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IP - IR - Adrenal Venous Sampling - Adult - Preprocedure [4724]

IP - IR - Adrenal Venous Sampling - Adult - Preprocedure [4724] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Radiology


IP - IR - Adrenal Venous Sampling - Adult - Preprocedure [4724]
Patient Care Orders
Vitals [185187]
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 arrival
Patient Monitoring [185188]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Starting today, Routine
Peripheral IV Device:
Peripheral IV Location:
Peripheral IV Size:
Peripheral IV Status:
Does this need to be inserted/placed?
Insert and Maintain Urinary Catheter [NURELM0013] CONTINUOUS, Routine, To discontinue this order, enter a
new order for "Discontinue Urinary Catheter".
To modify this order, enter a new order for "Maintain Urinary
Catheter" and make the necessary changes in the new order.
Type: Indwelling Single Lumen
Indication for Placement:
Details:
Irrigate With:
Irrigation Frequency:
Does this need to be inserted/placed?
Nutrition [182374]
Page 1 of 4
Pr i nt ed by O'BRIEN, RYLEY P [RPO249] at 6/11/2015 2:25:49 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
04/2017CCKM@uwhealth.org

NPO Except Medications [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:
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.
Intake and Output [185189]
Void Prior to Transport [NURELM0061] ONCE, Starting today For 1 Occurrences
Non-Categorized Patient Care Orders [185190]
Nursing Communication [NURCOM0022] ONCE, Starting today For 1 Occurrences, Procedure to be
performed Adrenal Venous Sampling.
Please call patient with appointment instructions.
*** called the patient.
For Diabetic Patients [182381]
Glucose, POC [IPGLUCOSE] ONCE, Starting today For 1 Occurrences, Routine
If Conditional, What Condition? On Arrival and every 60
minutes for prior glucose less than 60 mg/dL or greater than
300 mg/dL
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? Obtain if POC Glucose is less
than 40 or greater than 400 mg/dL.
Intravenous Therapy
Premedications for Needle Insertion [124125]
Page 2 of 4
Pr i nt ed by O'BRIEN, RYLEY P [RPO249] at 6/11/2015 2:25:49 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
04/2017CCKM@uwhealth.org

Use lidocaine topical dressing kit for stable patient, no lidocaine allergies, have at least 30 minutes time prior to needing
to use IV
Sodium chloride (bacteriostatic) 0.9% intradermal: Useful for patients requiring urgent IV access; onset is within 1 minute.
Choice of medication should be based on patient’s previous experience/preference, history of lidocaine allergy and ease
of access.
lidocaine (LMX) 4% topical dressing kit [66882] Topical, EVERY 1 HOUR PRN, peripheral line insertion - see
Admin Instructions
Do NOT apply to area greater than 200 square centimeters
(maximum 2.5 g/site; maximum 4 sites per hour, 6 times per
day). Do NOT leave on longer than 2 hours. Use for stable
patient, no allergies to lidocaine, with at least 30 minutes time
prior to IV use
lidocaine (XYLOCAINE) 1% injection [39034] 0.1-0.4 mL, Intradermal, PRN, peripheral line insertion - see
Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge needle to
inject solution and create a wheal. Wait 30 seconds to 1
minute then insert IV catheter into center of wheal. Use if IV
is needed within 30 minutes. Choice of medication should be
based on patient’s previous experience/preference, history of
lidocaine allergy and ease of access
sodium chloride (bacteriostatic) 0.9 % injection [50585] 0.05-0.1 mL, Intradermal, PRN, peripheral line insertion - see
Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge needle to
inject solution and create a wheal. Wait 30 seconds to 1
minute then insert IV catheter into center of wheal. Use if IV
is needed within 30 minutes. Choice of medication should be
based on patient’s previous experience/preference, history of
lidocaine allergy and ease of access
IV Fluids [16760]
dextrose 5%-NaCl 0.45% infusion [51613] at 150 mL/hr, Intravenous, CONTINUOUS
sodium chloride 0.9% infusion [64367] at 150 mL/hr, Intravenous, CONTINUOUS
Medications
Medications [186534]
cosyntropin (CORTROSYN) 0.25 mg in sodium chloride
0.9 % 250 mL infusion [700918]
50 mcg/hr, Intravenous
Laboratory
Preprocedure Labs [185191]
CORTISOL [CORT] 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?
Peripheral, post cosyntropin infusion.
DILUTE FOR ABSOLUTE CORTISOL LEVEL.
CORTISOL [CORT] 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?
RIGHT adrenal, post cosyntropin infusion.
DILUTE FOR ABSOLUTE CORTISOL LEVEL.
CORTISOL [CORT] 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?
LEFT adrenal, post cosyntropin infusion.
DILUTE FOR ABSOLUTE CORTISOL LEVEL.
Page 3 of 4
Pr i nt ed by O'BRIEN, RYLEY P [RPO249] at 6/11/2015 2:25:49 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
04/2017CCKM@uwhealth.org

ALDOSTERONE [XALDST] 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?
RIGHT, post cosyntropin infusion.
ALDOSTERONE [XALDST] 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?
Peripheral, post cosyntropin infusion.
ALDOSTERONE [XALDST] 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?
LEFT, post cosyntropin infusion.
WHITE CELL COUNT [WBC] 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?
HEMOGLOBIN [HGB] 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?
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?
ELECTROLYTES [LYTE] 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?
GLUCOSE [GLU] 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?
CREATININE [CRET] 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?
HCG, QUALITATIVE, URINE [UPREG] 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?
Page 4 of 4
Pr i nt ed by O'BRIEN, RYLEY P [RPO249] at 6/11/2015 2:25:49 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
04/2017CCKM@uwhealth.org