/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/order-sets/,/clinical/cckm-tools/content/order-sets/inpatient/,/clinical/cckm-tools/content/order-sets/inpatient/vascular-surgery/,

/clinical/cckm-tools/content/order-sets/inpatient/vascular-surgery/name-97888-en.cckm

20170235

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Vascular Surgery

IP - Carotid Endarterectomy Stent - Adult - Postprocedure [5433]

IP - Carotid Endarterectomy Stent - Adult - Postprocedure [5433] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Vascular Surgery


IP - Carotid Endarterectomy/Stent - Adult - Postprocedure [5433]
for Adult Patients OnlyIntended
Admission Status
Admission Status (Single Response) [219633]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service:
I certify that an inpatient stay is medically necessary
because of either an anticipated LOS >2 midnights,
complexity and/or severity of illness, an inpatient-only
surgery, or a previously-authorized inpatient stay.
Rationale listed below. Yes
C - CLEAR DIAGNOSIS:
E - EVALUATIONS PLANNED:
R - RESULTS EXPECTED:
T - TREATMENTS ORDERED:
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Procedure Specific Orders
Procedure Specific Orders (Single Response) [154577]
Carotid Endarterectomy [154467]
Activity [NURACT0008] CONTINUOUS, Routine
AD LIB:
AMBULATE:
CHAIR: ad lib
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
Elevate Head Of Bed [NURACT0002] Equal to (degrees):
Greater than (degrees): 30
Less than (degrees):
Other options:
Routine, CONTINUOUS, Post-Op/Phase II
Maintain Drain [NURTAD0003] CONTINUOUS, Routine
Type: Closed Suction (Jackson-Pratt)
Site: Head/Neck
Location: Anterior
Drainage Options: Bulb
Irrigate Frequency:
Irrigate With:
Irrigant Volume (mL):
Strip: EVERY 2 HOURS
Strip For:
Dressing Change Frequency:
Dressing Type:
Post-Op/Phase II
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Wound Care [NURWND0015] CONTINUOUS, Routine
Wound Type: Closed - Incision
Wound Site: Head/Neck
Wound Location: Anterior
Assess Frequency: SEE COMMENTS (Post-
procedure: Every 15 minutes times 4, then every 30
minutes times 4, then every hour times 4, then
every 4 hours.)
Care Frequency: 1X DAILY
Wash With: Soap and Water
Irrigate/Rinse With:
Apply (Must also enter separate medication order
to obtain drug):
Primary Dressing:
Secondary Dressing:
Maintain Arterial Line [NURVAD0001] CONTINUOUS, Routine
Device Status:
Flush Solution:
Site: Other (Comment) (as placed by anesthesia)
Check and document patency, tubing change, site
assessment and dressing change per policy.
aspirin rectal suppository [34799] 300 mg, Rectal, ONCE For 1 Doses
Give in PACU
PACU
aspirin chew tab [720164] 81 mg, Oral, 1 X DAILY Starting tomorrow, Post-
Op/Phase II
clopidogrel (PLAVIX) tab [720168] 75 mg, Oral, 1 X DAILY Starting tomorrow, Post-
Op/Phase II
Carotid Stent With Sheath [154469]
Assess Pulse [NURMON0008] SEE COMMENTS, Routine
Method:
Pulse Side: Bilateral
Pulse Location: Pedal,Posterial Tibial
Post-procedure: Every 15 minutes times 4, then
every 30 minutes times 4, then every hour times 4,
then every 4 hours., Post-Op/Phase II
Assess Pulse [NURMON0008] SEE COMMENTS, Routine
Method:
Pulse Side: Bilateral
Pulse Location: Pedal,Posterial Tibial
Post-procedure: Every 15 minutes times 4, then
every 30 minutes times 4, then every hour times 4,
then every 4 hours., PACU
Wound Care [NURWND0018] ONCE, Keep entry site covered with transparent
dressing. Remove dressing before discharge and
cover site with Band-Aid., Post-Op/Phase II
Maintain Femoral Arterial Sheath [NURVAD0060] CONTINUOUS, Routine
Location:
Infuse With (Separate Medication Order Must Also
be Completed):
Site Assessment Frequency:
Care Frequency: Every 24 Hours
Wash With: Chlorhexidine Sponge
Primary Dressing: Biopatch
Secondary Dressing: Transparent Dressing
(TEGADERM)
Post-Op/Phase II
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Prior to Sheath Removal - Bedrest/Logroll
[NURACT0011]
CONTINUOUS, Prior to sheath removal -
Bedrest/Logroll. Patient may roll to affected side
for comfort, keeping the affected leg extended.,
Post-Op/Phase II
Prior to Sheath Removal - Elevate Head Of Bed
Less Than 30 Degrees [NURACT0002]
Equal to (degrees):
Greater than (degrees):
Less than (degrees):
Other options:
Routine, CONTINUOUS, Prior to sheath removal -
elevate head of bed less than 30 degrees., Post-
Op/Phase II
ACTIVATED CLOTTING TIME, POC
[HCACTPOC]
SEE COMMENTS For 1 Days, Routine
If Conditional, What Condition?
Monitor Activated Clotting Time (ACT) every hour
starting within an hour upon arrival to unit until
activated clotting time (ACT) is equal or less than
160 seconds., Post-Op/Phase II
Remove Femoral Sheath [NURCOM0022] SEE COMMENTS, Femoral sheath to be pulled by
credentialed provider., Post-Op/Phase II
Femoral Compression System - Post Sheath
Removal [NURTAD0048]
CONTINUOUS, Routine, Maintain dome pressure
at 60 mmHg for 20 minutes, then 40 mmHg for 20
minutes, then 20 mmHg for 20 minutes, then band
pressure for 20 minutes, then remove., Post-
Op/Phase II
Post Sheath Removal - Vital Signs
[NURMON0013]
SEE COMMENTS, 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 4, then every 4
hours., Post-Op/Phase II
Post Sheath Removal - Assess Entry Puncture
Site [NURMON0060]
ONCE, Every 15 minutes times 4, then every 30
minutes times 4, then every hour times 4, then
every 4 hours., Post-Op/Phase II
Post Sheath Removal - Assess Pulse
[NURMON0060]
ONCE
Method:
Pulse Side: Bilateral
Pulse Location: Pedal,Posterial Tibial
Every 15 minutes times 4, then every 30 minutes
times 4, then every hour times 4, then every 4
hours., Post-Op/Phase II
Post Sheath Removal - Activity [NURACT0011] SEE COMMENTS, {Activity:30005433}, Post-
Op/Phase II
aspirin chew tab [720164] 81 mg, Oral, 1 X DAILY, Post-Op/Phase II
aspirin tab [34787] 325 mg, Oral, 1 X DAILY, Post-Op/Phase II
clopidogrel (PLAVIX) tab [720168] 75 mg, Oral, Post-Op/Phase II
clopidogrel (PLAVIX) tab [720168] 150 mg, Oral, ONCE For 1 Doses, Post-Op/Phase
II
clopidogrel (PLAVIX) tab [720168] 300 mg, Oral, ONCE For 1 Doses, Post-Op/Phase
II
clopidogrel (PLAVIX) tab [58345] 600 mg, Oral, ONCE For 1 Doses, Post-Op/Phase
II
Carotid Stent WithOUT Sheath [154851]
Page 3 of 12
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Assess Pulse [NURMON0008] SEE COMMENTS, Routine
Method:
Pulse Side: Bilateral
Pulse Location: Pedal,Posterial Tibial
Post-procedure: Every 15 minutes times 4, then
every 30 minutes times 4, then every hour times 4,
then every 4 hours., Post-Op/Phase II
Assess Pulse [NURMON0008] SEE COMMENTS, Routine
Method:
Pulse Side: Bilateral
Pulse Location: Pedal,Posterial Tibial
Post-procedure: Every 15 minutes times 4, then
every 30 minutes times 4, then every hour times 4,
then every 4 hours., PACU
Assess Entry Site [NURMON0060] SEE COMMENTS, Femoral Artery
Location: bilateral
Monitor entry site for hematoma or new bleeding;
Post-procedure: Every 15 minutes times 4, then
every 30 minutes times 4, then every hour times 4,
then every 4 hours., Post-Op/Phase II
Wound Care [NURWND0018] ONCE, Keep entry site covered with transparent
dressing. Remove dressing before discharge and
cover site with Band-Aid., Post-Op/Phase II
Femoral Compression System - Post Sheath
Removal [NURTAD0048]
CONTINUOUS, Routine, Maintain dome pressure
at 60 mmHg for 20 minutes, then 40 mmHg for 20
minutes, then 20 mmHg for 20 minutes, then band
pressure for 20 minutes, then remove., Post-
Op/Phase II
Post Sheath Removal - Activity [NURACT0011] SEE COMMENTS, {Activity:30005433}, Post-
Op/Phase II
aspirin chew tab [720164] 81 mg, Oral, 1 X DAILY, Post-Op/Phase II
aspirin tab [34787] 325 mg, Oral, 1 X DAILY, Post-Op/Phase II
clopidogrel (PLAVIX) tab [720168] 75 mg, Oral, 1 X DAILY, Post-Op/Phase II
clopidogrel (PLAVIX) tab [720168] 150 mg, Oral, 1 X DAILY For 7 Doses, Post-
Op/Phase II
clopidogrel (PLAVIX) tab [720168] 300 mg, Oral, ONCE For 1 Doses, Post-Op/Phase
II
clopidogrel (PLAVIX) tab [58345] 600 mg, Oral, ONCE For 1 Doses, Post-Op/Phase
II
Venous Thromboembolism (VTE) Prophylaxis
VTE Prophylaxis (Single Response) [131999]
Caprini VTE Risk Assessment URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/hematology-and-
coagulation/related/name-97521-en.cckm
Low VTE Risk [130084]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered: Low Risk
Post-Op/Phase II
Moderate VTE Risk with Low Bleed Risk (Single
Response) [209954]
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 12 HOURS,
Post-Op/Phase II
High VTE with Low Bleed Risk [211018]
Page 4 of 12
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02/2017CCKM@uwhealth.org

enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 8 HOURS,
Post-Op/Phase II
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
High Bleed Risk [129757]
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
Post-Op/Phase II
No VTE Prophylaxis [130084]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered:
Post-Op/Phase II
PACU
PACU Post-procedure [214928]
Vital Signs [NURMON0013] SEE COMMENTS, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Post-procedure: Every 15 minutes times 4, then every
thirty minutes times 4, then every hour times 4, then
every 4 hours., PACU
Assess Neurologic Status using UWHC
Abbreviated NIHSS Flowsheet [NURMON0006]
SEE COMMENTS, Routine, Post-procedure: Every
15 minutes times 4, then every thirty minutes times 4,
then every hour times 4, then every 4 hours., PACU
Surgical Site Assessment [NURWND0015] CONTINUOUS, Routine
Wound Type:
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:
Post-procedure: Every 15 minutes times 4, then
every thirty minutes times 4, then every hour times 4,
then every 4 hours., PACU
Patient Care Orders
Page 5 of 12
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Vital Signs [154582]
Vital Signs [NURMON0013] SEE COMMENTS, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Post-procedure: Every 15 minutes times 4, then every
30 minutes times 4, then every hour times 4, then
every 4 hours., Post-Op/Phase II
Patient Monitoring [154583]
Assess Neurologic Status Using UWHC
Abbreviated NIHSS Flowsheet [NURMON0006]
SEE COMMENTS, Routine, Post-procedure every 15
minutes times 4, then every thirty minutes times 4,
then every hour times 4, then every 4 hours., Post-
Op/Phase II
Nutrition [154584]
Diet - Custom [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Liquid
Liquid: Clear Liquid
No Red or Purple Dye:
Liquid Thickness: Thin
Bedside Meal Instructions:
Room Service Class:
Respiratory [154585]
Pulse Oximetry [NURMON0009] CONTINUOUS, Routine, Post-Op/Phase II
Oxygen Therapy [RT0032] CONTINUOUS, Routine
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%): 92
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen? Yes
Post-Op/Phase II
Incentive Spirometry [NURTRT0018] EVERY 2 HOURS, Routine, While awake, Post-
Op/Phase II
Intake and Output [154586]
Measure Intake And Output [NURMON0005] SEE COMMENTS, Routine, Every 2 hours times 4,
then every 4 hours., Post-Op/Phase II
Non-Categorized Patient Care Orders [154588]
Measure Weight [NURMON0015] ONCE For 1 Occurrences, Routine
Weigh With?
Weigh when?
Post-Op/Phase II
Maintain Arterial Line [NURVAD0001] CONTINUOUS, Routine
Device Status:
Flush Solution:
Site:
Post-Op/Phase II
Cardiac Rhythm Monitoring - Adult
[NURMON0010]
CONTINUOUS, Routine
Indication: Other (Comment Required)
Notify Provider:
Functional Cardiac Defibrillator Present:
Post-Op/Phase II
Page 6 of 12
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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: Other (Comment Required)
(monitoring urine output)
Initiate Urinary Catheter Removal Protocol? (NP/PA
Must Select "No"):
Details: To Dependent Drainage
Does this need to be inserted/placed?
Post-Op/Phase II
Urinary Catheterization-Intermittent
[NURELM0018]
EVERY 6 HOURS PRN, Routine, If unable to void.,
Post-Op/Phase II
Initiate Peripheral Vascular
Surgery/Neurosurgery Discontinuation of Radial
Arterial Line Protocol [NURTRT0091]
CONTINUOUS, Routine, Post-Op/Phase II
Contingency Parameters [154589]
Notify [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 160
If systolic blood pressure < (mmHg): 90
If diastolic blood pressure > (mmHg): 100
If diastolic blood pressure < (mmHg): 50
If temperature > (C): 38.5
If temperature < (C):
If heart rate > (bpm): 110
If heart rate < (bpm): 50
If respiratory rate >: 26
If respiratory rate <: 10
If blood glucose > (mg/dL): 180
If blood glucose < (mg/dL): 70
If pain score >:
Pulse Oximetry < (%): 92
If urine output < (mL): 30 mL/h
Other: Stridor,Any decrease in neurological
status,Unable to maintain bulb suction,Closed suction
drain output is greater than 30 mL in 2
hours,Maximum dose of nitroglycerin
reached,Maximum dose of esmolol
reached,Maximum dose of phenlphrine
reached,Develops headache
Post-Op/Phase II
Intravenous Therapy
Premedications for Needle Insertion [106327]
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.
Page 7 of 12
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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
Post-Op/Phase II
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
Post-Op/Phase II
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
Post-Op/Phase II
IV Fluids [154521]
sodium chloride 0.9 % infusion [64367] at 75 mL/hr, Intravenous, CONTINUOUS, Post-
Op/Phase II
General Medications
ICU -Adult -Supplementation Electrolyte -Please refer to IP -Electrolyte Supplementation For
[3439]Supplemental -IMC
Analgesics - Acetaminophen - PRN [219365]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, EVERY 4 HOURS PRN, pain,
Temperature grater than 38.5 degrees Celsius or pain
For mild to moderate pain.
No more than 4 grams acetaminophen per 24 hours
for adults or 15mg/kg per dose for peds <40kg.
Post-Op/Phase II
Analgesics - Opioids - PRN [154522]
hydrocodone-acetaMINOPHEN (NORCO) 5-325
MG per tab RANGE [750021]
1-2 tab, Oral, EVERY 4 HOURS PRN, pain
Administer for severe pain.
No more than 4 grams acetaminophen per 24 hours
for adults or 15mg/kg per dose for peds <40kg.
Post-Op/Phase II
Anti-emetics [154523]
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, EVERY 24 HOURS PRN,
nausea/vomiting
First line agent
Post-Op/Phase II
Page 8 of 12
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prochlorperazine (COMPAZINE) tab [41372] 10 mg, Oral, EVERY 6 HOURS PRN,
nausea/vomiting
Second line agent - Give if patient fails to respond to
first line agent after 1 hour.
Post-Op/Phase II
prochlorperazine (COMPAZINE) injection [41369] 10 mg, Intravenous, EVERY 6 HOURS PRN,
nausea/vomiting
If ordered IV: push slowly, max rate 5 mg/minute.
Second line agent - Give if patient fails to respond to
first line agent after 1 hour and cannot take orally.
Post-Op/Phase II
Bowel Management [154524]
senna-docusate (SENOKOT S) 8.6-50 MG per
tab [60530]
2 tab, Oral, 2 X DAILY
Hold for loose stools.
Post-Op/Phase II
polyethylene glycol (MIRALAX) oral powder
[61829]
17 g, Oral, 1 X DAILY PRN, constipation
First line agent
Dissolve in 240 mL of liquid
Post-Op/Phase II
magnesium hydroxide (MILK OF MAGNESIA)
susp [65443]
30 mL, Oral, 1 X DAILY PRN, constipation
Second line agent
May dilute with a small amount of water prior to
administration. Follow administration with a full glass
of water.
Post-Op/Phase II
bisacodyl (DULCOLAX) rectal suppository
[35231]
10 mg, Rectal, 1 X DAILY PRN, constipation
Use if unresponsive to 1st or 2nd line therapy or if
immediate laxation is required.
Post-Op/Phase II
Anti-hypertensives - First Line [154525]
labetalol injection RANGE [750053] 10-20 mg, Intravenous, EVERY 1 HOUR PRN, SBP >
160mmHg
First line agent. Administer for SBP > 160 mmHg
AND HR > 60 bpm.
for 2 Minutes, Post-Op/Phase II
Anti-hypertensives - Second Line [219366]
hydrALAZINE (APRESOLINE) injection RANGE
[750049]
10-20 mg, Intravenous, EVERY 1 HOUR PRN, SBP >
160mmHg
Second line agent. Administer for SBP > 160.
Post-Op/Phase II
Anti-hypertensives - Third Line [154526]
esmolol (BREVIBLOC) 2.5 g in sodium chloride
0.9% 250 mL infusion [66486]
50-300 mcg/kg/min, Intravenous, CONTINUOUS
Third line agent
Give 0.5 mg/kg bolus prior to starting esmolol drip
and before each dose increase.
Initiate at 50 mcg/kg/min or current rate and titrate by
50 mcg/kg/min every 5-20 min to keep SBP < 160
mmHg and HR < 110 bpm. For HR < 50, wean by 50
mcg/kg/min every 5-20 min until HR > 50.
Post-Op/Phase II
Page 9 of 12
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nitroglycerin 50 mg in dextrose 5% 250 mL
infusion [51611]
0.2-3 mcg/kg/min, Intravenous, CONTINUOUS
Third line agent
Initiate at 0.2 mcg/kg/min or current rate and titrate by
0.2-0.5 mcg/kg/min every 5-15 min to keep SBP <
160 mmHg. For SBP < 90 mmHg, wean by 0.2-0.5
mcg/kg/min every 5-15 min until SBP > 90 mmHg.
Post-Op/Phase II
Beta Blockers (Single Response) [154530]
atenolol (TENORMIN) tab [720016] Oral, 1 X DAILY
Hold for heart rate less than 50 beats/min or systolic
blood pressure less than 90 mmHg
Post-Op/Phase II
carvedilol (COREG) tab [54511] Oral, 2 X DAILY
Hold for heart rate less than 50 beats/min or systolic
blood pressure less than 90 mmHg
Post-Op/Phase II
metoprolol tartrate (LOPRESSOR) tab [720094] Oral, 2 X DAILY
Hold for heart rate less than 50 beats/min or systolic
blood pressure less than 90 mmHg
Post-Op/Phase II
Statins (Single Response) [154533]
atorvastatin (LIPITOR) tab [720017] Oral, 1 X DAILY (HS), Post-Op/Phase II
rosuvastatin (CRESTOR) tab [73638] Oral, 1 X DAILY (HS), Post-Op/Phase II
pravastatin (PRAVACHOL) tab [46292] Oral, 1 X DAILY (HS), Post-Op/Phase II
simvastatin (ZOCOR) tab [46562] Oral, 1 X DAILY (HS), Post-Op/Phase II
Vasopressors [154535]
phenylEPHRINE (NEO-SYNEPHRINE) 20 mg in
dextrose 5 % 250 mL infusion [700258]
0.1-1 mcg/kg/min, Intravenous, CONTINUOUS
Initiate at 0.25-0.5 mcg/kg/min or current rate and
titrate by 0.25 mcg/kg/min every 1-15 min to maintain
SBP > 90.
Post-Op/Phase II
Laboratory
On Arrival to Post-Anesthesia Recovery [154590]
ELECTROLYTES [LYTE] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PACU
CBC [SACRCBCD] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Postoperative Day 1 in AM [154591]
CBC [SACRCBCD] NEXT AM 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] NEXT AM 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
Page 10 of 12
Printed by O'BRIEN, RYLEY P [RPO249] at 2/2/2017 8:36:27 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2017CCKM@uwhealth.org

ELECTROLYTES [LYTE] NEXT AM 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
MAGNESIUM [MAG] NEXT AM 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
Consults
Consults [154596]
Diabetes Consult Order Panel (Adult) [188497]
Diabetes Management Service : Will provide management or treatment recommendations for
patients with hyperglycemia and/or those who report outpatient use of insulin or other diabetes
medications. Patients should be expected to remain inpatient > 24 hrs from time of consult.
Consult is required for patients with insulin pumps or who use U-500 insulin. Consult Endocrine
for any non-diabetes-related endocrine questions.
Learning Center - Diabetes Education (Adult): Diabetes Education (Adult): Diabetes education
(meter/insulin skills/other diabetes survival skills) for patients/families with knowledge deficits
and/or need for diabetes knowledge assessment. Recommended for all new diagnoses or
patients with A1C > 9.
Diabetes Education – Nutrition: Diabetes nutrition therapy including nutrition assessment,
carbohydrate education (consistent carbohydrate meals, use of insulin-to-carbohydrate ratio),
and/or individualized, nutritious meal planning for carbohydrates, portions, or considering other
comorbidities. Recommended for all new diagnoses or patients with A1C > 9
Consult Diabetes Management Service (DMS)
(Inpatient) [CON0022]
ONCE
Can this consult be done via video?
Call back number:
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be
Addressed (Symptom, Sign, or Diagnosis):
Consult Learning Center - Diabetes Education
(Adult) [CON0021]
ONCE, Routine, · If patient is newly diagnosed or
is new to insulin, provide 24 hours notice to allow
adequate time for education.
· Indicate diabetes medication/treatment plan if
known.
· Consults requested after 1600 on Fridays may
not be seen until following Monday. Learning
Center available Mon-Sat 0800-1630 (only 1 RN
available on Saturday for CSC and AFCH).
· Learning Center staff are not available on
holidays.
Type of Education: Diabetes Self-Management
Education
Reason For Consult:
Expected Discharge Date:
Diabetes management / treatment plan:
Can this consult be done via video?
Post-Op/Phase II
Page 11 of 12
Printed by O'BRIEN, RYLEY P [RPO249] at 2/2/2017 8:36:27 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2017CCKM@uwhealth.org

Consult Diabetes Education - Nutrition (Inpatient)
[CON0126]
ONCE, Routine, · If your patient is newly
diagnosed and/or is new to insulin therapy, provide
24 hours notice to allow adequate time for nutrition
education.
· Indicate diabetes medication/treatment plan if
known.
· Consults requested after 1300 on Friday may not
be completed until the following Monday.
· If you are placing a consult on a weekend day for
a patient who will be discharging that weekend,
please have the Paging Center contact the on-call
dietitian to help you facilitate the diabetes nutrition
education session prior to the patient's discharge.
Type of Education: Diabetes Self-Management
Education
Reason For Consult:
Expected Discharge Date:
Diabetes management / treatment plan:
Can this consult be done via video?
Post-Op/Phase II
Consult Renal-Acute (Inpatient) [CON0069] ONCE
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be
Addressed (Symptom, Sign, or Diagnosis): Renal
compromise
Post-Op/Phase II
Consult Stroke - Non-Acute (Inpatient)
[CON0133]
ONCE
Intent: Consult and Recommend (No Orders)
Concern or Specific Question or Task to be
Addressed (Symptom, Sign, or Diagnosis): Stroke
Post-Op/Phase II
Consult Ace/Geriatric (Inpatient) [CON0001] ONCE, Routine
Reason for Consult: Overall Geriatric Evaluation
Post-Op/Phase II
Consult Hematology (Inpatient) [CON0034] ONCE
Intent: Consult and Recommend (No Orders)
Concern or Specific Question or Task to be
Addressed (Symptom, Sign, or Diagnosis):
Coagulopathy
Post-Op/Phase II
Consult Cardiology (Inpatient) [CON0012] ONCE
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be
Addressed (Symptom, Sign, or Diagnosis): Coronary
Artery Disease
Post-Op/Phase II
Page 12 of 12
Printed by O'BRIEN, RYLEY P [RPO249] at 2/2/2017 8:36:27 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2017CCKM@uwhealth.org