/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/order-sets/,/clinical/cckm-tools/content/order-sets/inpatient/,/clinical/cckm-tools/content/order-sets/inpatient/neurosciences/,

/clinical/cckm-tools/content/order-sets/inpatient/neurosciences/name-98150-en.cckm

201606170

page

100

UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Neurosciences

IP - Neurosurgery - Ethanol 95% - Adult - Ongoing - Supplemental [2632]

IP - Neurosurgery - Ethanol 95% - Adult - Ongoing - Supplemental [2632] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Neurosciences


IP - Neurosurgery - Ethanol 95% - Adult - Ongoing - Supplemental [2632]
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 Extended Tapering
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
Extended Tapering [83480]
ethanol 95% soln [52429] 15 mL, Oral, EVERY 8 HOURS For 24 Hours
ethanol 95% soln [52429] 10 mL, Oral, EVERY 8 HOURS Starting tomorrow For 24
Hours
Page 1 of 2
Pr i nted by O'BRIEN, RYLEY P [RPO249] at 7/14/2015 10:18:02 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


ethanol 95% soln [52429] 10 mL, Oral, EVERY 12 HOURS Starting 7/16/15 For 24
Hours
Medications
Non-categorized [83481]
Note: No more than 2.6 grams acetaminophen per 24
hours for adults while on ethanol [950018]
EVERY 8 HOURS
Note: No more than 2.6 grams acetaminophen per 24 hours
for adults while on ethanol
Laboratory
Laboratory [83963]
AST/SGOT [AST] NEXT AM, Starting 7/16/15 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 7/16/15 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 2 of 2
Pr i nted by O'BRIEN, RYLEY P [RPO249] at 7/14/2015 10:18:02 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority