Newborn Clinical Pathways

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Newborn Clinical Pathways

DOCTOR’S ORDER SHEET

DRUG ALLERGIES:

INTRAPARTAL/POSTPARTAL IV INSULIN PATIENT IDENTIFICATION ROOM NO. ORDERS – Clinical Pathway DATE TIME ORDERS FOR MEDICATION, DIET AND TREATMENTS LABOR - 1. Initial Finger stick blood sugar (FSBS) then every 2 hours; if on insulin infusion FSBS every 1 hour. (Notify MD if BS greater than 200 or less than 60.) 2. Begin second IV line with D5RL 1000 ml at 30 ml/hr. Adjust D5RL infusion rate if blood sugar drops below 71 according to order #4. (Pharmacy to dispense D5RL.) 3. Human Regular Insulin to sliding scale (Concentration = 100 units Human Regular Insulin in 500 ml 0.9% Sodium Chloride) Blood Glucose (mg/dl) Insulin Dosage (Units/hr) Insulin Infusion Rate (ml/hr) Less than 75 0 0 76 to 85 0.6 3 86 to 100 1.2 6 101 to 120 1.8 9 121 to 140 2.4 12 141 to 160 3 15 161 to 200 4.6 23 201 to 240 6 30 4. Intrapartal Hypoglycemia: If the patient’s blood sugar is less than 75 mg/dl, stop insulin infusion and adjust D5RL according to the table below: Glucose (mg/dl) D5RL Infusion Rate (ml/hr) greater than or equal to 71 30 66 to 70 60 61 to 65 90 56 to 60 120 51 to 55 150 46 to 50 180 5. If IDGDM or IDDM notify admit/transition nursery on admit. 6. Discontinue IV insulin infusion after delivery. POSTPARTAL 1. If no insulin required in Labor & Delivery, follow routine Clinical Pathway Postpartal order. 2. If previously on insulin: FSBS on admit, every AM and 2 hours after meals. (Notify MD if BS greater than 200 or less than 60.) 3. Resume ADA diet.

POSTPARTAL HYPOGLYCEMIA (BS less than 60) Step One: Give 15 grams of glucose (1/2 cup orange juice or 4 ounces Coke); 25 ml IV push of D50W if patient is NPO. Step Two: Wait 15 minutes, then test blood sugar levels. If level is still less than 60 mg/dl, give 15 more grams of glucose per above and notify MD. Step Three: If the patient’s next meal is over 30 minutes away, give a snack with protein (i.e. peanut butter, cheese, etc.).

10/2015 INTRAPARTAL/POSTPARTAL IV INSULIN ORDERS Clinical Pathway

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