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IP - Cesarean Delivery - Preprocedure [6267]

IP - Cesarean Delivery - Preprocedure [6267] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Obstetrics


SmartSet: IP - CESAREAN DELIVERY - PREPROCEDURE (ID:6267)
General Information
Display name: IP - Cesarean Delivery - Preprocedure
Type: General
Merge priority: 0
Version comment:
Content source:
Synonyms: 1. Cesarean
2. Delivery
3. Birth
4. C Section
5. C-Section
SmartSet notes:
Description:
Web information: Title URL
1.
Questionnaire:
Configuration
Patient Care Orders
Vital Signs
Vital Signs ONCE For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Once Upon admission, Pre-Op Day Of Procedure
Activity
Page 1 of 8
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 12:06:16 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org

Activity: AMBULATE: ad lib CONTINUOUS For Until specified, Routine
AD LIB:
AMBULATE: ad lib
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Pre-Op Day Of Procedure
Activity: AMBULATE: with assistance CONTINUOUS, Routine
AD LIB:
AMBULATE: 4x daily,with assistance
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Pre-Op Day Of Procedure
Diet
Diet NPO Except Medications EFFECTIVE NOW, Starting S, Routine
Patient Type: Adult
Diet Type: NPO
NPO: NPO except Medications
Bedside Meal Instructions:
Room Service Class:
Pre-Op Day Of Procedure
Diet STRICT NPO EFFECTIVE NOW, Starting S, Routine
Patient Type: Adult
Diet Type: NPO
NPO: Strict NPO
Bedside Meal Instructions:
Room Service Class:
Pre-Op Day Of Procedure
Patient Monitoring
Measure Weight ONCE For 1 Occurrences, Routine
Weigh With? Portable Scale
Weigh when?
Standing preferred, Pre-Op Day Of Procedure
Measure Height ONCE For 1 Occurrences, Routine, Pre-Op Day Of
Procedure
For Patients with BMI Greater Than or Equal to 40
Pulse Oximetry CONTINUOUS, Routine, Pre-Op Day Of Procedure
ECG - 12 Lead ONCE For 1 Occurrences, Routine
Reason for exam:
Pre-Op Day Of Procedure
External Fetal Monitoring
Fetal Monitor CONTINUOUS, Routine, Pre-Op Day Of Procedure
Bladder Management
Page 2 of 8
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Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org

Insert and Maintain Urinary Catheter CONTINUOUS, Routine, To discontinue this order,
enter a new order for "Discontinue Urinary Catheter".
To modify this order, enter a new order for "Maintain
Urinary Catheter" and make the necessary changes
in the new order.
Type: Indwelling Single Lumen
Indication for Placement:
Details: To Dependent Drainage
Does this need to be inserted/placed?
IntraOp
Contingency Parameters
Notify Provider Provider to Notify: Provider
If systolic blood pressure > (mmHg): 160
If systolic blood pressure < (mmHg): 100
If diastolic blood pressure > (mmHg): 105
If diastolic blood pressure < (mmHg): 60
If temperature > (C): 38
If temperature < (C):
If heart rate > (bpm): 110
If heart rate < (bpm): 60
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): 120
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%): 92
If urine output < (mL): 30 for 4 hours
Other: If Fetal nonstress test results are
nonreactive.,If patient BMI greater than or equal to 40
kg.,Notify Neonatology patient is in hospital.
Pre-Op Day Of Procedure
Venous Thromboembolism (VTE) Prophylaxis
VTE Prophylaxis
Sequential Compression Device (SCD) Panel
(TREATMENT AND SUPPLY)
Sequential Compression Device (SCD)
(TREATMENT)
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
IntraOp
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY)
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
IntraOp
heparin PF 5000 UNIT/0.5ML injection 5,000 units, Subcutaneous, ON CALL For 1 Doses
If patient scheduled for block, give after block placed
IntraOp
VTE Prophylaxis - Reason Not Ordered ONCE For 1 Occurrences, Routine
Reason Not Ordered:
Pre-Op Day Of Procedure
Intravenous Therapy
Page 3 of 8
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 12:06:16 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org

Premedications for Needle Insertion
lidocaine (LMX) 4% topical dressing kit Topical, EVERY 1 HOUR PRN, peripheral line
insertion - see Admin Instructions
Do NOT apply to area greater than 200 square
centimeters (maximum 2.5 g/site; maximum 4 sites
per hour, 6 times per day). Do NOT leave on longer
than 2 hours. Use for stable patient, no allergies to
lidocaine, with at least 30 minutes time prior to IV use
Pre-Op Day Of Procedure
lidocaine (XYLOCAINE) 1% injection 0.1-0.4 mL, Intradermal, PRN, peripheral line
insertion - see Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge
needle to inject solution and create a wheal. Wait 30
seconds to 1 minute then insert IV catheter into
center of wheal. Use if IV is needed within 30
minutes. Choice of medication should be based on
patient’s previous experience/preference, history of
lidocaine allergy and ease of access
Pre-Op Day Of Procedure
sodium chloride (bacteriostatic) 0.9 % injection 0.05-0.1 mL, Intradermal, PRN, peripheral line
insertion - see Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge
needle to inject solution and create a wheal. Wait 30
seconds to 1 minute then insert IV catheter into
center of wheal. Use if IV is needed within 30
minutes. Choice of medication should be based on
patient’s previous experience/preference, history of
lidocaine allergy and ease of access
Pre-Op Day Of Procedure
IV Fluids
Insert and Maintain Peripheral IV CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Pre-Day of Procedure
Surgical Prophylaxis - Anti-infectives
C-Section Preoperative Antibiotics
cefazolin (ANCEF) intraVENOUS 2 g, Intravenous, ONCE For 1 Doses
Administer 60 minutes prior to procedure. Start within
1 hour prior to incision.
Pre-Op Day Of Procedure
cefazolin (ANCEF) intraVENOUS - For patients
greater than 100 kg
3 g, Intravenous, ONCE For 1 Doses
Administer 60 minutes prior to procedure. Start within
1 hour prior to incision.
Pre-Op Day Of Procedure
Clindamycin and Gentamicin - If patient has a
beta lactam allergy
clindamycin (CLEOCIN) intraVENOUS 900 mg, Intravenous, ONCE For 1 Doses
Administer 60 minutes prior to procedure
Pre-Op Day Of Procedure
Page 4 of 8
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 12:06:16 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org

gentamicin (GARAMYCIN) intraVENOUS 5 mg/kg, Intravenous, ONCE For 1 Doses
Administer 60 minutes prior to procedure. Start
within 1 hour prior to incision.
Pre-Op Day Of Procedure
vancomycin (VANCOCIN) intraVENOUS - For
patients with beta-lactam allergy or high MRSA
risk
15 mg/kg, Intravenous, ONCE For 1 Doses
Administer 2 hours prior to procedure
Pre-Op Day Of Procedure
Medications - General
Preprocedure Medications
metoclopramide (REGLAN) tab 10 mg, Oral, ONCE For 1 Doses
Administer 30-40 minutes prior to anesthesia
Pre-Op Day Of Procedure
metoclopramide (REGLAN) injection 10 mg, Intravenous, ONCE For 1 Doses
Administer 30-40 minutes prior to anesthesia
Pre-Op Day Of Procedure
ranitidine (ZANTAC) injection 50 mg, Intravenous, ONCE For 1 Doses
Administer 30-40 minutes prior to anesthesia
Pre-Op Day Of Procedure
ranitidine (ZANTAC) tab 150 mg, Oral, ONCE For 1 Doses
Administer 30-40 minutes prior to anesthesia
Pre-Op Day Of Procedure
citric acid-sodium citrate (BICITRA) 334-500
MG/5ML soln
30 mEq, Oral, ONCE For 1 Doses
Administer 30-40 minutes prior to anesthesia
Pre-Op Day Of Procedure
Post-Partum Hemorrhage Prophylaxis
oxytocin (PITOCIN) injection 10 units, Intramuscular, ONCE For 1 Doses
Administer immediately following delivery
IntraOp
oxytocin (PITOCIN) bolus and infusion panel "And" Linked Panel
oxytocin (PITOCIN) 30 units in sodium chloride
0.9 % 500 mL infusion BOLUS - 167 mL or 10
units
333 milli-units/min, Intravenous, ONCE For 1
Doses
Bolus 167 mL or 10 units. Immediately following
delivery
IntraOp
oxytocin (PITOCIN) 30 units in sodium chloride
0.9 % 500 mL infusion
95 milli-units/min, Intravenous, CONTINUOUS
95 mL/hr for 3.5 hours Immediately following 10
units oxytocin bolus
IntraOp
misoprostol (CYTOTEC) tab 800 mcg, Rectal, ONCE PRN For 1 Doses
Administer immediately following delivery
IntraOp
Post-Partum Hemorrhage Treatment
misoprostol (CYTOTEC) tab 800 mcg, Rectal, ONCE PRN For 1 Doses, treatment
of post-partum hemorrhage, IntraOp
methylergonovine (METHERGINE) injection 200 mcg, Intramuscular, ONCE PRN For 1 Doses,
treatment of post-partum hemorrhage
Notify provider PRIOR to administration and if patient
has history of hypertension
IntraOp
Page 5 of 8
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 12:06:16 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org

carboprost (HEMABATE) injection 250 mcg, Intramuscular, ONCE PRN For 1 Doses,
treatment of post-partum hemorrhage
Notify provider PRIOR to administration if patient has
history of asthma.
IntraOp
Laboratory
Laboratory
CBC WITH DIFFERENTIAL STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Pre-Op Day Of Procedure
Glucose, POC ONCE For 1 Occurrences, STAT, 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?
Pre-Op Day Of Procedure
Glucose, POC STAT - RN COLLECT 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?
IntraOp
Tests
Tests
Type and Screen STAT - RN COLLECT For 1 Occurrences, Routine,
As good clinical practice and for patient safety, the
Transfusion Service will automatically crossmatch 2
packed RBCs on all patients with antibodies to
ensure blood would be available in the event it is
needed. If you would like to opt out of this automatic
order for this patient please contact the UWHC Blood
Bank at (608) 263-8367 or The American Center Lab
at (608) 234-6600 as appropriate., Pre-Op Day Of
Procedure
Blood Bank
Blood Product
Page 6 of 8
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 12:06:16 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org

Red Blood Cells (Adult) 2 UNITS, Starting S For 2 Occurrences, Routine
Reason for Order: R1 Life-threatening hemorrhage or
anticipated/ongoing surgical blood loss
Blood Product Need (It will take approximately 30 to
60 minutes from the time nursing notifies the Blood
Bank to prepare the products): SURGICAL USE
Date Product Needed:
Uncrossmatched **WARNING** Requesting MD
verifies that the clinical situation is sufficiently urgent
to require release of blood before completion of
compatibility testing and agrees to hold UWHC
harmless for any and all liability for any injuries
resulting from release of blood before such testing:
Irradiated (See Blood Product Guidelines) (May be
pre-selected based on history):
CMV Negative (Heart/Lung Transplant and Neonates
up to 4 Months Only) (May be pre-selected based on
history):
Consent Status:
Pre-Op Day Of Procedure
Transfusion
Transfuse Red Blood Cells (Adult) TRANSFUSE 2 UNITS For 2 Occurrences, Routine,
Patient Weight
No data found for Wt
All cellular products are leukocyte-reduced (CMV
safe)
1 Red Blood Cell Unit ~ 350 mL.
Run Each Unit Over:
Pre-Op Day Of Procedure
Diagnostic Tests & Imaging
Diagnostic Tests & Imaging
US PREGNANCY LIMITED ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
Is this to be done remotely (Not in Radiology)?
Transport Method: Floor Determined/Entered
Pre-Op Day Of Procedure
Criteria
Suggestions:
Filter: UWIP ORDER SET RESTRICTION - HOSPITAL ENCOUNTERS EXCEPT ED -
NOT IP DC[3000400]
Restrict SmartSet:
Page 7 of 8
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 12:06:16 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org

Settings
Discontinue action:
Deselect sections for
Pended/Held orders:
Pended/Held orders
display:
Release date: Use System Definitions Setting
Disallow user override:
Page 8 of 8
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 12:06:16 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org