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201710276

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IP - IR - Post Percutaneous Sclerotherapy - Adult - Postprocedure [3675]

IP - IR - Post Percutaneous Sclerotherapy - Adult - Postprocedure [3675] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Radiology


IP - IR - Post Percutaneous Sclerotherapy - Adult - Postprocedure [3675]
Intended for Adult Patients Only
Patient Care Orders
Vital Signs [153196]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today For Until specified,
Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 15 minutes times 4, then every 30 minutes
times 2.
Patient Monitoring [106744]
Monitor Entry Site for Hematoma or New Bleeding
[NURMON0078]
SEE COMMENTS, Starting today For Until specified,
Routine
Site: Other (Comment Required)
Location:
Every 15 minutes x 4, then every 30 minutes x 2.
Activity [NURACT0008] CONTINUOUS, Starting today For Until specified,
Routine
AD LIB: 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:
Keep affected extremity elevated on pillows above
level of heart for 24 hours.
Nutrition [106745]
General Diet [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: General (no Modifications)
Bedside Meal Instructions:
Room Service Class:
Post-Op/Phase II
Contingency Parameters [106746]
Page 1 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 10/2/2017 10:07:00 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

Notify Interventional Radiology Resident
[NURCOM0001]
Provider to Notify: Other (Comment)
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg): 100
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C): 38.5
If temperature < (C):
If heart rate > (bpm): 120
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: Pain not controlled with ordered analgesics or
ordered interventions.,Injection site hematoma or new
bleeding. ,Change in skin color or
temperature.,Nausea or vomiting.
Non-Categorized Patient Care Orders [106751]
Page 2 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 10/2/2017 10:07:00 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Home Care - Post Percutaneous Sclerotherapy
[NURCOM0071]
Procedure Performed: Post Percutaneous
Sclerotherapy
Home Care Instructions:
- Elevate affected extremity above level of the heart as
much as possible for next 72 hours. It is otherwise
okay to walk around and to participate in non-
strenuous activity.
- Apply ice pack to treated area for 20 minutes at a
time, 4-5 times per day over next 72 hours.
- Apply stocking or wrap to extremity when up and
about. May remove stocking or wrap when in lying
position.
- No heavy lifting (> 10 pounds), strenuous exercise,
running or jumping for next 72 hours.
- Take steroid medication as prescribed (Medrol dose
pack). If ordered.
Pain Control (adult)
- For MILD pain:
Acetaminophen 650mg orally every 4-6 hours as
needed (maximum 4000mg per day)
OR
Ibuprofen 400mg orally every 4-6 hours as needed
(maximum 2400mg per day)
- If moderate to severe pain, numbness or tingling in
affected extremity, or any other concerns call:
From 8:00am - 4:30pm, Monday - Friday: 608-263-
9729, prompt #3 and ask to have a message sent to
the Interventional Radiology triage RN pool.
After 4:30pm and on weekends: 608-262-2122 and
ask for "Angio- Interventional Radiology First Call".
Apply Ice Pack to Affected Area [NURTRT0008] SEE COMMENTS, Starting today, Routine
Site: Affected Area
To affected area for 20 minutes every hour.
Apply Compression Garment [NURTRT0002] CONTINUOUS, Routine
Type: Elastic Wrap (ACE)-Single
Left/Right/Bilateral?
Limb(s):
Wearing schedule:
Elevate affected extremity above level of heart
[NURCOM0022]
ONCE
Medications
Analgesics - Acetaminophen - PRN [106719]
acetaMINOPHEN 500 mg (TYLENOL) tab
RANGE [750002]
500-1,000 mg, Oral, EVERY 6 HOURS PRN,
pain/fever, Administer for mild to moderate pain,
multimodal therapy, or fever greater than 38.5 C
Analgesics - NSAIDS - PRN [226545]
ibuprofen 200 mg (MOTRIN) tab RANGE
[750024]
400-600 mg, Oral, EVERY 6 HOURS PRN, pain,
Administer for mild to moderate pain
Page 3 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 10/2/2017 10:07:00 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Analgesics - Opioids - Oral - PRN [226546]
oxycodone tab RANGE [750032] 5-10 mg, Oral, EVERY 4 HOURS PRN For 24 Hours,
pain, Administer for severe pain
Analgesics - Opioids - Intravenous - PRN [226547]
MORPHine PF injection RANGE [750057] 1-2 mg, Intravenous, EVERY 2 HOURS PRN For 24
Hours, pain, Administer for severe pain if unable to
take oral pain medications, for 4 Minutes
Outpatient Discharge Medications - Skin Procedures
First Line [230431]
penicillin V potassium (VEETID) 500 MG tab
[40832]
500 mg, 15 tab, 0, starting 10/2/17 until 10/7/17,
Normal
Patients with IgE-mediated or severe reaction to beta-lactam [230432]
clindamycin (CLEOCIN) 300 MG cap [44723] 300 mg, 15 cap, , starting 10/2/17 until 10/7/17,
Normal
Outpatient Discharge Medications - Intra-oral Procedures
First Line [230431]
penicillin V potassium (VEETID) 500 MG tab
[40832]
500 mg, 15 tab, 0, starting 10/2/17 until 10/7/17,
Normal
Patients with IgE-mediated or severe reaction to beta-lactam [230433]
metRONIDazole (FLAGYL) 500 MG tab [39640] 500 mg, 15 tab, , starting 10/2/17 until 10/7/17, Normal
Non-Categorized Medications [230434]
chlorhexidine (PERIDEX) 0.12 % mouth/throat
soln [44614]
15 mL, 473 mL, , starting 10/2/17, Normal
Page 4 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 10/2/2017 10:07:00 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org