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IP - Neurosurgery - Ethanol 95% - Adult - Initial - Supplemental [2633]

IP - Neurosurgery - Ethanol 95% - Adult - Initial - Supplemental [2633] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Neurosciences


IP - Neurosurgery - Ethanol 95% - Adult - Initial - Supplemental [2633]
Intended for Adult Patients Only
Patient Care Orders
Patient Monitoring - During Ethanol 95% Taper [83071]
CIWA-Ar [NURMON0060] SEE COMMENTS, Starting today, Every 2 hours until CIWA-
Ar score <10 for 4 consecutive measurements and then
change assessment to every 4 hours and as needed during
ethanol 95% taper.
Monitor for Adverse Effects of Ethanol, Which Includes
Active Clinically Relevant GI Bleeding, Clinically
Relevant Pancreatitis, or ALT & AST Concentration
Greater than 3 Times Normal [NURMON0060]
SEE COMMENTS, Starting today, NOTE: If patient develops
active clinically relevant GI bleeding, clinically relevant
pancreatitis, or ALT & AST concentrations greater than 3
times normal, discontinue regimen. (Symptoms of clinically
relevant GI bleeding may include melena, hematemesis,
hematochezia. This does not include occult positive GI
bleeding. Symptoms of clinically relevant pancreatitis may
include increased abdominal distention, epigastric pain or
umbilical pain radiating to the back or shoulders, increasing
pain in the supine position, pain aggravated by food intake.)
Contingency Parameters [83072]
Notify Provider [NURCOM0001] 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: CIWA-Ar score of greater than or equal to 10 during
ethanol administration,Signs & symptoms of clinically relevant
GI bleeding (May include melena, hematemesis,
hematochezia. This does not include occult positive GI
bleeding),Signs & symptoms of clinically relevant pancreatitis
(May include increased abdominal distention, epigastric pain
or umbilical pain radiating to the back or shoulders,
increasing pain in the supine position, pain aggravated by
food intake),ALT & AST concentrations greater than 3 times
normal
Medications - Ethanol Daily Regimen
NOTE: Daily alcohol drink equivalents equals 360 mL beer, 150 mL wine, 45 mL distilled spirits; one bottle of wine = 5
drinks equivalents, one quart of distilled spirits = 21 drink equivalents.
NOTE: Patients will NOT receive any form of wine or beer
NOTE: Patients can NOT receive disulfiram, naltrexone, acamprosate, metronidazole or warfarin while on 95% enteral
ethanol
Medications - Ethanol Daily Regimen (Single Response) [138305]
For 5-8 Daily Alcohol Drink Equivalents [138306]
ethanol 95% soln [52429] 45 mL, Oral, EVERY 6 HOURS For 24 Hours
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Pr i nt ed by O'BRIEN, RYLEY P [RPO249] at 7/27/2015 9:51:35 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


ethanol 95% soln [52429] 30 mL, Oral, EVERY 5 HOURS Starting tomorrow For 24
Hours
ethanol 95% soln [52429] 30 mL, Oral, EVERY 6 HOURS Starting 7/29/15 For 24
Hours
ethanol 95% soln [52429] 30 mL, Oral, EVERY 8 HOURS Starting 7/30/15 For 24
Hours
ethanol 95% soln [52429] 15 mL, Oral, EVERY 5 HOURS Starting 7/31/15 For 24
Hours
ethanol 95% soln [52429] 15 mL, Oral, EVERY 6 HOURS Starting 8/1/15 For 24
Hours
ethanol 95% soln [52429] 15 mL, Oral, EVERY 8 HOURS Starting 8/2/15 For 24
Hours
For 9-13 Daily Alcohol Drink Equivalents [138312]
ethanol 95% soln [52429] 45 mL, Oral, EVERY 5 HOURS For 24 Hours
ethanol 95% soln [52429] 45 mL, Oral, EVERY 6 HOURS Starting tomorrow For 24
Hours
ethanol 95% soln [52429] 30 mL, Oral, EVERY 5 HOURS Starting 7/29/15 For 24
Hours
ethanol 95% soln [52429] 30 mL, Oral, EVERY 6 HOURS Starting 7/30/15 For 24
Hours
ethanol 95% soln [52429] 30 mL, Oral, EVERY 8 HOURS Starting 7/31/15 For 24
Hours
ethanol 95% soln [52429] 15 mL, Oral, EVERY 5 HOURS Starting 8/1/15 For 24
Hours
ethanol 95% soln [52429] 15 mL, Oral, EVERY 6 HOURS Starting 8/2/15 For 24
Hours
ethanol 95% soln [52429] 15 mL, Oral, EVERY 8 HOURS Starting 8/3/15 For 24
Hours
For 14-20 Daily Alcohol Drink Equivalents [138308]
ethanol 95% soln [52429] 60 mL, Oral, EVERY 6 HOURS For 24 Hours
ethanol 95% soln [52429] 45 mL, Oral, EVERY 5 HOURS Starting tomorrow For 24
Hours
ethanol 95% soln [52429] 45 mL, Oral, EVERY 6 HOURS Starting 7/29/15 For 24
Hours
ethanol 95% soln [52429] 30 mL, Oral, EVERY 5 HOURS Starting 7/30/15 For 24
Hours
ethanol 95% soln [52429] 30 mL, Oral, EVERY 6 HOURS Starting 7/31/15 For 24
Hours
ethanol 95% soln [52429] 30 mL, Oral, EVERY 8 HOURS Starting 8/1/15 For 24
Hours
ethanol 95% soln [52429] 15 mL, Oral, EVERY 5 HOURS Starting 8/2/15 For 24
Hours
ethanol 95% soln [52429] 15 mL, Oral, EVERY 6 HOURS Starting 8/3/15 For 24
Hours
ethanol 95% soln [52429] 15 mL, Oral, EVERY 8 HOURS Starting 8/4/15 For 24
Hours
For 21-36 Daily Alcohol Drink Equivalents [138309]
ethanol 95% soln [52429] 60 mL, Oral, EVERY 5 HOURS For 24 Hours
ethanol 95% soln [52429] 60 mL, Oral, EVERY 6 HOURS Starting tomorrow For 24
Hours
ethanol 95% soln [52429] 45 mL, Oral, EVERY 5 HOURS Starting 7/29/15 For 24
Hours
ethanol 95% soln [52429] 45 mL, Oral, EVERY 6 HOURS Starting 7/30/15 For 24
Hours
ethanol 95% soln [52429] 30 mL, Oral, EVERY 5 HOURS Starting 7/31/15 For 24
Hours
ethanol 95% soln [52429] 30 mL, Oral, EVERY 6 HOURS Starting 8/1/15 For 24
Hours
ethanol 95% soln [52429] 30 mL, Oral, EVERY 8 HOURS Starting 8/2/15 For 24
Hours
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


ethanol 95% soln [52429] 15 mL, Oral, EVERY 5 HOURS Starting 8/3/15 For 24
Hours
ethanol 95% soln [52429] 15 mL, Oral, EVERY 6 HOURS Starting 8/4/15 For 24
Hours
ethanol 95% soln [52429] 15 mL, Oral, EVERY 8 HOURS Starting 8/5/15 For 24
Hours
For 37-42 Daily Alcohol Drink Equivalents [138240]
ethanol 95% soln [52429] 60 mL, Oral, EVERY 4 HOURS For 24 Hours
ethanol 95% soln [52429] 60 mL, Oral, EVERY 5 HOURS Starting tomorrow For 24
Hours
ethanol 95% soln [52429] 60 mL, Oral, EVERY 6 HOURS Starting 7/29/15 For 24
Hours
ethanol 95% soln [52429] 45 mL, Oral, EVERY 5 HOURS Starting 7/30/15 For 24
Hours
ethanol 95% soln [52429] 45 mL, Oral, EVERY 6 HOURS Starting 7/31/15 For 24
Hours
ethanol 95% soln [52429] 30 mL, Oral, EVERY 5 HOURS Starting 8/1/15 For 24
Hours
ethanol 95% soln [52429] 30 mL, Oral, EVERY 6 HOURS Starting 8/2/15 For 24
Hours
ethanol 95% soln [52429] 30 mL, Oral, EVERY 8 HOURS Starting 8/3/15 For 24
Hours
ethanol 95% soln [52429] 15 mL, Oral, EVERY 5 HOURS Starting 8/4/15 For 24
Hours
ethanol 95% soln [52429] 15 mL, Oral, EVERY 6 HOURS Starting 8/5/15 For 24
Hours
ethanol 95% soln [52429] 15 mL, Oral, EVERY 8 HOURS Starting 8/6/15 For 24
Hours
For Over 42 Daily Alcohol Drink Equivalents [138311]
ethanol 95% soln [52429] 60 mL, Oral, EVERY 3 HOURS For 24 Hours
ethanol 95% soln [52429] 60 mL, Oral, EVERY 5 HOURS Starting tomorrow For 24
Hours
ethanol 95% soln [52429] 60 mL, Oral, EVERY 6 HOURS Starting 7/29/15 For 24
Hours
ethanol 95% soln [52429] 45 mL, Oral, EVERY 5 HOURS Starting 7/30/15 For 24
Hours
ethanol 95% soln [52429] 45 mL, Oral, EVERY 6 HOURS Starting 7/31/15 For 24
Hours
ethanol 95% soln [52429] 30 mL, Oral, EVERY 5 HOURS Starting 8/1/15 For 24
Hours
ethanol 95% soln [52429] 30 mL, Oral, EVERY 6 HOURS Starting 8/2/15 For 24
Hours
ethanol 95% soln [52429] 30 mL, Oral, EVERY 8 HOURS Starting 8/3/15 For 24
Hours
ethanol 95% soln [52429] 15 mL, Oral, EVERY 5 HOURS Starting 8/4/15 For 24
Hours
ethanol 95% soln [52429] 15 mL, Oral, EVERY 6 HOURS Starting 8/5/15 For 24
Hours
ethanol 95% soln [52429] 15 mL, Oral, EVERY 8 HOURS Starting 8/6/15 For 24
Hours
ethanol 95% soln [52429] 15 mL, Oral, EVERY 8 HOURS Starting 8/7/15 For 24
Hours
Medications
Supplements [83388]
thiamine (VITAMIN B-1) injection [800077] 100 mg, Intravenous, ONCE For 1 Doses
May give IM if unable to give IV
thiamine (VITAMIN B-1) tab [43657] 100 mg, Oral, 1 X DAILY Starting tomorrow For 2 Days
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


Uncategorized [83481]
Note: No acetaminophen while on ethanol taper.
[950018]
EVERY 8 HOURS
Note: No acetaminophen while on ethanol taper.
Laboratory
Draw Prior to Administering Ethanol 95% [83076]
ALCOHOL [GM2440] 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?
Draw prior to administering ethanol 95%, once.
LIPASE [LIPS] 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?
Draw prior to administering ethanol 95%, once.
AST/SGOT [AST] 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?
Draw prior to administering ethanol 95%, once.
ALT/SGPT [ALT] 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?
Draw prior to administering ethanol 95%, once.
For Female Patients of Child Bearing Age (Age 12 or WIth Onset of Menses to 55 Inclusive), Prior to Administering
Ethanol 95% [83077]
HCG, QUALITATIVE, URINE [UPREG] 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?
Draw prior to administering ethanol 95%, once.
Draw Every 4 Days While on Ethanol 95% [83073]
AST/SGOT [AST] NEXT AM, Starting 7/31/15 at 5:00 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?
AST/SGOT [AST] NEXT AM, Starting 8/4/15 at 5:00 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?
ALT/SGPT [ALT] NEXT AM, Starting 7/31/15 at 5:00 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?
ALT/SGPT [ALT] NEXT AM, Starting 8/4/15 at 5:00 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?
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


Consults
Consults [83078]
Consult Nutrition (Inpatient) [CON0043] ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult:
Delegate to Initiate and Manage Tube Feeding:
Delegate to Manage Diet Order/Supplement Order:
Delegate to Dysphagia Diet Order Progression:
Enteral nutrition during ethanol taper regimen for protein
calorie malnutrition.
Behavioral Health Consults (select below) [146847]
Health Psychology - adjustment, protocol (eg. burn, trauma, rehab, pre-amp, transplant), noncompliance, grief, pain
Addictive Disorders - alcohol or drug related problems (eg. treatment recommendations, withdrawal mgmt)
Psychiatry - safety, agitation, capacity, med mgmt, psychotropic SE
ACE - 65 and older - delirium, dementia, depression, decisional capacity, sleep (also for non-behavioral geriatric
syndromes; overall geriatric evaluation, mobility/falls, functional decline, social/caregiver issues, disposition, medication
management)
Consult Health Psychology (Inpatient) [CON0033] ONCE, Routine, Please notify consulting provider if patient
needs to be seen same day (Monday-Friday) or if special
assessment needs.
Intent for Consult:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Consult Addictive Disorders (Inpatient) [CON0003] ONCE, Routine, This order is for ADULT patients.
Please use the Consult Adolescent/Pediatric AODA
Counselor order for adolescent/pediatric patients instead.
Intent for Consult: Other
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis): Ethanol taper regimen
Consult Psychiatry (Inpatient) [CON0064] ONCE
Intent for Consult:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Consult Ace/Geriatric (Inpatient) [CON0001] ONCE, Routine
Reason for Consult:
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority