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201706181

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IP - IR - Post Y90 SIRT Selective Internal Radiation Therapy - Adult - Postprocedure [1295]

IP - IR - Post Y90 SIRT Selective Internal Radiation Therapy - Adult - Postprocedure [1295] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Radiology


IP - IR - Post Y90 SIRT Selective Internal Radiation Therapy - Adult -
Postprocedure [1295]
Patient Care Orders
Vital Signs [16817]
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 4, then every hour times 3, then every shift.
Radial/Femoral Artery Puncture (Single Response) [199078]
Radial Artery Puncture [188540]
Monitor Entry Site for hematoma or new Bleeding
[NURWND0018]
SEE COMMENTS, Monitor entry site for swelling,
hematoma, or new bleeding every 15 minutes times
4, then every 30 minutes times 2, then every hour
times 4, then every shift.
Neurovascular Checks [NURMON0045] SEE COMMENTS, Routine, Monitor procedure arm
for neurovascular changes every 15 minutes times 4,
then every 30 minutes times 2, then every hour
times 4, then every shift.
Use non-procedure arm to obtain blood
pressures for the first 24 hours [NURWND0018]
CONTINUOUS For 24 Hours
Apply TR Band to procedure site
[NURWND0018]
ONCE For 1 Occurrences, Apply TR Band to
procedure site: {RIGHT/LEFT LOWERCASE:18777}
wrist.
Maintain TR Band pressure [NURWND0018] SEE COMMENTS, Maintain TR Band pressure at ***
mL for {30, 45, 60, 90 min:24815} minutes
(maximum 3 hours). Then release 3 mL every 15
minutes until completely deflated. Assess for signs
of oozing, hematoma, and neurovascular changes
with each deflation.
Once device is completely deflated and
hemostasis has been maintained, proceed with
removal of the radial compression device. Keep
bedside until patient discharge. [NURWND0018]
ONCE For 1 Occurrences
Apply sterile transparent dressing (no gauze) to
puncture site immediately after compression
device is removed. [NURWND0018]
ONCE For 1 Occurrences
Page 1 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 6/30/2017 9:53:25 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 06/2017CCKM@uwhealth.org

Pulse Oximetry [NURMON0009] SEE COMMENTS, Routine, Continuous pulse
oximetry of index finger on treated wrist distal to
radial compression device during compression and
weaning of device.
If pulse oximetry waveform is lost, air should be
removed 1 mL at a time until waveform returns. If
wave form does not return immediately, notify
procedural physician.
If pulse oximetry waveform is lost and there is
bleeding at the access site, re-inflate device until
hemostasis is obtained and immediately notify
procedural physician or IR resident on-call.
Up Ad Lib with assistance first 4 hours
postprocedure then return to baseline activity.
[NURCOM0022]
CONTINUOUS
Do not have patient use wrist or hand while
moving in bed or getting out of bed
[NURCOM0022]
CONTINUOUS
Do not allow patient to bend wrist or lift anything
with procedural arm for 24 hours post procedure
[NURCOM0022]
CONTINUOUS For 24 Hours
For bleeding, oozing, swelling, or hematoma at
entry site [NURCOM0022]
ONCE, For bleeding, oozing, swelling, or hematoma
at entry site
-Apply direct manual pressure
-Notify Interventional Radiology resident on call
-Do not apply sandbag
Femoral Artery Puncture [188541]
Monitor Entry Site for hematoma or new Bleeding
[NURWND0018]
SEE COMMENTS, Monitor entry site for swelling,
hematoma, or new bleeding every 15 minutes times
4, then every 30 minutes times 2, then every hour
times 4, then every shift.
Site: Femoral
Location: {right/left/bilaterally:4001510}
Neurovascular Checks [NURMON0045] SEE COMMENTS, Routine, Location: {right, left,
bilateral:3200103}
Extremity: Lower
Every 15 minutes times 4, then every 30 minutes
times 2, then every hour times 4, then every shift.
Activity - Post IR Procedure [NURACT0011] SEE COMMENTS, Bedrest for {number:4001732}
hours with {right/left/bilateral:4001510} leg straight
Elevate Head Of Bed [NURACT0002] Equal to (degrees):
Greater than (degrees):
Less than (degrees): 30
Other options:
Routine, CONTINUOUS
Page 2 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 6/30/2017 9:53:25 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

No Lifting [NURACT0008] CONTINUOUS, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS: No Lifting
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
No lifting greater than 10 pounds for 24 hours
postprocedure.
Keep Entry Site Clean and Dry for 24 Hours
Postprocedure [NURWND0015]
CONTINUOUS, Routine
Wound Type: Puncture
Wound Site:
Wound Location:
Assess Frequency:
Care Frequency:
Wash With:
Irrigate/Rinse With:
Apply (Must also enter separate medication order to
obtain drug):
Primary Dressing:
Secondary Dressing:
Keep entry site clean and dry for 24 hours
postprocedure.
Remove Dressing 24 Hours Postprocedure
[NURWND0018]
CONTINUOUS
Nutrition [16968]
General Diet [NUT9999] EFFECTIVE _____, Starting today, Routine
Patient Type: Adult
Diet Type: General (no Modifications)
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
Radiation Safety [16970]
Radiation Precautions - Selective Internal
Radiation Therapy (SIRT) [PRECAU0016]
CONTINUOUS, Starting today For 72 Hours, Routine
Non-Categorized Patient Care Orders [117659]
Nursing Communication [NURCOM0052] ONCE, Routine
Order Name (Only necessary if something other than
"Nursing Communcation" is preferred.):
Contingency Parameters [16972]
Page 3 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 6/30/2017 9:53:25 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Notify Interventional Radiology Resident
[NURCOM0001]
Provider to Notify: Provider
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg): 100 mmHg
during first 24 hours after procedure
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C): 38.5 degrees Celsius during first
24 hours after procedure
If temperature < (C):
If heart rate > (bpm): 120 beats/minute 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: Entry site hematoma or new bleeding,Change
in pedal pulses,Nausea or vomiting,New abdominal
pain
Intravenous Therapy
IV Fluids (Single Response) [14688]
dextrose 5%-NaCl 0.45% infusion [51613] Intravenous, CONTINUOUS
sodium chloride 0.9 % infusion [64367] Intravenous, CONTINUOUS
General Medications
Analgesics - Acetaminophen - PRN [226911]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, EVERY 4 HOURS PRN, pain,
Administer for moderate to severe pain
Analgesics - Opioids - Oral - PRN [226912]
oxycodone tab [750032] 5-10 mg, Oral, EVERY 4 HOURS PRN, pain,
Administer for severe pain
Analgesics [18140]
MORPHine PF injection RANGE [750057] 1-2 mg, Intravenous, EVERY 1 HOUR PRN, pain,
Administer for severe pain, for 4 Minutes
Anti-emetics [17173]
ondansetron (ZOFRAN) tab [45939] 4 mg, Oral, EVERY 24 HOURS PRN, nausea/vomiting
Administer as first line therapy.
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, EVERY 24 HOURS PRN,
nausea/vomiting
Administer as first line therapy if unable to take orally.
prochlorperazine (COMPAZINE) tab [41372] 10 mg, Oral, EVERY 6 HOURS PRN, nausea/vomiting
Administer as second line therapy.
prochlorperazine (COMPAZINE) injection [41369] 10 mg, Intravenous, EVERY 6 HOURS PRN,
nausea/vomiting
Administer as second line therapy if unable to take
orally
If ordered IV: push rate 5 mg/minute.
Discharge Orders
Discharge Orders [16974]
Call staff MD when patient is ready for discharge
[NURCOM0022]
CONTINUOUS, Starting today For Until specified
Page 4 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 6/30/2017 9:53:25 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org