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IP - IR - Post Uterine Fibroid Embolization - Adult - Postprocedure [1300]

IP - IR - Post Uterine Fibroid Embolization - Adult - Postprocedure [1300] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Radiology


IP - IR - Post TIPS Transjugular Intrahepatic Portosystemic Shunt - Adult -
Postprocedure [1133]
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 [153198]
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Admission Status [153197]
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Patient Care Orders
Vital Signs [14225]
Page 1 of 3
Printed by O'BRIEN, RYLEY P [RPO249] at 6/23/2017 7:33:13 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 06/2017CCKM@uwhealth.org

Vital Signs [NURMON0013] SEE COMMENTS, Starting today, 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 4, then Every hour times 3, then every shift.
Activity [18178]
Activity - Post IR Procedure [NURACT0011] SEE COMMENTS, Bedrest for *** hours. Resume
previous activity orders after designated bedrest.
Nutrition (Single Response) [14364]
NPO Except Medications [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: NPO
NPO: NPO except Medications
Bedside Meal Instructions:
Room Service Class:
NPO Postprocedure - Hold Diet [DIE0007] CONTINUOUS NPO, Routine
NPO For Which Procedure? IR Post Procedure
Modifiers: NPO EXCEPT MEDICATIONS
Non-Categorized Patient Care Orders [153874]
Give Patient HFFY: Preparing for Your
Transjugular Intrahepatic Portosystemic Shunt
Placement (TIPS Procedure) [NURCOM0025]
ONCE, Routine, Give patient HFFY #4640: Preparing
for Your Transjugular Intrahepatic Portosystemic
Shunt Placement (TIPS Procedure)
Contingency Parameters [14405]
Notify Interventional Radiology Resident On Call
[NURCOM0001]
Provider to Notify: Other (Comment)
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg): 100 during first
24 hours after procedure
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C): 38.5 during first 24 hours after
procedure
If temperature < (C):
If heart rate > (bpm): 120 during first 24 hours after
procedure
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: Bleeding at puncture sites,Hemoglobin
decreases by more than 1 gram/deciliter from
morning lab results,New Abdominal Pain,Nausea or
Vomiting,Shortness of Breath
Intravenous Therapy
IV Fluids [16741]
sodium chloride 0.9 % infusion [64367] Intravenous, CONTINUOUS
Administer via intrajugular sheath
dextrose 5%-NaCl 0.45% infusion [51613] Intravenous, CONTINUOUS
Page 2 of 3
Printed by O'BRIEN, RYLEY P [RPO249] at 6/23/2017 7:33:13 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Laboratory
2 Hours Postprocedure [14406]
ELECTROLYTES [LYTE] CONDITIONAL - RN COLLECT For 1 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw when patient is
2 hours postprocedure
MAGNESIUM [MAG] CONDITIONAL - RN COLLECT For 1 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw when patient is
2 hours postprocedure
HEMOGLOBIN [HGB] CONDITIONAL - RN COLLECT For 1 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw when patient is
2 hours postprocedure
4 Hours Postprocedure [14407]
ELECTROLYTES [LYTE] CONDITIONAL - RN COLLECT For 1 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw when patient is
4 hours postprocedure
MAGNESIUM [MAG] CONDITIONAL - RN COLLECT For 1 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw when patient is
4 hours postprocedure
HEMOGLOBIN [HGB] CONDITIONAL - RN COLLECT For 1 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw when patient is
4 hours postprocedure
Imaging
Schedule Appointment (Single Response) [14408]
Schedule Appointment for Ultrasound: Hepatic
Duplex for Next Day [NURCOM0026]
Reason for Hospital Follow Up Appointment: Obtain
baseline velocities for TIPS surveillance
Which Provider: Patient's Specific PCP/Care Team
When do you want appointment:
Which Clinic or Specialty: Ultrasound Radiology
Schedule Appointment for Outpatient Ultrasound:
Hepatic Duplex Post-Procedure Day 7 (For
Covered Stents) [NURCOM0026]
Reason for Hospital Follow Up Appointment: Obtain
baseline velocities for TIPS surveillance
Which Provider: Patient's Specific PCP/Care Team
When do you want appointment:
Which Clinic or Specialty: Ultrasound Radiology
Diagnostic Test and Imaging - Post Discharge [188868]
US DEEP DOPPLER [R93975] Status: Future, Expires: 8/23/18, Normal, Routine
Page 3 of 3
Printed by O'BRIEN, RYLEY P [RPO249] at 6/23/2017 7:33:13 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org