Unique Plan Description: NICU Herpes Simplex (WH)
Plan Selection Display: NICU Herpes Simplex (WH)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2011-12-13 14:20:15
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-20 11:14:16
Available at all facilities: No

NICU Herpes Simplex (WH)
Laboratory
Diagnostic Tests
Radiology
	MRI Brain w/o Contrast
		HSV, Routine, Herpes Simplex Virus
Medications

	Zovirax IVPB (NICU)
		20 mg/kg, Solution-Injection, IVPB, Q8H, HSV-treatment
			Comment: PMA (Weeks)         Interval (hours)< 30                         Q12H30-36                       Q8H                                                                                                                                       > 36                        Q6H
		20 mg/kg, Solution-Injection, IVPB, Q12H, HSV-treatment
			Comment: PMA (Weeks)         Interval (hours)< 30                         Q12H30-36                       Q8H                                                                                                                                       > 36                        Q6H
		20 mg/kg, Solution-Injection, IVPB, Q6H, HSV-treatment
			Comment: PMA (Weeks)         Interval (hours)< 30                         Q12H30-36                       Q8H                                                                                                                                       > 36                        Q6H
Patient Care
	Isolation Precautions
		Contact, Reason for Isolation: other
Consults/Follow-up
	Consult Infectious Disease
		Reason for Referral: Herpes Simplex, Refer to/Consult with: Robert Penn, MD
	Consult Neurologist
		Reason for Referral: Herpes Simplex, Refer to/Consult with: Fred Kader, MD
		Reason for Referral: Herpes Simplex, Refer to/Consult with: Jennifer Hanowell, MD
	Consult Ophthalmologist
		Reason for Referral: Herpes Simplex, Refer to/Consult with: Sebastian Troia, MD or Robert Troia, MD
		Reason for Referral: Herpes Simplex, Refer to/Consult with: Eyal Margalit, MD
		Reason for Referral: Herpes Simplex, Refer to/Consult with: Thomas Hejkal, MD

Herpes Panel (NICU)
Laboratory
	Herpes Simplex Virus (HSV-1/HSV-2) Subtype by PCR (disseminated infection only)
		Nurse Collect, T;N, Stat, spec type = Blood
	Herpes Simplex Virus 1/2 PCR. Other than blood
		Routine, spec type = Cerebrospinal Fluid
		Routine, spec type = Ocular, Nurse Collect, Eye
		Routine, spec type = Throat, Nurse Collect, Throat
		Routine, spec type = Skin, Nurse Collect, Rectal
		Routine, spec type = Skin, Nurse Collect

CSF/Meningitis Panel (MH WH FH)
	Protein CSF
		T;N, Stat, spec type = Cerebrospinal Fluid
	Glucose CSF
		T;N, Stat, spec type = Cerebrospinal Fluid
	Cell Count and Diff CSF
		T;N, Stat, spec type = Cerebrospinal Fluid
	Culture Routine
		T;N, Stat, Body Fluid, spec type = Cerebrospinal Fluid

*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