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/clinical/cckm-tools/content/order-sets/inpatient/radiology/name-97951-en.cckm

201605142

page

100

UWHC,UWMF,

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

IP - Body - Percutaneous Biopsy - Adult - Preprocedure [1611]

IP - Body - Percutaneous Biopsy - Adult - Preprocedure [1611] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Radiology


IP - Body - Percutaneous Biopsy - Adult - Preprocedure [1611]
Intended for Adult Patients Only
Patient Care Orders
Vital Signs [22269]
Vital Signs [NURMON0013] ONCE, Starting today For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
On admission
Nutrition [22311]
NPO [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question 25): NPO
EXCEPT MEDICATIONS
Liquids & Modified Consistency (If Dysphagia Protocol see
questions 21-24):
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat:
Sodium:
Potassium:
Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO):
Research:
Metabolic:
Other Modifiers:
Infant Nutrition (Select product and calories per ounce):
Infant Formula (Calories per Ounce):
Dysphagia Protocol:
Dysphagia Protocol-Modified Consistency (Also select
Dysphagia Protocol Liquid Consistency and Dysphagia
Protocol-Supervision):
Dysphagia Protocol-Liquid Consistency:
Dysphagia Protocol-Supervision:
Tube Feeding (Use Tube Feeding Order Set to indicate order
detail):
Tube Feeding Management:
Room Service Class:
Starting 2 hours prior to procedure
Hypoglycemia Management [199584]
Select BOTH orders when ordering
Glucose, POC [IPGLUCOSE] ONCE 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?
Hypoglycemia Management (Adult) [191576]
Adult Hypoglycemia Treatment Algorithm URL: https://uconnect.wisc.edu/clinical/cckm-
tools/cpg/guidelines/diabetes-and-
endocrinology/resources/name-77827-en.file
Page 1 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 12/17/2015 8:47:40 AM

Copyright © 2015 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
12/2015Lee Vermeulen, CCKM@uwhealth.org

Glucose, POC [IPGLUCOSE] AS NEEDED FOR SIGNS AND SYMPTOMS OF
HYPOGLYCEMIA, Starting today For Until specified,
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?
Glucose, POC [IPGLUCOSE] AFTER PROVIDING HYPOGLYCEMIA TREATMENT,
Starting today For Until specified, 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?
Per hypoglycemia treatment algorithm Recheck glucose
15 minutes after providing treatment until glucose is
greater than or equal to 70 mg/dL. If patient has been
critically low (i.e., glucose less than 40 mg/dL), recheck
glucose after 1 hour to ensure glucose remains greater
than or equal to 70mg/dL. After resolution of mild
hypoglycemia (i.e., glucose 40-69 mg/dL), consider
rechecking after 1 hour if patient has signs/symptoms of
hypoglycemia or is at risk for a subsequent hypoglycemic
event (e.g., previously administered insulin still active,
altered renal status, altered mental status, NPO or
interrupted nutrition, or any other condition that increases
hypoglycemia risk)
Notify Provider [NURCOM0001] Provider to Notify: Provider
Notify based on: Blood Glucose,Other
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
Other: Nutritional status changes
Hypoglycemia Treatment for blood glucose less than 40
mg/dL and patient able to eat/swallow safely
[NURCOM0022]
CONDITIONAL, Starting today For Until specified
If Conditional, What Condition? If blood glucose less than
40mg/dL and patient able to eat/swallow safely.
Give 30 grams of carbohydrate (8 oz. of fruit juice). Repeat
treatment until glucose is 70 mg/dL or greater.
Hypoglycemia Treatment for blood glucose between 40
to 69 mg/dL and patient able to eat/swallow safely
[NURCOM0022]
CONDITIONAL, Starting today For Until specified
If Conditional, What Condition? If glucose is 40-69 mg/dL
and patient able to eat/swallow safely
Give 15 grams of carbohydrate (4 oz of fruit juice). Repeat
treatment until glucose is 70 mg/dL or greater.
glucose-vitamin C chew tab [50690] 16 g, Oral, EVERY 15 MINUTES PRN, hypoglycemia,
Hypoglycemia, For blood glucose 40-69 mg/dL
Use in patients able to safely eat/swallow but unable to
tolerate volume of fruit juice or per patient preference.
Repeat every 15 minutes until blood glucose is 70 mg/dL
or greater.
glucose-vitamin C chew tab [50690] 32 g, Oral, EVERY 15 MINUTES PRN, hypoglycemia,
Hypoglycemia, For blood glucose less than 40 mg/dL
Use in patients able to safely eat/swallow but unable to
tolerate volume of fruit juice or per patient preference.
Repeat every 15 minutes until blood glucose is 70 mg/dL
or greater.
glucagon injection kit [107799] 1 mg, Subcutaneous, PRN, For blood glucose less than 69
mg/dL and patient unable to eat/swallow safely AND has
NO IV access
Repeat every 15 minutes until blood glucose is 70 mg/dL
or greater. See Adult Hypoglycemia Algorithm
Page 2 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 12/17/2015 8:47:40 AM

Copyright © 2015 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
12/2015Lee Vermeulen, CCKM@uwhealth.org

dextrose injection [800233] 12.5 g, Intravenous, PRN, For blood glucose 40-69 mg/dL
and patient unable to eat/swallow safely AND has IV
access
Repeat every 15 minutes until blood glucose is 70 mg/dL
or greater. See Adult Hypoglycemia Algorithm
dextrose injection [800233] 25 g, Intravenous, PRN, For blood glucose less than 40
mg/dL and patient unable to eat/swallow safely AND has
IV access.
Repeat every 15 minutes until blood glucose is 70 mg/dL
or greater. See Adult Hypoglycemia Algorithm
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL - RN COLLECT, 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? Draw if blood glucose is
less than 40 mg/dL or greater than 400 mg/dL.
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL - RN COLLECT, Starting 12/25/15 For 7
Days, STAT
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Draw if blood glucose is
less than 40 mg/dL or greater than 400 mg/dL.
Non-Categorized Patient Care Orders [22317]
Void prior to transport [NURELM0022] CONTINUOUS, Routine
Contingency Parameters [22322]
Notify - Radiologist On Call [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: aspirin in the last 5 days,clopidogrel (PLAVIX) in the
last 7 days,low molecular weight heparin (LMWH) in the last
12 hours,unfractionated heparin for the last 8 hours,warfarin
(COUMADIN) for the last 5 days,INR greater than
1.5,platelets less than 50K/uL
Intravenous Therapy
IV Fluids [22357]
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?
dextrose 5%-NaCl 0.45% infusion [51613] at 25 mL/hr, Intravenous, CONTINUOUS
sodium chloride 0.9% infusion [64367] at 75 mL/hr, Intravenous, CONTINUOUS
Laboratory
Laboratory [22327]
Page 3 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 12/17/2015 8:47:40 AM

Copyright © 2015 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
12/2015Lee Vermeulen, CCKM@uwhealth.org

PLATELET COUNT [PLT] 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?
PROTHROMBIN TIME/INR [PT] 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?
Pathology [146197]
SURGICAL PATHOLOGY [HCPATHS] ONCE For 1 Occurrences, Routine, This order is to be used
for fresh or formalin-fixed (for gross and micro evaluation)
tissues.
Slides and/or paraffin-embedded blocks coming from outside
institutions needing second opinion pathology review should
be ordered as Surgical Pathology Consult [HCPATHSP].
Specimen Source Description:
Number of containers: 1
Clinical Diagnosis:
Reason for procedure:
Other pertinent information:
Frozen section call back number:
Type of procedure:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Page 4 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 12/17/2015 8:47:40 AM

Copyright © 2015 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
12/2015Lee Vermeulen, CCKM@uwhealth.org