/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/pulmonary/,

/clinical/cckm-tools/content/order-sets/inpatient/pulmonary/name-98034-en.cckm

201606175

page

100

UWHC,UWMF,

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

IP – Nitric Oxide – Adult – Procedure [2181]

IP – Nitric Oxide – Adult – Procedure [2181] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Pulmonary


IP - Nitric Oxide - Adult - Procedure [2181]
Intended for Adult Patients Only
Patient Care Orders
Respiratory [30242]
Nitric Oxide Continuous [RT0030] CONTINUOUS, Starting today, Routine
Indication:
Indications which Require Approval of the ICU Director or
Designee:
Initial Dose (ppm):
Maximum Dose (ppm):
Titrate Nitric Oxide dose by 20ppm Every 5 Minutes to
Achieve SaO2 Greater Than (%):
Titrate Nitric Oxide dose by 20ppm Every 5 Minutes to
Achieve PA Pressure less than (mmHg):
Decrease NO for Methemoglobinemia > (%):
Decrease NO for NO2 of > (ppm):
Decrease Inhaled Nitric Oxide Dose by 20 ppm for
Methemoglobin Level Greater than 5% [RT0073]
CONTINUOUS, Starting today, Routine
Decrease Inhaled Nitric Oxide Dose by 20 ppm for
Nitrogen Dioxide Greater than 5 ppm [RT0073]
CONTINUOUS, Starting today, Routine
Weaning [30252]
Recommended Wean [RT0073] CONTINUOUS, Starting today, Routine, Decrease nitric oxide
inhalation by 5 ppm every 30 minutes as tolerated until off.
Alternative Wean [RT0073] CONTINUOUS, Starting today, Routine, Decrease nitric oxide
inhalation by *** ppm every *** minutes as tolerated until off.
Contingency Parameters [30253]
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: No response noted within 4 hours of treatment.,For
increasing methemoglobin level.,For abnormal
methemoglobin levels.
Laboratory
Draw Every 6 Hours [30254]
METHEMOGLOBIN [XMHGB] EVERY 6 HOURS, Starting today For 7 Days, STAT
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
While patient is on nitric oxide.
Page 1 of 1
Pr i nt ed by LIND, JANNA S [JSL237] at 2/19/2015 2:42:29 PM
Copyright © 2015 University of Wisconsin Hospital and Clinics Authority