Unique Plan Description: Cellulitis
Plan Selection Display: Cellulitis
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-19 12:14:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-03-27 10:52:21
Available at all facilities: Yes

Cellulitis
Activity
	Activity-Position
		Elevate affected extremity
			Comment: Continuously
Laboratory
Today's Lab
	CBC with Diff
		Stat, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	hsCRP
		Stat, spec type = Blood
	Sed Rate
		Stat, spec type = Blood
	MRSA Screen
		Stat, Micro Swab, spec type = Nose
	MRSA Nasal Screen Rapid - JE
		Stat, Micro Swab, Nares
Tomorrow's Lab
	CBC with Diff
		T+1;0400, Routine, spec type = Blood
Diagnostic Tests

	Venous Duplex Unilat Upper or Lower
		T;N, Routine, Indication: Pain, Location Left Upper
		T;N, Routine, Indication: Pain, Location Left Lower
		T;N, Routine, Indication: Pain, Location Right Upper
		T;N, Routine, Indication: Pain, Location Right Lower
	Venous Duplex Bil Upper or Lower
		Indication: Pain, Location Upper Bilateral
		Indication: Pain, Location Lower Bilateral
Medications
	Eucerin topical cream
		1 appl, Cream, TOPICAL, TID
			Comment: to affected area
	LamISIL AT 1% topical cream
		1 appl, Cream, TOPICAL, TID
			Comment: to affected area
Non-purulent
		(Cellulitis/ Facial cellulitis/Erysipelas)(NOTE)*
		Mild: Select one of the following(NOTE)*
	cephalexin
		500 mg, Capsule, By Mouth, Q6H, Skin soft tissue
	Cleocin HCl
		450 mg, Capsule, BY MOUTH, Q6H, Skin soft tissue
		Moderate: Select one of the following(NOTE)*
	Ancef IVPB
		1,000 mg, Injection-Premix, IVPB, Q8H, Skin soft tissue
	Ancef IVPB (FH)
		1,000 mg, INT, IVPB, Q8H, Skin soft tissue
	Cleocin IVPB
		900 mg, Injection-Premix, IVPB, Q8H, Skin soft tissue
		Severe or severely immunocompromised (Consider ID consult)(NOTE)*
	vancomycin IVPB
		15 mg/kg, Injection-Premix, IVPB, PHARMACY TO DETERMINE, Skin soft tissue
	vancomycin IVPB (FH)
		15 mg/kg, INT, IVPB, PHARMACY TO DETERMINE, Skin soft tissue
	Rocephin IVPB (FH)
		2,000 mg, INT, IVPB, Q24H, Skin soft tissue, 5 Day(s)
	nafcillin
		2 gm, INT, IVPB, Q6H, Skin soft tissue, 5 Day(s)
	Zosyn IVPB (FH)
		4.5 gm, INT, IVPB, Q8H, Skin soft tissue, 5 Day(s)
Purulent
		(Furuncle/Carbuncle/Abcess), Incision and drainage plus:(NOTE)*
		Mild: Consider incision and drainage(NOTE)*
		Moderate: choose one of the following(NOTE)*
	Bactrim DS
		1 TAB, Tab, By Mouth, Q12H, Indication: Skin soft tissue
	doxycycline
		100 mg, Capsule, BY MOUTH, Q12H, Skin soft tissue
		Severe: Consider ID consult(NOTE)*
	vancomycin IVPB
		15 mg/kg, Injection-Premix, IVPB, PHARMACY TO DETERMINE, Skin soft tissue
	vancomycin IVPB (FH)
		15 mg/kg, INT, IVPB, PHARMACY TO DETERMINE, Skin soft tissue
	amoxicillin
		500 mg, Capsule, By Mouth, TID, Other- type in, Skin soft tissue, 5 Day(s)
	linezolid IVPB
		600 mg, Injection-Premix, IVPB, Q12H, Skin soft tissue, 5 Day(s)
	DAPTOmycin IVPB
		6 mg/kg, INT, IVPB, Q24H, Indication: Skin soft tissue, 5 Day(s)
		MSSA:(NOTE)*
	Ancef
		2,000 mg, Injection-Premix, IVPB, Q8H, Skin soft tissue, 5 Day(s)
	nafcillin
		2 gm, INT, IVPB, Q6H, Skin soft tissue, 5 Day(s)
	vancomycin IVPB
		15 mg/kg, Injection-Premix, IVPB, PHARMACY TO DETERMINE, Skin soft tissue
	vancomycin IVPB (FH)
		15 mg/kg, INT, IVPB, PHARMACY TO DETERMINE, Skin soft tissue
		B-Lactam Allergy/ Alternative Therapy(NOTE)*
	Cleocin IVPB
		900 mg, Injection-Premix, IVPB, Q8H, Skin soft tissue
		600 mg, Injection-Premix, IVPB, Q8H, Skin soft tissue
	vancomycin IVPB
		15 mg/kg, Injection-Premix, IVPB, PHARMACY TO DETERMINE, Skin soft tissue
	vancomycin IVPB (FH)
		15 mg/kg, INT, IVPB, PHARMACY TO DETERMINE, Skin soft tissue
Necrotizing Fasciitis
		(Empiric therapy) (Consider surgical and ID consults)(NOTE)*
	Cleocin IVPB
		900 mg, Injection-Premix, IVPB, Q8H, Skin soft tissue
	vancomycin IVPB
		15 mg/kg, Injection-Premix, IVPB, PHARMACY TO DETERMINE, Skin soft tissue
	vancomycin IVPB (FH)
		15 mg/kg, INT, IVPB, PHARMACY TO DETERMINE, Skin soft tissue
	Zosyn IVPB
		4.5 gm, Injection-Premix, IVPB, Q8H, Skin soft tissue
	Zosyn IVPB (FH)
		4.5 gm, INT, IVPB, Q8H, Skin soft tissue
Animal Bite
		(Choose one), If beta-lactam allergic, consider ID consult(NOTE)*
	Unasyn IVPB
		3,000 mg, Injection-Premix, IVPB, Q6H, Skin soft tissue
	Unasyn IVPB (FH)
		3,000 mg, INT, IVPB, Q6H, Skin soft tissue
	Rocephin IVPB
		2,000 mg, Injection-Premix, IVPB, DAILY, Skin soft tissue
	Rocephin IVPB (FH)
		2,000 mg, Injection-Premix, IVPB, DAILY, Skin soft tissue
	amoxicillin-clavulanate  875 mg-125 mg oral tablet
		1 TAB, Tab, BY MOUTH, Q12H, Skin soft tissue
Human Bite
		(Choose one) If beta-lactam allergic, consider ID consult(NOTE)*
	Unasyn IVPB
		3,000 mg, Injection-Premix, IVPB, Q6H, Skin soft tissue
	Unasyn IVPB (FH)
		3,000 mg, INT, IVPB, Q6H, Skin soft tissue
	amoxicillin-clavulanate  875 mg-125 mg oral tablet
		1 TAB, Tab, BY MOUTH, Q12H, Skin soft tissue
Patient Care

	Heat Therapy
		T;N
			Comment: Continuously
	Notify MD
		T;N, Notify Radiologist to insert PICC line
Consults/Follow-up
	Consult Wound Care
		Reason for Referral: Cellulitis
	vancomycin - Pharmacy to Dose
		treating cellulitis, Skin soft tissue
	Consult Infectious Disease
		Reason for Referral: bite injury
	Consult General Surgery
		
	Consult Infectious Disease
		Reason for Referral: suspect facial cellulitis
		Reason for Referral: suspect MRSA cellulitis
		Reason for Referral: suspect MRSA cellulitis, facial cellulitis, suspect necrotizing fasciitis, or
	Consult General Surgery
		Reason for Referral: suspect necrotizing fasciitis, Refer to/Consult with: Surgery West on call MD
	Pharmacy Consult
		T;N+2880, pharmacy to assess patient in 48 hours for IV to oral conversion
	Consult Physical Therapy, Evaluate and Treat
		T;N, Reason to See: Evaluate and Treat
			Comment: Cellulitis

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase