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IP - IR - Post Percutaneous Sclerotherapy - Pediatric - Postprocedure [5708]

IP - IR - Post Percutaneous Sclerotherapy - Pediatric - Postprocedure [5708] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Radiology


IP - IR - Post Percutaneous Sclerotherapy - Pediatric - Postprocedure [5708]
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 10/24/2017 5:03:52 PM
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 [188024]
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
Monitor Patient In Campground [NURCOM0022] CONTINUOUS, Starting today For Until specified,
Monitor patient in campground for a minimum of ***
hours prior to discharge. Patient may then be
discharged if they meet all anesthesia criteria and
there are no new concerns at wound site.
Page 2 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 10/24/2017 5:03:52 PM
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]
Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, 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 (children)
- For MILD pain:
Acetaminophen 15mg/kg orally every 4 hours as
needed (maximum 650mg per dose)
OR
Ibuprofen 10mg/kg orally every 6 hours as needed
(maximum 600mg per dose)
- 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".
Medications
Analgesics - Acetaminophen/Ibuprofen [188046]
acetaMINOPHEN alcohol free (TYLENOL) susp
RANGE - NOTE: Suggested dose 10-15
mg/kg/dose (Maximum 650 mg/dose) [750003]
10-15 mg/kg, Oral, EVERY 4 HOURS PRN, pain
Administer for mild to moderate pain
NOTE: Suggested dose 10-15 mg/kg/dose (Maximum
650 mg/dose)
ibuprofen (MOTRIN) susp - NOTE: Suggested
dose 10 mg/kg/dose (Maximum 600 mg/dose)
[45376]
10 mg/kg, Oral, EVERY 6 HOURS PRN, pain
Administer for mild to moderate inflammatory pain
NOTE: Suggested dose 10 mg/kg/dose (Maximum
600 mg/dose)
Analgesics - Opioids [188422]
oxycodone 5 MG/5ML soln RANGE [750031] 0.01-0.2 mg/kg, Oral, EVERY 4 HOURS PRN, pain
Administer for severe pain (Maximum 5 mg/dose)
Page 3 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 10/24/2017 5:03:52 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

MORPHine PF injection RANGE - NOTE:
Suggested dose 0.05-0.1 mg/kg/dose (Maximum
2 mg/dose) [750057]
0.05-0.1 mg/kg, Intravenous, EVERY 2 HOURS PRN,
pain
Administer for severe pain if unable to tolerate orally
for 4 Minutes
NOTE: Suggested dose 0.05-0.1 mg/kg/dose
(Maximum 2 mg/dose)
Outpatient Discharge Medications - Skin Procedures
First Line [233843]
amoxicillin (AMOXIL) 250 MG/5ML susp [34527] 25 mg/kg, starting 10/24/17 until 10/29/17, Normal
Patients with IgE-mediated or severe reaction to beta-lactam [233844]
clindamycin (CLEOCIN) 75 MG/5ML soln [74681] 10 mg/kg, starting 10/24/17 until 10/29/17, Normal
Outpatient Discharge Medications - Intra-oral Procedure
First Line [233845]
amoxicillin (AMOXIL) 250 MG/5ML susp [34527] 25 mg/kg, starting 10/24/17 until 10/29/17, Normal
Patients with IgE-mediated or severe reaction to beta-lactam [233846]
metRONIDazole (FLAGYL) 50 MG/ML
compounded susp [780100]
10 mg/kg, starting 10/24/17 until 10/29/17, Normal
Page 4 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 10/24/2017 5:03:52 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org