PICU Therapeutic Hypothermia Post Cardiac Arrest Re Warming Phase
|
|
- Cameron Sparks
- 5 years ago
- Views:
Transcription
1 Arrest Re Warming Phase Weight Allergies Patient Care ***After 24 hours initiate re warming (or after 72 hours for an infant less than one month old)*** PICU Re Warming Protocol ***See Reference Text*** Communication Seizure Precautions Monitor for Seizure Activity Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. Loading Dose PHENobarbital (PHENobarbital pediatric) 10 mg/kg, IVPush, inj, ONE TIME, PRN seizure activity Recommended maximum dose = 1000 mg. Suggested rate NOT TO EXCEED 1 mg/kg/min (max: 30 mg/min). 20 mg/kg, IVPush, inj, ONE TIME, PRN seizure activity Recommended maximum dose = 1000 mg. Suggested rate NOT TO EXCEED 1 mg/kg/min (max: 30 mg/min). levetiracetam (levetiracetam pediatric) 20 mg/kg, IVPB, inj, ONE TIME, PRN seizure activity Recommended maximum dose = 2500 mg. Suggested to infuse over 15 minutes. fosphenytoin (fosphenytoin pediatric) 10 mgpe/kg, IVPush, inj, ONE TIME, PRN seizure activity Recommended maximum dose = 1000 mg. Suggested infusion rate of 1 3 mgpe/kg/min (max of 150 mgpe/min). 20 mgpe/kg, IVPush, inj, ONE TIME, PRN seizure activity Recommended maximum dose = 1000 mg. Suggested infusion rate of 1 3 mgpe/kg/min (max of 150 mgpe/min). Maintenance Dose PHENobarbital (PHENobarbital pediatric) 3 mg/kg, IVPush, inj, q12h Recommended maximum dose = 1000 mg. Suggested rate NOT TO EXCEED 1 mg/kg/min (max: 30 mg/min). levetiracetam (levetiracetam pediatric) 10 mg/kg, IVPB, inj, q12h Recommended maximum dose = 2500 mg. Suggested to infuse over 15 minutes. fosphenytoin (fosphenytoin pediatric) 2 mgpe/kg, IVPush, inj, q8h Recommended maximum dose = 1000 mg. Suggested infusion rate of 1 3 mgpe/kg/min (max of 150 mgpe/min). Laboratory CBC Routine, T;N, q6h for 2 days Prothrombin Time with INR Page: 1 Arrest Version: 1 Effective on: 08/13/13
2 Arrest Re Warming Phase PTT Comprehensive Metabolic Panel Arterial Blood Gas Routine, Additional Tests: Lactate, q6h For 2 days Phenobarbital Level Phenytoin Level Free Phenytoin Level Total Culture Blood Blood, Routine, T;N, q24h for 1 days Culture Urine Urine, Routine, T;N Culture Sputum with Gram Stain Sputum, Routine, T;N Page: 2 Arrest Version: 1 Effective on: 08/13/13
3 Arrest Initial Phase Patient Care PICU Therapeutic Hypothermia Guidelines ***Required to continue with ordering Plan.*** Vital Signs Per Unit Standards, Continous monitoring and record q1h q1h Strict Intake and Output Per Unit Standards Set Up for Arterial Line Placement Set Up for Central Line Placement Insert Gastric Tube Nasogastric NG Orogastric OG If patient has existing NG/OG tube: Maintain Gastric Tube Insert Urinary Catheter Foley, with CBT Monitor. Criticore, with CBT Monitor. Monitoring Core Body Temperature Monitoring Utilize Bladder, Trans Esophageal, or Rectal Thermometers for CBT. End Tidal CO2 Monitoring Laboratory Baseline Labs CBC with Differential Comprehensive Metabolic Panel DIC Panel Arterial Blood Gas, Additional Tests: Lactate Amylase Level Lipase Level Diagnostic Tests DX Chest Portable Consults/Referrals Page: 3 Arrest Version: 1 Effective on: 08/13/13
4 Arrest Initial Phase Consult MD Service: Pedi Neurosurgery...Additional Orders Page: 4 Arrest Version: 1 Effective on: 08/13/13
5 Arrest Initial Phase PICU Continuous Med Infusion Plan IV Solutions Standard Concentration DOBUTamine 100 mg/50 ml D5W (NI/PI) IVsyr Final concentration = 2 mg/ml (2000 mcg/ml) Range is 2 20 mcg/kg/min Start at rate: mcg/kg/min This patient is allergic to morphine. EPINEPHrine 1.25 mg/50 ml D5W (Pedi) milrinone 5 mg/50 ml NS (Pedi) IVsyr Final concentration 0.1 mg/ml (100 mcg/ml). Mixed in syringe. Usual Dose Range is mcg/kg/min. Notify physician if administered dose (rate) is greater than the usual dose range. Start at rate: mcg/kg/min isoproterenol 1.6 mg/50 ml NS (Pedi) lidocaine 200 mg/50 ml NS (PICU) nitroprusside 5 mg/50 ml D5W (NICU) norepinephrine 0.8 mg/50 ml NS (Pedi) Maximum Concentration DOBUTamine 200 mg/50 ml D5W (NI/PI) EPINEPHrine 2.5 mg/50 ml D5W (Pedi) milrinone 10 mg/50 ml NS (Pedi) isoproterenol 3.2 mg/50 ml NS (Pedi) lidocaine 400 mg/50 ml NS (PICU) nitroprusside 10 mg/50 ml D5W (NICU) norepinephrine 1.6 mg/50 ml NS (Pedi) Minimum Concentration Page: 5 Arrest Version: 1 Effective on: 08/13/13
6 Arrest Initial Phase PICU Continuous Med Infusion Plan DOBUTamine 50 mg/50 ml D5W (NI/PI) DOPamine 40 mg/50 ml D5W (NI/PI) IVsyr Final concentration= 0.8 mg/ml (800 mcg/ml). Mixed in syringe. Dose range is 2 20 mcg/kg/min. Titrate to desired effect. Start at rate: mcg/kg/min EPINEPHrine 0.5 mg/50 ml D5W (Pedi) isoproterenol 0.8 mg/50 ml NS (Pedi) Page: 6 Arrest Version: 1 Effective on: 08/13/13
7 Arrest Initial Phase PICU Mechanical Ventilation Plan Patient Care Patient Activity Bedrest, HOB elevation degrees Obtain Specialty Bed Order: Rotorest Perform Oral Care Per Unit Standards Per Unit Standards, Assess and brush teeth within 2 hours of admission. Then brush teeth every 12 hours q4h q4h, Assess and brush teeth within 2 hours of admission. Then brush teeth every 12 hours Suction Patient Per VAP Protocol Perform Neurological Checks q1h q1h, until NMBA infusion rate has not changed for 4 hours, then q2h. q2h Insert Gastric Tube Nasogastric NG Dobhoff Tube Monitoring Brain Function Monitoring (Apply Brain Function Monitor) Type: Brain Z Type: 5 Lead EEG Type: SEDline Protocol VAP Prevention Protocol Neuromuscular Blocking Agent Protocol Peripheral Nerve Stimulator Protocol Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. ocular lubricant (Lacri Lube S.O.P. ophthalmic ointment) 1 app, both eyes, ophth oint, As Needed, PRN dry eyes Paralytic Titrate Train of Four to be 2/4 twitches. Perform Train of Four (TOF) every 30 minutes during initiation until desired TOF is reached and every 4 hours throughout duration of therapy to maintain ordered TOF. ***Do not perform wake up trials while patient is on paralytic*** Page: 7 Arrest Version: 1 Effective on: 08/13/13
8 Arrest Initial Phase PICU Mechanical Ventilation Plan vecuronium 0.05 mg/kg, IVPush, inj, ONE TIME 0.08 mg/kg, IVPush, inj, ONE TIME 0.1 mg/kg, IVPush, inj, ONE TIME vecuronium 30 mg/30 ml NS (Pedi) IVsyr Final Concentration = 1 mg/ml (1000 mcg/ml). Mixed in syringe. Dose range is mg/kg/hr. Titrate to desired effect. Start at rate: mg/kg/hr rocuronium 0.3 mg/kg, IVPush, inj, ONE TIME 0.45 mg/kg, IVPush, inj, ONE TIME 0.6 mg/kg, IVPush, inj, ONE TIME 1.2 mg/kg, IVPush, inj, ONE TIME rocuronium 30 mg/30 ml NS (Pedi) IVsyr Final concentration 1 mg/ml. Usual dose range is mg/kg/hr Start at rate: mg/kg/hr Respiratory Ventilator Settings Ventilator Settings APRV Ventilator Settings HFOV CPAP BiPAP SiPAP Arterial Blood Gas End Tidal CO2 Monitoring Weaning Parameters Page: 8 Arrest Version: 1 Effective on: 08/13/13
9 Arrest Initial Phase PICU Procedural Sedation Med Plan IV Solutions NS IV, ml/hr Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. midazolam (midazolam pediatric) 10 mg, IVPush, inj, ONE TIME Vial to bedside. fentanyl (fentanyl pediatric) 250 mcg, IVPush, inj, ONE TIME Vial to bedside. propofol 200 mg, IVPush, inj, ONE TIME Vial to bedside. ketamine (ketamine pediatric) 200 mg, IVPush, inj, ONE TIME Vial to bedside. lidocaine topical (lidocaine 4% topical solution) 2 ml, inhalation, soln, ONE TIME To bedside. Dilute in 3 ml NSS. lidocaine (lidocaine 1% preservative free injectable solution) 5 ml, locally, inj, ONE TIME Vial to bedside. lidocaine topical (lidocaine 2% topical gel with applicator) 1 app, topical, jelly, ONE TIME ranitidine (ranitidine pediatric) 0.67 mg/kg, IVsyr, syringe, ONE TIME Diluent NS. Infuse over 30 min. Dose + 3 ml overfill. 1 mg/kg, IVsyr, syringe, ONE TIME Diluent NS. Infuse over 30 min. Dose + 3 ml overfill mg/kg, IVsyr, syringe, ONE TIME Diluent NS. Infuse over 30 min. Dose + 3 ml overfill. metoclopramide (metoclopramide pediatric) 0.1 mg/kg, IVPush, inj, ONE TIME Page: 9 Arrest Version: 1 Effective on: 08/13/13
10 Arrest Cooling Phase Patient Care ***At 24 hours from time the time of cooling induction, advance to and initiate Re Warming Phase. Except in infants less than 1 month old where cooling is maintained for 72 hours.*** PICU Cooling Induction and Maintenance P (PICU Cooling Induction and Maintenance Protocol) ***See Reference Text*** Apply K Thermia (Cooling) Cooling Measures For Induction (T > 34C) set blanket to 6 degrees Celcius. For Maintaince (T 32 34C) set to automatic mode at 33 degrees Celcius. If temp <32 degrees Celcius turn off blanket. K Thermia, Without Pads Apply Ice To: Head, Torso, and Extremities, until Temp Degrees Celcius then remove. Laboratory CBC Routine, T;N, q6h for 2 days Prothrombin Time with INR PTT Comprehensive Metabolic Panel Arterial Blood Gas Routine, Additional Tests: Lactate, q6h For 2 days Culture Blood Blood, Routine, T;N, q24h for 1 days Culture Urine Urine, Routine, T;N Culture Sputum with Gram Stain Sputum, Routine, T;N Diagnostic Tests EEG Request Page: 10 Arrest Version: 1 Effective on: 08/13/13
PICU BRONCHIOLITIS PLAN
PICU BRONCHIOLITIS PLAN Diagnosis Weight PHYSICIAN S Allergies Admit/Discharge/Transfer Patient Status Pt Status: Inpatient (LOS > 2 midnights) Pt Status: Observation (LOS < 2 midnights) Patient Care Code
More informationTherapeutic Hypothermia for Post Cardiac Arrest Plan Initial Orders
Arrest Plan Initial Orders Weight Allergies Therapeutic Hypothermia Guidelines ***Required to continue with ordering Plan.*** Strict Intake and Output q1h, throughout cooling and re warming. Set Up for
More informationUMC Health System Patient Label Here. PHYSICIAN ORDERS Diagnosis
PICU GENERAL PLAN UMC Health System PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Daily Weight Patient Activity Bedrest Up Ad Lib/Activity as Tolerated Strict Intake
More informationPEDIATRIC 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
More informationLIFEGIFT BRAIN DEATH PLAN
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 procedure)
More informationPEDIATRIC PICU TRAUMA PLAN EKM - Phase: PICU Trauma Plan
- Phase: PICU Trauma Plan Diagnosis Weight Allergies DETAILS Patient Care Vital Signs Per Unit Standards Daily Weight Perform Neurological Checks q15min q30min q1h Special Instructions, with Vital Signs
More informationPICU TRAUMA PLAN - Phase:.
- Phase:. UMC Health System PHYSICIAN S Diagnosis Weight Allergies DETAILS Patient Care CR Monitoring Vital Signs Per Unit Standards Daily Weight Perform Neurological Checks q15min q30min q1h Special Instructions,
More informationPHYSICIAN ORDERS Diagnosis
PICU PROCEDURE PLAN PHYSICIAN S Diagnosis Weight Allergies DETAILS Admit/Discharge/Transfer Patient Status Pt Status: Inpatient (LOS > 2 midnights) Pt Status: Observation (LOS < 2 midnights) Patient Care
More information(31189) Hypothermia Initiation Phase One
Hypothermia Initiation Phase One Diagnosis Allergies For hypothermia tracking purposes only. Please do not uncheck.- Required Cardiac Emergency Tracking For hypothermia tracking purposes only. Consults
More informationINPATIENT INTERVENTIONAL RADIOLOGY PLAN - Phase: Pre-Procedure Orders
- Phase: Pre-Procedure Orders DETAILS Patient Care Obtain Consent If one is not present on chart today. Vital Signs Per Policy Insert Peripheral Line T;N, Start IV on right side If left radial access is
More informationUMC Health System Patient Label Here. PHYSICIAN ORDERS Diagnosis
PHYSICIAN S Diagnosis Weight Allergies Admit/Discharge/Transfer Patient Status Requested Location: NICU, Pt Status: Inpatient (LOS > 2 midnights) Pt Status: Observation (LOS < 2 midnights) Pt Status: Inpatient
More informationPICU 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
More informationHypothermia Short Set-Critical Care HYPOTHERMIA SS- CRITICAL CARE
Hypothermia Short Set-Critical Care HYPOTHERMIA SS- CRITICAL CARE Inclusion Criteria all must be present Cardiac arrest with return of spontaneous circulation (ROSC) ROSC within 60 mins of witnessed arrest;
More informationPediatric Outpatient Surgery Plan - Diagnostic/Pre-Op Orders
Pediatric Outpatient Surgery Plan - Diagnostic/Pre-Op Orders Diagnosis Weight PHYSICIAN S Allergies Admit/Discharge/Transfer Request for Outpatient Services Location: Outpatient Surgery Communication Misc
More informationDONATION 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
More informationUMC Health System Patient Label Here. PHYSICIAN ORDERS Diagnosis
Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards q12h q12h, Temperature Only - Every Shift and PRN Patient Activity Assist as Needed, Bed Position: As Tolerated, elevate to patient
More informationPEDIATRIC 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
More informationUMC Health System Patient Label Here PHYSICIAN ORDERS
Weight Allergies Patient Care Vital Signs Per Unit Standards, Q5 min during critical event. Insert Peripheral Line Use 20 gauge or larger. Notify Nurse (DO NOT USE FOR MEDS) Place crash cart with cardiac
More informationPhysician 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)*
More informationTRANSCATHETER AORTIC VALVE REPLACEMENT POST- OP PLAN - Phase:.
- Phase:. PHYSICIAN S Diagnosis Weight Allergies DETAILS Patient Care Vital Signs Per Unit Standards, q15min x 4, q30min x 2, then q1h x 4 until sheath discontinued. Per Unit Standards Perform Neurovascular
More informationPEDIATRIC 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
More informationUMC Health System Patient Label Here PHYSICIAN ORDERS
Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards q12h q12h, Temperature Only - Every Shift and PRN Patient Activity Assist as Needed, Bed Position: As Tolerated, elevate to patient
More informationTRANSCATHETER AORTIC VALVE REPLACEMENT POST- OP ADMIT PLAN - Phase: Begin Immediately/PACU Phase
- Phase: Begin Immediately/PACU Phase PHYSICIAN S Diagnosis Weight Allergies DETAILS Admit/Discharge/Transfer Patient Status Requested Location: CICU Patient Condition Acuity Level Critical Acuity Level
More informationPEDIATRIC 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,
More informationPhysician 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
More informationPhysician 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
More informationPhysician 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:
More informationGENERAL SURGERY PLAN - Phase:.
- Phase:. PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Daily Weight Patient Activity Up Ad Lib/Activity as Tolerated Assist as Needed Bedrest Bedrest Bathroom Privileges
More informationPEDIATRIC ARGININE CLONIDINE STIMULATION TEST PLAN
Diagnosis Weight Allergies Patient Care Arginine Clonidine Stimulation Test Guid (Arginine Clonidine Stimulation Test Guidelines) See Reference Guidelines. Vital Signs Routine, q1h, With BP, During the
More informationOPEN AAA/MAJOR ABDOMINAL POST-OP PLAN - Phase:.
- Phase:. PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Maintain Gastric Tube Maintain Nasogastric - NG, Low Intermittent Suction Maintain Nasogastric - NG, Low Constant
More informationStandard Precautions Droplet Precautions Standard Precautions Contact Precautions Droplet Precautions Standard Precautions Neutropenic Precautions
Unique Plan Description: Neurosurgery Subarachnoid Hemorrhage Admission Adult Plan Selection Display: Neurosurgery Subarachnoid Hemorrhage Admission Adult PlanType: Medical Version: 10 Begin Effective
More informationADMIT 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
More informationTRAUMA AND SURGICAL ICU PLAN
TRAUMA AND SURGICAL ICU PLAN PHYSICIAN S Diagnosis Weight Allergies DETAILS Patient Care Vital Signs Per Unit Standards Daily Weight Insert Peripheral Line Patient Activity Bedrest, Bed Position: HOB Greater
More informationPHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
Available ONLY at: BMC-B BMC-D BMC-N BMC-S Intubation Phase Notify Therapy for STAT intubation SUB Rapid Sequence Induction(SUB)* ***The above subphase is available at the end of the powerplan under the
More informationADMIT STROKE NEUROINTERVENTION PLAN - Phase: Begin Immediately
- Phase: Begin Immediately PHYSICIAN S Diagnosis Weight Allergies DETAILS Admit/Discharge/Transfer Patient Status Pt Status: Inpatient (LOS > 2 midnights) Pt Status: Observation (LOS < 2 midnights) Pt
More informationALL 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 Intubation Phase Notify Therapy for STAT intubation Medications SUB Rapid Sequence Induction (SUB)* ***Reminder: Order SUB Rapid Sequence Induction (SUB) on a separate form*** lidocaine
More informationSTROKE NEUROINTERVENTION PLAN - Phase:.
- Phase:. PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Notify Nurse (DO NOT USE FOR MEDS) Right Lower Extremity-Check peripheral pulse distal to the cath site. If
More informationNEUROSURGERY ICU PLAN
NEUROSURGERY ICU PLAN PHYSICIAN S Diagnosis Weight Allergies DETAILS Patient Care Vital Signs Per Unit Standards Per Unit Standards, including cerebral perfusion pressure (CPP) and end tidal CO2. Perform
More informationUMC Health System Patient Label Here. PHYSICIAN ORDERS Diagnosis
GI BLEED PLAN UMC Health System Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Notify Provider of VS Parameters Daily Weight Patient Activity Up Ad Lib/Activity as Tolerated Assist
More information** Medication exercises ** NICU Phase II
** Medication exercises ** NICU Phase II A) Baby A has had a bowel resection six hours ago. She weighs 3 kg. Post-op, she is quite agitated and she is on a fentanyl drip at 2 micrograms/kg/hr (#1). She
More informationPhysician 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
More informationPHYSICIAN 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
More informationPhysician Orders ADULT: Routine Deceased Donor Adult Plan
Initiate Orders Phase Non Categorized NOTE: Nurse - confirm PM Discharge disposition set to "Donor and or Life Support" on hospital encounter. Enter these orders on new OP encounter created by Access/Registration
More informationPhysician 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
More informationOrgan Donor Management Recommended Guidelines ADULT Brain Death (NDD)
Date: Time: = Always applicable = Check if applicable ADMISSION INSTRUCTIONS Neurological Determination of Death (NDD) has been performed by at least 2 licensed physicians Contact initiated with BC Transplant
More informationState of Florida Hypothermia Protocol. Michael D. Weiss, M.D. Associate Professor of Pediatrics Division of Neonatology
State of Florida Hypothermia Protocol Michael D. Weiss, M.D. Associate Professor of Pediatrics Division of Neonatology I. Entry Criteria 1. Gestational Age greater than or equal to 35 weeks gestation
More informationIV Medication Drip Chart
IV Medication Drip Chart Index Summary chart 2 IV Medication drip chart Amiodarone 2 Atracurium 2, 5 Cisatracurium 2, 5 Dexmedetomidine 2 Dobutamine 2, 6 Dopamine 2, 6 Epinephrine 2, 7 Esmolol 2, 7 Etomidate
More informationENT 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
More informationTHROMBOLYTIC THERAPY FOR PERIPHERAL OCCLUSION
THROMBOLYTIC THERAPY FOR PERIPHERAL OCCLUSION PHYSICIAN S Diagnosis Weight Allergies Admit/Discharge/Transfer ***PROVIDER MUST CHECK MEDICATION LIST PRIOR TO PLACING THESE S*** Patient Care Vital Signs
More informationOB/GYN ANTEPARTUM PLAN
OB/GYN ANTEPARTUM PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Patient Activity Up Ad Lib/Activity as Tolerated Bedrest STRICT Bedrest Up to Bedside Commode Only
More informationBariatric 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
More informationSample. Affix patient label within this box.
Instructions for completing orders: Determine PRAM Clinical Score as per the Alberta Acute Childhood Asthma Pathway for Emergent/Urgent Care and select orders based on PRAM Score. Custom orders can be
More informationADMIT 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
More informationEPIDURAL / INTRATHECAL POST-OP PLAN
EPIDURAL / INTRATHECAL POST-OP PLAN Diagnosis Weight PHYSICIAN S Allergies Patient Care Vital Signs Per Unit Standards, PLUS check and record RR q1h x 12, then q2h x 6, until 24h following narcotic administration.
More informationGENERAL SURGERY POST-OP PLAN
GENERAL SURGERY POST-OP PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Patient Activity Up Ad Lib/Activity as Tolerated Assist as Needed Bedrest Bedrest Bathroom
More informationLYSIS OF ADHESIONS POST-OP PLAN - Phase: PACU Phase
- Phase: PACU Phase PHYSICIAN S Diagnosis Weight Allergies Communication Place Device at Bedside Confirm there are 3 x Aliquots of 0.2% Ropivacaine. 2 x Medfusion Infusion pumps. Confirm 3 x PF Aliquots
More informationGENERAL MEDICINE PLAN
GENERAL MEDICINE PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Daily Weight Patient Activity Up Ad Lib/Activity as Tolerated Assist as Needed Bedrest Bedrest Bathroom
More informationQ1HR (DEF)* Q2HR Intra-Abdominal Pressure Notify Provider if greater than 15mmHg, Q4HR Activity Activity Bedrest, Constant Indicator (DEF)* Bedrest
Unique Plan Description: ICU General Admission Adult Plan Selection Display: ICU General Admission Adult PlanType: Medical Version: 28 Begin Effective Date: 4/13/2015 03:46 End Effective Date: Current
More informationGabapentin 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
More informationStandardize comprehensive care of the patient with severe traumatic brain injury
Trauma Center Practice Management Guideline Iowa Methodist Medical Center Des Moines Management of Patients with Severe Traumatic Brain Injury (GCS < 9) ADULT Practice Management Guideline Contact: Trauma
More informationPHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
Available at: BMC-B BMC-D BMC-N BMC-S Activity Activity Bedrest with BRP, with assistance at nurse's discretion (DEF)* Ambulate with Assistance Diet Communication Order Patient to remain NPO while in PACU
More informationPhysician 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
More informationNonConvulsive Seizure
Sample Protocol #5: Management of status epilepticus and seizures in hospitalized patients nconvulsive Seizure Patient presents with alteration of consciousness unexplained by other etiologies AND suspicious
More informationOB/GYN POSTPARTUM VAGINAL DELIVERY PLAN
OB/GYN POSTPARTUM VAGINAL DELIVERY PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Patient Activity Up Ad Lib/Activity as Tolerated Bedrest STRICT Bedrest Up to
More informationCard Open Heart POD1 POD3 Plan Post Op Day 1
Day 1 PHYSICIAN S Weight Allergies Admit/Discharge/Transfer Transfer Patient Transfer to: Floor, Pt Status: Inpatient (LOS > 2 midnights) Vital Signs q2h, POD 1 Vital Signs q2h for 24 hours then per unit
More informationIV Acetaminophen Pain Study for Neurosurgery Post Op Non ICU Admit Plan Begin Immediately/PACU
Post Op Non ICU Admit Plan Begin Immediately/PACU PHYSICIAN S Weight Allergies Admit/Discharge/Transfer Request Patient Bed Requested Location: 3W, Pt Status: Inpatient (LOS > 2 midnights) Patient Condition
More informationOB/GYN POSTPARTUM VAGINAL DELIVERY PLAN
OB/GYN POSTPARTUM VAGINAL DELIVERY PLAN PHYSICIAN S Diagnosis Weight Allergies DETAILS Admit/Discharge/Transfer Patient Discharge Anticipated in 24 Hour (Patient Discharge Anticipated in 24 Hours) Patient
More informationRoutine, Every 2 hours, Starting today, If temperature greater than 38.5 C initiate Evaluation for Possible Sepsis Physician Order #829
Height Weight Allergies General Vital Signs [X] Frequent vital signs Indication: Q15 minutes x (# of occurrences): 4 Q30 minutes x (# of occurrences): 4 Q1 hour x (# of occurrences): Q2 hours x (# of occurrences):
More informationBaptist Health South Florida - Therapeutic Hypothermia for Comatose Survivors of Cardiac Arrest Critical Care / ICU Admission Orders
Date: Time: Inclusion Criteria all must be checked: Non traumatic cardiac arrest with return of spontaneous circulation (ROSC ) Mean arterial blood pressure maintained greater than 50 either with fluids
More informationOrgan Donor Management Recommended Guidelines ADULT CARDIAC DEATH (DCD)
Date: Time: = Always applicable = Check if applicable ADMISSION INSTRUCTIONS Move to Comfort Care Note in chart. Contact initiated with BC Transplant Consent for Organ Donation obtained Code Status: Full
More informationENT THYROIDECTOMY/PARATHYROIDECTOMY POST OP ADMIT PLAN - Phase: Begin Immediately/PACU
- Phase: Begin Immediately/PACU Diagnosis Weight Allergies DETAILS Admit/Discharge/Transfer Patient Status Pt Status: Inpatient (LOS > 2 midnights) Pt Status: Observation (LOS < 2 midnights) Pt Status:
More informationPhysician 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
More informationIDPH 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
More informationORTHO 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
More informationAdmit Heart Failure Plan - Begin Immediately
Admit Heart Failure Plan - Begin Immediately Diagnosis Weight PHYSICIAN S Allergies Admit/Discharge/Transfer Patient Status Requested Location: CICU, Pt Status: Observation (LOS < 2 midnights) Requested
More informationUMC Health System Patient Label Here. PHYSICIAN ORDERS Diagnosis
COPD PLAN UMC Health System PHYSICIAN S Diagnosis Weight Allergies DETAILS Patient Care Vital Signs Per Unit Standards Daily Weight Patient Activity Up Ad Lib/Activity as Tolerated Assist as Needed Bedrest
More informationCARD THORACOTOMY PRE-OP PLAN
CARD THORACOTOMY PRE-OP PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Perform Oral Care Perform night before surgery. Brush teeth with toothpaste, then swish and spit 15 ml chlorhexidine mouth
More informationPOST-OP CARDIAC SURGERY PHYSICIAN S ORDER SHEET USE BALLPOINT PEN ONLY. CARDIAC INTENSIVE CARE UNIT
PHYSICIAN S SHEET Automatically Activate, if not in agreement, cross out and initial Activated by Checking Box ALLERGIES: None known YES Patient s Height: Patient s Weight: ALL MEDICATION and INTRAVENOUS
More informationMedication Calculation Practice Problems
Medication Calculation Practice Problems Below is a section of the list of medications that are programmed in the Alaris IV Pump s Guardrail Drug Library. During your orientation you will learn more about
More informationDiagnosis: Allergies:
Patient Name: Diagnosis: Allergies: ICU Sepsis Version 5 1/11/17 This order set must be used with an admission order set if patient not already admitted. Nursing Orders Verify that cultures have been obtained
More informationRefractory Status Epilepticus in Children: What are the Options?
Refractory Status Epilepticus in Children: What are the Options? Weng Man Lam, PharmD, BCPS, BCPPS PICU Clinical Pharmacy Specialist Memorial Hermann Texas Medical Center November 11, 2017 Objectives 1.
More informationOB/GYN CESAREAN SECTION POST-OP PLAN - Phase: General Orders
- Phase: General Orders DETAILS Patient Care Vital Signs Per Unit Standards Patient Activity Up Ad Lib/Activity as Tolerated Assist as Needed Bedrest Bedrest Bathroom Privileges Bedrest Up to Bedside Commode
More informationPediatric Intensive Care Unit (PICU) Pediatric Diabetic Ketoacidosis (DKA) Admission Order Set
Discontinue all previous orders Weight: kg DKA admit order set is for initial management Ongoing management required based on frequent reassessment of TFI, fluid balance and lab results. Admit to PICU
More informationParamedic Pediatric Medical Math Practice
Paramedic Pediatric Medical Math Practice Name: Date: Problem 1 Your 4 year old patient weighs 40 pounds. She is febrile. You need to administer acetaminophen (Tylenol) 15mg/kg. How many mg will you administer?
More informationPHYSICIAN ORDERS Diagnosis
GENERAL UROLOGY PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Strict Intake and Output Per Unit Standards q4h q12h Patient Activity Assist as Needed Up in Chair,
More informationNeurosurgery 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:
More informationWHS POSTOPERATIVE POWERPLAN CHANGES
Medications simplified and standardized to improve safety and effectiveness in the management of pain, itching, nausea/vomiting. Management: o The Anesthesiologist will continue to manage pain in the PACU.
More information** Medication exercises ** NICU Phase II
** Medication exercises ** NICU Phase II A) Baby A has had a bowel resection six hours ago. She weighs 3 kg. Postop, she is quite agitated and she is on a fentanyl drip at 2 micrograms/kg/hr (#1). She
More informationPhysician 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:
More informationAdult Critical Care Intravenous Infusions Titration Protocol
Adult Critical Care Intravenous Infusions Protocol Nursing staff to titrate drip to achieve goal ordered by provider in assigned time intervals. Amiodarone (Pacerone ) Argatroban Non-heparin anticoagulant
More informationWEIGHT: KG HEIGHT: CM ALLERGY CAUTION sheet reviewed Code Status Full code
(Page 1 of 5) Code Status Full code Status/Admit/Transfer/Discharge Surgical Procedure(s) and date performed: Cardiologist: Cardiac Surgeon: Intensivist: Patient Care CMV status Recipient CMV status Donor
More informationPHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Non Categorized SUB Sub Phase (SUB)* Non Categorized Quality Measures STK Diet ED NPO Until Bedside Swallow Screen passed Nursing Orders Activate Code Stroke Vital Signs Q15MINS Int
More information6 th Floor and 7 East Nurses Guide Intravenous Drip List Approved for RN Administration University of Kentucky Chandler Medical Center
RATE Abciximab (Reopro) Alteplase (tpa, Activase) All units 6S and 6W ONLY Platelet aggregation inhibitor Thrombolytic agent Bolus: 0.25 mg/kg IV over 5 min Infusion: 0.125 0.9 mg/kg (max 90 mg); 10% of
More informationALL 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
More informationPhysician 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
More informationPICU CARD SURG Post Operative Cardiac Transplant Age LESS than 6 months (Page 1 of 5)
(Page 1 of 5) Code Status Full code Status/Admit/Transfer/Discharge Surgical Procedure(s) and date performed (if applicable): Cardiologist: Cardiac Surgeon: Intensivist: Patient Care CMV status Donor CMV
More informationADMIT CHEST PAIN PLAN - Phase: Begin Immediately
- Phase: Begin Immediately PHYSICIAN S Diagnosis Weight Allergies Admit/Discharge/Transfer Patient Status Requested Location: CICU, Pt Status: Observation (LOS < 2 midnights) Requested Location: 5E / IMCU,
More informationNEUROSURGERY ICU PLAN
NEUROSURGERY ICU PLAN Weight Allergies Patient Care Vital Signs Per Unit Standards Per Unit Standards, including cerebral perfusion pressure (CPP) and end tidal CO2. Perform Neurological Checks q1h q2h
More informationADULT POST NEUROLOGIC INTERVENTION ORDERS 2 of 4
9 Actual 9 Estimated DOWNTIME INTERVENTION 1 of 4 Weight kg 9 Actual 9 Estimated Height cm ALLERGIES: REFER TO ALLERGY PROFILE/ POWERCHART Admit to Dr.: Bed Type: Dx: ( ) Check, circle and/or fill in all
More informationNorth Carolina College of Emergency Physicians Standards for EMS Medications and Skills Use
. The baseline medications and skills required in all systems and Specialty Care Transport Programs) with EMS personnel credentialed at the specified level. S. The equipment required in all Specialty Care
More information