Unique Plan Description: Gen Adm Renal Failure
Plan Selection Display: Gen Adm Renal Failure
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2015-04-20 10:46:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-09-23 00:43:11
Available at all facilities: Yes

Gen Adm Renal Failure
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
	Admit to Observation Status
		T;N
	Admit to Critical Care Inpatient Status (MH)
		T;N, Anticipated LOS 2 midnight or more
	Admit to Critical Care Observation Status (MH)
		T;N
Vital Signs
	Vital Signs
		T;N
			Comment: Per Floor Routine
		Q1H
		Q2H
		Q4H
Activity
	Activity-As Tolerated
		
	Bedrest
		
	Up with Assistance
		
	Bedrest with Bathroom Privileges
		
	Up in Chair
		TIDWM
		TID
	Ambulate
		In hall, TID
		In hall, QID
Diet
	NPO
		T;N
	Regular Diet
		T;N
	Sodium Restricted Diet
		T;N
	Renal Diet
		T;N
	Fluid Restriction
		T;N
	Clear Liquid Diet
		T;N
	Cardiac Diet
		T;N
	Renal Diet
		T;N
	Diabetic Diet
		T;N
Laboratory
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
	CBC with Diff
		T;N, Stat, spec type = Blood
	Magnesium Level
		T;N, Stat, spec type = Blood
	Phosphorus
		T;N, Stat, spec type = Blood
	TSH
		T;N, Stat, spec type = Blood
	hs Troponin I - FH
		T;N, Stat, spec type = Blood
	hs Troponin T - MH/WH/JE
		T;N, Stat, spec type = Blood
	Myoglobin
		T;N, Stat, spec type = Blood
	UA (Culture if Positive)
		T;N, Stat, Stat, spec type = Urine
	Sodium Urine Random
		T;N, Stat, Stat, Urine Random, spec type = Urine
	Creatinine Urine Random
		T;N, Stat, Stat, Urine Random, spec type = Urine
	Urea Urine Random
		T;N, Stat, Stat, Urine Random, spec type = Urine
	Osmolality Urine Random
		T;N, Stat, Stat, Urine Random, spec type = Urine
	Protein Urine Random
		T;N, Stat, Stat, Urine Random, spec type = Urine
	Eosinophil Urine
		T;N, Stat, Stat, Urine Random, spec type = Urine
	Pregnancy Test Urine
		T;N, Stat, Stat, Urine Random, spec type = Urine
	Toxicology Screen DAU - MH/WH/JE
		T;N, Stat, Urine Random, spec type = Urine
	ANA Screen
		T;N, Stat, spec type = Blood
	Hemoglobin
		T;N, Stat, spec type = Blood
Tomorrow's Lab
	CBC with Diff
		T+1;0400, Routine, spec type = Blood
	Basic Metabolic Panel
		T+1;0400, Routine, spec type = Blood
	Comprehensive Metabolic Panel
		T+1;0400, Routine, spec type = Blood
	Magnesium Level
		T+1;0400, Routine, spec type = Blood
	Phosphorus
		T+1;0400, Routine, spec type = Blood
Diagnostic Tests

	US Renal Retro Complete
		Acute Renal Failure, Abnormal Findings
	US Duplex Abd Pelvis Renal Scrotum Complete
		Acute Renal Failure, Abnormal Findings
	US Duplex Abd Pelvis Renal Scrotum Limited
		Acute Renal Failure, Abnormal Findings
	US Renal Retro Complete
		Chronic Renal Failure
Medications
Patient Care
	Resuscitation Status
		Full Code
		No Code
	Cardiac Telemetry Monitoring
		
	Foley Catheter
		Insert, Once
	No NSAIDS (non steroidal anti-inflamatory)
		
	No ACE (angiotensin converting enzyme) inhibitors
		
	No ARB (angiotensin receptor blocker)
		
	Do not give medication
		T;N
			Comment: Blood pressure medications if SBP less than 100.
	Intake and Output
		
Consults/Follow-up
	Consult Nephrologist
		Reason for Referral: Acute Renal Failure
	Consult Vascular Surgeon
		Reason for Referral: re: vascular access

Electrophoresis
Laboratory
	Protein Electrophoresis Serum w/Reflex to Immunofixation
		
	Protein Electrophoresis Serum with Immunofixation
		
	Protein Electrophoresis Serum
		
	Kappa Lambda Free Light Chains Quant w/ Ratio
		
	Bence Jones Urine (Immunofixation).
		
	Protein Electrophoresis CSF
		
	Hgb Eval Rflx EP/RBC Solubility
		
Chemistry
		Recommended screening orders are Serum Protein Electrophoresis with Immunofixation and the Kappa Lambda Free Light Chains Quant with Ratio.(NOTE)*
		Serum Electrophoresis orderables include orders with Immunofixation, Reflexing to Immunofixation (if a suspicious band is detected), and without Immunofixation.(NOTE)*
		Urine Electrophoresis Order Bence Jones (Preferred sample is a 24 Hour Urine)(NOTE)*

VTE Prophylaxis
Medications

	Lovenox
		40 mg, Syringe, SUBCUTANEOUS, DAILY, T;N
			Comment: (CrCl>30) Pharmacy to adjust dose based on pt weight. VTE Prophylaxis
		40 mg, Syringe, SUBCUTANEOUS, DAILY, T;N+480
			Comment: (CrCl>30) Start 8 hours after admission. Pharmacy to adjust dose based on pt weight. VTE Prophylaxis
		40 mg, Syringe, SUBCUTANEOUS, DAILY, T+1;0900
			Comment: (CrCl>30) Pharmacy to adjust dose based on pt weight. VTE Prophylaxis
	HEParin 5000 units/mL SUBCUTANEOUS
		5,000 units, Injection, SUBCUTANEOUS, Q8H-Sch, T;N
			Comment: VTE Prophylaxis
		5,000 units, Injection, SUBCUTANEOUS, Q8H-Sch, T;N+480
			Comment: Start 8 hours after admission. VTE Prophylaxis
		5,000 units, Injection, SUBCUTANEOUS, Q8H-Sch, T+1;0600
			Comment: VTE Prophylaxis
Patient Care
		Sequential Compression Device and Anti Embolism Device orders will not suppress the VTE Advisor(NOTE)*
	Sequential Compression Device
		T;N, Apply, Once
	Anti Embolism Stockings
		T;N, Apply, Once
			Comment: knee high
	VTE Prophylaxis Contraindication
		High Risk of Bleeding
		Procedure Planned
		ASA order meets prophylaxis requirement
		If patient is low risk or further evaluation needed, complete advisor:(NOTE)*
	VTE Advisor
		Medical

Insulin Sliding Scale - NovoLOG
Laboratory
	Glucose POC - RN
		T;N, QIDACHS
		T;N, 15 minutes after carbohydrate source or medication administered
	Hemoglobin A1C
		T+1;0400, Routine, spec type = Blood
	Order Lab
		T;N
			Comment: Blood Glucose (POC) as needed for signs and symptoms of hypoglycemia for patients with diabetic medication orders or known diabetic.
Medications
	Standard Dose NovoLOG
		2 - 12 units, Injection, SUBCUTANEOUS, QIDACHS, PRN, sliding scale, Routine
			Comment: << Sliding Scale Comments >>Under 150, Do not give any insulin150 - 199 = 2 units,200 - 249 = 4 units,250 - 299 = 6 units,300 - 349 = 8 units,350 - 399 = 10 units.Over 399 = 12 units,<< Sliding Scale Comments >> Check  POC in 3 hours; notify physician if repeat POC  greater than or equal to 400mg or less than or equal to 100.  Do not give insulin based on repeat POC value.  RN may change sliding scale insulin order and POC glucose order to every 6 hours if patient is NPO or not on oral diet (tube/enteral feedings, TPN, etc).  Enter as Q6H-SCH  PRN
	Moderate Dose NovoLOG
		4 - 24 units, Injection, SUBCUTANEOUS, QIDACHS, PRN, sliding scale
			Comment: << Sliding Scale Comments >>Under 150, Do not give any insulin150 - 199 = 4 units,200 - 249 = 8 units,250 - 299 = 12 units,300 - 349 = 16 units,350 - 399 = 20 units.Over 399 = 24 units,<< Sliding Scale Comments >> Check  POC in 3 hours; notify physician if repeat POC  greater than or equal to 400mg or less than or equal to 100.  Do not give insulin based on repeat POC value.  RN may change sliding scale insulin order and POC glucose order to every 6hours if patient is NPO or not on oral diet (tube/enteral feedings,TPN, etc). Enter as Q6H-SCH PRN
	High Dose NovoLOG
		5 - 30 units, Injection, SUBCUTANEOUS, QIDACHS, PRN, sliding scale
			Comment: << Sliding Scale Comments >>Under 150, Do not give any insulin150 - 199 = 5 units,200 - 249 = 10 units,250 - 299 = 15 units,300 - 349 = 20 units,350 - 399 = 25 units.Over 399 = 30 units, << Sliding Scale Comments >>Check  POC in 3 hours; notify physician if repeat POC  greater than or equal to 400mg or less than or equal to 100.  Do not give insulin based on repeat POC value.  RN may change sliding scale insulin order and POC glucose order to every 6hours if patient is NPO or not on oral diet (tube/enteral feedings, TPN, etc).  Enter as Q6H-SCH  PRN
	glucose oral gel (JE)
		15 gm, Gel, By Mouth, Q15MIN, PRN, low blood sugar
			Comment: For blood glucose is 60-70mg/dL as an alternative to apple juice. Notify provider if given with corresponding POC glucose recheck value
	Dextrose 50%
		25 mL, Injection, IV PUSH, Q15MIN, PRN for low blood sugar, Routine
			Comment: Give if blood glucose less than 60mg/dL or 60-70 mg/dL and patient unable to tolerate oral intake. Notify provider if given with corresponding POC glucose recheck value.
	Dextrose 10% in Water (FH)
		250 mL, Injection, IVPB, Q30MIN, PRN for low blood sugar, infuse over 30 min(s)
			Comment: Give if blood glucose less than 60mg/dL or 60-70 mg/dL and patient unable to tolerate oral intake. Notify provider if given with corresponding POC glucose recheck value.
	glucagon
		1 mg, Injection, IV Push, Q15MIN, PRN for low blood sugar, T;N
			Comment: Give if blood glucose < 70mg/dL AND if dextrose 50% injectable unavailable OR inadequate response to IV dextrose 50%. May give SubQ or IM if patient does not have IV access. Notify provider if given with corresponding POC glucose recheck value.
Patient Care
	Order Lab
		T;N, RN may change schedule of point of care glucose and sliding scale insulin order to every 6 hours if patient is NPO or not on oral diet (tube/enteral feedings, TPN, etc).. Enter POC order as Q6H-SCH, TIMED and medication order as Q6H-SCH PRN.
	Diabetic Snack
		T;N, Give snack (1 complex carb (15g), 1 protein snack (7g) ) anytime insulin is administered after the evening meal is complete and POC glucose is <150mg/dL.
	IV-Maintain
		T;N
			Comment: Patient should have IV site while on hypoglycemia protocol
	Hypoglycemia Treatment Parameters
		T;N, Hypoglycemia protocol initiated for patients with glucose <70mg/dl. Patient should have an IV while in Hypoglycemia protocol.
		T;N, glucose <60 mg/dL treat with Dextrose 50% 25 mL OR glucagon 1mg as per medication orders. Notify provider as per critical result protocol.
			Comment: Repeat treatment as outlined in hypoglycemia parameters. Notify provider of all treatments given and POC glucose recheck values. When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy
		T;N, glucose 60-70 mg/dL, administer 4 oz apple juice, 4 oz non-diet soda, or glucose gel (MJE/MFH).  If patient NPO or unable to tolerate oral intake, give Dextrose 50% 25 mL OR glucagon 1mg as per medication orders.
			Comment: Repeat treatment as outlined in hypoglycemia parameters. Notify provider of all treatments given and POC glucose recheck values. When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy.
		T;N, After initial treatment of any glucose value </= 70 mg/dL, repeat POC glucose in 15 min; if result </= 70mg/dL continue treating as per protocol and rechecking glucose 15 min after treatment until glucose >70mg/dL.
			Comment: Notify provider of all treatments given and corresponding POC glucose recheck values. When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy.
		T;N, Once glucose is within normal limits, give 1 complex carb and 1 protein source (such as ½ sandwich OR 1 individual container of peanut butter and 3 packs of crackers) or patient meal if patient able to take orals to prevent recurrent hypoglycemia.
			Comment: When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy.

*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