Gastroenteritis Pathway - Children's Hospital Central California

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1.0 .1 cc U IU µg MS TIW QD QID QOD MSO 4 MGSO 4 DRUG SENSITIVITY: WT: kg ORDERS: GENERIC EQUIVELANT WILL BE DISPENSED UNLESS ORDER SPECIFIES “DO NOT SUBSTITUTE” General Admitting physician: ___________________________ Attending physician: ___________________________ Primary service: ¨ Hospitalist ¨ Team A ¨ Team B ¨ __________ Patient Status: Admission Diagnosis: Condition: Code status: Isolation: x Admit x Stable Gastroenteritis ¨ Full Code or ¨ __________________________ x Contact Precautions Dietary Use “Gastro Diet” instructions. If then, vomiting: If vomiting, attempt small volumes of Pedialyte given frequently, and advance as tolerated. If oral fluids unsuccessful due to vomiting, give normal saline bolus 20 mL/kg IV over 20-30 minutes if no bolus given in ER. If not vomiting, give formula, breast milk, 2% milk, solid foods or sugar-free drinks instead of Pedialyte even if patient still has diarrhea. IVF RN communication, IVF: Provide IV fluids at 1½ times maintenance for 8 hrs and then Saline lock IV. Maintenance Fluids (PO plus IV) calculated by 4:2:1 method. Choice of IV fluids: • for children under 2 months of age, use D5 ¼ NS + 20 mEq KCl/L • for children over 2 months of age, use D5 ½ NS + 20 mEq KCl/L • If admission serum bicarbonate (total CO2) 20, resume use of KCl instead of K-Acetate. (nurse to call pharmacy) Notify MD if, Stool: If excessive stool output (>20 mL/kg/day) or patient still vomiting, continue IV fluids at maintenance. Once saline locked, do not replace IV if it comes out. If IV placement fails despite 3 attempts, contact physician to consider placing NG tube instead. NS bolus option: NS bolus 20 ml/kg 0ml IV one time ONE. COMMENTS: Dose = 20 mL/kg X 1 if oral fluids unsuccessful due to vomiting. Give over 20 - 30 minutes, if no bolus given in ER Medications Acetaminophen 15 mg/kg (max = 650 mg) PO every 4 hrs PRN T > 38.0º C - 38.9º C or mild pain (max. dose= 75 mg/kg/day or 4000 mg/day, whichever is less). If patient’s temperature remains above 38.0º C one hour after administration, then give Ibuprofen Acetaminophen 15 mg/kg (max = 650 mg) PR every 4 hrs PRN T > 38.0º C - 38.9º C or mild pain (max. dose= 75 mg/kg/day or 4000 mg/day, whichever is less). If patient’s temperature remains above 38.0º C one hour after administration, then give Ibuprofen Gastroenteritis 0032 *0032* pathway 6/2012 Physician’s Order Sheet page 1 of 2 Patient Label
1.0 .1 cc U IU µg MS TIW QD QID QOD MSO 4 MGSO 4 DRUG SENSITIVITY: WT: kg ORDERS: GENERIC EQUIVELANT WILL BE DISPENSED UNLESS ORDER SPECIFIES “DO NOT SUBSTITUTE” Ibuprofen 10 mg/kg (max. dose=400 mg) PO every 6 hrs PRN T >38.9º C or moderate pain. If patient’s temperature remains above 38º C one hour after administration, then give Acetaminophen. (Nurse to contact physician for unrelieved pain) Lactobacillus Rhamnosus Capsule (Culturelle) ___ cap (Fill in desired dose) PO BID - may open capsule and sprinkle over food or formula. Desitin topically PRN diaper rash Nursing Care Give as much as possible of the fluid PO. for patients who are vomiting, instruct a parent or aid to offer sips of PO fluid every 5-10 minutes. Choose the PO fluids from the gastro diet. Only use IV fluids to supplement what the patient cannot take PO. Measure weight daily. Activity: No restrictions. Dressings (Wound) care: 3M Cavilon Durable Barrier Cream (for intact skin) or 3M No-Sting Barrier Film (for excoriated skin) to diaper area PRN for rash. If then, Result: Order BMP 12 hrs after initial result if initial total CO2
Page 1: COVER SHEET GASTROENTERITIS PATHWAY
Page 5 and 6: Ongoing Interdisciplinary Patient/F
Page 7 and 8: Gastroenteritis Education Informati
Page 9 and 10: Children’s Hospital Central Calif

Gastroenteritis Pathway - Children's Hospital Central California

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