Physician Orders. PED Endocrine General Admit Plan [X or R] = will be ordered unless marked out. [ ] No known allergies
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- Julianna Stevenson
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1 Height: cm Weight: kg Allergies: [ ] No known allergies [ ] Initiate Powerplan Phase T;N, Phase:PED Endo General Admit Phase Admission/Transfer/Discharge [ ] Admit Patient to Dr. Admit Status: [ ] Inpatient [ ] Routine Post Procedure <24hrs [ ] 23 hour OBS Bed Type: [ ] Med/Surg [ ] Critical Care [ ] Stepdown [ ] Telemetry; Specific Unit Location: [ ] Admit Patient T;N [ ] Notify Physician-Once T;N, Of room number on arrival to unit. Primary Diagnosis: Secondary Diagnosis: Vital Signs [ ] Vital Signs T;N, Monitor and Record T,P,R,BP, routine per unit [ ] Vital Signs w/neuro Checks T;N, q4h(std) Activity [ ] Out Of Bed T;N, Up Ad Lib Food/Nutrition [ ] NPO Start at: T;N, Instructions: NPO except for ice chips [ ] NPO Start at: T;N [ ] Breastfeed T;N [ ] Formula Per Home Routine T;N, [ ] American Diabetic Association Pediatric i Diet ( ADA Diet Pediatric i ) T;N, calories, age group, Include 3 meals and 3 snacks. [ ] Clear Liquid Diet T;N Patient Care [ ] Advance Diet As Tolerated T;N, ADA, start clear liquids and advance as tolerated to ADA Diet Pediatric calories [ ] Isolation Precautions T;N, Isolation Type: [ ] Suicide Precautions T;N, Routine, q2h(std) [ ] Strict I/O T;N, Routine, q2h(std) [ ] Restrict Fluids T;N, Routine, ml/hr over next hours (total fluids) [ ] Restrict Fluids T;N, Routine, ml/(12h-shift) (total fluids) [ ] Whole Blood Glucose Nsg ( Bedside T;N, Routine, ACHS and 0200 Glucose Nsg ) [ ] Whole Blood Glucose Nsg ( Bedside T;N, 2h post prandial Glucose Nsg ) [ ] INT Insert/Site Care T;N, Routine, qeve [ ] Daily Weights T;N, Routine, qeve [ ] O2 Sat Spot Check-NSG T;N, with vital signs [ ] O2 Sat Monitoring NSG T;N [ ] Cardiopulmonary Monitor T;N Routine, Monitor Type: CP Monitor [ ] Nursing Communication T;N, Target Blood Sugar Range- Low = 70mg/dL (greater than 3 years of age) [ ] Nursing Communication T;N, Target Blood Sugar Range- Low = 100mg/dL (below 3 years of age) [ ] Nursing Communication T;N, Target Blood Sugar Range- High = 150mg/dL *111* Page 1 of 5
2 Patient Care continued [ ] Nursing Communication T;N, If patient's blood sugar is less than 65 mg/dl and patient is UNresponsive and incapable of taking food orally, call MRT and notify physician immediately. [ ] Nursing Communication T;N, If patient's blood sugar is less than 65 mg/dl and patient is responsive and capable of taking food orally, recheck blood sugar and if still less than 65 mg/dl, give juice or milk and crackers. If about to eat a meal, feed immediatley. Notify physician. [ ] Nursing Communication T;N, Place order for ketones urine if blood glucose greater than 250 mg/dl [ ] Request Supply to Bedside ( Supply to T;N, place home supplies for urine ketone and blood sugar testing at bedside for Bedside ) diabetic education [ ] Nursing Communication T;N, If bedside glucose is greater than 500mg/dL, place order for serum glucose. [ ] Simple Facemask Respiratory Care T; N, L/min, Titrate to keep O2 sat =/> 92% Wean to room air [ ] O2 Nasal Cannula T; N, L/min, Titrate to keep O2 sat =/> 92% Wean to room air [ ] Sodium Chloride 0.9% Continuous Infusions 1,000mL,IV,Routine,T:N, at ml/hr [ ] D10 NS + 20 meq/l KCL 1000mL,IV,Routine,T:N, at ml/hr [ ] D5 1/2 NS 1000mL,IV,Routine,T:N, at ml/hr [ ] D5 1/4 NS 1000mL,IV,Routine,T:N, at ml/hr [ ] D5 1/2 NS KCl 20 meq/l 1000mL,IV,Routine,T:N, at ml/hr [ ] D5 1/4 NS KCl 20 meq/l 1000mL,IV,Routine,T:N, at ml/hr Medications [ ] acetaminophen mg(10 mg/kg), Liq, PO, q4h, PRN, Pain or Fever, T;N,Max Dose = 90mg/kg/day up to 4 g/day [ ] acetaminophen 80 mg, chew tab, PO, q4h, PRN, Pain or Fever, T;N,Max Dose = 90 mg/kg/day up to 4 g/day [ ] acetaminophen 325mg, tab, PO, q4h, PRN, Pain or Fever, T;N,Max Dose = 90 mg/kg/day up to 4 g/day [ ] acetaminophen mg(10 mg/kg), Supp, PR, q4h, PRN, Pain or Fever, T;N,Max Dose = 90mg/kg/day up to 4 g/day [ ] insulin glargine units, (0.5 units/kg),injection, Subcutaneous, hs, routine, T;N [ ] insulin glargine units, (0.5 units/kg),injection, Subcutaneous, qam, routine, T;N NOTE: Insulin Lispro Corrective Dose per blood glucose mg/dl. Carbohydrate counting dose per grams of carbohydrate with meals. Comment, routine, T;N, Corrective dose: 1 unit for every 25 mg/dl over target 120 Comment, routine, T;N, Corrective dose: 1 unit for every 25 mg/dl over target 150 Comment, routine, T;N, Corrective dose: 1 unit for every 25 mg/dl over target 180 Comment, routine, T;N, Corrective dose: 1 unit for every 50 mg/dl over target 120 Page 2 of 5
3 Medications continued [ ] insulin lispro units, (1 unit), Injection, Subcutaneous,prn, PRN Other Specify in Comment Other Specify in Comment, routine, T;N, Corrective dose: 1 unit for every 50 mg/dl over target 150 Comment, routine, T;N, Corrective dose: 1 unit for every 50 mg/dl over target 180 [ ] insulin lispro units, (1 unit), Injection, Subcutaneous, prn,prn Other Specify in Comment, routine, T;N, Corrective dose: 1 unit for every 75 mg/dl over target 120 Comment, routine, T;N, Corrective dose: 1 unit for every 75 mg/dl over target 150 Comment, routine, T;N, Corrective dose: 1 unit for every 75 mg/dl over target t grams of carbohydrate with meals and as needed for snack(s) 7.5 grams of carbohydrate with meals and as needed for snack(s) 10 grams of carbohydrate with meals and as needed for snack(s) 15 grams of carbohydrate with meals and as needed for snack(s) 20 grams of carbohydrate with meals and as needed for snack(s) 25 grams of carbohydrate with meals and as needed for snack(s) 30 grams of carbohydrate with meals and as needed for snack(s) [ ] insulin lispro units, (0.25 units/kg), Injection, Subcutaneous, once, routine, T;N [ ] glucagon 1 mg, Injection, Subcutaneous, PRN, Hypoglycemic seizure, routine, T;N [ ] glucagon 1 mg, Injection, Subcutaneous, once, Hypoglycemia, routine, T;N, Available for diabetes education Page 3 of 5
4 Laboratory [ ] Basic Metabolic Panel ( BMP ) T;N, Routine, once, Type: Blood [ ] Osmolality Serum T;N, Routine, once, Type: Blood [ ] FSH T;N, Routine, once, Type: Blood [ ] LH T;N, Routine, once, Type: Blood [ ] Growth Hormone Human Level T;N, Routine, once, Type: Blood [ ] Anti Diuretic Hormone T;N, Routine, once, Type: Blood [ ] Prolactin Level T;N, Routine, once, Type: Blood [ ] BNP T;N, Routine, once, Type: Blood [ ] ProBNP T;N, Routine, once, Type: Blood [ ] Androstenedione T;N, Routine, once, Type: Blood [ ] Deoxycortisol-11 (Specific S) T;N, Routine, once, Type: Blood [ ] Cortisol Level T;N, Routine, once, Type: Blood [ ] DHEA Level T;N, Routine, once, Type: Blood [ ] Deoxycorticosterone T;N, Routine, once, Type: Blood [ ] 17-HydroxyPregnenolone T;N, Routine, once, Type: Blood [ ] Progesterone Level T;N, Routine, once, Type: Blood [ ] 17-HydroxyPregesterone T;N, Routine, once, Type: Blood [ ] Testosterone Level T;N, Routine, once, Type: Blood [ ] Amylase Level T;N, Routine, once, Type: Blood [ ] Lipase Level T;N, Routine, once, Type: Blood [ ] Hepatic Panel T;N, Routine, once, Type: Blood [ ] Thyroglobulin Comp Panel T;N, Routine, once, Type: Blood [ ] Microsomal Antibody T;N, Routine, once, Type: Blood [ ] TSH T;N, Routine, once, Type: Blood [ ] T4 Free ( Free T4 ) T;N, Routine, once, Type: Blood [ ] T3 Level T;N, Routine, once, Type: Blood [ ] T3 Reverse ( Reverse T3 ) T;N, Routine, once, Type: Blood [ ] Chromosome Analysis Blood T;N, Routine, once, Type: Blood [ ] Calcium Ionized T;N, Routine, once, Type: Blood [ ] Phosphorus Level T;N, Routine, once, Type: Blood [ ] Magnesium Level T;N, Routine, once, Type: Blood [ ] PTH T;N, Routine, once, Type: Blood [ ] Lactic Acid Level ( Lactate Level ) T;N, Routine, once, Type: Blood [ ] Pyruvate T;N, Routine, once, Type: Blood [ ] Insulin Like Growth Factor I T;N, Routine, once, Type: Blood [ ] Insulin Like Growth Factor II T;N, Routine, once, Type: Blood [ ] IGF Binding Protein 1 T;N, Routine, once, Type: Blood [ ] IGF Binding Protein 3 T;N, Routine, once, Type: Blood [ ] PED GTT 2Hr with Insulin Plan see separate sheet [ ] Ketones Urine Routine, T;N, once, Type: Urine, Nurse Collect [ ] Osmolality Urine Routine, T;N, once, Type: Urine, Nurse Collect [ ] Catecholamine Urine Random Routine, T;N, once, Type: Urine, Nurse Collect [ ] Iodide Urine Random Routine, T;N, once, Type: Urine, Nurse Collect [ ] GGT Routine, T;N, once, Type: Blood [ ] Vitamin D 25 Hydroxy Routine, T;N, once, Type: Blood [ ] Vitamin D1, 25 Dihydroxy Routine, T;N, once, Type: Blood Page 4 of 5
5 Laboratory continued [ ] Hemoglobin A1C Routine, T;N, once, Type: Blood [ ] Hemoglobinopathy Evaluation Routine, T;N, once, Type: Blood (Abnormal Hemoglobin Analysis(HPLC) ) [ ] Erythrocyte Sedimentation Rate ( Sed Routine, T;N, once, Type: Blood Rate ) [ ] FISH Study, t(22;11) Routine, T;N, once, Type: Blood [ ] Cortisol Level Routine, T+1;0400, once, Type: Blood [ ] Lipid Profile Routine, T+1;0400, once, Type: Blood [ ] Hepatitis Profile (A,B,&C) PED Routine, T;N, once, Type: Blood Diagnostic Tests [ ] Chest 2VW Frontal & Lat ( Chest PA & T;N, Routine, Routine, Transport: Wheelchair Lateral) [ ] Abd Sing AP VW ( KUB ) T;N, Routine, Routine, Transport: Wheelchair [ ] GI Upper Air Cont w Sm Bowel see separate sheet Follow Thro w/delay diet Plan [ ] Urethrocystogram Voiding T;N, Routine, Routine, Transport: Wheelchair [ ] US Retroperitoneal B Scan/Real Time T;N,Routine,Routine, Transport: Wheelchair Comp ( Renal Ultrasound ) [ ] US Head & Neck Soft Tissues Thyroid/Para ( Thyroid Ultrasound ) T;N, Reason for Exam: Goiter, Routine, Wheelchair [ ] Abd Ltd Sing Organ F/U w/delay diet see separate sheet Plan [ ] US Pelvic Non OB Comp T;N, Reason for Exam: Other, Enter in Comments, ROUTINE, Wheelchair, Comment: ambiguous genitalia [ ] Echocardiogram Pediatric (0-18 yrs) T;N,Routine,Routine, Transport: Wheelchair [ ] NM Thyroid Imag Only T;N,Routine, Routine, Transport: Wheelchair Consults/Notifications [ ] Notify Physician-Continuing T;N, For: All Blood Sugar Results, Who : [ ] Physician Group Consult T;N, Consult Who:,Reason: [ ] Physician Consult T;N, Consult Who:,Reason: [ ] Consult Medical Social Work T;N, Routine, Reason [ ] Diabetic Teaching Consult T;N, Reason [ ] Dietitian Consult T;N, Type of Consult: Education Date Time Physician's Signature MD Number Page 5 of 5
Physician Orders LEB PICU Status Epilepticus Plan. [ ] No known allergies
![Physician Orders LEB PICU Status Epilepticus Plan. [ ] No known allergies](/thumbs/80/82315048.jpg "Physician Orders LEB PICU Status Epilepticus Plan. [ ] No known allergies")
Height: cm Weight: kg Allergies: [ ] No known allergies [ ] Initiate Powerplan Phase T;N, Phase: LEB PICU Admit Phase Admission/Transfer/Discharge [ ] Admit Patient to Dr. [ ] Admit Status: [ ] Inpatient
Physician Orders PEDIATRIC: LEB Oral Maxillofacial Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Oral Maxillofacial Postop Phase, When to Initiate: LEB Oral Maxillofacial Post Op Phase Admission/Transfer/Discharge
Physician Orders PEDIATRIC: LEB DKA Diabetes Mellitus Admit Plan
Initiate Orders Phase Non Categorized R Powerplan Open Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: Admit DKA Two-Bag Calculations Phase, When to Initiate: Initiate Powerplan Phase Phase:
Physician Orders PEDIATRIC: LEB NEURO Epilepsy Monitoring Unit Admit Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Neuro Epilepsy Monitoring Unit Admit Phase, When to Initiate: LEB Neuro Epilepsy Monitor Unit Admit Phase Non Categorized
Physician Orders PEDIATRIC: LEB Stroke Admit Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Stroke Admit Phase. When to Initiate: LEB Stroke Admit Phase Admission/Transfer/Discharge Patient Status Initial
Physician Orders ADULT: Asthma and Bronchitis Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase, Phase: Asthma and Bronchitis Phase, When to Initiate: Asthma and Bronchitis Phase Non Categorized Problem: Asthma Problem:
Physician Orders ADULT Order Set: Respiratory Failure Orders
[R] = will be ordered Height: cm Weight: kg Allergies: [ ] No known allergies [ ]Medication allergy(s): [ ] Latex allergy [ ]Other: Admission/Transfer/Discharge [ ] Patient Status Initial Inpatient Attending
Physician Orders PEDIATRIC: LEB Kidney Transplant Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Kidney Transplant Post Op Phase, When to Initiate: LEB Kidney Transplant Post Op Phase Admission/Transfer/Discharge
Physician Orders ADULT: LEB Asthma Admit Plan. Anticipated LOS: 2 midnights or more Patient Status Initial Outpatient T;N Attending Physician:
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase, Phase: LEB Asthma Admit Phase, When to Initiate: LEB Asthma Admit Phase Non Categorized Add To Problem List Problem: Asthma
Physician Orders ADULT: Head and Neck Postoperative Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase, Phase: Head and Neck Postoperative Phase, When to Initiate: Head and Neck Post Operative Phase, Monitor and Record T,P,R,BP,
Physician Orders PEDIATRIC: LEB Eating Disorder Admit Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Eating Disorder Admit Phase, When to Initiate: When patient arrives to unit LEB Eating Disorder Admit Phase Admission/Transfer/Discharge
Physician Orders PEDIATRIC: LEB NEURO SURG Surgical Spine Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Neuro Surg Spine Postop Phase, When to Initiate: LEB Neuro Surgical Spine Post Op Phase Admission/Transfer/Discharge
Physician Orders ADULT: Sickle Cell Inpatient Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: Sickle Cell Inpatient Phase, When to Initiate: When patient arrives to unit Sickle Cell Inpatient Phase Admission/Transfer/Discharge
Physician Orders ADULT: Acute MI/Acute Coronary Syndrome Adult Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: Acute MI/Acute Coronary Syndrome Adult Phase, When to Initiate: Acute MI/Acute Coronary Syndrome Adlt Phase Non Categorized
Physician Orders: Pediatric. Title: LEB PICU Asthma Plan [X or R] = will be ordered unless marked out.
![Physician Orders: Pediatric. Title: LEB PICU Asthma Plan [X or R] = will be ordered unless marked out.](/thumbs/71/65974412.jpg "Physician Orders: Pediatric. Title: LEB PICU Asthma Plan [X or R] = will be ordered unless marked out.")
Height: cm Weight: kg Allergies: [ ] No known allergies [ ]Medication allergy(s): [ ] Latex allergy [ ]Other: Uncategorized [X] Initiate Powerplan Phase T;N, Phase: LEB PICU Asthma Phase When to Initiate:
Physician Orders ADULT: Kidney-Panc/PancTransplant Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase T;N, Phase: Kidney-Panc/Panc Transp Post Op Phase, When to Initiate: Kidney-Panc/Panc Transp Post Op Phase Vital Signs Vital
Physician Orders PEDIATRIC: LEB ED Hx of DKA with Hyperglycemia Plan
LEB ED Triage Hx of DKA w Hyperglycemia Non Categorized Criteria for use: Patients less than 18 years of age with known or suspected Diabetes Mellitus and blood glucose greater than 300mg/dL.(NOTE)* Vital
Physician Orders ADULT: Renal Transplant Admit Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase, Phase: Renal Transplant Admit Phase, When to Initiate: Renal Transplant Admit Phase Non Categorized Initiate Powerplan Phase,
Physician Orders ADULT: Atrial Fib/Flutter Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: Atrial Fib/Flutter Phase, When to Initiate: Atrial Fib/Flutter Phase Non Categorized Problem: Atrial fibrillation Problem:
*111* attach patient label here
Physician Orders ADULT [R] = will be ordered Height: cm Weight: kg Allergies: No known allergies Medication allergy(s): Latex allergy Other: Admission/Transfer/Discharge Patient Status Initial Inpatient
ADMIT DIABETIC KETOACIDOSIS (DKA) PLAN - Phase: Begin Immediately/Emergency Center
- Phase: Begin Immediately/Emergency Center Weight PHYSICIAN S Allergies Admit/Discharge/Transfer Patient Status Requested Location: MICU, Pt Status: Inpatient (LOS > 2 midnights) Requested Location: 5E
PICU ADMIT DKA PLAN - Phase: Begin Immediately
- Phase: Begin Immediately Diagnosis Weight Allergies Admit/Discharge/Transfer Patient Status Requested Location: PICU, Pt Status: Inpatient (LOS > 2 midnights) Requested Location: PICU, Pt Status: Observation
Physician Orders PEDIATRIC: : LEB ED Trauma (Major) Plan
LEB ED Standing Orders Trauma (Major) Ph Non Categorized Criteria: Patients between 0-18 years of age that present with a Major Trauma that meet LeBonheur Trauma stat or Trauma Alert Guidelines.(NOTE)*
Physician Orders Pediatric: LEB ED Asthma Plan
LEB ED Triage Standing SOB/Wheeze Asthma Non Categorized Criteria: Patients greater than 2 years of age with a history of asthma or airway active disease or two or more previous illnesses treated with
IDPH ESF-8 Plan: Pediatric and Neonatal Surge Annex Sample Pediatric Admission Orders 2015
Purpose: To provide guidance to practitioners caring for pediatric patients who need inpatient hospital care during a disaster. Disclaimer: This guideline is not meant to be all inclusive, replace an existing
Neurosurgery Pre-Op [1710] Patient Name MRN. General. Nursing. Case Request [ ] Case request operating room Scheduling/ADT, Scheduling/ADT [ ] Other
![Neurosurgery Pre-Op [1710] Patient Name MRN. General. Nursing. Case Request [ ] Case request operating room Scheduling/ADT, Scheduling/ADT [ ] Other](/thumbs/96/128298591.jpg "Neurosurgery Pre-Op [1710] Patient Name MRN. General. Nursing. Case Request [ ] Case request operating room Scheduling/ADT, Scheduling/ADT [ ] Other")
Neurosurgery Pre-Op [1710] Patient Name MRN General Case Request [ ] Case request operating room Scheduling/ADT, Scheduling/ADT Inpatient Only Procedure (Single Response) ( ) Admit to Inpatient Diagnosis:
DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available at: BMC-B BMC-D BMC-N BMC-S Vital Signs Vital Signs Q4H (DEF)* Q2H Q1H Vital Signs Orthostatic Activity Activity Bedrest, for 12 hours then Up ad lib (DEF)* Bedrest, for 24
Physician Orders. LEB NICU Sepsis Plan [X or R] = will be ordered unless marked out.
![Physician Orders. LEB NICU Sepsis Plan [X or R] = will be ordered unless marked out.](/thumbs/77/75931338.jpg "Physician Orders. LEB NICU Sepsis Plan [X or R] = will be ordered unless marked out.")
Height: cm Weight: kg Allergies: [ ] No known allergies [ ] Latex allergy [ ]Other: [ ] Initiate Powerplan Phase, Phase: LEB NICU Sepsis Phase Admission/Transfer/Discharge [ ] Patient Status Initial Inpatient
Attach patient label here. Physician Orders ADULT: Palliative Care Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase T;N, Phase: Palliative Care Phase, When to Initiate: Palliative Care Phase Admission/Transfer/Discharge Patient Status Initial
Physician Orders ADULT: Ortho Total Joint Plan
Initiate Orders Phase Non Categorized R Powerplan Open Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: Ortho Total Joint Preop Phase, When to Initiate: Other-See Special Instructions, initiate
ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked DRUG AND TREATMENT ORDERS
DRUG AND TREATMENT Available at: BMC-B BMC-D BMC-N BMC-S Vital Signs Vital Signs Q4H (DEF)* Q2H Q1H Vital Signs Orthostatic Activity Activity Bedrest, for 12 hours then Up ad lib (DEF)* Bedrest, for 24
PEDIATRIC CYSTIC FIBROSIS PLAN - Phase:.
PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Per Unit Standards, with Sleeping SpO2 nightly until sat greater than 92% Daily Weight Every AM In AM on Monday, Wednesday,
PEDIATRIC SPINE SURGERY POST-OP PLAN - Phase:.
- Phase:. PHYSICIAN S Diagnosis Weight Allergies DETAILS Patient Care Patient Activity Bedrest Maintain Surgical Drain Maintain JP Drain, Measure Output q12h, and PRN Convert IV to INT when tolerating
Physician Orders ADULT
Admission Height (Actual) : cm Admission Weight (Actual): kg Allergies: No known allergies Medication allergy(s): Latex allergy Other: Non-Categorized ATTENTION SURGEON: Please discontinue Open Heart Post
Physician Orders ADULT: PCI Post Procedure Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: PCI Post Procedure Phase, When to Initiate: Initiate Powerplan Phase Phase: Post Cath/PCI Hydration Protocol Phase,
Physician Orders PEDIATRIC: LEB Critical Care Respiratory Plan
LEB Critical Care Respiratory Plan Patient Care Cardiopulmonary Monitor T;N Routine, Monitor Type: End Tidal Co2 (DEF)* T;N Routine, Monitor Type: Transcutaneous Co2 Respiratory Care Initiate Pediatric
***SPECIAL CONSIDERATION:
ADULT ANESTHESIA POST-OP OUTPATIENT SURGERY PLAN Dx PHYSICIAN S Weight Allergies DETAILS Admit/Discharge/Transfer Return Patient to PACU Patient Care ***Patients who are at high risk for obstructive sleep
Physician Orders PEDIATRIC: LEB Ortho Accelerated Posterior Spinal Fusion Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Ortho Accelerated PSF Post Op Initial Phase, When to Initiate: Initiate Powerplan Phase Phase: LEB Ortho Accelerated
Physician Orders ADULT: Vascular Surgery AAA Repair Open Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: AAA Repair Open Postop Phase, When to Initiate: Initiate Powerplan Phase Phase: Mechanically Ventilated Patients Phase,
ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked DRUG AND TREATMENT ORDERS
Available at: ALL Adult Facilities Non Categorized SUB Protocol(SUB)* SUB Protocol Lab Orders(SUB)* ED Rainbow Tubes(SUB)* ***Reminder: Order ED Rainbow Tubes (SUB) as a separate form*** Nursing Orders
Gabapentin Research Pain Study for Ortho Total Knee Replacement Post-Op Plan - PACU Ortho Phase
Total Knee Replacement Post-Op Plan - PACU Ortho Phase Diagnosis Weight Allergies Admit/Discharge/Transfer Patient Status Requested Location: 3W, Pt Status: Inpatient (LOS > 2 midnights) Patient Condition
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT *****ALSO ORDER SUB ACUTE DKA IV FLUIDS REGIMEN & SUB ACUTE ELECTROLYTE REPLACEMENT on separate forms ***** Condition/Status For purpose of this DKA Regimen, DKA is considered clear
Physician Orders ADULT: Vascular Surgery AAA Endovascular Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: AAA Endovascular PACU Phase, When to Initiate: Initiate Powerplan Phase Phase: Mechanically Ventilated Patients Phase,
PEDIATRIC SPINE SURGERY POST-OP PLAN - Phase: Pediatric Spine Surgery General Orders
- Phase: Pediatric Spine Surgery General Orders PHYSICIAN S Diagnosis Weight Allergies Patient Care Patient Activity Bedrest Maintain Surgical Drain Maintain JP Drain, Measure Output q12h, and PRN Convert
DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Acute Diabetic Ketoacidosis Condition/Status ***(NOTE)*** For purpose of this DKA Regimen, DKA is considered clear only when the CO2 is GREATER than 18 meq/l and the anion gap is LESS
DONATION AFTER CARDIAC DEATH PLAN
DONATION AFTER CARDIAC DEATH PLAN Diagnosis Weight Allergies Patient Care Core Body Temperature Monitoring Maintain body temp 96-99 degrees Farenheit. Utilize Hyper/Hypothermia blanket prn Insert Gastric
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available at: BMC-B BMC-D BMC-N BMC-S Condition/Status Patient Status Inpatient Patient Status: Inpatient, Level of Care: Med/Surg without Telemetry (1) (DEF)* Patient Status: Inpatient,
LIBERTYHEALTH. Jersey City Medical Center Department of Patient Care Services. Approved by Policy Committee:
LIBERTYHEALTH Jersey City Medical Center Department of Patient Care Services Guidelines: CRITICAL CARE INSULIN PROTOCOL (MICU/SICU, CCU, ED) Developed by: Pharmacy Dept Approved by: Rita Smith, DNP Senior
Bariatric Surgery Post Op Plan PACU Phase
Bariatric Surgery Post Op Plan PACU Phase PHYSICIAN S Weight Allergies Admit/Discharge/Transfer Patient Status Pt Status: Inpatient (LOS > 2 midnights) Pt Status: Observation (LOS < 2 midnights) Code Status
DKA Adult ICU Powerplan
DKA Adult ICU Powerplan Key Points for ED to ICU DKA power plan In addition to NS fluids and maintenance the regular insulin drip will either already be infusing from ED or needs to be initiated. Regular
Patient: Becky Smith DOB: 01/26/XXXX Age: 5 y/o Attending: Dr. D. Miles Allergies: NKA MR#: 203. Patient Chart #203 Becky Smith
Patient Chart #203 Becky Smith 1 Property of CSCLV CSCLV Rev: 06/04/2018 Chief Complaint: Abdominal pain. Informant: Parents. HISTORY & PHYSICAL HPI: Ill looking patient, healthy until 2 days ago when
Physician s Order Form. Physician s Order Form. Telemetry/Progressive Care Orders. Continued on next page. >>>>>>> Continued on next page.
DATE: TIME: DATE TIME INTRAVENOS FLID and MEDICATION Status: Admit to Telemetry Admit to Progressive Care nit Transfer to Progressive Care nit Note: Discontinue Previous Orders Transfer to Telemetry nit
PEDIATRIC LIFEGIFT BRAIN DEATH PLAN
PHYSICIAN S Diagnosis Weight Allergies Admit/Discharge/Transfer THIS PLAN IS TO BE ED ONLY ON THE LIFEGIFT ENCOUNTER, WITH DR LIFEGIFT AS THE ATTENDING. Patient Status Pt Status: Inpatient (Inpatient only
Tables of Normal Values (As of February 2005)
Tables of Normal Values (As of February 2005) Note: Values and units of measurement listed in these Tables are derived from several resources. Substantial variation exists in the ranges quoted as normal
Physician Orders ADULT: Medical Response Team Standing Orders Protocol Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase When to Initiate: Other-See Special Instructions, If MRT is notified per MD, Condition H or any associate, review and Initiate
Bariatric Surgery Post Op Day Version 2 Approved 11/13/2017
Patient Name: Diagnosis: Allergies with reaction type: Bariatric Surgery Post Op Day Version 2 Approved 11/13/2017 Diagnosis Preferred Location/Unit Surgical ICU Code Status: Full Code Activity Ambulate
ADMIT GENERAL MEDICINE PLAN - Phase: Begin Immediately
- Phase: Begin Immediately Weight PHYSICIAN S Allergies Admit/Discharge/Transfer Patient Status Patient Condition Acuity Level Floor Status Acuity Level Critical Acuity Level Intermediate Continuous Telemetry
ENT THYROIDECTOMY/PARATHYROIDECTOMY POST OP PLAN - Phase: Begin Immediately/PACU
- Phase: Begin Immediately/PACU PHYSICIAN S Diagnosis Weight Allergies Laboratory Calcium Level STAT Outpatient/PACU, T;N PTH Intact STAT Outpatient/PACU, T;N 1 of 7 - Phase: When Patient Arrives to Room
Physician Orders ADULT
Physician Orders ADULT attach patient label here Order Set: ED Non-STEMI Unstable Angina Orders Height: cm Weight: kg Allergies: No known allergies Medication allergy(s): Latex allergy Other: Admission/Transfer/Discharge
ORTHO TOTAL KNEE REPLACEMENT POST-OP PLAN - Phase: PACU Ortho Phase
- Phase: PACU Ortho Phase PHYSICIAN S Diagnosis Weight Allergies DETAILS Admit/Discharge/Transfer Patient Status Patient Condition Acuity Level Floor Status Acuity Level Critical Acuity Level Intermediate
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available ONLY at: BMC-B BMC-D BMC-N BMC-S Nursing Orders Communication Order If CVP unavailable, administer fluid boluses every 30 minutes except monitor O2 requirements Comments: Every
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