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IP – Asthma Exacerbation – Pediatric – General Case - Admission [997]

IP – Asthma Exacerbation – Pediatric – General Case - Admission [997] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Pulmonary


IP - Asthma Exacerbation - Pediatric - General Care - Admission [997]
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.
Admit to Inpatient (Single Response) [188296]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service:
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:
Admit to Observation (Single Response)
[188297]
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Admit to Outpatient Short Stay (Single
Response) [188298]
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Admission Status (Single Response) [82665]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service:
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:
Page 1 of 7
Printed by WILLIAMS, HEATHER R [HRS0] at 9/26/2017 12:57:16 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org

Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Admission Status (Single Response) [200275]
Admit To Inpatient Status [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service:
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:
Admit To Observation Status [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Isolation Status
Isolation Status [152666]
Isolation - Contact And Droplet - Respiratory
Infection - Acute - Panel [116343]
Isolation - Contact and Droplet - Respiratory
Infection - Acute [ISO0045]
CONTINUOUS
Isolation Cart [EQP0016] CONTINUOUS, Routine
Patient Care Orders
Vital Signs [12194]
Vital Signs - Every 4 hours [NURMON0013] EVERY 4 HOURS, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Vital Signs - Every 2 hours x4, then every 4 hours
[NURMON0013]
SEE COMMENTS, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 2 hours x4, then every 4 hours
Page 2 of 7
Printed by WILLIAMS, HEATHER R [HRS0] at 9/26/2017 12:57:16 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org

Vital Signs - Every hour x2, then every 2 hours
x2, then every 4 hours [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.
Activity [12195]
Ad Lib [NURACT0008] CONTINUOUS, Starting today For Until specified,
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:
Nutrition [12196]
General Diet [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Pediatric
Diet Type: General (no Modifications)
Bedside Meal Instructions:
Room Service Class:
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:
Respiratory [12197]
Oxygen Therapy [RT0032] CONTINUOUS, Starting today, Routine
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%): 90
O2 Delivery Device:
Attempt to Wean Off Oxygen? Yes
Initiate Pediatric Asthma or Recurrent Wheezing
Protocol [192235]
Initiate Pediatric Asthma or Recurrent Wheezing
Protocol [RT0072]
Routine
RT to Provide Asthma Education to Patient
[RT0125]
ONCE, Routine
Pulse Oximetry [NURMON0009] SEE COMMENTS, Starting today, Routine, On
admission, and with Vital Signs
Intake and Output [12198]
Measure Intake And Output [NURMON0005] EVERY 8 HOURS, Starting today, Routine
Non-Categorized Patient Care Orders [112138]
Measure Height on Admission [NURMON0052] ONCE For 1 Occurrences, Routine, On Admission
Measure Weight on Admission [NURMON0015] ONCE For 1 Occurrences, Routine
Weigh With?
Weigh when?
Page 3 of 7
Printed by WILLIAMS, HEATHER R [HRS0] at 9/26/2017 12:57:16 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org

Note: Notify Pharmacy [950015] PRN, For new patients
For new patients, RPh, please investigate insurance
coverage for inpatient/outpatient inhalers
Contingency Parameters [12199]
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 < (%): 90
If urine output < (mL):
Other: FiO2 greater than 40%,Increasing
supplemental oxygen requirement,Initiation of
supplemental oxygen therapy
Contingency Parameters for Respiratory Therapy [200237]
Notify Provider [RT0073] RT PRN, Routine, Fi02 greater than 40%
Increasing supplemental oxygen requirement.
Initiation of supplemental oxygen therapy.
Worsening or increasing respiratory distress.
Increasing frequency of bronchodilator therapy.
Asthma score not improving after bronchodilator
therapy.
Asthma score continuing to be > 2 following 8 puffs
(which equates to 1 treatment) of bronchodilator
therapy.
Unable to wean frequency from Q2 hours after
receiving 3 bronchodilator therapies within 6 hours.
Intravenous Therapy
Premedication for Needle Insertion [30232]
Lidocaine [152737]
Page 4 of 7
Printed by WILLIAMS, HEATHER R [HRS0] at 9/26/2017 12:57:16 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org

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
LMX Use Instructions for Premedication Prior to
Needle Insertion [NURCOM0095]
Details
Medications - Admission-Specific
Protocol are ordered via Pediatric Asthma or Recurrent Wheezing Bronchodilators
Analgesics - Acetaminophen - PRN [200230]
acetaMINOPHEN (TYLENOL) tab - NOTE:
Suggested dose 10-15 mg/kg/dose (Maximum
650 mg/dose) [34149]
Oral, EVERY 4 HOURS PRN, pain, 1st Line Therapy.
Temperature greater than *** C or mild to moderate
pain
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - NOTE: Suggested dose 10-15
mg/kg/dose (Maximum 650 mg/dose) [800005]
Oral, EVERY 4 HOURS PRN, fever, 1st Line Therapy.
Temperature greater than *** C or mild to moderate
pain.
Temperature greater than *** C or pain
NOTE: Suggested dose 10-15 mg/kg/dose (Maximum
650 mg/dose)
acetaMINOPHEN (TYLENOL) suppository -
NOTE: Suggested dose 10-15 mg/kg /dose
(Maximum 650 mg/dose) [43994]
Rectal, EVERY 4 HOURS PRN, pain/fever, 1st Line
Thearpy, if unable to tolerate oral. Temperature
greater than *** C or mild to moderate pain.
Temperature greater than *** C or pain
NOTE: Suggested dose 10-15 mg/kg/dose (Maximum
650 mg/dose)
Analgesics - NSAIDS - PRN [233433]
ibuprofen (MOTRIN) susp - NOTE: Suggested
dose 10 mg/kg/dose (Maximum 600 mg/dose)
[45376]
10 mg/kg, Oral, EVERY 6 HOURS PRN, pain,
Administer if no response to 1st line therapy after 30
minutes. Mild to moderte pain.
Temperature greater than *** C or pain
NOTE: Suggested dose 10 mg/kg/dose (Maximum
600 mg/dose)
ibuprofen (MOTRIN) tab - NOTE: Suggested dose
10 mg/kg/dose (Maximum 600 mg/dose) [38353]
Oral, EVERY 6 HOURS PRN, pain, Administer if no
response to 1st line therapy after 30 minutes.
Temperature greater than *** C or mild to moderate
pain
Corticosteroids (Single Response) [12284]
prednisolone (PRELONE) syrup - NOTE:
Suggested dose 1 mg/kg (Maximum 30 mg/dose).
Change priority to routine if already received
steroids on day of admission [46299]
1 mg/kg, Oral, 2 X DAILY (AT MEALTIME)
NOTE: Suggested dose 1 mg/kg (Maximum 30
mg/dose). Change priority to routine if already
received steroids on day of admission
Page 5 of 7
Printed by WILLIAMS, HEATHER R [HRS0] at 9/26/2017 12:57:16 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org

prednisone (DELTASONE) tab - NOTE:
Suggested dose 1 mg/kg (Maximum 30 mg/dose).
Change priority to routine if already received
steroids on day of admission [41277]
1 mg/kg, Oral, 2 X DAILY (AT MEALTIME)
NOTE: Suggested dose 1 mg/kg (Maximum 30
mg/dose). Change priority to routine if already
received steroids on day of admission
Corticosteroid Reason Not Ordered [COR0006] ONCE For 1 Occurrences, Routine
Reason Not Ordered:
Inhaled Corticosteroids (Single Response) [12285]
fluticasone HFA (FLOVENT HFA) 44 MCG/ACT
inhaler [106425]
2 puff, Inhalation, RT 2 X DAILY
fluticasone HFA (FLOVENT HFA) 110 MCG/ACT
inhaler [106426]
2 puff, Inhalation, RT 2 X DAILY
fluticasone HFA (FLOVENT HFA) 110 MCG/ACT
inhaler [106426]
4 puff, Inhalation, RT 2 X DAILY
fluticasone-salmeterol (ADVAIR HFA) 45-21
mcg/dose inhaler [113962]
2 puff, Inhalation, RT 2 X DAILY
fluticasone-salmeterol (ADVAIR HFA) 115-21
mcg/dose inhaler [113963]
2 puff, Inhalation, RT 2 X DAILY
fluticasone-salmeterol (ADVAIR HFA) 230-21
mcg/dose inhaler [113964]
2 puff, Inhalation, RT 2 X DAILY
beclomethasone (QVAR) 40 MCG/ACT inhaler
[65596]
Inhalation
beclomethasone (QVAR) 80 MCG/ACT inhaler
[65597]
Inhalation
Sucrose for Oral Analgesia [110384]
sucrose (SWEET-EASE) 24% buccal soln
[794009]
Oral, PRN, pain, mild pain or potentially painful
procedures. See Admin Instructions
Consults
Consults [12202]
Consult Pediatric Allergy (For hospitalizations
anticipated longer than 24 hours or PICU
admission or history of prior intubation for asthma
or > 2 ED visits for asthma in the past 6 months)
[CON0088]
ONCE
Intent:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis): For Hospitalizations
anticipated longer than 24 hours or PICU admission or
history of prior intubation for asthma or > 2 ED visits
for asthma in the past 6 months.
Can this consult be done via video?
Consult Pediatric Allergy (For Medication
Requirements Equal to or Greater than Step 3)
[CON0088]
ONCE
Intent:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis): Poorly controlled
asthma
Consult Pediatric Pulmonary (For hospitalizations
anticipated longer than 24 hours or PICU
admission or history of prior intubation for asthma
or > 2 ED visits for asthma in the past 6 months)
[CON0098]
ONCE
Intent:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis): For hospitalizations
anticipated longer than 24 hours or PICU admission or
history of prior intubation for asthma or > 2 ED visits
for asthma in the past 6 months
Consult Pediatric Pulmonary (For Medication
Requirements Equal to or Greater than Step 3)
[CON0098]
ONCE
Intent:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis): Poorly controlled
asthma
Page 6 of 7
Printed by WILLIAMS, HEATHER R [HRS0] at 9/26/2017 12:57:16 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org

Consult Social Work (Inpatient) [CON0076] ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult: OTHER
Poorly controlled asthma complicated by home
stressors.
Consult Pediatric Health Psychology (Inpatient)
[CON0202]
ONCE, Routine, Please notify consulting provider if
patient needs to be seen same day (Monday-Friday)
or if special assessment needs.
Reason for Consult: Poorly controlled asthma
complicated by psychosocial factors
BestPractice
No Hospital Problems have yet been identified. [107035]
Specify Hospital Problem(s) [COR0018] You will be prompted to specify a hospital problem on
signing.
Page 7 of 7
Printed by WILLIAMS, HEATHER R [HRS0] at 9/26/2017 12:57:16 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org