that
increases hypoglycemia risk)
Notify Provider [NURCOM0001] Provider to Notify: Provider
Notify based on: Blood Glucose,Other
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
Other: Nutritional status changes
Hypoglycemia Treatment for blood glucose less
than 40 mg/dL and patient able to eat/swallow
safely [NURCOM0022]
CONDITIONAL, Starting tomorrow For Until
specified
If Conditional, What Condition? If blood glucose less
than 40mg/dL and patient able to eat/swallow safely.
Give 30 grams of carbohydrate (8 oz. of fruit juice).
Repeat treatment until glucose is 70 mg/dL or
greater.
Hypoglycemia Treatment for blood glucose
between 40 to 69 mg/dL and patient able to
eat/swallow safely [NURCOM0022]
CONDITIONAL, Starting tomorrow For Until
specified
If Conditional, What Condition? If glucose is 40-69
mg/dL and patient able to eat/swallow safely
Give 15 grams of carbohydrate (4 oz of fruit juice).
Repeat treatment until glucose is 70 mg/dL or
greater.
glucose-vitamin C chew tab [50690] 16 g, Oral, EVERY 15 MINUTES PRN Starting
tomorrow, hypoglycemia, Hypoglycemia, For blood
glucose 40-69 mg/dL
Use in patients able to safely eat/swallow but unable
to tolerate volume of fruit juice or per patient
preference. Repeat every 15 minutes until blood
glucose is 70 mg/dL or greater.
glucose-vitamin C chew tab [50690] 32 g, Oral, EVERY 15 MINUTES PRN Starting
tomorrow, hypoglycemia, Hypoglycemia, For blood
glucose less than 40 mg/dL
Use in patients able to safely eat/swallow but unable
to tolerate volume of fruit juice or per patient
preference. Repeat every 15 minutes until blood
glucose is 70 mg/dL or greater.
Page 2 of 6
Printed by O'BRIEN, RYLEY P [RPO249] at 9/18/2017 8:52:04 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

glucagon injection kit [107799] 1 mg, Subcutaneous, PRN Starting tomorrow, For
blood glucose less than 69 mg/dL and patient unable
to eat/swallow safely AND has NO IV access
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
dextrose injection [800233] 12.5 g, Intravenous, PRN Starting tomorrow, For
blood glucose 40-69 mg/dL and patient unable to
eat/swallow safely AND has IV access
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
dextrose injection [800233] 25 g, Intravenous, PRN Starting tomorrow, For blood
glucose less than 40 mg/dL and patient unable to
eat/swallow safely AND has IV access.
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL - RN COLLECT, Starting tomorrow
For 7 Days, STAT
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Draw if blood
glucose is less than 40 mg/dL or greater than 400
mg/dL.
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL - RN COLLECT, Starting tomorrow
For 7 Days, STAT
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Draw if blood
glucose is less than 40 mg/dL or greater than 400
mg/dL.
Intravenous Therapy
IV Fluids [224040]
dextrose 5%-NaCl 0.9% infusion [51641] Intravenous, CONTINUOUS Starting tomorrow
dextrose 5%- NaCl 0.9% with KCl 20 mEq/L
infusion [44904]
Intravenous, CONTINUOUS Starting tomorrow
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L
infusion [44910]
Intravenous, CONTINUOUS Starting tomorrow
dextrose 5%-NaCl 0.45% infusion [51613] at 125 mL/hr, Intravenous, CONTINUOUS Starting
tomorrow
Medications - Pre-Procedure
Refer to "Contrast Induced Nephropathy Prophylaxis - Adult Supplemental Order Set"
For Patients On Oral Diabetics Agents [224041]
Note: Hold oral diabetic agents on morning of
procedure [950018]
ONCE Starting tomorrow For 1 Doses
Hold oral diabetic agents on morning of procedure
For Patients With Contrast Allergy [224042]
methylprednisolone (MEDROL) tab [720092] 32 mg, Oral, ONCE Starting tomorrow For 1 Doses
Give 12 hours prior to procedure for contrast allergy
methylprednisolone (MEDROL) tab [720092] 32 mg, Oral, ONCE Starting tomorrow For 1 Doses
Give 2 hours prior to procedure for contrast allergy
diphenhydramine (BENADRYL) cap [36791] 50 mg, Oral, ONCE Starting tomorrow For 1 Doses
Give 1 hour prior to procedure for contrast allergy
Laboratory
Labs [22629]
Page 3 of 6
Printed by O'BRIEN, RYLEY P [RPO249] at 9/18/2017 8:52:04 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

BUN [BUN] STAT - RN COLLECT, Starting tomorrow For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
CBC WITHOUT DIFFERENTIAL [HEMO] STAT - RN COLLECT, Starting tomorrow For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
CREATININE [CRET] STAT - RN COLLECT, Starting tomorrow For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ELECTROLYTES [LYTE] STAT - RN COLLECT, Starting tomorrow 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 Reactivity (PRU) Test and ADP
Aggregation (w/ Platelet and Hematocrit)
[183724]
Test measures the ability of platelets to aggregate in whole blood in response to ADP. This test
can be used to assess the affect of clopidogrel, prasugrel or any drug specific for the inhibition of
the ADP receptor.
valid.count must be greater that 75 K/uL for test results to be Platelet
PLATELET REACTIVITY (PRU) TEST
[HCVNPRU]
NEXT AM For 1 Occurrences, Routine, Patients who
have been treated with Glycoprotein IIb/IIIa inhibitors
should not be tested until platelet function has
recovered. This time period is approximately 14 days
after discontinuation of abciximab (ReoPro) and up
to 48 hours after discontinuation of eptifibatide
(Intergrilin) and tirofiban (Aggrastat).
Dose and name of antiplatelet medication:
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
HEMATOCRIT [HCT] NEXT AM 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 AM 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 6
Printed by O'BRIEN, RYLEY P [RPO249] at 9/18/2017 8:52:04 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

PLATELET AGGREGATION, ADP [HCADPAGG] NEXT AM For 1 Occurrences, Routine, Test
measures the ability of platelets to aggregate in
whole blood in response to ADP. This test can be
used to assess the affect of clopidogrel, prasugrel or
any drug specific for the inhibition of the ADP
receptor. Platelet count must be greater that 75 K/uL
for test results to be valid.
Dose of Clopidogrel?
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
IP - LAB - ARACHIDONIC ACID
AGGREGATION (W/ PLATELET AND
HEMATOCRIT) [181407]
to arachidonic measures the ability of platelets to aggregate in whole blood in response Test
like drug. -or any aspirinacid. This test can be used to assess the affect of aspirin
valid.count must be greater that 75 K/uL for test results to be Platelet
HEMATOCRIT [HCT] NEXT AM 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 AM 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 AGGREGATION, ARACHIDONIC
ACID [HCAAAGG]
NEXT AM For 1 Occurrences, Routine, Test
measures the ability of platelets to aggregate in
whole blood in response to arachidonic acid. This
test can be used to assess the affect of aspirin or
any aspirin-like drug. Platelet count must be greater
that 75 K/uL for test results to be valid.
Dose of Aspirin:
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
PROTHROMBIN TIME/INR [PT] STAT - RN COLLECT, Starting tomorrow For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PTT [PTT] STAT - RN COLLECT, Starting tomorrow For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
URINALYSIS, NO MICROSCOPY [UACHEM] ONCE, Starting tomorrow For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Laboratory - Pregnancy Test [112034]
surgery is pelvic, renal, pregnancy test if female between menarche & menopause and any of: (1) Obtain
intercourse, (3) patient missed menses, (4) patient says abdominal, (2) patient had unprotected -or intra
pregnant. she "could" be
Page 5 of 6
Printed by O'BRIEN, RYLEY P [RPO249] at 9/18/2017 8:52:04 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

Urine, Pregnancy Test [UPREG] STAT - RN COLLECT, 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 6 of 6
Printed by O'BRIEN, RYLEY P [RPO249] at 9/18/2017 8:52:04 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org