Unique Plan Description: Peds Admission Pneumonia (JE/FH)
Plan Selection Display: Peds Admission Pneumonia (JE/FH)
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-19 22:35:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-21 10:41:43
Available at all facilities: No

Peds Admission Pneumonia (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-Sch
		Q6H-Sch
		Q8H-Sch
		Q12H-Sch
		Q4HAWAKE
Activity
	Activity-As Tolerated
		
Diet
	Regular Diet
		T;N
			Comment: Appropriate for age
	NPO
		
	Clear Liquid Diet
		Advance as Tolerated
			Comment: No Juices
	Breast Milk
		Feed Base: Mother Breast Milk, Special Instructions: Supplement with formula
		Feed Base: Mother Breast Milk, Special Instructions: No supplementation
	breast milk (maternal)
		PRN for see comment
			Comment: per feeding protocol
	Formula
		Base Caloric Density: 20
	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
	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
	Sputum Culture
		Routine, spec type = Sputum
	MRSA Nasal Screen Rapid - JE
		Routine, spec type = Swab
			Comment: used for nares
	MRSA/Staph Aureus Nasal Screen by PCR - FH
		Routine, spec type = Nasal
	Staph (Skin/Tissue) Rapid - JE
		Routine, spec type = Swab
			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
	Blood Gases Capillary (CBG) - FH
		T;N, Routine, spec type = Blood
	hsCRP
		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, Routine, spec type = Blood
	UA (Culture if Positive)
		T+1;0400, Routine, Routine, spec type = Urine
Diagnostic Tests

	Chest 1 View
		Stat, SOB
	Chest 2 View
		Stat, SOB
			Comment: in not already done in ED
	KUB
		T;N, Stat
	CT Abd w & w/o Contrast
		T;N, Stat
	CT Chest w & w/o Contrast
		T;N, Stat
	CT Pelvis w & w/o Contrast
		T;N, Stat
	CT Head w & w/o Contrast
		T;N, Stat
	CT Mastoids w & w/o Contrast
		T;N, Stat
	CT Sinus w/o Contrast
		T;N, Stat
	US Pelvis Complete Non OB
		T;N, Stat
	US Renal Retro Complete
		T;N, Stat
In AM
	Chest 1 View
		T+1;0600, Routine
	Chest 2 View
		T+1;0600, Routine
	KUB
		T+1;0600, Routine
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
	D5-0.45NaCl
		1,000 mL, IV, ml/hr
	D545K10
		1,000 mL, IV, ml/hr
	D545K20
		1,000 mL, IV, ml/hr
	D5LR
		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
			Comment: Bolus in ED
		10 mL/kg, IVPB, Once, STAT, 1 Dose(s)/Time(s), 1 hr
			Comment: Bolus in ED
Medications
		For Uncomplicated Bacterial Pneumonia(NOTE)*
	ampicillin IVPB
		50 mg/kg, INT, IVPB, Q6H, Pneumonia
		100 mg/kg, INT, IVPB, Q12H, Pneumonia
	ampicillin IVPB (FH)
		50 mg/kg, INT, IVPB, Q6H, Pneumonia
			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, Pneumonia
			Comment: Dilute vials as follows to get concentration of 100mg/mL250mg=2.5mL500mg=5ml1000mg=10mLWithdraw ___ml for dose of ___mgExpires: 1 hr
	Rocephin IVPB
		50 mg/kg, Injection-Premix, IVPB, Q12H, Pneumonia
		100 mg/kg, Injection-Premix, IVPB, Q12H, Pneumonia
			Comment: ___ mg in 50 mL water
	Rocephin IVPB (FH)
		50 mg/kg, INT, IVPB, Q12H, Pneumonia
		100 mg/kg, INT, IVPB, Q12H, Pneumonia
			Comment: ___ mg in 50 mL water
		Add if Atypical Pneumonia is suspected(NOTE)*
	azithromycin
		10 mg/kg, Suspension, BY MOUTH, DAILY, Pneumonia
	Zithromax IVPB
		10 mg/kg, INT, IVPB, Q24H, Pneumonia
		Add if Staph Aureus is suspected(NOTE)*
	vancomycin - Pharmacy to Dose
		Pneumonia
		Antipyretics(NOTE)*
	Tylenol 325 mg/10.15 mL elixir (JE)
		15 mg/kg, Elixir, BY MOUTH, Q4H, PRN, fever
			Comment: temp > 100.4
	acetaminophen 160 mg/5 mL oral liquid
		15 mg/kg, Elixir, By Mouth, Q4H, for fever
			Comment: temp > 100.4
	Tylenol
		325 mg, Tab, BY MOUTH, Q4H, PRN, fever
			Comment: temp > 100.4
		15 mg/kg, Suppository, RECTALLY, Q4H, PRN, fever
			Comment: temp > 100.4
	ibuprofen
		10 mg/kg, Suspension, BY MOUTH, Q6H, PRN, fever
			Comment: temp > 100.4  For Infants >6 months of age.
		200 mg, Tab, BY MOUTH, Q6H, PRN, fever
			Comment: temp > 100.4
		Analgesics(NOTE)*
	lidocaine-prilocaine 2.5%-2.5% topical cream
		1 appl, Cream, TOPICAL, Once, PRN, pain-mild
			Comment: Apply 60 minutes prior to procedure
	Tylenol 325 mg/10.15 mL elixir (JE)
		15 mg/kg, Elixir, BY MOUTH, Q4H, PRN, pain-mild
	acetaminophen 160 mg/5 mL oral liquid
		15 mg/kg, Elixir, By Mouth, Q4H, PRN for pain-mild
	Tylenol
		325 mg, Tab, BY MOUTH, Q4H, PRN, pain-mild
		15 mg/kg, Suppository, RECTALLY, Q4H, PRN, pain-mild
	ibuprofen
		10 mg/kg, Suspension, BY MOUTH, Q6H, PRN, pain-mild
			Comment: For infants >6 months of age.
		200 mg, Tab, BY MOUTH, Q4H, PRN, pain-mild
		Respiratory Therapy(NOTE)*
	albuterol 2.5 mg/3 mL (0.083%) inh soln
		3 mL, Solution-Nebulization, NEBULIZED, Q4H
		3 mL, Solution-Nebulization, NEBULIZED, Q4H, PRN, wheezing
	albuterol-ipratropium 2.5 mg-0.5 mg/3 mL inhalation solution
		3 mL, Solution-Nebulization, NEBULIZED, Q4H
		3 mL, Solution-Nebulization, NEBULIZED, Q4H, PRN, wheezing
	budesonide 0.5 mg/2 mL inhalation suspension
		2 mL, Solution-Nebulization, NEBULIZED, BID
		Miscellaneous(NOTE)*
	Ocean 0.65% nasal spray
		1 spray, Solution, NOSTRIL, AFFECTED, Q1H, PRN, congestion
	predniSONE
		1 mg/kg, Solution, BY MOUTH, Q12H
	prednisoLONE
		1 mg/kg, Syrup, BY MOUTH, Q12H
Patient Care
	Resuscitation Status
		Full Code
		No Code
	Intake and Output
		Q12H-End of Shift
		Q4H-Sch
		Q6H-Sch
		Weigh diaper
	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
	Oxygen Therapy
		Titrate->Keep Sats>/= to 88%
Consults/Follow-up
	Consult Care Management
		T;N
			Comment: Discharge Planning
	Consult Social Work
		T;N
	Consult General Surgery
		
	Consult Ear Nose and Throat
		Reason for Referral: Pneumonia admission
	Consult Infectious Disease
		Reason for Referral: Pneumonia admission
	Consult Pulmonologist
		Reason for Referral: Pneumonia admission

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 IV Insert Peripheral lock with flush
	sodium chloride 0.9% flush injectable soln
		3 mL, Syringe, IV PUSH, BID
		3 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush
		3 mL, Syringe, IV PUSH, Q5MIN, PRN, blood sampling or tpn administration
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