DRUG AND TREATMENT Condition/Status Patient Status (WCH) Patient Status: Inpatient Update Resident Team C (DEF)* A B X Vital Signs Vital Signs Q4H, Do not wake for vitals 2300-0700 (DEF)* DAILY Q4H Blood Pressure Measurement Activity Activity Up Ad Lib, ASDIR (DEF)* Lobby Privileges Bedrest, ASDIR Diet Diet Order (Pediatric) High Calorie/High Protein (DEF)* High Calorie/High Protein No Concentrated Sweets (NCS) Regular--peds menu No Concentrated Sweets (NCS) Diet Message 2 snacks a day Dietary Supplement / Tube Feeding (BMCW) PO, Additional Instructions: Boost Plus (DEF)* PO, Ensure Plus PO, Pediasure (Kid Approved) PO, Carnation Instant Breakfast G TUBE, TwoCal HN (RTH) G TUBE, Peptamen 1.5 G TUBE, Peptamen 1.5 G TUBE, Pediasure (Kid Approved) Nursing Orders Notify Resident Team C after arrival to floor Page 1 of 7
DRUG AND TREATMENT Notify Resident Team C after arrival to floor. Weigh Patient DAILY, By 9:00 AM Isolation Order Contact Strict I & O Pulse Oximetry (Continuous) Special Instructions: Routine until SPO2 above greater than 90% overnight on room air then d/c. Comments: Q8H reposition pulse oximeter probe and assess skin that has been in contact with the sensor. Notify Provider Vital Signs/Urine Output SpO2 < 90, Special Instructions: After max ordered oxygen administration IV/INT Start Access Central Line Port per sterile technique Medications ***(NOTE)*** Heparin For Port Use Only heparin flush 10 Units/mL (pediatric) 5 ml IV PUSH inj ASDIR, PRN, Clinical Instructions: after each use heparin flush portacath 100 units/ml 5 ml IV PUSH inj ASDIR, PRN Comments: for de-access tobramycin (tobramycin (pediatric)) 10 mg/kg ped_abx IVPB Q24H Int, Clinical Instructions: May consider once-daily dosing using previous total daily dose for greater than 6 years (DEF)* 3.3 mg/kg ped_abx IVPB Q8H, Clinical Instructions: for children less than 6 years Lab Order Entry per Previous CPOE Tobramycin level: 12 hour level for daily dosing. (DEF)* Tobramycin level Peak after 3rd dose 1 hour post for Q8 and Q12 frequency and trough 1 hour prior to fourth dose for Q8 and Q12 frequency Lab Order Entry per Previous CPOE Tobramycin level: Routine Q week trough for Q8 and Q12 dose Lab Order Entry per Previous CPOE Tobramycin Level QWEEK at hour 1 for Q24H dose. (DEF)* Tobramycin Level QWEEK at hour 2 for Q24H dose. Tobramycin Level QWEEK at hour 12 for Q24H dose. Tobramycin Level QWEEK at hour 18 for Q24H dose. ceftazidime (Fortaz (pediatric)) 50 mg/kg ped_abx IVPB Q8H Comments: Max 2g/dose ticaricillin-clavulanate (Timentin (pediatric)) 100 mg/kg ped_abx IVPB Q6H Comments: Max 4.5g/dose Page 2 of 7
DRUG AND TREATMENT piperacillin-tazobactam (Zosyn (pediatric)) 100 mg/kg ped_abx IVPB Q6H Comments: Max 4.5g/dose dosing per piperacillin component imipenem-cilastatin (Primaxin (pediatric)) 25 mg/kg ped_abx IVPB Q6H Comments: Max 1 g/dose ciprofloxacin (Cipro (pediatric)) 15 mg/kg liquid PO Q12H, Clinical Instructions: Max 750 mg/dose (DEF)* 20 mg/kg liquid PO Q12H, Clinical Instructions: Max 750 mg/dose 250 mg tab PO Q12H, Clinical Instructions: Max 750 mg/dose 500 mg tab PO Q12H, Clinical Instructions: Max 750 mg/dose 15 mg/kg ped_abx IVPB Q12H, Clinical Instructions: Max 400 mg/dose 10 mg/kg ped_abx IVPB Q8H, Clinical Instructions: Max 400 mg/dose levofloxacin (Levaquin (pediatric)) 10 mg/kg tab PO DAILY, Clinical Instructions: Max 750 mg/dose (DEF)* 10 mg/kg ped_abx IVPB DAILY, Clinical Instructions: Max 750 mg/dose sulfamethoxazole-trimethoprim (Bactrim suspension (pediatric)) 5 mg/kg liquid PO BID sulfamethoxazole-trimethoprim (Bactrim SS tablet (pediatric)) 1 tab PO tab BID, Clinical Instructions: Trimethoprim component (Single Strength) sulfamethoxazole-trimethoprim (Bactrim DS Tablet (pediatric)) 1 tab PO tab DS BID, Clinical Instructions: Trimethoprim component (Double Strength) sulfamethoxazole-trimethoprim (Bactrim IV (pediatric)) 5 mg/kg ped_abx IVPB BID, Clinical Instructions: Trimethoprim component azithromycin (Zithromax (pediatric)) 250 mg tab PO MWF (DEF)* 500 mg tab PO MWF cetirizine (Zyrtec (pediatric)) 5 mg tab PO DAILY, Clinical Instructions: 2-5 years (DEF)* 10 mg tab PO DAILY, Clinical Instructions: Greater than 5 years 5 mg syrup PO DAILY, Clinical Instructions: 2-5 years cyproheptadine (periactin (pediatric)) 2 mg tab PO QID (DEF)* 4 mg tab PO QID lansoprazole (Prevacid (pediatric)) 15 mg tab soluble PO DAILY, Clinical Instructions: 10 to 30 kg (DEF)* 15 mg tab soluble PO BID, Clinical Instructions: 10 to 30 kg 30 mg tab soluble PO DAILY, Clinical Instructions: Greater than 30 kg 30 mg tab soluble PO BID, Clinical Instructions: Greater than 30 kg insulin glargine (Lantus (pediatric)) unit inj SUBCUT BEDTIME insulin aspart (NovoLog (pediatric)) unit inj SUBCUT Page 3 of 7
DRUG AND TREATMENT ***(NOTE)*** Respiratory albuterol (Proventil Neb 0.083% (pediatric)) 2.5 mg neb inh NEB QID RT, Clinical Instructions: Prior to CPT (DEF)* 2.5 mg neb inh NEB TID, Clinical Instructions: Prior to CPT 2.5 mg neb inh NEB Q4H RT albuterol Proventil 90 mcg/inh metered dose inhaler (pediatric) 2 puff INHALE aerosol QID RT (DEF)* Comments: Prior to CPT 2 puff INHALE aerosol TID RT Comments: Prior to CPT 2 puff INHALE aerosol Q4H RT, PRN Wheezing fluticasone (Flovent 44 mcg/inh (HFA) metered dose inhaler (pediatric)) fluticasone (Flovent 110 mcg/inh (HFA) metered dose inhaler (pediatric)) fluticasone (Flovent 220 mcg/inh (HFA) metered dose inhaler (pediatric)) fluticasone-salmeterol (Advair HFA 45 mcg-21 mcg/inh inhalation aerosol) Comments: May use home medication fluticasone-salmeterol (Advair HFA 115 mcg-21 mcg/inh inhalation aerosol) Comments: May use home medication fluticasone-salmeterol (Advair HFA 230 mcg-21 mcg/inh inhalation aerosol) Comments: May use home medication dornase alfa (Pulmozyme neb (pediatric)) 2.5 mg soln NEB DAILY sodium chloride (Hypertonic Saline 6.5% Neb (pediatric)) 4 ml INHALE soln BID RT Comments: For Nebulization only. Mix 2 ml of 3% solution and 2 ml of 10% solution to make a total of 4 ml 6.5% final concentration sodium chloride. budesonide-formoterol (Symbicort 80 mcg/4.5 mcg metered dose inhaler (pediatric)) budesonide-formoterol (Symbicort 160 mcg/4.5 mcg metered dose inhaler (pediatric)) tobramycin (tobramycin neb (pediatric)) 300 mg soln INHALE Q12H RT ursodiol (ursodiol (pediatric)) 10 mg/kg soln PO TID (DEF)* 10 mg/kg soln PO BID Page 4 of 7
DRUG AND TREATMENT pancrelipase (Zenpep 5,000 unit (pediatric)) 5,000 unit cap PO MEALS, Clinical Instructions: Meals (DEF)* 5,000 unit cap PO, Clinical Instructions: With snacks 5,000 unit cap PO, Clinical Instructions: Meals and with snacks pancrelipase (Zenpep 10,000 unit (pediatric)) 10,000 unit cap PO MEALS, Clinical Instructions: Meals (DEF)* 10,000 unit cap PO, Clinical Instructions: With snacks 10,000 unit cap PO, Clinical Instructions: Meals and with snacks pancrelipase (Zenpep 15,000 unit (pediatric)) 15,000 unit cap PO MEALS, Clinical Instructions: Meals (DEF)* 15,000 unit cap PO, Clinical Instructions: With snacks 15,000 unit cap PO, Clinical Instructions: Meals and with snacks pancrelipase (Zenpep 20,000 unit (pediatric)) 20,000 unit cap PO MEALS, Clinical Instructions: Meals (DEF)* 20,000 unit cap PO, Clinical Instructions: With snacks 20,000 unit cap PO, Clinical Instructions: Meals and with snacks pancrelipase (Creon 6 (pediatric)) cap PO cap MEALS, Clinical Instructions: Meals (DEF)* cap PO cap, Clinical Instructions: with snacks cap PO cap, Clinical Instructions: Meals and with snacks ***(NOTE)*** Vitamins multivitamin with minerals (AquADek oral tablet (pediatric)) 1 tab PO tab DAILY multivitamin with minerals (AquADEKs Pediatric) 1 ml PO drops DAILY ***(NOTE)***PRN*** acetaminophen (acetaminophen (pediatric)) 10 mg/kg susp PO Q4H, PRN Other (see comment) (DEF)* Comments: PRN pain mild OR fever GREATER than 38.3 degrees Celsius. Give if GREATER than 4 hours since last dose acetaminophen given. If ineffective use ibuprofen. Do NOT administer over a total 3g/day acetaminophen. 325 mg tab PO Q4H, PRN Other (see comment) Comments: PRN pain mild OR fever GREATER than 38.3 degrees Celsius. Give if GREATER than 4 hours since last dose acetaminophen given. If ineffective use ibuprofen. Do NOT administer over a total 3g/day acetaminophen. 500 mg tab PO Q4H, PRN Other (see comment) Comments: PRN pain mild OR fever GREATER than 38.3 degrees Celsius. Give if GREATER than 4 hours since last dose acetaminophen given. If ineffective use ibuprofen. Do NOT administer over a total 3g/day acetaminophen. Page 5 of 7
DRUG AND TREATMENT ibuprofen (ibuprofen (pediatric)) 10 mg/kg susp PO Q6H, PRN Other (see comment) (DEF)* Comments: PRN pain mild OR fever GREATER than 38.3 degrees Celsius. If last dose of acetaminophen given GREATER than 1 hour or LESS than 4 hours, may give ibuprofen. If acetaminophen not given or ineffective. 200 mg tab PO Q6H, PRN Other (see comment) Comments: PRN pain mild OR fever GREATER than 38.3 degrees Celsius. If last dose of acetaminophen given GREATER than 1 hour or LESS than 4 hours, may give ibuprofen. If acetaminophen not given or ineffective. Laboratory CBC with Differential. CRP CHEM 12 ESR GGT Hemoglobin A1C Vitamin A Level Vitamin E Tocopherol CF Sputum Culture Expedite/ASAP, SPUTUM, ONCE (DEF)* Expedite/ASAP, THROAT, ONCE PT INR Vitamin D IgE Sputum for AFB Expedite/ASAP, SPUTUM, ONCE HCG Screen Urine Expedite/ASAP, URINE, ONCE CBC with Differential. Timed Study, BLOOD, QWEEK Int BUN Timed Study, BLOOD, QWEEK Int Page 6 of 7
DRUG AND TREATMENT Creatinine Serum Timed Study, BLOOD, QWEEK Int Radiology XR Chest *2 view PA and LAT CF Exacerbation, Pending Discharge - No Respiratory Chest Physiotherapy Routine, TID, May substitute vest, for 2 treatments a day (DEF)* Routine, QID RT, May substitute vest, for 2 treatments a day Oxygen Therapy (WCH) Maintain O2 Saturation >: 92% Consults Nutrition Consult Nutrition Assessment, for intake evaluation Social Work Consult Routine, Emotional/Spiritual Support, Physician (DEF)* Routine, Other - See Special Instructions, Physician, Chronic Disease Assessment and Support Routine, Discharge Planning, Physician Routine, Other - See Special Instructions, Physician, Financial Assistance Support Physical Therapy Consult (Peds) No exercise PICC Consult-Ped Routine, PICC Line Insertion Pediatric Sedation Service Consult Routine, PICC Line Placement Consult Pharmacy Kinetics Dosing Child Life Consult-Ped Routine, Distraction Page 7 of 7