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/clinical/cckm-tools/content/order-sets/inpatient/orthopedicsrehab/name-98103-en.cckm

20170117

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IP - Orthopedics - Neuromuscular Spinal Fusion - Pediatric - Postoperative [2770]

IP - Orthopedics - Neuromuscular Spinal Fusion - Pediatric - Postoperative [2770] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Orthopedics/Rehab


IP - Orthopedics - Neuromuscular Spinal Fusion - Pediatric - Postoperative
[2770]
Admission Status
Admission Status [185007]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service: PEDIATRIC CRITICAL CARE
I certify that an inpatient stay is medically necessary
because of either an anticipated LOS >2 midnights,
complexity and/or severity of illness, an inpatient-only
surgery, or a previously-authorized inpatient stay.
Rationale listed below. Yes
C - CLEAR DIAGNOSIS:
E - EVALUATIONS PLANNED:
R - RESULTS EXPECTED:
T - TREATMENTS ORDERED:
Post-Op/Phase II
Patient Care Orders
Vital Signs [86529]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every hour times 2, then every 2 hours times 2, then
every 4 hours times 3, then every 8 hours., Post-
Op/Phase II
Neurovascular Checks [NURMON0045] EVERY 1 HOUR, Starting today, Routine, Post-
Op/Phase II
Activity [86530]
Bedrest [NURACT0008] CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST: other (comment)
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Post-Op/Phase II
Page 1 of 7
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

Ambulate [NURACT0008] CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE: other (comment)
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Post-Op/Phase II
Activity Progression Trial [NURACT0008] CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE: other (comment)
CHAIR: other (comment)
DANGLE: other (comment)
BEDREST: other (comment)
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Post-Op/Phase II
Limit Hip Flexion [NURACT0011] SEE COMMENTS, Starting today, Limit hip flexion to
less than 90 degrees., Post-Op/Phase II
Nursing Communication - Activity
[NURACT0011]
SEE COMMENTS, ***, Post-Op/Phase II
Nutrition [86531]
NPO Except Medications [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Pediatric
Diet Type: NPO
NPO Diet: NPO except Medications
Bedside Meal Instructions:
Room Service Class:
Post-Op/Phase II
Clear Liquid Diet [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Pediatric
Diet Type: Diet Modifications
Diet Modifications: Liquid
Liquid:
Liquid Thickness: Thin
Bedside Meal Instructions:
Room Service Class:
Post-Op/Phase II
Respiratory [86532]
Pulse Oximetry [NURMON0009] CONTINUOUS, Starting today, Routine, Post-
Op/Phase II
Provide Manual Resuscitator at Bedside
[RT0039]
CONTINUOUS, Starting today, Routine, Post-
Op/Phase II
Incentive Spirometry [NURTRT0018] EVERY 2 HOURS, Routine, Post-Op/Phase II
Intake and Output [86533]
Measure Intake And Output [NURMON0005] EVERY 8 HOURS, Starting today, Routine, Post-
Op/Phase II
Non-Categorized Patient Care Orders [86534]
Page 2 of 7
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01/2017CCKM@uwhealth.org

Insert and Maintain Urinary Catheter
[NURELM0013]
CONTINUOUS, Starting today For Until specified,
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?
Post-Op/Phase II
Check Bladder Volume with Bladder Scan
[NURELM0001]
SEE COMMENTS, Starting today, Routine
Straight Cath for Residual > (mL):
Bladder scan if patient has not voided in 8 hours,
Post-Op/Phase II
Maintain Chest Tube [NURTAD0001] CONTINUOUS, Starting today, Routine
Location:
Position: N/A - Single Location
Drainage Options: -20 cm wall suction
Site Assessment Frequency:
Care Frequency:
Wash With:
Primary Dressing:
Secondary Dressing:
Post-Op/Phase II
Contingency Parameters for Patients 3 through 6 Years Old [135347]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 118
If systolic blood pressure < (mmHg): 87
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C): 38.5
If temperature < (C):
If heart rate > (bpm): 140
If heart rate < (bpm): 75
If respiratory rate >: 30
If respiratory rate <: 18
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%): 93
If urine output < (mL):
Other:
Post-Op/Phase II
Intravenous Therapy
IV Fluids (Single Response) [86538]
Suggested dose: For weight less than 10 kg suggested dose (mL/hr) = weight in kg x 4 For weight 10-20
kg suggested dose (mL/hr) = (weight in kg x 2) + 20 For weight greater than 20 kg suggested dose (mL/hr)
= weight in kg + 40)
dextrose 5%-NaCl 0.45% infusion [51613] Intravenous, CONTINUOUS
Suggested dose: For weight less than 10 kg
suggested dose (mL/hr) = weight in kg x 4 For weight
10-20 kg suggested dose (mL/hr) = (weight in kg x 2)
+ 20 For weight greater than 20 kg suggested dose
(mL/hr) = weight in kg + 40)
Post-Op/Phase II
Page 3 of 7
Printed by O'BRIEN, RYLEY P [RPO249] at 1/9/2017 4:04:36 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2017CCKM@uwhealth.org

dextrose 5%-NaCl 0.2% with KCl 20 mEq/L
infusion [44909]
Intravenous, CONTINUOUS
Suggested dose: For weight less than 10 kg
suggested dose (mL/hr) = weight in kg x 4 For weight
10-20 kg suggested dose (mL/hr) = (weight in kg x 2)
+ 20 For weight greater than 20 kg suggested dose
(mL/hr) = weight in kg + 40)
Post-Op/Phase II
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L
infusion [44910]
Intravenous, CONTINUOUS
Suggested dose: For weight less than 10 kg
suggested dose (mL/hr) = weight in kg x 4 For weight
10-20 kg suggested dose (mL/hr) = (weight in kg x 2)
+ 20 For weight greater than 20 kg suggested dose
(mL/hr) = weight in kg + 40)
Post-Op/Phase II
Premedication for Needle Insertion [84317]
Lidocaine [152737]
lidocaine (LMX) 4% topical dressing kit [66882] Topical, EVERY 1 HOUR PRN, prior to needle
sticks to reduce pain. See "LMX Use Instructions"
order in Active Orders report or the Admin
Instructions for application details
FOR PATIENTS 5 Kg OR LESS: Do NOT apply to
area greater than 100 square centimeters.
(maximum 1 g/site; maximum 1 site per hour, 6
times per day).
FOR PATIENTS 5.1-10 Kg: Do NOT apply to area
greater than 100 square centimeters. (maximum 1
g/site; maximum 2 sites per hour, 6 times per day).
FOR PATIENTS GREATER THAN 10 Kg: Do NOT
apply to area greater than 200 square centimeters.
(maximum 2.5 g/site; maximum 4 sites per hour, 6
times per day).
For patients less than 1 year old do NOT leave on
longer than 1 hour. For patients 1 year or older do
NOT leave on longer than 2 hours
Post-Op/Phase II
LMX Use Instructions for Premedication Prior to
Needle Insertion [NURCOM0095]
Post-Op/Phase II
Surgical Prophylaxis
First Line [146325]
Cefepime and Vancomycin [207773]
cefepime (MAXIPIME) intraVENOUS [800016] 50 mg/kg, Intravenous, EVERY 8 HOURS For 2
Doses, Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, EVERY 6 HOURS For 3
Doses, Post-Op/Phase II
Immediate/Severe Rxn to PCN or Known Ceph Allergies [218449]
Vancomycin and Tobramycin [208500]
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, EVERY 6 HOURS For 3
Doses
tobramycin (NEBCIN) intraVENOUS [800081] 4 mg/kg, Intravenous, EVERY 12 HOURS For 1
Doses
General Medications
Analgesics - Acetaminophen - Scheduled (Single Response) [131815]
Page 4 of 7
Printed by O'BRIEN, RYLEY P [RPO249] at 1/9/2017 4:04:36 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2017CCKM@uwhealth.org

acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - NOTE: Suggested dose 15 mg/kg
(Maximum 650 mg/dose) [800005]
15 mg/kg, Oral, EVERY 6 HOURS For 72 Hours,
Post-Op/Phase II
acetaMINOPHEN (TYLENOL) tab [34149] Oral, EVERY 6 HOURS For 72 Hours, Post-
Op/Phase II
acetaMINOPHEN (TYLENOL) suppository -
NOTE: Suggested dose 20 mg/kg. Must order in
whole suppository size (maximum 650 mg/dose)
[43994]
Rectal, Post-Op/Phase II
Analgesics - Acetaminophen - PRN (Starting in 72 hours) (Single Response) [187907]
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - NOTE: Suggested dose 15 mg/kg
(Maximum 650 mg/dose) [800005]
15 mg/kg, Oral, EVERY 4 HOURS PRN Starting
1/12/17, pain, Mild pain or multimodal therapy., Post-
Op/Phase II
acetaMINOPHEN (TYLENOL) tab - NOTE:
Suggested dose 15 mg/kg (maximum 650
mg/dose) [34149]
Oral, EVERY 4 HOURS PRN Starting 1/12/17, pain,
Mild pain or multimodal therapy, Post-Op/Phase II
acetaMINOPHEN (TYLENOL) suppository -
NOTE: Suggested dose 20 mg/kg. Must order in
whole suppository size (Maximum 650 mg/dose)
[43994]
Rectal, EVERY 6 HOURS PRN Starting 1/12/17,
pain, Mild pain or multimodal therapy, Post-Op/Phase
II
Analgesics - NSAID - Scheduled (Single Response) [187906]
ketOROLAC (TORODOL) injection - NOTE:
Suggested dose 0.5 mg/kg (Maximum 15
mg/dose) [800050]
0.5 mg/kg, Intravenous, EVERY 6 HOURS For 72
Hours, Post-Op/Phase II
ibuprofen (MOTRIN) susp - NOTE: Suggested
dose 10 mg/kg (Maximum 600 mg/dose) [45376]
10 mg/kg, Oral, EVERY 6 HOURS For 72 Hours,
Post-Op/Phase II
Analgesics - NSAID - PRN (Starting in 72 hours) [187870]
ibuprofen (MOTRIN) susp - NOTE: Suggested
dose 10 mg/kg (Maximum 600 mg/dose) [45376]
10 mg/kg, Oral, EVERY 6 HOURS PRN Starting
1/12/17, pain, Mild to Moderate Pain or Multimodal
therapy, Post-Op/Phase II
Analgesics - Opioids (Oral) - PRN (Single Response) [187909]
oxycodone 5 MG/5ML soln RANGE – (Maximum
20 mg/dose) [750031]
0.1-0.2 mg/kg, Oral, EVERY 4 HOURS PRN, pain,
Moderate/Severe Pain, Post-Op/Phase II
oxycodone tab RANGE – NOTE: Suggested
dose 0.1-0.2 mg/kg (Maximum 20mg/dose)
[750032]
Oral, EVERY 4 HOURS PRN, pain, Moderate/Severe
Pain, Post-Op/Phase II
Analgesics - Opioids (Intravenous) - PRN (Single Response) [187910]
morphine PF injection – NOTE: suggested dose
0.05 – 0.1 mg/kg (Maximum 2 mg/dose) [800122]
0.05-0.1 mg/kg, Intravenous, EVERY 2 HOURS PRN,
pain, Moderate/Severe Pain and unable to take oral
opiod, Post-Op/Phase II
HYDROmorphone PF (DILAUDID) injection -
NOTE: suggested dose 0.01-0.02 mg/kg
(Maximum 0.4 [800120]
0.01-0.02 mg/kg, Intravenous, EVERY 2 HOURS
PRN, pain, Moderate/Severe Pain and unable to take
oral opiod, Post-Op/Phase II
Bowel Management (Single Response) [131817]
docusate sodium (COLACE) cap [36859] 100 mg, Oral, 2 X DAILY, Post-Op/Phase II
polyethylene glycol (MIRALAX) oral powder -
NOTE: suggested dose 0.01-0.02 mg/kg
(Maximum 0.4 [61829]
3.4 g, Oral, 1 X DAILY, Post-Op/Phase II
polyethylene glycol (MIRALAX) oral powder -
NOTE: For patients 10 - 25 kg [61829]
8.5 g, Oral, 1 X DAILY
Dissolve in 4 ounces of water
NOTE: For patients less than 25 kg
Post-Op/Phase II
polyethylene glycol (MIRALAX) oral powder -
NOTE: For patients 25 kg or greater [61829]
17 g, Oral, 1 X DAILY
Dissolve in 8 ounces of water
NOTE: For patients 25 kg or greater
Post-Op/Phase II
Page 5 of 7
Printed by O'BRIEN, RYLEY P [RPO249] at 1/9/2017 4:04:36 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2017CCKM@uwhealth.org

Anti-emetics [88788]
ondansetron (ZOFRAN) injection - NOTE:
Suggested dose 0.1 mg/kg (Maximum 4
mg/dose) [800202]
0.1 mg/kg, Intravenous, EVERY 24 HOURS PRN,
nausea/vomiting
NOTE: Suggested dose 0.1 mg/kg (Maximum 4
mg/dose)
Post-Op/Phase II
Non-categorized Medications [202767]
nalbuphine (NUBAIN) injection - Maximum Dose
= 2.5 mg [39994]
0.05 mg/kg, Intravenous, EVERY 6 HOURS PRN,
pain, 1st Line Pruiritis, for 3 Minutes
Laboratory
Now [86547]
HEMATOCRIT [HCT] 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?
Post-Op/Phase II
ELECTROLYTES [LYTE] 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?
Post-Op/Phase II
CALCIUM [CA] 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?
Post-Op/Phase II
MAGNESIUM [MAG] 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?
Post-Op/Phase II
PHOSPHATE [PHOS] 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?
Post-Op/Phase II
Tomorrow in AM [86548]
CBC WITHOUT DIFFERENTIAL [HEMO] 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?
Post-Op/Phase II
ELECTROLYTES [LYTE] 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?
Post-Op/Phase II
Consults
Consults [86550]
Page 6 of 7
Printed by O'BRIEN, RYLEY P [RPO249] at 1/9/2017 4:04:36 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2017CCKM@uwhealth.org

Consult Physical Therapy (Inpatient) Eval and
Treat [CON0061]
ONCE, Starting today For 1 Occurrences, Routine
Reason for Physical Therapy Consult: Mobility
Training
Post-Op/Phase II
Consult Occupational Therapy (Inpatient) Eval
and Treat [CON0046]
ONCE, Starting today For 1 Occurrences, Routine
Reason for Occupational Therapy Consult:
Post-Op/Phase II
Consult Pediatric Anesthesia Pain Service
[CON0166]
ONCE, Routine
Reason for Consult:
Can this consult be done via video?
Post-Op/Phase II
Consult Pediatric Hospitalist (Inpatient)
[CON0135]
ONCE
Intent:
Concern or Specific Question or Task to be
Addressed (Symptom, Sign, or Diagnosis):
Can this consult be done via video?
Call back number:
Post-Op/Phase II
Consult Respiratory Therapy (Inpatient)
[CON0071]
ONCE, Routine
Reason for Consult:
Can this consult be done via video?
Post-Op/Phase II
BestPractice
No Hospital Problems have yet been identified [107363]
Specify Hospital Problem(s) [COR0018] You will be prompted to specify a hospital problem on
signing., Post-Op/Phase II
Page 7 of 7
Printed by O'BRIEN, RYLEY P [RPO249] at 1/9/2017 4:04:36 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2017CCKM@uwhealth.org