Bililite Bronchiolitis Physician Orders User Manual

User Manual: bililite Bronchiolitis

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*POG1001*

*POG1001*

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= Do Not Substitute

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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 Outpatient observation

Diagnosis: RSV 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: 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:

Isolation: 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

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)

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