OB Well Baby Nursery Admission (Term) [3040000234] For specialty focused order sets for your patient, refer to: 3040000424 Neonatal Circumcision Order Set 3040000522 Neonatal Herpes Viral Order Set 3040000524 Neonatal HIV Exposure Order Set 3040000501 Neonatal Hypoglycemia Order Set 3040000504 Neonatal In Utero Drug Order Set 3040000503 Neonatal Jaundice Order Set 3040000575 Neonatal Suspected Bacterial Infection Order Set General Admission [ ] Admit to Newborn Nursery Details Code Status (Single Response) ( ) Full code Details Code Status (Single Response) ( ) Full code Details Newborn Vital Signs [ ] Vital signs (Transition) Routine, Once For 1 Occurrences Transition vital signs: First 15 minutes. Every 30 min x 2 hours until stable for 2 hours, then as needed. [ ] Vital signs (Routine) Routine, Once For 1 Occurrences Routine vital signs: Every 4 hours for first 24 hours. Every 8 hours and PRN until discharge. [ ] Measure blood pressure Routine, Every 4 hours [ ] Continuous Pulse Oximetry Routine, Until discontinued, Starting S [ ] Pulse Oximetry, spot Routine, Once For 1 Occurrences [ ] Pulse Oximetry Routine, Once For 1 Occurrences Congenital Heart Disease Screen before discharge. Newborn Feeding [ ] BREAST MILK Oral, See admin instructions Initiate ASAP in stable infants. [ ] Infant formula Routine, Until discontinued, Starting S Formula: Similac Formula of mother's choice [ ] Infant feeding Routine, Until discontinued, Starting S Type: Breast Breast or bottle Feeding on demand per Mother's choice Page 1 of 6
[ ] Nursing Communication Routine, Until discontinued, Starting S Supplement breast feeding with physician's orders / mother's request. [ ] Supplement EBM or formula Routine, Until discontinued, Starting S Supplement with EBM or formula if any of the following conditions exist: 1) Greater than 10% weight loss, 2) Urine & stool less than 2 X each by 36 hours old, 3) No active breastfeeding (ineffective milk transfer) by 12-24 hours of age. [ ] Infant feeding Routine, Until discontinued, Starting S Type: If weight less than 5 pounds, feed every 3 hours. [ ] Breast pump Routine, Until discontinued, Starting S Mother to use breast pump if needed. [ ] Diet NPO Diet effective now, Starting S Except: Notify Physician [ ] Notify physician Routine, Until discontinued, Starting S For Until specified Other: Rectal temp greater than or equal to 38 or less than 36.7 on repeat, serum glucose less than 40 mg/dl, venous hematocrit greater greater than or equal to 65%. [ ] Notify physician Routine, Until discontinued, Starting S Other: failed heart screening Failed heart screening. [ ] Notify physician (specify) Routine, Until discontinued, Starting S Temperature greater than: Temperature less than: Systolic BP greater than: Systolic BP less than: Diastolic BP greater than: Diastolic BP less than: Heart rate greater than: Heart rate less than: Respiratory rate greater than: Respiratory rate less than: SpO2 less than: Other: Newborn Bed Type (Single Response) ( ) Bassinet Routine, Until discontinued, Starting S ( ) Incubator Routine, Until discontinued, Starting S ( ) Open warmer Routine, Until discontinued, Starting S Newborn Patient Care [ ] Car seat test Routine, Once For 1 Occurrences Car seat trending (Angle Tolerance Test) for at-risk or under 2500 gm newborn. Page 2 of 6
[ ] Neonatal Abstinence syndrome scoring Routine, As needed Specify: Neonatal Abstinence syndrome scoring If symptoms, positive maternal history, or positive toxicology screen Newborn Nursing Assessments A scientific statement from the AAP and the AHA published in the August 2009 issue of Pediatrics analyzes the evidence in support of routine pulse oximetry after 24 hours of age as a screening tool for cyanotic congenital heart disease. Infants with an oxygen saturation of 95% or less should be evaluated further. Echocardiography is the definitive diagnostic modality. The cardiac lesions with greates risk of acute cardiovascular compromise, obstructive left heart lesions, may be less detectable by pulse oximetry. Role of Pulse Oximetry in Examining Newborns for Congenital Heart Disease (abstract) Universal Newborn Hearing Screening 2008 (abstract) "http://pediatrics.aappublications.org/cgi/content/abstract/1 24/2/823" "http://pediatrics.aappublications.org/cgi/content/abstract/1 22/1/e266" [ ] Assess Routine, Once For 1 Occurrences Specify: Newborn assessment Initial newborn assessment within 2 hours of birth. [ ] Daily weights Routine, Daily For Until specified Upon admission and daily. [ ] Pulse oximetry spot check Routine, Once For 1 Occurrences Congenital Heart Screen after 24 hours of age. Notify physician if it fails screen. Newborn Nursing Interventions [ ] Cord Care Routine, Continuous [ ] Care order / instruction Routine, As needed Skin-to-Skin (within 5 minutes). PRN [ ] Positioning instruction Routine, Until discontinued, Starting S Skin to skin or swaddle gently and posiiton infant to encourage flexion rather than extension. [ ] Nursing Communication Routine, Until discontinued, Starting S Room in with parent except for procedures and / or assessments. Newborn Oxygen Administration [ ] Nasal cannula oxygen Routine, Continuous Liters per minute: 2 [ ] Simple face mask oxygen Routine, Every 4 hours while awake (RT) Liters per minute: 2 Blow-by. Physician Consult [ ] Inpatient consult to Neonatology Reason for Consult? Did you attempt to contact the consulting physician (REQUIRED for a STAT consult)? No Ancillary Consults Page 3 of 6
[ ] Inpatient consult to Audiology Reason for Consult? Newborn hearing screen [ ] Inpatient consult to Lactation Specialist Reason For Consult? Labs Labs - Routine Newborn Group B Streptococcus Guidelines [ ] Nursing request CBC with differential and Blood Culture if indicated per GBS algorithm "http://www.cdc.gov/groupbstrep/guidelines/downloads/ind ications.pdf" ASAP, Once For 1 Occurrences Specify: request CBC with differential and Blood Culture if indicated per GBS algorithm If baby's mother is Group B streptococcus positive or unknown, please refer to the GBS algorithm and request orders for a blood culture and a CBC with differential as indicated. [ ] Newborn Metabolic Screening (ODH) Once For 1 Occurrences To be collected between 24 and 48 hours of age, regardless of feeding status or before blood transfusion. [ ] Drugs of Abuse Screen, Urine Once For 1 Occurrences Urine drug screen if suspected or known maternal drug use. If urinates prior to starting collection and at risk, please initiate meconium collection. [ ] Buprenorphine Screen, Urine Once For 1 Occurrences Urine drug screen if suspected or known maternal drug use. [ ] POCT glucose Routine, As needed Initial feed within 1 hour. Screen high-risk infants 30 minutes after feed. Send STAT serum glucose if less than 40 mg/dl. [ ] Blood Culture Aerobic/Anaerobic Routine, Once For 1 Occurrences [ ] Obtain arterial blood gases Routine, Once For 1 Occurrences Do you want additional tests to be run with the blood gases? [ ] Obtain capillary blood gases Routine, Once For 1 Occurrences Do you want additional tests to be run with the blood gases? [ ] Obtain venous blood gases Routine, Once For 1 Occurrences Do you want additional tests to be run with the blood gases? [ ] CBC and Differential Once For 1 Occurrences [ ] Drug Abuse Screen, Cord Tissue Once For 1 Occurrences [ ] Meconium Drug Screen Routine, Once For 1 Occurrences. [ ] Buprenorphine Screen, Meconium Once For 1 Occurrences Labs - For Infant Born to Type O or Rh Negative Mother [ ] Type and Direct Coombs Neonate Routine Once For 1 Occurrences If not already completed in L&D. Labs - Bilirubin Monitoring Bilirubin Paper "http://pediatrics.aappublications.org/content/124/4/1052.f ull.pdf+html" Page 4 of 6
Bilirubin Nomogram Serum Bilirubin Scale "http://pediatrics.aappublications.org/content/124/4/1052/f 3.expansion.html" "http://pediatrics.aappublications.org/content/114/1/297/f2.large.jpg" [ ] POCT bilirubinometry Routine, As needed Transcutaneous bilirubin screen on day of discharge or PRN jaundice. [ ] Bilirubin, Total and Direct As needed If transcutaneous bilirubin in the high risk zone, obtain serum bilirubin lab and notify physician if serum bilirubin is in high risk zone. [ ] Bilirubin, Total and Direct Morning draw For 1 Occurrences [ ] Bilirubin, Total and Direct Once Follow up bilirubin level *** hours after discontinuation of phototherapy. [ ] Bilirubin, Total and Direct Once For 1 Occurrences Repeat bilirubin level *** hours after starting of phototherapy. [ ] Notify physician STAT, Until discontinued, Starting S Temperature greater than: Temperature less than: Systolic BP greater than: Systolic BP less than: Diastolic BP greater than: Diastolic BP less than: Heart rate greater than: Heart rate less than: Respiratory rate greater than: Respiratory rate less than: SpO2 less than: Other: Serum bilirubin level is in high-intermediate risk range. Imaging Imaging - Chest [ ] XR Chest 1 View Routine, 1 time imaging For 1 Occurrences Portable? [ ] XR Chest 2 Views Routine, 1 time imaging For 1 Occurrences X-Ray Clavicles [ ] X-ray clavicle left Routine, 1 time imaging For 1 Occurrences Reason for exam: suspected perinatal fracture [ ] X-ray clavicle right Routine, 1 time imaging For 1 Occurrences Reason for exam: suspected perinatal fracture Page 5 of 6
Newborn Radiology [ ] XR Baby Routine, 1 time imaging For 1 Occurrences Portable? [ ] Renal Ultrasound Routine, 1 time imaging For 1 Occurrences What is the patient's sedation requirement? [ ] Baby Head Ultrasound Routine, 1 time imaging For 1 Occurrences What is the patient's sedation requirement? Page 6 of 6