/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/pain-management/,

/clinical/cckm-tools/content/order-sets/inpatient/pain-management/name-98086-en.cckm

20170117

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Pain Management

IP – Spinal Cord Stimulator Therapy – Adult – Postprocedure [2370]

IP – Spinal Cord Stimulator Therapy – Adult – Postprocedure [2370] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Pain Management


IP - Spinal Cord Stimulator Therapy - Adult - Postprocedure [2370]
Intended for Adult Patients Only
Admission Status
Level of Care (Single Response) [186484]
*An admit patient order has already been written, but the level of care at which the patient
should be placed still needs to be identified.
Place Patient on General Care [ADT0018] General Care, has already been signed. This order
will ensure that the patient is placed at the
appropriate level of care.
Place Patient on Intermediate Care (IMC)
[ADT0018]
Intermediate Care, has already been signed. This
order will ensure that the patient is placed at the
appropriate level of care.
Place Patient on Intensive Care (ICU) [ADT0018] Intensive Care, has already been signed. This order
will ensure that the patient is placed at the
appropriate level of care.
Patient Care Orders
Vital Signs [34106]
Measure Heart Rate and Blood Pressure
[NURMON0056]
SEE COMMENTS, Starting today, Routine, Every one
hour for the first 4 hours, then every 4 hours.
Measure Temperature [NURMON0029] EVERY 8 HOURS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
Measure Respiratory Rate (Full Minute)
[NURMON0028]
SEE COMMENTS, Starting today, Routine, Every one
hour times 24 hours, then every 4 hours.
Assess for Orthostatic Changes in Blood
Pressure and Heart Rate [NURMON0007]
ONCE, Starting today For 1 Occurrences, Routine,
Prior to first ambulation.
Patient Monitoring [34107]
Assess Patient's Pain Rating [NURMON0060] SEE COMMENTS, Starting today, In 1 hour, then
every 8 hours while awake and as needed if patient
develops pain at insertion site, diffuse back pain,
spinal headache, or if inadequate pain control.
Assess for Changes in Sensation and Strength in
Extremities [NURMON0060]
SEE COMMENTS, Starting today, Every 8 hours
while awake.
Patient is to Maintain Pain Log as Directed
[NURMON0060]
CONTINUOUS, Starting today
Activity [34108]
Ad Lib [NURACT0008] CONTINUOUS, Starting today, Routine
AD LIB: ad lib
AMBULATE:
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
No Turning, Twisting, Bending, Reaching,
Pushing, Pulling, Straining, Coughing or
Sneezing [NURACT0011]
CONTINUOUS, Starting today
Page 1 of 4
Printed by STRAKA, KEVIN F [KFS1] at 1/13/2017 1:24:54 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

Logroll in Bed [NURACT0008] CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST: strict logroll
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Logroll in bed.
Nutrition [34109]
General Diet [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: General (no Modifications)
Bedside Meal Instructions:
Room Service Class:
Intake and Output [34110]
Urinary Catheterization-Intermittent
[NURELM0018]
EVERY 6 HOURS PRN, Starting today, Routine, As
needed if unable to void and bladder scan is greater
than 400 mL.
Procedure Site Care [34111]
Physican or Mid-Level Provider to Change
Dressing [NURWND0018]
CONTINUOUS, Starting today
Wound Care [NURWND0015] CONTINUOUS, Starting today, Routine
Wound Type: Closed - Incision
Wound Site:
Wound Location:
Assess Frequency: SEE COMMENTS
Care Frequency:
Wash With:
Irrigate/Rinse With:
Apply (Must also enter separate medication order to
obtain drug):
Primary Dressing: Gauze (RN to reinforce dressing
with gauze)
Secondary Dressing:
Site Assessment Frequency: Every 8 hours for the
first 24 hours and as needed, then daily.
Apply Brace, Spine - Abdominal Binder
[NURTRT0014]
CONTINUOUS, Starting today, Routine
Type: Abdominal Binder
Wearing schedule: Continuous
If Drainage Soaks Through Dressing [34112]
RN to Mark Borders, Date, and Time.
[NURWND0018]
SEE COMMENTS, Starting today, RN to continue to
monitor for excess ooze every 8 hours for the first 24
hours and as needed, then every day.
Contingency Parameters [34113]
Page 2 of 4
Printed by STRAKA, KEVIN F [KFS1] at 1/13/2017 1:24:54 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2017CCKM@uwhealth.org

Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 160
If systolic blood pressure < (mmHg): 80
If diastolic blood pressure > (mmHg): 90
If diastolic blood pressure < (mmHg): 50
If temperature > (C): 38
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <: 8
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: Greater than 20% orthostatic
changes,Uncontrolled pain or pain greater than 8-9
(1-10 scale),New back pain or tenderness, head or
neck pain,Progressive loss of sensation and strength
in lower extremities,Increased discharge or bleeding
at insertion site,Side effects unrelieved by prescribed
treatment
Notify provider at pager # ***.
Intravenous Therpay
IV Fluids [33988]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Starting today For Until specified,
Routine
Peripheral IV Size: 20 Gauge
Does this need to be inserted/placed?
sodium chloride 0.9% infusion [64367] Intravenous, CONTINUOUS
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L
infusion [44910]
Intravenous, CONTINUOUS
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Starting today For Until specified,
Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Flushes [33935]
Note: Initate Vascular Access Device Flushing
Protocol [950018]
ONCE For 1 Doses
Note: Initate Flushing Protocol
sodium chloride 0.9% flush 10 mL injection
[785055]
Flush, PRN, flush/line care
Flush per VAD guidelines
Medications - General
Non-categorized [33943]
Note: Resume subcutaneous heparin or warfarin
starting 24 hours after procedure [950018]
ONCE Starting tomorrow For 1 Doses
Note: Resume subcutaneous heparin or warfarin
starting 24 hours after procedure
Analgesics - Acetaminophen - Oral - PRN [218533]
acetaMINOPHEN (TYLENOL) tab [34149] 325-650 mg, Oral, EVERY 6 HOURS PRN, pain, Mild
to moderate pain or multi-modal therapy
Bowel Management - Scheduled [19071]
Page 3 of 4
Printed by STRAKA, KEVIN F [KFS1] at 1/13/2017 1:24:54 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2017CCKM@uwhealth.org

senna-docusate (SENOKOT-S) 8.6-50 mg per
tab [60530]
2 tab, Oral, 2 X DAILY
Hold for loose stools
Bowel Management [218534]
polyethylene glycol (MIRALAX) oral powder
[61829]
17 g, Oral, 1 X DAILY PRN, constipation
Dissolve in 8 ounces of water, Use as first line
therapy
magnesium hydroxide (MILK OF MAGNESIA)
susp [65443]
30 mL, Oral, 2 X DAILY PRN, constipation
Second line therapy. Administer if no response to
first line laxative within 24 hours.
bisacodyl (DULCOLAX) rectal suppository
[35231]
10 mg, Rectal, 1 X DAILY PRN, constipation
Third line therapy. Administer if there is no response
to first and second line laxatives, or when there is
need for immediate laxation.
Page 4 of 4
Printed by STRAKA, KEVIN F [KFS1] at 1/13/2017 1:24:54 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2017CCKM@uwhealth.org