Patient Label Here

UMC PEDIATRIC ADMISSION ORDERS

1. Attending Physician:_________________________________________ Resident __________________________________

Consult: ____________________________________________________________________________________________
2. Location: PICU Pedi Weight :_________Length :_________FOC :_________BSA :________

3. Admission Dx: _________________________________________________________Isolation:_________________________

Status: Full Admission Observation Condition: Stable Fair Serious Critical

4. Allergies: NKDA Allergic to: ___________________________________________________________________

5. NURSING:

Vital Signs every 4hrs Other: _____________________ Notify MD for T>____RR>____HR<___or>____

Weigh on admission and daily Strict Intake and output Other: ___________________________________
Diet: NPO Clear Liquids Regular ADA _________________________________________________
Other______________________________________________________________________________________
Activity: Bedrest Ad lib As tolerated Bathroom privileges Ambulate_______________
6. LABORATORY/DIAGNOSTICS: (DO NOT REPEAT IF DONE IN THE EC UNLESS OTHERWISE INDICATED)
______________________________________ _____________________________________
______________________________________ _____________________________________
______________________________________ _____________________________________
7. RESPIRATORY THERAPY:
8. O2 to keep sats >____
SaO2 Monitoring: Continuous With vitals
Inhalation therapy:___________________________________________________________________________________
Vent Settings: ____________ Settings ______ FIO2 ______ Rate ______ TV ______Peep ______PIP _____
Blood gases: _______________________________________________________________________________________

9. IV: INT Routine central line care and flushes

Continuous IV fluids________________________________ to run at ________________________ml/hr

Bolus_______________________________________________________________________________________________

10. MEDICATIONS: Refer also to Admission Medication Reconciliation Form

_____________________________________ _____________________________________
_____________________________________ _____________________________________
_____________________________________ _____________________________________
11. OTHER: _______________________________________________________________________________________________

TO Read back
Order taken by Signature: ________________________________________Date/Time: _____________________________
Physician Signature__________________________________________ Date/Time_____________________________

Page 1 of 1- UMC Pediatric Admission Orders 3/4/2010 (#900 R-2)