Unique Plan Description: Peds Admission (JE/FH)
Plan Selection Display: Peds Admission (JE/FH)
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-19 22:33:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-01-26 08:40:43
Available at all facilities: No

Peds Admission (JE/FH)
Admit/Discharge/Transfer
	Admit to Observation Status
		T;N
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
Vital Signs
	Vital Signs
		Q4H
		Q6H
		Q8H
		Q12H
		Q4HAWAKE
Activity
	Activity-As Tolerated
		
Diet
	Regular Diet
		T;N
			Comment: For Age
	NPO
		
	Clear Liquid Diet
		T;N
			Comment: No Juices
		Advance as Tolerated
	Breast Milk
		Feed Base: Mother Breast Milk, Special Instructions: Supplement with formula
		Feed Base: Mother Breast Milk, Special Instructions: No supplementation
	Formula
		Base Caloric Density: 20
	breast milk (maternal)
		PRN for see comment
			Comment: Per feeding protocol
	Infant Feeding
		
Laboratory
Today's Lab
	CBC with Diff
		Routine, spec type = Blood
	Basic Metabolic Panel
		Routine, spec type = Blood
	Comprehensive Metabolic Panel
		Routine, spec type = Blood
	Respiratory Syncytial Virus (RSV) PCR
		T;N, Routine, spec type = Nasopharynx
	Influenza A and B Screen PCR
		Routine, spec type = Nasopharynx
	Pertussis and Parapertussis PCR
		Routine, spec type = Nasopharynx
	Strep Group A PCR
		T;N, Routine, spec type = Throat
	Fecal Lactoferrin
		T;N, Routine, spec type = Stool
	Stool Pathogen Panel (PCR)
		T;N, Routine, spec type = Stool
		Includes targets for: Campylobacter, Salmonella, Shigella, Vibrio, Yersinia enterocolitica, Shiga Toxins 1 and 2, Norovirus and Rotavirus.(NOTE)*
	Occult Blood Stool - JE
		Routine, spec type = Stool
	Sputum Culture
		Routine, spec type = Sputum
	MRSA Nasal Screen Rapid - JE
		Routine, spec type = Swab, Nares
	MRSA/Staph Aureus Nasal Screen by PCR - FH
		Routine, spec type = Nasal
			Comment: used for nares
	Staph (Skin/Tissue) Rapid - JE
		Routine, spec type = Swab, Do not swab Nares, Skin
			Comment: used for everything except nares
	MRSA Screen
		Routine, Swab in VTM, spec type = Miscellaneous
			Comment: used for everything except nares
	Blood Gases Capillary (CBG) - MH/WH/JE
		Routine, spec type = Blood
		T;N, Routine, spec type = Blood
	Blood Gases Capillary (CBG) - FH
		T;N, Routine, 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
	Sed Rate
		T+1;0400, Routine, spec type = Blood
	hsCRP
		T+1;0400, spec type = Blood
	UA (Culture if Positive)
		T+1;0400, Routine, Routine, spec type = Urine, Clean Catch
		T+1;0400, Routine, Routine, spec type = Urine, Bag Collect
		T+1;0400, Routine, Routine, spec type = Urine, Straight Cath
Diagnostic Tests

	Chest 1 View
		T;N, Routine, SOB
	Chest 2 View
		T;N, SOB
	KUB
		T;N, Routine
	CT Abd w & w/o Contrast
		T;N, Routine
	CT Chest w & w/o Contrast
		T;N, Routine
	CT Pelvis w & w/o Contrast
		T;N, Routine
	CT Head w & w/o Contrast
		T;N, Routine
	CT Mastoids w & w/o Contrast
		T;N, Routine
	CT Sinus w/o Contrast
		T;N, Routine
	US Pelvis Complete Non OB
		T;N, Routine
	US Renal Retro Complete
		T;N, Routine
In AM
	KUB
		T+1;0600, Routine
	Chest 1 View
		T+1;0600, Routine, SOB
	Chest 2 View
		T+1;0600, Routine, SOB
IV Solutions

	Dextrose 5% with 0.225% NaCl
		1,000 mL, IV, ml/hr
	Dextrose 5% with 0.225% NaCl w/KCl 10 mEq/1000 mL
		1,000 mL, IV, ml/hr
		10 mEq, EVERY BAG
	Dextrose 5% with 0.225% NaCl w/KCl 20 mEq/1000 mL
		1,000 mL, IV, ml/hr
		20 mEq, EVERY BAG
	Dextrose 5% with 0.45% NaCl
		1,000 mL, IV, ml/hr
	Dextrose 5% with 0.45% NaCl w/KCl 10 mEq
		1,000 mL, IV, ml/hr
	Dextrose 5% with 0.45% NaCl w/KCl 20 mEq
		1,000 mL, IV, ml/hr
	Sodium Chloride 0.9%
		1,000 mL, IV, ml/hr
	Sodium Chloride 0.9% Intravenous Solution (Bolus)
		20 mL/kg, IVPB, Once, STAT, 1 Dose(s)/Time(s), 1 hr
		10 mL/kg, IVPB, Once, STAT, 1 Dose(s)/Time(s), 1 hr
			Comment: Bolus in ED
	Dextrose 5% in Lactated Ringers
		1,000 mL, IV, ml/hr
Medications
	Rocephin IVPB
		50 mg/kg, IVPB, Q12H
		100 mg/kg, IVPB, Q12H
	Rocephin IVPB (FH)
		50 mg/kg, INT, IVPB, Q12H
		100 mg/kg, INT, IVPB, Q12H
	Zithromax
		10 mg/kg, Suspension, By Mouth, DAILY
	Zithromax IVPB
		10 mg/kg, IVPB, DAILY
	vancomycin - Pharmacy to Dose
		Pharmacy to Dose, IVPB, Per protocol
	ampicillin IVPB
		50 mg/kg, INT, IVPB, Q6H
		100 mg/kg, INT, IVPB, Q12H
	ampicillin IVPB (FH)
		50 mg/kg, INT, IVPB, Q6H
			Comment: Dilute vials as follows to get concentration of 100mg/mL250mg=2.5mL500mg=5ml1000mg=10mLWithdraw ___ml for dose of ___mgExpires: 1 hr
		100 mg/kg, INT, IVPB, Q12H
			Comment: Dilute vials as follows to get concentration of 100mg/mL250mg=2.5mL500mg=5ml1000mg=10mLWithdraw ___ml for dose of ___mgExpires: 1 hr
	Cleocin IVPB (JE)
		10 mg/kg, INT, IVPB, Q8H
	Cleocin IVPB
		10 mg/kg, INT, IVPB, Q8H
	nafcillin
		25 mg/kg, INT, IVPB, Q6H
		50 mg/kg, INT, IVPB, Q6H, Other- type in, meningitis
	Unasyn IVPB
		75 mg/kg, INT, IVPB, Q6H
	Unasyn IVPB (FH)
		75 mg/kg, INT, IVPB, Q6H
	Tylenol 325 mg/10.15 mL elixir (JE)
		15 mg/kg, Elixir, BY MOUTH, Q4H, PRN, pain-mild
			Comment: Use first - alternate with Motrin
	acetaminophen 160 mg/5 mL oral liquid
		15 mg/kg, Elixir, By Mouth, Q4H, PRN for pain-mild
			Comment: Use first - alternate with Motrin
	Tylenol
		15 mg/kg, Suppository, RECTALLY, Q4H, PRN, pain-mild
			Comment: Use first - alternate with Motrin
		15 mg/kg, Tab, BY MOUTH, Q4H, PRN, pain-mild
			Comment: Use first - alternate with Motrin
	ibuprofen
		10 mg/kg, Suspension, By Mouth, Q6H, PRN, pain-mild
			Comment: for infants >6 months of age. Alternate with Tylenol
		10 mg/kg, Tab, By Mouth, Q6H, PRN, pain-mild
			Comment: Alternate with Tylenol
	albuterol 2.5 mg/3 mL (0.083%) inh soln
		3 mL, Solution-Nebulization, NEBULIZED, Q4H
		3 mL, Solution-Nebulization, NEBULIZED, Q4H, PRN, wheezing
	ipratropium 0.02% inhalation solution
		2.5 mL, Solution-Nebulization, NEBULIZED, Q6H
		2.5 mL, Solution-Nebulization, NEBULIZED, Q4H, PRN, wheezing and/or shortness of breath
	albuterol-ipratropium 2.5 mg-0.5 mg/3 mL inhalation solution
		3 mL, Solution-Nebulization, NEBULIZED, Q4H, PRN, wheezing
	budesonide 0.5 mg/2 mL inhalation suspension
		2 mL, Solution-Nebulization, NEBULIZED, BID
	sodium chloride 0.65% nasal spray
		1 spray, Solution, NARE, EACH, Q4H, PRN, congestion
	SOLU-Medrol
		0.5 mg/kg, Injection, IV Push, Q12H
		0.5 mg/kg, Injection, IV Push, Q6H
		1 mg/kg, Injection, IV Push, Q12H
		1 mg/kg, Injection, IV Push, Q6H
	predniSONE
		1 mg/kg, Solution, By Mouth, Q12H
	dexAMETHasone
		0.6 mg/kg, Tab, BY MOUTH, Once
		0.6 mg/kg, Injection, IM-IntraMUSCULAR, Once
	prednisoLONE
		1 mg/kg, Syrup, BY MOUTH, Q12H
Patient Care
	Resuscitation Status
		Full Code
		No Code
	Intake and Output
		Q12H-End of Shift
			Comment: Per Unit Protocol
		Q4H-Sch
		Q6H-Sch
		Weigh diaper
	Weigh Diapers
		
	Notify MD
		Elevated temp. not responding to antipyretics. HR and RR below or above normal values and O2 sat below 92
	Isolation Precautions
		T;N, Droplet and Contact, Reason for Isolation: other
Therapies
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID
	Pulse Oximetry Spot Check RT
		T;N, Q4H-Sch
Consults/Follow-up
	Consult Care Management
		
	Consult Social Work
		T;N
	Consult General Surgery
		
	Consult Urology
		
	Consult Infectious Disease
		
	Consult Pulmonologist
		
	Consult Ear Nose and Throat

CSF Panel (Pediatric) (FH JE)
Laboratory
	Protein CSF
		T;N, Stat, spec type = Cerebrospinal Fluid
			Comment: Save CSF
	Glucose CSF
		T;N, Stat, spec type = Cerebrospinal Fluid
			Comment: Save CSF
	Cell Count and Diff CSF
		T;N, Stat, spec type = Cerebrospinal Fluid
	Enterovirus PCR CSF
		T;N, Stat, spec type = Cerebrospinal Fluid
	Herpes Simplex Virus 1/2 PCR. Other than blood
		T;N, Stat, spec type = Cerebrospinal Fluid
	Culture Routine
		T;N, Stat, Body Fluid, spec type = Cerebrospinal Fluid
			Comment: Save CSF

cefTRIAXone IM Pediatric Dose / lidocaine 1% MPF (
Medications
	Rocephin IM
		25 mg/kg, Injection, IM-Intramuscular, Once, STAT
			Comment: Routine is 25 to 50 mg/kg/dose
		50 mg/kg, Injection, IM-Intramuscular, Once, STAT
			Comment: Routine is 25 to 50 mg/kg/dose
	Xylocaine-MPF 1% preservative-free injectable solution
		mL, Injection, IM-Intramuscular, Once, STAT
			Comment: Use 2.1mL lidocaine to dissolve 1,000mg vial to yield 350mg/mL  Use 1mL lidocaine to dissolve 500mg vial to yield 350mg/mL.  Use 0.9mL lidocaine to dissolve 250mg vial to yield 250mg/mL.

Oxygen Protocol
Therapies
Respiratory Therapy
	Oxygen Therapy
		T;N
	Pulse Oximetry Spot Check RT
		T;N, BID
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID

racemic epinephrine-NS (racepinephrine)
Medications

	racepinephrine 2.25% inhalation soln
		0.5 mL, Solution-Nebulization, NEBULIZED, Once, NOW
			Comment: Mix with 3 mL sodium chloride 0.9% inh soln.
	sodium chloride 0.9% inhalation solution
		3 mL, Solution-Nebulization, NEBULIZED, Once, NOW
			Comment: Mix with 0.5 mL racemic EPINEPHrine

Peds Nausea (JE/FH)
		Proceed to next choice if ineffective during dosing interval(NOTE)*
	ondansetron
		0.1 mg/kg, Injection, IV PUSH, Q24H, PRN for nausea and/or vomiting
			Comment: > 1 month old. Maximum dose is 4mg
		0.1 mg/kg, Liquid, By Mouth, Q24H, PRN for nausea and/or vomiting
			Comment: > 1 month old. Maximum dose is 4mg
	prochlorperazine
		0.1 mg/kg, Injection, IM-Intramuscular, Q6H, PRN for nausea and/or vomiting
			Comment: >= 2 years old.  Maximum dose is 10mg
		2.5 mg, Tab, BY MOUTH, BID, PRN, nausea and/or vomiting
			Comment: 9-13 kg
		2.5 mg, Tab, BY MOUTH, TID, nausea and/or vomiting
			Comment: 9-13 kg
		5 mg, Tab, BY MOUTH, BID, PRN, nausea and/or vomiting
			Comment: 9-13 kg
	Reglan
		0.1 mg/kg, Injection, IV PUSH, Q6H, PRN, nausea and/or vomiting
			Comment: <6 years old; Maximum dose is 2.5mg
		2.5 mg, Injection, IV PUSH, Q6H, PRN for nausea and/or vomiting
			Comment: 6-14 years old
		5 mg, Injection, IV PUSH, Q6H, PRN for nausea and/or vomiting
			Comment: 6-14 years old
		10 mg, Injection, IV PUSH, Q6H, PRN for nausea and/or vomiting
			Comment: >14 years old
	Phenergan rectal suppository
		12.5 mg, Suppository, RECTALLY, Q4H, nausea and/or vomiting
		25 mg, Suppository, RECTALLY, Q4H, nausea and/or vomiting
	Phenergan oral tablet
		0.25 mg/kg, Tab, BY MOUTH, Q4H, nausea and/or vomiting
	Benadryl
		1 mg/kg, Injection, IV PUSH, Q6H, PRN, nausea and/or vomiting
			Comment: > 1 month old.  Maximum dose is 12.5mg
		1 mg/kg, Injection, IM-Intramuscular, Q6H, PRN, nausea and/or vomiting
			Comment: > 1 month old.  Maximum dose is 12.5mg
Patient Care
	Notify MD
		T;N, If symptoms persists, notify primary care physician or ordering prescriber.

Peripheral Lock - Access
Medications
	sodium chloride 0.9% flush injectable soln
		10 mL Syringe IV PUSH BID
		10 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush
	lidocaine 1% injectable solution (MH/WH/FH)
		0.1 mL, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start
	sodium chloride bacteriostatic 0.9% injectable soln
		0.1 mL, Injection, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start, use if patient has lidocaine allergy.
	Sodium Chloride 0.9% IVPB Flush
		25 mL, IVPB, Q1H, PRN, IV line flush, 5 min(s)
			Comment: Use if medication not compatible with primary line or there is no primary line;  infuse 25mL.
Patient Care
	Peripheral Lock-Insert
		T;N

Blood Culture Set
Laboratory
	.Blood Culture.
		T;N, Stat, spec type = Blood
		T;N, Routine, spec type = Blood
		Timed, spec type = Blood
		T+1;0400, Routine, spec type = Blood
	.Blood Culture
		T;N, Stat, spec type = Blood
		T;N, Routine, spec type = Blood
		Timed, spec type = Blood
		T+1;0400, Routine, spec type = Blood

*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