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IP - Renal Transplant - Pediatric - Postoperative [2974]

IP - Renal Transplant - Pediatric - Postoperative [2974] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Transplant


IP - Renal Transplant- Pediatric - Postoperative [2974]
Patient Care Orders
Vital Signs [91932]
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 hour times 24
hours, then every 2 hours., Post-Op/Phase II
Activity [91933]
Elevate Head Of Bed [NURACT0002] Equal to (degrees):
Greater than (degrees): 30
Less than (degrees):
Other options:
Routine, CONTINUOUS, Starting today, Post-
Op/Phase II
Chair 3 Times Daily [NURACT0008] CONTINUOUS, Starting tomorrow, Routine
AD LIB:
AMBULATE:
CHAIR: 3x daily
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Post-Op/Phase II
Ambulate 3 Times Daily [NURACT0008] CONTINUOUS, Starting 6/2/17, Routine
AD LIB:
AMBULATE: 3x daily
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Post-Op/Phase II
Nutrition [91934]
Strict NPO [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Pediatric
Diet Type: NPO
NPO Diet: Strict NPO
Bedside Meal Instructions:
Room Service Class:
Post-Op/Phase II
Respiratory [91935]
Provide Manual Resuscitator and Mask at
Bedside [RT0039]
CONTINUOUS, Starting today, Routine, Post-
Op/Phase II
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Pulse Oximetry [NURMON0009] CONTINUOUS, Starting today, Routine, Post-
Op/Phase II
Pulse Oximetry [NURMON0009] SEE COMMENTS, Starting tomorrow, Routine, Every
2 hours and as needed., Post-Op/Phase II
Incentive Spirometry [NURTRT0018] EVERY 1 HOUR, Starting today, Routine, While
awake., Post-Op/Phase II
Turn, Cough And Deep Breathe [NURTRT0022] EVERY 2 HOURS, Starting today, Routine, Post-
Op/Phase II
Intake and Output [91936]
Measure Intake And Output [NURMON0005] EVERY 1 HOUR, Starting today, Routine, Post-
Op/Phase II
Measure Urine Output [NURMON0012] SEE COMMENTS, Starting today, Routine, Every 15
minutes times 12 hours, then every 1 hour times 24
hours, then every 2 hours., Post-Op/Phase II
Patient Monitoring [91937]
Measure Central Venous Pressure
[NURMON0002]
EVERY 1 HOUR, Starting today, Routine, Post-
Op/Phase II
Glucose, POC [IPGLUCOSE] EVERY 2 HOURS, Starting today For 4 Days,
Routine, Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
Every 2 hours if brisk diuresis: urine output is greater
than *** mL per hour., Post-Op/Phase II
Measure Weight [NURMON0015] 1X DAILY, Starting today, Routine
Weigh With?
Weigh when?
At 0800., Post-Op/Phase II
Non-Categorized Patient Care Orders [91938]
Insert and Maintain Urinary Catheter
[NURELM0013]
CONTINUOUS, Starting today, 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: To Dependent Drainage
Does this need to be inserted/placed?
Post-Op/Phase II
Intermittent Manual Urinary Catheter Irrigation
[NURELM0070]
PRN, Starting today For Until specified, Routine, Low
urine output is not an indication for irrigation.
Irrigation through the catheter sampling port is NOT
recommended practice.
Does not apply to Pediatric patients.
Indication for Irrigation: Suspected Blood Clot (or
sudden decrease in urine output)
Irrigate With: Normal Saline
Amount to irrigate with: Up to 60 mL
Method of Irrigation:
Irrigate as needed with sterile Sodium Chloride 0.9%
for clots or sudden decrease in urine output., Post-
Op/Phase II
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NG Tube Placement - Pediatric [121658]
Insert and Maintain Nasogastric Tube
[NURTAD0014]
CONTINUOUS, Routine
Options: Low, Continuous Suction
Flush with:
Flush Frequency: EVERY 8 HOURS
Clamp NG Tube:
Check Residual:
Does this need to be inserted/placed?
Device Status:
Recommendations for flush quantity:
For patients < 30 kg, use 1mL of fluid per 1 kg.
For patients >30 kg, 30 mLs of fluid should be
sufficient.
In general, consider the amount of fluid needed to
clear the tube and patient’s fluid status before
determining flush quantity., Post-Op/Phase II
lidocaine-oxymetazoline 3%-0.01% (PEDS) nasal
spray [785104]
Nasal, ONCE For 1 Doses
For numbing prior to feeding tube insertion. Slowly
spray the chosen nostril once, if required may
repeat x1 in opposite nostril. Angle toward back of
throat spraying the anterior nostril and wait 30-60
seconds before introducing more local anesthetic
into the nostril. Caution: Entire bottle should not be
used for insertion of tube. Discard excess solution
when procedure completed.
Post-Op/Phase II
X-RAY ABDOMEN AP VIEW (KUB) [R74000] CONDITIONAL For 3 Days, Routine
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms?
What specific question(s) would you like answered
by this exam? Evaluate nasogastric tube placement
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where?
Last patient weight? (will auto pull in value and date
in comment):
Transport Method: Floor Determined/Entered
If Conditional, What Condition? Evaluate
nasogastric tube placement. The location of
nasogastric tube should be confirmed prior to the
instillation of fluids, medications, or feedings. Refer
to Policy 2.20 Enteral Tubes Used for Instillation of
Fluids, Medications, or Feeding
Post-Op/Phase II
Contingency Parameters for Patients Less Than 7 Months of Age [91939]
Page 3 of 14
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Notify Provider [NURCOM0001] CONTINUOUS
Provider to Notify: Provider
If systolic blood pressure > (mmHg): 120
If systolic blood pressure < (mmHg): 90
If diastolic blood pressure > (mmHg): 75
If diastolic blood pressure < (mmHg):
If temperature > (C): 38
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): *** mL/hour
Other: Central venous pressure less than ***
mmHg,Sudden decrease in urine output
Post-Op/Phase II
Contingency Parameters for Patients 7 Months to 3 Years of Age [91940]
Notify Provider [NURCOM0001] CONTINUOUS
Provider to Notify: Provider
If systolic blood pressure > (mmHg): 130
If systolic blood pressure < (mmHg): 100
If diastolic blood pressure > (mmHg): 85
If diastolic blood pressure < (mmHg):
If temperature > (C): 38
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): *** mL/hour
Other: Central venous pressure less than ***
mmHg,Sudden decrease in urine output
Post-Op/Phase II
Contingency Parameters for Patients 3 to 7 Years of Age [91941]
Page 4 of 14
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Notify Provider [NURCOM0001] CONTINUOUS
Provider to Notify: Provider
If systolic blood pressure > (mmHg): 140
If systolic blood pressure < (mmHg): 110
If diastolic blood pressure > (mmHg): 95
If diastolic blood pressure < (mmHg):
If temperature > (C): 38
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): *** mL/hour
Other: Central venous pressure less than ***
mmHg,Sudden decrease in urine output
Post-Op/Phase II
Contingency Parameters for Patients 7 to 11 Years of Age [125641]
Notify Provider [NURCOM0001] CONTINUOUS
Provider to Notify: Provider
If systolic blood pressure > (mmHg): 140
If systolic blood pressure < (mmHg): 110
If diastolic blood pressure > (mmHg): 95
If diastolic blood pressure < (mmHg):
If temperature > (C): 38
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): *** mL/hour
Other: Central venous pressure less than ***
mmHg,Sudden decrease in urine output
Post-Op/Phase II
Contingency Parameters for Patients 11 Years of Age and Older [125642]
Page 5 of 14
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Notify Provider [NURCOM0001] CONTINUOUS
Provider to Notify: Provider
If systolic blood pressure > (mmHg): 140
If systolic blood pressure < (mmHg): 110
If diastolic blood pressure > (mmHg): 95
If diastolic blood pressure < (mmHg):
If temperature > (C): 38
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): *** mL/hour
Other: Central venous pressure less than ***
mmHg,Sudden decrease in urine output
Post-Op/Phase II
Intravenous Therapy
IV Fluids [91943]
dextrose 2.5%-NaCl 0.2% with 30 mEq sodium
bicarbonate - NOTE: Suggested rate 0.5
mL/Kg/hr [710000]
at 1-200 mL/hr, Intravenous, CONTINUOUS
Titrate IV fluid rate every 15 minutes to match
previous urine output of *** mL/hr and maximum
output of *** mL/hr. Base equivalent to dextrose 2.5%
-NaCl 0.2%
NOTE: Suggested rate 0.5 mL/Kg/hr. Base equivalent
to dextrose 2.5%-NaCl 0.2%
Post-Op/Phase II
Premedication for Needle Insertion [84317]
Lidocaine [152737]
lidocaine (LMX) 4% topical dressing kit [66882] Topical, EVERY 1 HOUR PRN, prior to needle
sticks to reduce pain. See "LMX Use Instructions"
order in Active Orders report or the Admin
Instructions for application details
FOR PATIENTS 5 Kg OR LESS: Do NOT apply to
area greater than 100 square centimeters.
(maximum 1 g/site; maximum 1 site per hour, 6
times per day).
FOR PATIENTS 5.1-10 Kg: Do NOT apply to area
greater than 100 square centimeters. (maximum 1
g/site; maximum 2 sites per hour, 6 times per day).
FOR PATIENTS GREATER THAN 10 Kg: Do NOT
apply to area greater than 200 square centimeters.
(maximum 2.5 g/site; maximum 4 sites per hour, 6
times per day).
For patients less than 1 year old do NOT leave on
longer than 1 hour. For patients 1 year or older do
NOT leave on longer than 2 hours
Post-Op/Phase II
LMX Use Instructions for Premedication Prior to
Needle Insertion [NURCOM0095]
Post-Op/Phase II
Medications - General
Analgesics [91946]
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MORPHine PF injection RANGE - NOTE:
Suggested dose 0.05-0.1 mg/kg/dose (Maximum
4 mg/dose) [750057]
0.05-0.1 mg/kg, Intravenous, EVERY 2 HOURS PRN,
pain, for 4 Minutes
NOTE: Suggested dose 0.05-0.1 mg/kg/dose
(Maximum 4 mg/dose)
Post-Op/Phase II
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - NOTE: Suggested dose 10-15
mg/kg/dose (Maximum 650 mg/dose) [800005]
Oral, EVERY 4 HOURS PRN, pain/fever
Maximum 5 doses per day
NOTE: Suggested dose 10-15 mg/kg/dose (Maximum
650 mg/dose)
Post-Op/Phase II
acetaMINOPHEN (TYLENOL) tab [34149] Oral, EVERY 4 HOURS PRN, pain/fever, Post-
Op/Phase II
HYDROmorphone PF (DILAUDID) injection
[800120]
0.015 mg/kg, Intravenous, EVERY 3 HOURS PRN,
pain, Post-Op/Phase II
Anti-infectives [91947]
sulfamethoxazole-trimethoprim 200-40 mg/5 mL
(BACTRIM) susp - NOTE: Suggested dose 2
mg/kg/day of trimethoprim component [58784]
2 mg/kg, Oral, 1 X DAILY (HS)
NOTE: Suggested dose 2 mg/kg/day of trimethoprim
component
Post-Op/Phase II
sulfamethoxazole-trimethoprim (BACTRIM) 200-
40 mg per half-tab [720141]
1 each, Oral, 1 X DAILY (HS), Post-Op/Phase II
Anti-fungals (Single Response) [91948]
nystatin (MYCOSTATIN) susp - NOTE: Order for
children 2 years of age or less [40456]
2 mL, Oral, 3 X DAILY
Place 1 mL in each cheek
Post-Op/Phase II
nystatin (MYCOSTATIN) susp - NOTE: Order for
patients greater than 2 years and less than 10
years of age [40456]
5 mL, Swish & Swallow, 3 X DAILY
NOTE: Order for patients greater than 2 years and
less than 10 years of age
Post-Op/Phase II
nystatin (MYCOSTATIN) susp - NOTE: Order for
children 10 years of age or older [40456]
5 mL, Swish & Swallow, 4 X DAILY
NOTE: Order for children 10 years of age or older
Post-Op/Phase II
Anti-virals [91949]
ganciclovir (CYTOVENE) intraVENOUS [800188] 2.5 mg/kg, Intravenous, EVERY 24 HOURS, Post-
Op/Phase II
Note: Ganciclovir Dose Varies Daily [950018] 1 X DAILY (NOON)
Ganciclovir Dose Varies Daily. Unit pharmacist will
contact primary team daily to confirm current dosing.
Suggested Ganclovir Dosing:
5 mg/kg/dose IV every 12 hrs if GFR is equal to or
greater than 70 mL/min/1.73 m2 and creatinine
greater than *** to *** mg/dL
2.5 mg/kg/dose IV every 12 hrs if GFR is 50-69
mL/min/1.73 m2 and creatinine greater than *** to ***
mg/dL
2.5 mg/kg/dose IV every 24 hrs if GFR is 25-49
mL/min/1.73 m2 and creatinine greater than *** to ***
mg/dL
1.25 mg/kg/dose IV every 24 hrs if GFR is 10-24
mL/min/1.73 m2 and creatinine greater than *** to ***
mg/dL
1.25 mg/kg/dose IV three times a week if GFR is less
than 10 mL/min/1.73 m2 and creatinine greater than
*** to *** mg/dL
Post-Op/Phase II
Gastric Prophylaxis (Single Response) [91950]
Page 7 of 14
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ranitidine (ZANTAC) injection - NOTE:
Suggested dose 0.15-0.33 mg/kg/dose for GFR
less than 50 mL/min/1.73 m2 (Maximum 50
mg/dose) [800075]
Intravenous, EVERY 8 HOURS
NOTE: Suggested dose 0.15-0.33 mg/kg/dose for
GFR less than 50 mL/min/1.73 m2 (Maximum 50
mg/dose)
Post-Op/Phase II
ranitidine (ZANTAC) syrup - NOTE: Suggested
dose 0.5-1 mg/kg/dose for GFR less than 50
mL/min/1.73 m2 (Maximum 50 mg/dose) [41612]
Oral, 2 X DAILY
NOTE: Suggested dose 0.5-1 mg/kg/dose for GFR
less than 50 mL/min/1.73 m2 (Maximum 50 mg/dose)
Post-Op/Phase II
ranitidine (ZANTAC) injection - NOTE:
Suggested dose 0.3-0.6 mg/kg/dose for GFR
greater than 50 mL/min/1.73 m2 (Maximum 50
mg/dose) [800075]
Intravenous, EVERY 8 HOURS
NOTE: Suggested dose 0.3-0.6 mg/kg/dose for GFR
greater than 50 mL/min/1.73 m2 (Maximum 50
mg/dose)
Post-Op/Phase II
ranitidine (ZANTAC) syrup - NOTE: Suggested
dose 1-2 mg/kg/dose for GFR greater than 50
mL/min/1.73 m2 (Maximum 150 mg/dose)
[41612]
Oral, 2 X DAILY
NOTE: Suggested dose 1-2 mg/kg/dose for GFR
greater than 50 mL/min/1.73 m2 (Maximum 150
mg/dose)
Post-Op/Phase II
Sucrose for Oral Analgesia [110668]
sucrose (SWEET-EASE) 24% buccal soln
[794009]
Oral, PRN, pain, mild pain or potentially painful
procedures. See Admin Instructions, Post-Op/Phase
II
Non-categorized [91951]
DOPamine infusion PEDS - NOTE: Suggested
dose 2-5 mcg/kg/min [800137]
2-5 mcg/kg/min, Intravenous, CONTINUOUS
NOTE: Suggested dose 2-5 mcg/kg/min
Post-Op/Phase II
heparin lock flush 10 UNIT/ML injection [75031] 1-150 units, Flush, PRN, flush/line care
Flush per VAD Guidelines
Post-Op/Phase II
For EBV negative recipient/positive donor or CMV negative recipient/positive donor [91952]
cytomegalovirus immune glob (CYTOGAM) bag -
NOTE: Suggested dose 150 mg/kg/dose
[770005]
150 mg/kg, Intravenous, EVERY 14 DAYS Starting
tomorrow For 2 Doses
NOTE: Suggested dose 150 mg/kg/dose. Start on
POD#1 x 2 doses
Post-Op/Phase II
Immunosuppression
Induction Agents [206210]
basiliximab (SIMULECT) bag - NOTE: Suggested
dose 12 mg/m2/dose (Maximum 20 mg) on
POD#4 [700156]
12 mg/m2, Intravenous, ONCE Starting 6/4/17 For 1
Doses
NOTE: Suggested dose 12 mg/m2/dose (Maximum
20 mg) on POD#4
Post-Op/Phase II
alemtuzumab (CAMPATH) bag [700039] 20 mg/m2, Intravenous, ONCE For 1 Doses
Administer after methylprednisolone and other
premedications
Post-Op/Phase II
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - NOTE: Suggested dose
10mg/kg/dose (Maximum dose 650 mg) [800005]
10 mg/kg, Oral, ONCE For 1 Doses
Premedication for alemtuzumab
Suggested dose 10mg/kg/dose (Maximum dose 650
mg)
Post-Op/Phase II
Page 8 of 14
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diphenhydramine (BENADRYL) injection - NOTE:
Suggested dose 1 mg/kg/dose (Maximum 50
mg/dose) [800106]
1 mg/kg, Intravenous, ONCE For 1 Doses
Premedication for alemtuzumab
NOTE: Suggested dose 1 mg/kg/dose (Maximum 50
mg/dose)
Post-Op/Phase II
Steroids - Campath [211014]
methylprednisolone sodium succ. (SOLU-
MEDROL) intraVENOUS - NOTE: Suggested
dose 5 mg/kg/dose on POD#1 [800058]
5 mg/kg, Intravenous, 1 X DAILY Starting tomorrow
NOTE: Suggested dose 5 mg/kg/dose on POD#1
Post-Op/Phase II
methylprednisolone sodium succ. (SOLU-
MEDROL) intraVENOUS - NOTE: Suggested
dose 2.5 mg/kg/dose on POD#2 [800058]
2.5 mg/kg, Intravenous, 1 X DAILY Starting 6/2/17
NOTE: Suggested dose 2.5 mg/kg/dose on POD#2
Post-Op/Phase II
Steroids - Basiliximab and Thymoglobulin [91954]
prednisolone (PRELONE) syrup - NOTE:
Suggested dose 1 mg/kg/dose POD#3-7 [46299]
1 mg/kg, Oral, 1 X DAILY Starting 6/3/17 For 4 Doses
with First Dose As Scheduled
NOTE: Suggested dose 1 mg/kg/dose POD#3-7
Post-Op/Phase II
prednisolone (PRELONE) syrup - NOTE:
Suggested dose 0.75 mg/kg/dose POD#8-14
[46299]
0.75 mg/kg, Oral, 1 X DAILY Starting 6/8/17 For 7
Doses with First Dose As Scheduled
NOTE: Suggested dose 0.75 mg/kg/dose POD#8-14
Post-Op/Phase II
prednisolone (PRELONE) syrup - NOTE:
Suggested dose 0.5 mg/kg/dose POD#15-21
[46299]
0.5 mg/kg, Oral, 1 X DAILY Starting 6/15/17 For 7
Doses with First Dose As Scheduled
NOTE: Suggested dose 0.5 mg/kg/dose POD#15-21
Post-Op/Phase II
Mycophenolate [91955]
mycophenolate mofetil in dextrose 5%
(CELLCEPT) intraVENOUS - NOTE: Suggested
dose 300 mg/m2/dose (Maximum 2 g/day) -
POD#0 x1 dose, POD#1 x2 doses, POD#2 x2
doses [800198]
300 mg/m2, Intravenous, 2 X DAILY Starting today
For 5 Doses
NOTE: Suggested dose 300 mg/m2/dose (Maximum
2 g/day) - POD#0 x1 dose, POD#1 x2 doses, POD#2
x2 doses
Post-Op/Phase II
mycophenolate (CELLCEPT) intraVENOUS -
NOTE: Suggested dose 300 mg/m2/dose
(Maximum 2 g/day) on POD#3 and POD#4
[800198]
300 mg/m2, Intravenous, 1 X DAILY Starting 6/3/17
For 2 Doses
NOTE: Suggested dose 300 mg/m2/dose (Maximum
2 g/day) on POD#3 and POD#4
Post-Op/Phase II
mycophenolate (CELLCEPT) intraVENOUS -
NOTE: Suggested dose 600 mg/m2/dose
(Maximum 2 g/day) on POD#3 and POD#4
[800198]
600 mg/m2, Intravenous, 1 X DAILY (HS) Starting
6/3/17 For 2 Doses
NOTE: Suggested dose 600 mg/m2/dose (Maximum
2 g/day) on POD#3 and POD#4
Post-Op/Phase II
mycophenolate mofetil (CELLCEPT) susp -
NOTE: Suggested dose 600 mg/m2/dose
(Maximum 2 g/day) starting on POD#5 [61374]
600 mg/m2, Oral, 2 X DAILY Starting 6/5/17
NOTE: Suggested dose 600 mg/m2/dose (Maximum
2 g/day) starting on POD#5
Post-Op/Phase II
Calcineurin inhibitors [211017]
tacrolimus susp - NOTE: Suggested dose 0.1
mg/kg/dose [780140]
0.1 mg/kg, Oral, 2 X DAILY
Start when serum creatinine is less than *** mg/dL
(50% GFR)
NOTE: Suggested dose 0.1 mg/kg/dose
Post-Op/Phase II
Laboratory
Draw on Patient's Arrival to Unit [91958]
Page 9 of 14
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05/2017CCKM@uwhealth.org

HEMATOCRIT [HCT] NEXT DRAW, 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?
Post-Op/Phase II
ELECTROLYTES [LYTE] NEXT DRAW, 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?
Post-Op/Phase II
BUN [BUN] NEXT DRAW, 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?
Post-Op/Phase II
CREATININE [CRET] NEXT DRAW, 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?
Post-Op/Phase II
CALCIUM [CA] NEXT DRAW, 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?
Post-Op/Phase II
PHOSPHATE [PHOS] NEXT DRAW, 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?
Post-Op/Phase II
GLUCOSE [GLU] NEXT DRAW, 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?
Post-Op/Phase II
Draw Eight Hours After Patient Arrives to Unit [91959]
CBC WITH DIFFERENTIAL [CBC] 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 6 hours after
arrival to unit
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 6 hours after
arrival to unit
Post-Op/Phase II
Page 10 of 14
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BUN [BUN] 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 6 hours after
arrival to unit
Post-Op/Phase II
CREATININE [CRET] 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 6 hours after
arrival to unit
Post-Op/Phase II
GLUCOSE [GLU] 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 6 hours after
arrival to unit
Post-Op/Phase II
Draw Daily [91960]
CBC WITH DIFFERENTIAL [CBC] NEXT AM For 4 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
MAGNESIUM [MAG] NEXT AM For 4 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
PHOSPHATE [PHOS] NEXT AM For 4 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
BETA-2 MICROGLOBULIN [XB2MS] NEXT AM For 4 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
TACROLIMUS [HCTAC] CONDITIONAL - RN COLLECT For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw trough level, 30
minutes prior to morning dose
Post-Op/Phase II
ELECTROLYTES [LYTE] NEXT AM For 4 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
BUN [BUN] NEXT AM For 4 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
Page 11 of 14
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05/2017CCKM@uwhealth.org

CREATININE [CRET] NEXT AM For 4 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
GLUCOSE [GLU] NEXT AM For 4 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
CALCIUM [CA] NEXT AM For 4 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
Collect Daily While Patient is Catheterized [91961]
URINALYSIS WITH MICROSCOPY [UA] CONDITIONAL - RN COLLECT For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw daily if patient is
catheterized
Post-Op/Phase II
CULTURE, URINE [URC] CONDITIONAL - RN COLLECT For 4 Days, Routine
Does patient have an indwelling urinary catheter?
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw daily while
patient is catheterized
Post-Op/Phase II
Collect Every Monday, Wednesday, and Friday After Urinary Catheter has Been Removed [91962]
URINALYSIS WITH MICROSCOPY [UA] CONDITIONAL - RN COLLECT For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw every Monday,
Wednesday, and Friday after urinary catheter has
been removed
Post-Op/Phase II
CULTURE, URINE [URC] CONDITIONAL - RN COLLECT For 4 Days, Routine
Does patient have an indwelling urinary catheter?
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw every Monday,
Wednesday, and Friday after urinary catheter has
been removed
Post-Op/Phase II
Collect Every 24 Hours for Temperature Greater than 38 Degrees Celsius [91963]
CULTURE, URINE [URC] CONDITIONAL - RN COLLECT For 4 Days, Routine
Does patient have an indwelling urinary catheter?
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Collect ONCE for
temperature greater than 38 degrees Celsius
Post-Op/Phase II
Collect for Patient with Central Line [91964]
CULTURE, BLOOD, BACTERIA/YEAST (2
SITES) [116728]
Page 12 of 14
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.Practices for Blood Culturing Best This order equals 2 sites (4 bottles). See link below for
Best Practices for Blood Culturing URL: https://uconnect.wisc.edu/clinical/references/laboratory-
services/blood/
Lab Test Directory URL: https://uconnect.wisc.edu/clinical/tools-
resources/lab-test-directory/microbiology/name-
67798-en.labtest
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
NEXT DRAW, Routine, For optimum diagnosis of
sepsis, sample 3-4 sites only on the first day of a
septic episode. Cultures on subsequent days are
of minimal diagnostic value. Culture detects
bacteria, Candida and Cryptococcus. If filamentous
fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
NEXT DRAW, Routine, For optimum diagnosis of
sepsis, sample 3-4 sites only on the first day of a
septic episode. Cultures on subsequent days are
of minimal diagnostic value. Culture detects
bacteria, Candida and Cryptococcus. If filamentous
fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
Draw Once for Watery Diarrhea [91965]
UWIP - PANEL - C DIFF TOXIN B PCR, NAP1 IF
POSITIVE, CONDITIONAL [142816]
C DIFF TOXIN B PCR, NAP1 IF POSITIVE
[HCCDIFPCR]
CONDITIONAL - RN COLLECT, Starting today,
Routine, Reserve testing for patients with 3 or more
unformed stools in 1 or more days. Do not repeat a
negative test within 7 days. Do not perform for test
of cure. Samples positive for the C. difficile toxin B
gene (tcdB) will also be tested for the hypervirulent
epidemic strain (O27/NAP1/BI).
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Collect once for 3
unformed stools in 24 hour period.
Post-Op/Phase II
Isolation - Enhanced Contact - Clostridium
Difficile [ISO0010]
CONDITIONAL For 1 Occurrences
Isolation Cart [EQP0016] CONTINUOUS, Starting today, Routine, Post-
Op/Phase II
Diagnostic Tests and Imaging
Diagnostic Tests and Imaging [91967]
Page 13 of 14
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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05/2017CCKM@uwhealth.org

X-RAY CHEST AP VIEW [R71010] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where? Bedside
Transport Method: Floor Determined/Entered
On arrival to PICU., Post-Op/Phase II
Consults
Consults [211016]
Consult Social Work (Inpatient) [CON0076] ONCE, Routine
Reason for Consult: OTHER (Patient Assessment)
Is this a STAT consult?
Can this consult be done via video?
Consult Social Work (Inpatient) [CON0076] ONCE, Routine
Reason for Consult: DISCHARGE PLANNING
Is this a STAT consult?
Can this consult be done via video?
Page 14 of 14
Printed by STRAKA, KEVIN F [KFS1] at 5/31/2017 4:13:15 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org