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IP - IR - Pre Bland Hepatic Artery Embolization - Adult - Preprocedure [1289]

IP - IR - Pre Bland Hepatic Artery Embolization - Adult - Preprocedure [1289] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Radiology


IP - IR - Pre Bland Hepatic Artery Embolization - Adult - Preprocedure [1289]
Patient Care Orders
Nutrition [100643]

NPO Except Medications [NUT0001] EFFECTIVE _____, Starting tomorrow, 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:
Patient may have solid food until 6 hours prior to procedure.
May continue to take clear liquids until 4 hours prior to
procedure. Then NPO except medications with sips of water.
Non-Categorized Patient Care Orders [100645]

Insert and Maintain Urinary Catheter [NURELM0013] CONTINUOUS, Starting tomorrow For Until specified,
Routine
Type: Indwelling Single Lumen
Indication for Placement:
Initiate Urinary Catheter Removal Protocol? (NP/PA Must
Select "No"): Yes
Details: To Dependent Drainage
Irrigate With:
Irrigation Frequency:
Does this need to be inserted/placed?:

Nursing Communication [NURCOM0052] ONCE, Starting today For 1 Occurrences, Routine
Order Name (Only necessary if something other than
"Nursing Communcation" is preferred.):

Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Starting today, Routine
Does this need to be inserted/placed?:
Left/Right/Bilateral?: Bilateral
Type: Knee high
Contingency Parameters [28207]
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Notify Provider if [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): 300
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: Aspirin in the last 3 days
Intravenous Therapy
IV Fluids [100646]

Insert and Maintain Peripheral IV - Two 18 gauge
Angiocatheters [NURVAD0013]
CONTINUOUS, Starting tomorrow For Until specified,
Routine
Peripheral IV Size: 18 Gauge
Peripheral IV Location:
Peripheral IV Device: Angiocatheter
Peripheral IV Status: Capped
Does this need to be inserted/placed?:

dextrose 5%-NaCl 0.45% infusion - NOTE: Infuse in Line
1 [51613]
at 200 mL/hr, Intravenous, CONTINUOUS
NOTE: Infuse in Line 1

Note: Total IV Fluids 200 mL/hr [950004] EVERY 8 HOURS
Note: Total IV Fluids 200 mL/hr
Medications
Non-categorized [118037]

lidocaine (XYLOCAINE JELLY) 2 % gel [39030] Topical
Medications - Anti-infectives
Anti-infectives [28240]

Note: Pharmacy: Please tube antibiotic to Radiology
Prep/Recovery at #434 [950018]
ONCE For 1 Doses

cefoxitin (MEFOXIN) intraVENOUS [800022] 2 g, Intravenous, EVERY 8 HOURS
Give first dose 30 minutes prior to procedure

moxifloxacin (AVELOX) 400 mg in sodium chloride 0.9%
250 mL bag - NOTE: Order both moxifloxacin AND
metronidazole for cephalosporin/penicillin allergic
patients [68662]
400 mg, Intravenous, EVERY 24 HOURS
Give 30 minutes prior to procedure.
for 60 Minutes
NOTE: Order both moxifloxacin AND metronidazole for
cephalosporin/penicillin allergic patients

metRONIDazole (FLAGYL) intraVENOUS - NOTE:
Order both moxifloxacin AND metronidazole for
cephalosporin/penicillin allergic patients [800062]
500 mg, Intravenous, EVERY 8 HOURS
Give 30 minutes prior to procedure.
NOTE: Order both moxifloxacin AND metronidazole for
cephalosporin/penicillin allergic patients
Preprocedure Medications
Preprocedure Medications [18054]

Note: Pharmacy: Please tube dexamethasone to
Radiology Prep/Recovery at #434 [950018]
ONCE

dexamethasone (DECADRON) intraVENOUS [800037] 20 mg, Intravenous, ONCE For 1 Doses
30 minutes prior to procedure

diphenhydramine (BENADRYL) injection [36790] 50 mg, Intravenous, ONCE For 1 Doses
30 minutes prior to procedure
for 1 Minutes
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Copyright © 2012 University of Wisconsin Hospitals and Clinics Authority



ondansetron (ZOFRAN) injection [142579] 4 mg, Intravenous, ONCE For 1 Doses
30 minutes prior to procedure
Supplemental Orders

Contrast Induced Nephropathy Prophylaxis - Adult - Supplemental Order SetContrast Induced Nephropathy Prophylaxis -
Adult - Heart Failure/Fluid Overload Risk Supplemental Order SetPatient Controlled Analgesia (PCA) -
Order Using Adult IV Patient Controlled Analgesia Order Set

Laboratory
Labs [16896]

HEMOGLOBIN [HGB] STAT - RN COLLECT, Starting tomorrow For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?:
If Conditional, What Condition?:

PLATELET COUNT [PLT] STAT - RN COLLECT, Starting tomorrow For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?:
If Conditional, What Condition?:

ELECTROLYTES [LYTE] STAT - RN COLLECT, Starting tomorrow For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?:
If Conditional, What Condition?:

GLUCOSE [GLU] STAT - RN COLLECT, Starting tomorrow For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?:
If Conditional, What Condition?:

BUN [BUN] STAT - RN COLLECT, Starting tomorrow For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?:
If Conditional, What Condition?:

CREATININE [CRET] STAT - RN COLLECT, Starting tomorrow 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 tomorrow For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?:
If Conditional, What Condition?:
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Copyright © 2012 University of Wisconsin Hospitals and Clinics Authority