1 2 DRUG AND TREATMENT ORDERS PED SURG General...

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DRUG AND TREATMENT ORDERS

PED SURG General Inpatient

PHYSICIAN SIGNATURE _____________________________________ DATE __________ TIME _______

DRUG ALLERGIES WT: KG

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A pharmaceutical equivalent or pharmaceutical alternative may be substituted. Therapeutic alternatives may be substituted as determined by the Pharmacy and Therapeutics Committee.

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Available ONLY at: BMC-W Admit Condition/Status Patient Status (WCH)

Patient Status: Inpatient (DEF)*

Patient Status: Outpatient- Refer for Observation Status Vital Signs

Vital Signs with Blood Pressure Q4H

Cardiopulmonary Monitoring

Pulse Oximetry (Continuous) Special Instructions: See Order Comments

Comments: Q8H reposition pulse oximeter probe and assess skin that has been in contact with the probe.

Activity Activity

Up as tolerated (DEF)*

Bedrest

Bedrest with BRP, with assistance

Out of Bed to Chair

Encourage ambulating

Ambulate with Assistance

Lobby privileges Diet Diet Order (Pediatric)

Clear Liquid, Advance as Tolerated to Regular--peds menu (DEF)*

Clear Liquid Comments: Diet for age

Regular--peds menu

Enteral Feeding Formula (Pediatric) NPO

NPO except for ice chips, Maximum 1 ounce/hr WA (DEF)*

NPO except for medications

NPO except Oral Sucrose

NPO after Midnight No exceptions

Nursing Orders Weigh Patient

DAILY (DEF)*

MWF

QOTHERDAY

Strict I & O






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Sequential Compression Device

Maintain Indwelling Urinary Catheter

Start IV/INT

PED Venipuncture Pain Management Protocol (PANDA) EQUAL to/GREATER than 6 Months(SUB)* ***Reminder: Order PED Venipuncture Pain Management Protocol (PANDA) EQUAL to/GREATER than 6 Months (SUB) on a separate form.***

PED Venipuncture Pain Management Protocol (PANDA) LESS than or EQUAL to 6 Months(SUB)* ***Reminder: Order PED Venipuncture Pain Management Protocol (PANDA) LESS than or EQUAL to 6 Months (SUB) on a separate form.***

Notify Provider Vital Signs/Urine Output Urine Output < _____ mL/8 hours

Enteral Tube Care

Notify Physician Recurrent vomiting, respiratory distress

Notify Physician Other (See Special Instructions) Tube dislodgement

Irrigation Rectal with normal saline

Medications Antibiotics ampicillin (pediatric)

30 mg/kg ped_abx IVPB Q6H (DEF)* Comments: Max 2g

30 mg/kg ped_abx IVPB Q8H Comments: Max 2g

gentamicin (pediatric)

2.5 mg/kg ped_abx IV Q8H (DEF)* Comments: MAX 120mg

2.5 mg/kg ped_abx IV Q12H Comments: MAX 120mg

Lab Order Entry per Previous CPOE Gentamicin: P/T after 3rd dose

clindamycin (pediatric)

10 mg/kg ped_abx IV Q6H (DEF)* Comments: (MAX 600 mg)

600 mg ped_abx IV Q6H Comments: (MAX 600 mg)

cefazolin (Ancef (pediatric)) 30 mg/kg ped_abx IV Q8H

Comments: Max 1 g

metronidazole (Flagyl (pediatric)) 7.5 mg/kg ped_abx IV Q6H

Comments: MAX 500 mg






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ampicillin-sulbactam (Unasyn (pediatric)) 50 mg/kg ped_abx IV Q6H

Comments: (MAX 3g) piperacillin-tazobactam (osyn (pediatric))

75 mg/kg ped_abx IV Q6H (DEF)* Comments: MAX 3.375g

3.375 g ped_abx IV Q6H, Clinical Instructions: GREATER than 40 kg

neomycin (pediatric) 15 mg/kg tab PO TID, Duration: 3 dose, Clinical Instructions: Not to exceed 1 gram per dose; reschedule

administration times to 1500, 1600, and 2200 Comments: ATTN pharmacist - reschedule administration times to 1500, 1600, and 2200

erythromycin (pediatric) 20 mg/kg tab PO TID, Duration: 3 dose, Clinical Instructions: reschedule administration times to 1500,

1600, and 2200 Comments: ATTN pharmacist - reschedule administration times to 1500, 1600, and 2200

sulfamethoxazole-trimethoprim (Bactrim suspension (pediatric)) 5 mg/kg ped_abx PO BID

Comments: (MAX 160 mg TMP/ day)

cefotaxime (Claforan (pediatric)) 50 mg/kg ped_abx IV Q8H

Comments: (MAX 2g)

ceftriaxone (Rocephin (pediatric)) 50 mg/kg ped_abx IV DAILY

vancomycin (pediatric) 10 mg/kg ped_abx IV Q6H

Comments: (MAX 1g)

Vancomycin Level Ordering Directions Trough before 4th dose

Analgesics 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. MAX dose 650 mg/dose.

10 mg/kg susp G TUBE 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. MAX dose 650 mg/dose.

10 mg/kg susp NG TUBE 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. MAX dose 650 mg/dose.

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. MAX dose 650 mg/dose.

500 mg cap 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. MAX dose 500 mg/dose.






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650 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. MAX dose 500 mg/dose.

acetaminophen (pediatric) 15 mg/kg supp Q6H, PRN Other (see comment)

Comments: PRN pain mild OR fever GREATER than 38.5 degrees Celsius. Give if GREATER than 4 hours since last dose acetaminophen given. MAX dose 650 mg/dose.

ibuprofen (pediatric)

10 mg/kg susp PO Q6H, PRN Other (see comment) (DEF)* Comments: PRN pain mild/moderate OR fever GREATER than 38.5 degrees Celsius. If last dose of acetaminophen given GREATER than 1 hour or LESS than 4 hours, may give ibuprofen.

10 mg/kg susp G TUBE Q6H, PRN Other (see comment) Comments: PRN pain mild/moderate OR fever GREATER than 38.5 degrees Celsius. If last dose of acetaminophen given GREATER than 1 hour or LESS than 4 hours, may give ibuprofen.

10 mg/kg susp NG TUBE Q6H, PRN Other (see comment) Comments: PRN pain mild/moderate OR fever GREATER than 38.5 degrees Celsius. If last dose of acetaminophen given GREATER than 1 hour or LESS than 4 hours, may give ibuprofen.

200 mg tab PO Q6H, PRN Other (see comment) Comments: PRN pain mild/moderate OR fever GREATER than 38.5 degrees Celsius. If last dose of acetaminophen given GREATER than 1 hour or LESS than 4 hours, may give ibuprofen.

Toradol (pediatric) 0.5 mg/kg inj IV PUSH Q6H, Pain Moderate, Duration: 72 hour

Comments: MAX 30 mg acetaminophen-hydrocodone (Hycet (Hydrocodone 2.5mg - Acetaminophen 108mg per 5mL) pediatric)

0.1 mg/kg liquid PO Q6H, PRN Pain Moderate (DEF)* Comments: Dose based on Hydrocodone component. Max dose 10 mg for Hydrocodone component. Do NOT administer over a total 3g/day acetaminophen.

0.1 mg/kg liquid G TUBE Q6H, PRN Pain Moderate Comments: Dose based on Hydrocodone component. Max dose 10 mg for Hydrocodone component. Do NOT administer over a total 3g/day acetaminophen.

0.1 mg/kg liquid NG TUBE Q6H, PRN Pain Moderate Comments: Dose based on Hydrocodone component. Max dose 10 mg for Hydrocodone component. Do NOT administer over a total 3g/day acetaminophen.

acetaminophen-hydrocodone (Norco (Hydrocodone 5mg/APAP 325mg) Pediatric) 1 tab PO tab Q6H, PRN Pain Moderate

Comments: Do NOT administer over a total 3g/day acetaminophen.

acetaminophen-hydrocodone (Norco (Hydrocodone 7.5mg/APAP 325mg) Pediatric) 1 tab PO tab Q6H, PRN Pain Moderate

Comments: Do NOT administer over a total 3g/day acetaminophen. morphine (pediatric)

0.05 mg/kg inj IV Q2H, PRN Pain Severe (DEF)* Comments: usual adult dose is 4 mg; Use for breakthrough pain not relieved by PO pain meds or if unable to tolerate PO.

0.1 mg/kg inj IV Q2H, PRN Pain Severe Comments: usual adult dose is 4 mg; Use for breakthrough pain not relieved by PO pain meds or if unable to tolerate PO.






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Antiemetics

ondansetron (Zofran (pediatric)) 0.1 mg/kg inj IV PUSH Q6H, PRN Nausea/Vomiting

Comments: MAX 4 mg Antihistamines diphenhydrAMINE (Benadryl (pediatric))

1 mg/kg inj IV PUSH Q6H, PRN Itching (DEF)* Comments: MAX 25 mg

1 mg/kg liquid G TUBE Q6H, PRN Itching Comments: MAX 50 mg

1 mg/kg liquid NG TUBE Q6H, PRN Itching Comments: MAX 50 mg

diphenhydrAMINE (Benadryl (pediatric))

25 mg tab PO Q6H, PRN Itching (DEF)* Comments: MAX 50 mg

50 mg tab PO Q6H, PRN Itching Comments: MAX 50 mg

1 mg/kg liquid PO Q6H, PRN Itching Comments: MAX 50 mg

Gastrointestinal Agents ranitidine (Zantac (pediatric))

2 mg/kg syrup PO BID, Clinical Instructions: (Max 150mg) (DEF)*

75 mg tab PO BID, Clinical Instructions: (Max 150mg)


1 mg/kg syringe IVPB Q8H, Clinical Instructions: (Max 50mg)

50 mg inj IV PUSH Q8H, Clinical Instructions: (Max 50 mg) lansoprazole (Prevacid (pediatric))

15 mg cap CR PO DAILY (DEF)* Comments: Max 30 mg

30 mg cap CR PO DAILY Comments: Max 30 mg

polyethylene glycol 3350 (Miralax (pediatric))

17 g liquid PO DAILY (DEF)* Comments: Mix in 8 ounces of clear liquid

8.5 g liquid PO DAILY Comments: Mix in 4 ounces of clear liquid

docusate (Colace (pediatric))

100 mg tab PO BID (DEF)*

100 mg tab PO DAILY docusate (Colace (pediatric))

100 mg liquid PO DAILY (DEF)*

100 mg liquid PO BID

polyethylene glycol electrolyte solution (Golytely (pediatric)) mL PO soln ASDIR






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Miscellaneous Topical Agents

TNF medication Ilex 1 Appl TOPICAL ASDIR, PRN Other (see comment)

Comments: Small amount on top of skin for protection

menthol-zinc oxide topical (Calmoseptine (pediatric)) 1 dose TOPICAL ASDIR, PRN Other (see comment)


miconazole topical (miconazole topical (pediatric)) 1 dose TOPICAL powder ASDIR, PRN Other (see comment)

Comments: Use small amount on top of skin for protection IV Solutions D5 1/2NS + KCl 20 mEq

IV bag mL/hour (DEF)*

IV bag mL/hour, Clinical Instructions: when NPO D5NS + KCl 20 mEq


IV bag mL/hour, Clinical Instructions: when NPO LR


IV bag mL/hour, Clinical Instructions: when NPO

Normal Saline Single Dose (Pediatric) 20 mL/kg IVPB iv ONCE

Comments: Infuse over 1 hour then resume IV fluids

LR Single Dose (Pediatric) 20 mL/kg IVPB iv ONCE

Comments: Infuse over 1 hour then resume IV fluids ***NOTE*** Tube Replacements

NG Tube Replacements LR

bag NG Output Replacement, PRN Other (see comment), Clinical Instructions: 1mL per 1mL NG Output Q4 Hours, Infuse over 4 Hours bag NG Output Replacement, PRN Other (DEF)*

bag NG Output Replacement, PRN Other (see comment), Clinical Instructions: 0.5 mL per 1mL NG Output Q4 Hours, Infuse over 4 Hours bag NG Output Replacement, PRN Other (see comment)

NS

IV bag NG Output Replacement, PRN Other (see comment), Clinical Instructions: 1mL per 1mL NG Output Q4 Hours, Infuse over 4 Hours (DEF)*

IV bag NG Output Replacement, PRN Other (see comment), Clinical Instructions: 0.5 mL per 1mL NG Output Q4 Hours, Infuse over 4 Hours

Laboratory

CBC with Differential. Expedite/ASAP, Blood, ONCE

CBC with Differential. Early AM, Blood, ONCE






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CHEM 7

Expedite/ASAP, Blood, ONCE (DEF)*

Early AM, Blood, ONCE Chem 12


Early AM, Blood, ONCE Amylase Level


Early AM, Blood, ONCE Lipase Level


Early AM, Blood, ONCE PT INR


Early AM, Blood, ONCE PTT


Early AM, Blood, ONCE Blood Culture

Expedite/ASAP, BLOOD - PERIPHERAL, ONCE (DEF)*

Expedite/ASAP, BLOOD - LINE, ONCE Urinalysis

Expedite/ASAP, URINE, ONCE (DEF)*

Early AM, URINE, ONCE Urine Culture

Expedite/ASAP, URINE, CLEANCATCH, ONCE (DEF)*

T;N, Expedite/ASAP, URINE, CATHETER, ONCE

PED NEO Blood Transfusion (Use for patients LESS THAN 4 months old)(SUB)* ***Reminder: Order PED NEO Blood Transfusion (Use for patients LESS THAN 4 months old) (SUB) on a separate form.***

PED Blood Transfusion(SUB)* ***Reminder: Order PED Blood Transfusion (SUB) on a separate form.*** Radiology XR Chest *2 view PA and LAT

Stat, Pending Discharge - No, ONCE, Pre-Op (DEF)*

Early AM, Pending Discharge - No, ONCE, Pre-Op

XP Chest XR Abd (KUB) 1 view

Stat, Pending Discharge - No, ONCE (DEF)*

Early AM, Pending Discharge - No, ONCE

XR Abd 1 view (KUB) Portable

Obstructive Series Stat, Pending Discharge - No






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XP Obstructive Series

XP ABD Decubitus LAT Pending Discharge - No, Left Lateral

CT Guided Drainage Pending Discharge - No, of intra-abdominal abscess

US Guided Abscess Drainage

Upper GI w/o Air Contrast w/o KUB

UGI w/Small Bowel Pending Discharge - No

Esophagram

Enema w/Gastrograffin Respiratory

Oxygen Therapy (WCH) Maintain O2 Saturation >: 92%

Incentive Spirometry Routine, Q2H WA, may use bubbles

Chest Physiotherapy Routine, Q4H RT

Consults

Durable Medical Equipment Pediatric

Home Care

Physician Consult Anesthesia

Physician Consult GI

Physician Consult ID

PICC Consult-Ped

Wound Care Consult

Nutrition Consult Intra-Op Nursing Orders

Insert Indwelling Urinary Catheter

Discontinue Indwelling Urinary Catheter

PED Enteral Tube Insertion(SUB)* ***Reminder: Order PED Enteral Tube Insertion (SUB) on a separate form.***

PED SURG Chest Tube(SUB)* ***Reminder: Order PED SURG Chest Tube (SUB) on a separate form.*** Medications Local Anesthetic Agents

Intra-OP Medication (Volume Medication) Marcaine 0.25% PF inj soln 1 mL INFILTRATE PERIOP_ONCE






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Intra-OP Medication (Volume Medication) Marcaine 0.25%-Epinephrine 1:200,000 MDV inj 1 mL INFILTRATE PERIOP_ONCE

Intra-OP Medication (Volume Medication) Xylocaine Jelly 1 dose TOPICAL PERIOP_ONCE

Intra-OP Medication (Volume Medication) Ropivacaine 0.2% 1 mL INFILTRATE PERIOP_ONCE

Irrigants

Intra-OP Medication (Volume Medication) Bacitracin 50,000 Units/NS 500 mL 500 mL IRRIGATE PERIOP_ONCE

Intra-OP Medication (Volume Medication) Bacitracin 50,000 units/NS 1000 mL 1000 mL IRRIGATE PERIOP_ONCE

Intra-OP Medication (Volume Medication) Polymyxin 500,000 units/NS 1000 mL 100 mL IRRIGATE PERIOP_ONCE

Intra-OP Medication (Volume Medication) Epinephrine 1:1000 Topical Solution 10 mL IRRIGATE PERIOP_ONCE

Antibiotics

Intra-Op Antibiotic ampicillin 30 mg/kg IVPB PERIOP_ONCE

Comments: Prior to incision (Max 2g)

Intra-Op Antibiotic gentamycin 2.5 mg/kg IVPB PERIOP_ONCE

Comments: Prior to incision (Max 120mg) Intra-Op Antibiotic

clindamycin 10 mg/kg IVPB PERIOP_ONCE (DEF)* Comments: Prior to incision (Max 600mg)

clindamycin 600 mg IVPB PERIOP_ONCE Comments: Prior to incision (Max 600mg)

Intra-Op Antibiotic Ancef 30 mg/kg IVPB PERIOP_ONCE


Intra-Op Antibiotic ampicillin/sulbactam (Unasyn) 50 mg/kg IVPB PERIOP_ONCE


Intra-Op Antibiotic piperacillin/tazobactam (Zosyn) 75 mg/kg IVPB PERIOP_ONCE

Comments: Prior to incision (Max 3.375g) Miscellaneous Topical Agents

Intra-OP Medication (Volume Medication) Bacitracin Topical Ointment 1 dose TOPICAL PERIOP_ONCE

Intra-OP Medication (Volume Medication) Neosporin Ointment 1 dose TOPICAL PERIOP_ONCE

Intra-OP Medication (Volume Medication) Hydrogen Peroxide 1 dose TOPICAL PERIOP_ONCE






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Contrast Media

Intra-OP Medication (Volume Medication) Conray 60 (iothalamate 60%) 10 mL IV PERIOP_ONCE

Comments: Combine with 30 mL NS for contrast injection Corticosteroids Intra-OP Medication (Volume Medication)

Kenalog 40 mg IV PERIOP_ONCE (DEF)*

Kenalog 10 mg IV PERIOP_ONCE Hemostatic Agents

Intra-OP Medication (Volume Medication) Surgicel 2x14 1 unit TOPICAL PERIOP_ONCE

Miscellaneous Intra-Op Medications

Intra-OP Medication (Volume Medication) Botox 0.5 mL IV PERIOP_ONCE

Comments: Final Concentration = 8 units/0.1mL

Intra-OP Medication (Volume Medication) Mineral Oil 30 mL TOPICAL PERIOP_ONCE

Intra-OP Medication (Volume Medication) Mucomyst 30 mL NG TUBE PERIOP_ONCE

Intra-OP Medication (Volume Medication) Phenol EZ Swab (phenol89% topical applicator) 1 dose TOPICAL PERIOP_ONCE

Intra-OP Medication (Volume Medication) Alcohol wash 200 proof (pediatric) solution 5 mL TOPICAL PERIOP_ONCE

Intra-OP Medication (Volume Medication) Silver Nitrate Topical 1 appl TOPICAL PERIOP_ONCE

Vascular Access Flushes

Intra-OP Medication (Volume Medication) Heparin Flush 10 units/mL 3 mL IV PERIOP_ONCE



PACU Laboratory

CBC. STAT, Blood

CHEM 7 STAT, Blood

Blood Glucose Monitor POC STAT

Radiology

Chest *1 view AP Portable Pending Discharge - No, In PACU

Comments: line placement






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Post-Op Condition/Status

Admitting/Attending Physician Update. Vital Signs Vital Signs with Blood Pressure

Per policy (DEF)*

Q4H

ASDIR, Q1H X2, Q2H X2, then Q4H

Cardiopulmonary Monitoring

Pulse Oximetry (Continuous) Special Instructions: See Order Comments

Comments: Q8H reposition pulse oximeter probe and assess skin that has been in contact with the sensor.

Activity Activity

Up as tolerated (DEF)*

Bedrest

Bedrest with BRP, with assistance

Out of Bed to Chair

Encourage Ambulating

Ambulate with Assistance

Activity Lobby privileges

Diet NPO

No exceptions (DEF)*

NPO except for ice chips, Maximum 1 ounce/hr WA

NPO except for medications

NPO except for meds with sip of water Diet Order (Pediatric)

Clear Liquid, Advance as Tolerated to Regular--peds menu (DEF)*

Clear Liquid Comments: diet for age

Full Liquid

Soft, Advance as Tolerated to Regular--peds menu Comments: When tolerating PO

Regular--peds menu Comments: When tolerating PO

Enteral Feeding Formula (Pediatric) Nursing Orders Weigh Patient

DAILY (DEF)*

MWF






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QOTHERDAY

Strict I & O

Intake and Output Routine

Maintain Indwelling Urinary Catheter

Enteral Tube Care

PED Enteral Tube Insertion(SUB)* ***Reminder: Order PED Enteral Tube Insertion (SUB) on a separate form.***

PED Central Line Care(SUB)* ***Reminder: Order PED Central Line Care (SUB) on a separate form.***

PED SURG Chest Tube(SUB)* ***Reminder: Order PED SURG Chest Tube (SUB) on a separate form.***

SUB PED SURG NUSS Procedure Post-Op(SUB)* ***The above subphase is available at the end of the plan under the title of the subphase.***

Notify Provider Vital Signs/Urine Output Urine Output < _____ mL/8 hours

Notify Physician Recurrent vomiting, respiratory distress

Notify Physician TUBE DISLODGEMENT

Convert IV to INT when tolerating adequate oral intake

Surgical/Procedural Site Care Site Care: Leave Dressing in Place

Surgical/Procedural Site Care Site Care: OK to change dressing

Surgical/Procedural Site Care Site Care: Keep dressing supplies at bedside

Medications

PED Total Parenteral Nutrition (TPN)(SUB)* ***Reminder: Order PED Total Parenteral Nutrition (TPN) (SUB) on a separate form.*** Respiratory Medications Proventil Neb 0.083% (pediatric)

2.5 mg neb inh INHALE Q6H RT, Wheezing, Clinical Instructions: 15 Kg or less (DEF)*

5 mg neb inh INHALE Q6H RT, Wheezing, Clinical Instructions: Greater than 15 Kg

Proventil 90 mcg/inh metered dose inhaler (pediatric) 2 puff INHALE aerosol Q6H RT, Wheezing

Antibiotics ampicillin (pediatric)

30 mg/kg ped_abx IV Q6H (DEF)* Comments: Max 2g

30 mg/kg ped_abx IV Q8H Comments: Max 2g






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gentamicin (pediatric)

2.5 mg/kg ped_abx IV Q8H (DEF)* Comments: MAX 120 mg

2.5 mg/kg ped_abx IV Q12H Comments: Max 120 mg

Gentamicin Level Ordering Directions Order P/T after 3rd dose.

clindamycin (pediatric)

10 mg/kg ped_abx IV Q6H (DEF)* Comments: MAX 600 mg

600 mg ped_abx IV Q6H Comments: MAX 600 mg

cefazolin (Ancef (pediatric)) 30 mg/kg ped_abx IV Q8H

Comments: Max 1 g

metronidazole (Flagyl (pediatric)) 7.5 mg/kg ped_abx IV Q6H

Comments: MAX 500 mg

ampicillin-sulbactam (Unasyn (pediatric)) 50 mg/kg IV Q6H

Comments: Max 3g piperacillin-tazobactam (Zosyn (pediatric))

75 mg/kg ped_abx IV Q6H, Clinical Instructions: (MAX 3.375g) (DEF)*

3.375 g ped_abx IV Q6H, Clinical Instructions: GREATER than 40 kg

sulfamethoxazole-trimethoprim (Bactrim suspension (pediatric)) 5 mg/kg ped_abx PO BID

Comments: (MAX 160 mg TMP/ day)

cefotaxime (Claforan (pediatric)) 50 mg/kg ped_abx IV Q8H

Comments: MAX 2g

ceftriaxone (Rocephin (pediatric)) 50 mg/kg ped_abx IV DAILY

vancomycin (pediatric) 15 mg/kg ped_abx IV Q6H

Vancomycin Level Ordering Directions Trough before 4th dose

Analgesics acetaminophen (pediatric)

10 mg/kg liquid PO Q4H, PRN Pain Mild (DEF)* Comments: Give if GREATER than 4 hours since last dose acetaminophen given. MAX 650 mg. DO NOT ADMINISTER OVER 3 GRAMS OF ACETAMINOPHEN PER DAY.

10 mg/kg liquid G TUBE Q4H, PRN Pain Mild Comments: Give if GREATER than 4 hours since last dose acetaminophen given. MAX 650 mg. DO NOT ADMINISTER OVER 3 GRAMS OF ACETAMINOPHEN PER DAY.






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10 mg/kg liquid NG TUBE Q4H, PRN Pain Mild Comments: Give if GREATER than 4 hours since last dose acetaminophen given. MAX 650 mg. DO NOT ADMINISTER OVER 3 GRAMS OF ACETAMINOPHEN PER DAY.

325 mg tab PO Q4H, PRN Pain Mild Comments: Give if GREATER than 4 hours since last dose acetaminophen given. MAX 650 mg. DO NOT ADMINISTER OVER 3 GRAMS OF ACETAMINOPHEN PER DAY.

500 mg cap PO Q4H, PRN Pain Mild Comments: Give if GREATER than 4 hours since last dose acetaminophen given. MAX 500 mg. DO NOT ADMINISTER OVER 3 GRAMS OF ACETAMINOPHEN PER DAY.

acetaminophen (pediatric) 15 mg/kg supp Q6H, 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. DO NOT ADMINISTER OVER 3 GRAMS OF ACETAMINOPHEN PER DAY.

ibuprofen (pediatric)

10 mg/kg susp PO Q6H, PRN Other (see comment) (DEF)* Comments: PRN pain mild OR fever GREATER than 38.5 degrees Celsius. If last dose of acetaminophen given GREATER than 1 hour or LESS than 4 hours, may give ibuprofen. If Tylenol not administered or not effective. MAX 600 mg.

10 mg/kg susp G TUBE Q6H, PRN Other (see comment) Comments: PRN pain mild OR fever GREATER than 38.5 degrees Celsius. If last dose of acetaminophen given GREATER than 1 hour or LESS than 4 hours, may give ibuprofen. If Tylenol not administered or not effective. MAX 600 mg.

ketorolac (Toradol (pediatric)) 0.5 mg/kg inj IV PUSH Q6H, Pain Moderate, Duration: 72 hour

Comments: MAX 30mg acetaminophen-hydrocodone (Hycet (Hydrocodone 2.5mg - Acetaminophen 108mg per 5mL) pediatric)

0.1 mg/kg liquid PO Q6H, PRN Pain Moderate (DEF)* Comments: Dosing Hydrocodone component

0.1 mg/kg liquid G TUBE Q6H, PRN Pain Moderate Comments: Dosing Hydrocodone component

acetaminophen-hydrocodone (Norco (Hydrocodone 5mg/APAP 325mg) Pediatric) 1 tab PO tab Q6H, PRN Pain Moderate

acetaminophen-hydrocodone (Norco (Hydrocodone 7.5mg/APAP 325mg) Pediatric) 1 tab PO tab Q6H, PRN Pain Moderate

acetaminophen-codeine (Tylenol with Codeine Elixir (Codeine 12mg/APAP 120mg/5mL) Pediatric)

0.5 mg/kg liquid PO Q6H, PRN Pain Moderate (DEF)* Comments: Dosing codeine component

1 mg/kg liquid PO Q6H, PRN Pain Moderate Comments: Dosing codeine component

0.5 mg/kg liquid G TUBE Q6H, PRN Pain Moderate Comments: Dosing codeine component

1 mg/kg liquid G TUBE Q6H, PRN Pain Moderate Comments: Dosing codeine component






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morphine (pediatric)

0.05 mg/kg inj IV Q2H, PRN Pain Severe (DEF)* Comments: usual adult dose is 4 mg; Use for breakthrough pain not relieved by PO pain meds or if unable to tolerate PO.

0.1 mg/kg inj IV Q2H, PRN Pain Severe Comments: usual adult dose is 4 mg; Use for breakthrough pain not relieved by PO pain meds or if unable to tolerate PO



hydromorphone (Dilaudid (pediatric)) 0.015 mg/kg IV PUSH Q3H, PRN Pain Severe

Comments: Itching, Max 1 mg.Use for breakthrough pain not relieved by PO pain meds or if unable to tolerate PO.

Antiemetics ondansetron (Zofran (pediatric))

0.1 mg/kg inj IV Q6H, PRN Nausea/Vomiting (DEF)* Comments: Max 4mg

4 mg tab soluble IV Q6H, PRN Nausea/Vomiting

8 mg tab soluble IV Q6H, PRN Nausea/Vomiting Antihistamines diphenhydrAMINE (Benadryl (pediatric))

1 mg/kg inj IV PUSH Q6H, PRN Itching (DEF)* Comments: MAX 25 mg

1 mg/kg liquid G TUBE Q6H, PRN Itching Comments: MAX 50 mg

1 mg/kg liquid NG TUBE Q6H, PRN Itching Comments: MAX 50 mg

diphenhydrAMINE (Benadryl (pediatric))

25 mg tab PO Q6H (DEF)* Comments: MAX 50 mg

50 mg tab PO Q6H Comments: MAX 50 mg

1 mg/kg liquid PO Q6H Comments: MAX 50 mg

Gastrointestinal Agents ranitidine (Zantac (pediatric))

2 mg/kg syrup PO BID, Clinical Instructions: (Max 150mg) (DEF)*



1 mg/kg syringe IVPB Q8H, Clinical Instructions: (Max 50mg)

50 mg inj IV PUSH Q8H, Clinical Instructions: (Max 50 mg)






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lansoprazole (Prevacid (pediatric))

15 mg cap CR PO DAILY (DEF)* Comments: Max 30mg

30 mg cap CR PO DAILY Comments: Max 30mg

polyethylene glycol 3350 (Miralax (pediatric))

17 g liquid PO DAILY (DEF)* Comments: 17g of 8 ounce clear liquid daily

8.5 g liquid PO DAILY Comments: 8.5g of 4 ounce clear liquid daily

docusate (Colace (pediatric))

100 mg tab PO BID (DEF)*

100 mg tab PO DAILY

docusate (Colace (pediatric)) 100 mg liquid PO DAILY

Miscellaneous Topical Agents

TNF medication Ilex 1 Appl TOPICAL ASDIR, PRN Other (see comment)


menthol-zinc (Calmoseptine (pediatric)) 1 dose TOPICAL oint ASDIR, PRN Other (see comment)

Comments: Small amount on top of the skin for protection

miconazole topical (pediatric) 1 dose TOPICAL ASDIR, PRN Other (see comment)

Comments: Use small amount on top of skin for protection IV Solutions D5 1/2NS + KCl 20 mEq


IV bag mL/hour, Clinical Instructions: when NPO D5NS + KCl 20 mEq


IV bag mL/hour, Clinical Instructions: when NPO LR


IV bag mL/hour, Clinical Instructions: When NPO

Normal Saline Single Dose (Pediatric) 20 mL/kg IVPB bag ONCE

Comments: Infuse over 1 hour

LR Single Dose (Pediatric) 20 mL/kg IVPB bag ONCE

Comments: Infuse over 1 hour LR

1,000 IV bag NG Output Replacement, PRN Other (see comment), Clinical Instructions: 1 mL per 1 mL NG Output Q4 Hours, Infuse over 4 Hours (DEF)*






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1,000 IV bag NG Output Replacement, PRN Other (see comment), Clinical Instructions: 0.5 mL per 1 mL NG Output Q4 Hours

Comments: for output Greater Than ______ mL per 4 hours. Infuse over 4 Hours

1,000 IV bag NG Output Replacement, PRN Other (see comment) Comments: for output Greater Than ______ mL per 4 hours. Infuse over 4 Hours

NS

IV NG Output Replacement, PRN Other (see comment), Clinical Instructions: 1mL per 1mL NG Output Q4 Hours, Infuse over 4 Hours (DEF)*

IV NG Output Replacement, PRN Other (see comment), Clinical Instructions: 1mL per 1mL NG Output Q4 Hours

Comments: for output Greater Than ______ mL per 4 hours. Infuse over 4 Hours

IV NG Output Replacement, PRN Other (see comment), Clinical Instructions: 0.5 mL per 1mL NG Output Q4 Hours, Infuse over 4 Hours

IV NG Output Replacement, PRN Other (see comment), Clinical Instructions: 0.5mL per 1mL NG Output Q4 Hours

Comments: for output Greater Than ______ mL per 4 hours. Infuse over 4 Hours Laboratory

CBC with Differential. Expedite/ASAP, Blood, ONCE

CBC with Differential. Early AM, Blood, ONCE

CHEM 7 Expedite/ASAP, Blood, ONCE

CHEM 7 Early AM, Blood, ONCE

Chem 12


Early AM, Blood, ONCE Amylase Level


Early AM, Blood, ONCE Lipase Level


Early AM, Blood, ONCE Albumin


Early AM, Blood, ONCE

Albumin Early AM, Blood

Calcium Level








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Mg Level


Early AM, Blood, ONCE Phosphorus


Early AM, Blood, ONCE Triglycerides Level


Early AM, Blood, ONCE PT INR


Early AM, Blood, ONCE PTT


Early AM, Blood, ONCE Prealbumin Serum


Early AM, Blood, ONCE Sed Rate


Early AM, Blood, ONCE CRP



Wound Culture Expedite/ASAP, ONCE

Urinalysis

Expedite/ASAP, URINE, ONCE (DEF)*

Early AM, URINE, ONCE Urine Culture

Expedite/ASAP, URINE, CLEANCATCH, ONCE (DEF)*

T;N, Expedite/ASAP, URINE, CATHETER, ONCE Radiology XR Chest *2 view PA and LAT

Stat, Pending Discharge - No, ONCE (DEF)*

Early AM, ONCE

XP Chest Respiratory

Oxygen Therapy (WCH) Maintain O2 Saturation >: 92%

Incentive Spirometry

Routine, Q2H WA (DEF)*

Routine, Q2H WA, may use bubbles






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Chest Physiotherapy Routine, Q4H RT, While awake

Consults

Durable Medical Equipment Pediatric

Home Care

PICC Consult-Ped

Wound Care Consult

Nutrition Consult

Physician Consult Hematology/ Oncology

Physician Consult Pain Service

Physician Consult GI Service

Physician Consult NCC ID Service

Physical Therapy Consult (Peds)

Physician Consult Gen Peds

Discharge Condition/Status

Discharge Patient (Depart Process) Home

Activity Activity After Discharge

As Tolerated (DEF)*

No Swimming

No Bath Tub

No Gym/Physical Education Diet Discharge Diet

Regular (DEF)*

Other: See Free Text Diet, Enteral feeding order Nursing Orders Discharge Treatments/Instructions (peds)

DC Instructions Return to Work/School per Physician Note (DEF)*

DC Instructions Other: see special instructions, Leave open to air

DC Instructions Other: see special instructions, Keep dry dressing in place

DC Instructions Other: see special instructions, Steri Strips will fall off spontaneously

DC Instructions Other: see special instructions, Tissue adhesives precautions

DC Instructions Other: see special instructions, Apply antibiotic ointment to site twice a day and as needed

Discharge Treatments/Instructions (peds)






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Additional Discharge Instructions

Routine Ostomy Care (DEF)*

Routine Appendicostomy/Cecostomy Care

Routine GT Care

Gastroesophageal Reflux Precautions

Call Physician for Worsening Symptoms Fever Greater than 101.0 | Nausea/Vomiting | Redness, Swelling or Foul Odor | Unrelieved Pain

Discontinue Central Venous Access Device CVAD Line Type: PICC Line

Discontinue Central Venous Access Device

Discontinue Central Venous Access Device CVAD Line Type: Implanted Device Available ONLY at BMC-W SUB PED SURG NUSS Procedure Post-Op Vital Signs Vital Signs with Blood Pressure

ASDIR, Per Policy (DEF)*

Q4H Activity

+24 Hours Activity Ambulate with Assistance, With Physical Therapy to assist with initial up OOB and ambulation

Activity Ambulate with Assistance, ONCE, Post-Op Day 1 - with Physical Therapy to assist in initially getting

patient OOB and ambulating

Activity Restrictions Post NUSS Activity Restrictions.

Comments: Nurse to post sign at bedside.

+48 Hours Activity Up as tolerated

Activity No log rolling, No sleeping on side, No trunk twisting, rotating, or bending, Patient is to bend only at the

hips and keep shoulders in line with the hips, May elevate the head of the bed with flexion at the hips only






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Diet

Diet Order (Pediatric) Clear Liquid, Advance as Tolerated to Regular--peds menu

Nursing Orders

Indwelling Urinary Catheter Care Q12H, Bedside Drain, place to gravity drainage. Leave in place until epidural is removed

Strict I & O

SCD Continuous while in bed

Notify Provider Urine Output < 0.5ml/kg/hr

Patient Education Give patient/family Post-Op NUSS Procedure Instruction sheet and Give patient Biomet Medical Alert

Care Medications

cefazolin (Ancef (pediatric)) 25 mg/kg ped_abx IV Q8H, Duration: 3 dose, Clinical Instructions: Max 1g

docusate (Colace (pediatric)) 100 mg cap PO BID, Clinical Instructions: Children greater than 12 years

polyethylene glycol 3350 (Miralax (pediatric)) 17 g packet PO DAILY

Comments: mix in 8 ounces of fluid acetaminophen (Tylenol (pediatric))

10 mg/kg susp PO Q4H, PRN Other (see comment) (DEF)* Comments: PRN pain mild OR fever GREATER than 38.3 degrees Celsius. MAX dose 650 mg. Do NOT administer more than 3g/day of acetaminophen for adults; NO more than 75mg/kg/day or 3g/day total for pediatrics.

15 mg/kg susp PO Q4H, PRN Other (see comment) Comments: PRN pain mild OR fever GREATER than 38.3 degrees Celsius. MAX dose 650 mg. Do NOT administer more than 3g/day of acetaminophen for adults; NO more than 75mg/kg/day or 3g/day total for pediatrics.

acetaminophen (Tylenol (pediatric))

325 mg tab PO Q4H, PRN Other (see comment) (DEF)* Comments: PRN fever GREATER than 38.5 degrees Celsius OR pain mild (1-3). MAX 650 mg. Do NOT administer more than 3g/day of acetaminophen for adults; NO more than 75mg/kg/day or 3g/day total for pediatrics.

500 mg tab PO Q4H, PRN Other (see comment) Comments: PRN fever GREATER than 38.5 degrees Celsius OR pain mild (1-3). MAX 650 mg. Do NOT administer more than 3g/day of acetaminophen for adults; NO more than 75mg/kg/day or 3g/day total for pediatrics.

650 mg tab PO Q4H, PRN Other (see comment) Comments: PRN fever GREATER than 38.5 degrees Celsius OR pain mild (1-3). MAX 650 mg. Do NOT administer more than 3g/day of acetaminophen for adults; NO more than 75mg/kg/day or 3g/day total for pediatrics.






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IV Solutions

D5 1/2NS + KCl 20 mEq IV bag mL/hour

Convert IV to INT Post-Op Day #1 with good PO intake

Radiology

XR Chest *1 view AP Portable Post-Surgical Procedure, Early AM, Pending Discharge - No, ONCE, Post Op Day #1

+96 Hours XR Chest *2 view PA and LAT Post-Surgical Procedure, Early AM, Pending Discharge - No, Post-Op Day #4

Respiratory

Pulse Oximetry (Continuous) Special Instructions: Q8H reposition pulse oximeter probe and assess skin that has been in contact with

probe Comments: Q8H reposition pulse oximeter probe and assess skin that has been in contact with the sensor.

Incentive Spirometry Every 1 hour while awake

Oxygen Therapy (WCH) Maintain O2 Saturation >: 92%, Per Protocol

Consults

Consult Physical Therapy (Peds) Post Op Day #1 - Physical Therapy to assist with getting OOB and ambulating

Consult Physician Anesthesia Pain Service, To manage all pain issues

1 2 DRUG AND TREATMENT ORDERS PED SURG General...

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