Bililite Bronchiolitis Physician Orders User Manual

2012-01-04

User Manual: bililite Bronchiolitis

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UNSAFE ABBREVIATIONS - please use bolded items
1. ‘Daily’ not ‘qd’
2. ‘micrograms’ not ‘μg’
3. ‘Vidarabine‘ not ARA-A
4. ‘Units’ not ‘u’
5. ‘Morphine’ not ‘MSO4’ or ‘MS’ 6. ‘International Units’ not ‘IU’
7. ’Methotrexate’ not ‘MTX’ 8. ’Every other day’ not ‘Q.O.D.’ 9. ‘Magnesium Sulfate’ not ‘MgSO4’
10. No trailing zeros (1 mg not 1.0 mg)
11. Always use leading zeros (0.1 mg not .1 mg)

*POG1001*
*

P




O

G

1

0

0

1

*

= Do Not Substitute
DATE

TIME

INSTRUCTIONS: Please write plainly, use ballpoint pen, and press firmly. Include Physician Name and
Signature. Check appropriate boxes and fill in blanks.

Place on 8800, service of Dr.
Inpatient admission
Diagnosis:

RSV

Outpatient observation
Bronchiolitis

Other

Condition:
Allergies:
Growth: Wt:

kg Ht:

cm Surface Area:

m2

Diet:

Nurse ad lib
Formula (mother's preference) ad lib
Regular for age
Other
Vital
Every 4 hours
Daily Weights
Cardiorespiratory monitor
Signs:
Strict I&O’s
Check SaO2 with vital signs
Continuous pulse oximetry
Call House Pediatrician for SaO2 < 93 %
IV Fluids:
D5 ¼NS with 20 mEq KCl/liter
ml/hr =
ml/kg/day
D5 ½NS with 20 mEq KCl/liter
ml/hr =
ml/kg/day
Saline lock IV. Flush with saline 2-3 ml q 4-6 hours PRN to keep line open.
Other:
Respiratory:
Supplemental oxygen if necessary to keep SaO2 greater than 92%
Albuterol
mg nebulized every
hrs (2.5 mg = 0.5 cc)
Bulb suction to nares prn congestion
Saline nose drops: 2 drops in each naris every 2 hrs prn congestion with bulb suction
Medications:
Tylenol (15mg/kg)
mg every 4 hours PRN temperature > 38°C or irritability
Infant Drops - PO Suspension - PO Suppository - PR
✘ Desitin to diaper area prn rash
✘ May have 2 ml Sweet Ease PO prior to painful procedures.
✘ May use LMX or Pain Ease to skin prior to needlesticks.

Labs/Radiology:

Isolation:

CBC with manual diff automated diff
BMP
Blood culture
CXR PA & LAT
NP viral culture NP swab for influenza
Nasal specimen for RSV if negative, send for viral culture
NP swab for Pertussis PCR
Other:
Contact Precautions Droplet Precautions

Physician Signature:

PHYSICIAN ORDERS
Page 1 of 1

St. Luke’s Hospital
232 S. Woods Mill Road Chesterfield, MO 63017
Form No. SL-008

PHYSICIAN ORDERS TAB

Rev. 06/05



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