Pediatric Observation Dehydration Orders

PLACE LABEL HERE DEHYDRATION ORDERS Pediatric Observation

The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked. Initial all handwritten order modifications and the bottom of each page when indicated (multipage).

1. Diagnosis & Status: Place in Observation ______(reason for observation) 2. Primary Care Physician:  None  ______3. Allergies: ______4. Weight: ______kg 5. Vital signs: q ___ hrs 6. Diet:  NPO x _____ hrs, then clear liquids  Clear liquids  Advance age appropriate diet as tolerated 7. Activity as tolerated in room 8. Notify physician if blood glucose < 60 mg/dl, serum sodium < 130 meq/l, new onset blood in stool, bilious emesis, poor perfusion 9. Contact isolation 10. Laboratory:  CBC with differential  Stool for Rotazyme  Stool culture  Hemoccult  Urinalysis  Chem 7  Repeat Chem 7 in am  Other: ______MEDICATIONS 11.  Bolus IV fluids ______IV ml/hr for ____ hrs 12.  IV fluids ______IV at ____ ml/hr 13. Diaper rash: diaper cream with diaper change 14. Painful procedures: topical anesthetic cream one hr prior to procedure 15. Mild pain/temp >100.5F:  Tylenol (acetaminophen) ____ mg (consider 15 mg/kg, max 650 mg) po or per rectum q 4 hrs prn or  Ibuprofen ____ mg (consider 10 mg/kg) po q 6 hrs prn 16. Epigastric pain:  Pepcid (famotidine) ______po q12 hrs  Pepcid (famotidine) ______IV q 12 hrs 17. Nausea/Vomiting:  Zofran (ondansetron) _____ mg po q 6 hrs prn  Zofran (ondansetron) _____ mg IV q 6 hrs prn 18. Itching/Urticaria, GI Reflux:  Zantac (ranitidine) _____ mg po q 12 hrs prn ADDITIONAL ORDERS: ______

______Date Time Physician Signature PID Number Send copy to pharmacy

*1-27518* FORM 1-27518 REV. 07/2012 Page 1 of 1