Unique Plan Description: Special Care Nursery (JE FH)
Plan Selection Display: Special Care Nursery (JE FH)
PlanType: Medical                                 
Version: 3          
Begin Effective Date: 2020-12-04 15:05:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-03-11 15:05:33
Available at all facilities: No

Special Care Nursery (JE FH)
Admit/Discharge/Transfer
	Transfer
		To special care nursery
Vital Signs
	Vital Signs
		Once, BP all 4 extremities upon admission
	BP
		T;N+15, Use right arm, Q15MIN, 4, Dose(s)/Time(s)
		T;N+75, Use right arm, Q30MIN, 4, Dose(s)/Time(s)
		T;N+135, Q2H, Use right arm
	Temperature
		T;N+60, Q1H, 4, Dose(s)/Time(s)
		T;N+300, Q2H
	Pulse and Respirations
		T;N+30, Q30MIN, 4, Dose(s)/Time(s)
		T;N+150, Q2H
Diet
	NPO
		If respirations >60
	Breast Milk
		Feed Frequency: Per Hypoglycemia Protocol, Feed Base: Donor Breast Milk, If No Breast Milk: Donor Milk
	Donor Milk (Breast Milk)
		Feed Frequency: Per Hypoglycemia Protocol, Feed Base: Mother Breast Milk, Route: Breast, If No Breast Milk: Donor Milk
	Formula
		
Laboratory
Today's Lab
	Glucose POC - RN
		T;N, Stat
	CBC with Diff
		Stat, spec type = Blood
	.Blood Culture.
		T;N, Stat, spec type = Blood
		T;N, Routine, spec type = Blood
		T+1;0400, Routine, spec type = Blood
	UA (Culture if Positive)
		Nurse Collect, Stat, Stat, spec type = Urine
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	hsCRP
		Stat, spec type = Blood
	Blood Gases Capillary (CBG) - MH/WH/JE
		Stat, spec type = Blood
	Blood Gases Capillary (CBG) - FH
		T;N, Stat, spec type = Blood
Timed Lab
	CBC with Diff
		Timed, spec type = Blood
	hsCRP
		Timed, spec type = Blood
	Comprehensive Metabolic Panel
		Timed, spec type = Blood
	Basic Metabolic Panel
		Timed, spec type = Blood
Diagnostic Tests

	Chest 1 View
		Stat, Respiratory Distress, Portable
			Comment: Special Care infant, At Bedside
	Chest 2 View
		Stat, Respiratory Distress, Portable
			Comment: Special Care infant, At Bedside
IV Solutions
	Sodium Chloride 0.9% Intravenous Solution (NICU Bolus)
		10 mL/kg, Injection, IV Push, Once, infuse over 10 min(s)
	Dextrose 10% in Water
		250 mL, IV, 3.33 mL/kg/hr
	Dextrose 5% with 0.225% NaCl
		1,000 mL, IV, ml/hr
	Dopamine 400mg/D10W 250mL-Newborn
		250 mL, IV
		400 mg, EVERY BAG, 2.5 mcg/kg/min
	EPINEPHrine 5 mg/NS 250 mL
		5 mg, EVERY BAG, 0.1 mcg/kg/min, T;N
		250 mL, IV, STAT, Start: T;N
	DOBUTamine 500 mg/D5W 250 mL
		500 mg, EVERY BAG, 2.5 mcg/kg/min
		250 mL, IV, STAT, Start: T;N, Increment Increase: 1 mcg/kg/min, Increment Decrease: 1 mcg/kg/min, Increment Freq: 10 min(s), Max Dose: 40 mcg/kg/min
			Comment: Concentration: 800mcg/mL. .Notify MD if > 20mcg/kg/min.  If the dose has been titrated twice within the specified timeframe and goal parameter is not achieved, the titration dose can be doubled until the ordered parameter is achieved or maximum dose is reached.  IV may be re-initiated after weaning within 12hours, re-initiate at the last dosing rate that maintained Goal parameter. Discontinue order after 12hr if patient does not require IV re-initiation.
	alprostadil 500 mcg/D5W 50 mL
		50 mL, IV
		500 mcg, EVERY BAG, 0.05 mcg/kg/min
Medications
	gentamicin IVPB (NICU)
		5 mg/kg, Injection, IVPB, Q36H, Early onset neonatal sepsis
	gentamicin IVPB (FH)
		4 mg/kg, INT, IVPB, Q24H, Early onset neonatal sepsis, Infuse Over 30 min(s)
		5 mg/kg, INT, IVPB, Q24H, Early onset neonatal sepsis, Infuse Over 30 min(s)
		4 mg/kg, INT, IVPB, Q36H, Early onset neonatal sepsis, Infuse Over 30 min(s)
		4.5 mg/kg, INT, IVPB, Q36H, Early onset neonatal sepsis, Infuse Over 30 min(s)
		5 mg/kg, INT, IVPB, Q48H, Early onset neonatal sepsis, Infuse Over 30 min(s)
	ampicillin IVPB (NICU)
		100 mg/kg, Solution-Injection, IVPB, Q8H, Early onset neonatal sepsis
	ampicillin IVPB (FH)
		100 mg/kg, Solution-Injection, IVPB, Q8H, Early onset neonatal sepsis
			Comment: Dilute vials as follows to get concentration of 100mg/mL250mg=2.5mL500mg=5ml1000mg=10mLWithdraw ___ml for dose of ___mgExpires: 1 hr
	glucose oral gel
		0.2 gm/kg, By Mouth, Q1H, PRN, low blood sugar
	glucose oral gel UD
		0.2 gm/kg, By Mouth, Q1H, PRN, low blood sugar
	sodium chloride 0.9% flush injectable soln (FH)
		1 mL, Syringe, IV Push, Q5MIN, PRN for IV line flush
	sodium chloride 0.9% flush injectable soln (NICU)
		1 mL, Syringe, IV Push, Q5MIN, PRN for IV line flush
Patient Care
	Notify MD
		T;N, Call all Lab Results
	Intake and Output
		Weigh diaper, see comment
			Comment: Record in grams
	Cardiac Telemetry Monitoring Continuous
		T;N
	Newborn Gavage Feeding Protocol
		respirations > (see comment)
			Comment: Comment: prn if RR >60, poor suck/swallow, severe work of breathing (retracting, etc.).  Note 2-3 gavage feed
	Head Circumference
		T;N
		T;N, DAILY
	Neurological Assessment-Focused
		T;N T;N+30, Q30MIN, 4, Dose(s)/Time(s)
		T;N +150, Q2H-Sch
Therapies
	Oxygen Therapy
		T;N
			Comment: Titrate->Keep Sats>/= to 95
	Continuous Pulse Oximetry Monitoring Check
		Q1H, see comment
			Comment: Record pulse oximetry reading and FIO2 q1hour
	Mechanical Ventilation NICU
		
	CPAP (Continuous Positive Airway Pressure)
		
Consults/Follow-up
	Pharmacy Consult
		Check gentamicin level before 2nd dose. If level is >/=1, hold dose and re-check level q12 hours until level is <1, and make that the new dosing interval

Special Care Nursery Hypoglycemia protocol
Laboratory
	Glucose POC - RN
		T;N, Q1H, 2, Dose(s)/Time(s)
			Comment: After initiation of continuous IV maintenance fluids
		T;N
			Comment: AC prior to feeding. Target range >/=50mg/dL
		T;N, Q3H, 3, Dose(s)/Time(s)
			Comment: Prior to saline lock removal.
IV Solutions
	Dextrose 10% in Water
		250 mL, IV, 3.33 mL/kg/hr
	sodium chloride 0.9% flush injectable soln (NICU)
		1 mL, Syringe, IV Push, Q5MIN, PRN for IV line flush
	sodium chloride 0.9% flush injectable soln (FH)
		1 mL, Syringe, IV Push, Q5MIN, PRN for IV line flush
Patient Care
	Hypoglycemia Treatment Parameters
		T;N, Wean IV D10% at least 8 hours after stable blood sugars >/= 50mg/dL. Decrease rate by 2ml/hr for every AC POC >/=50mg/dL. Peripheral lock IV once D10 rates reaches 5-6ml/hr. Special care infant.

*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