Unique Plan Description: Nephrology Admission
Plan Selection Display: Nephrology Admission
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2011-10-17 21:00:08
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-11-14 09:10:14
Available at all facilities: Yes

Admission
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
	Admit to Critical Care Inpatient Status (MH)
		T;N, Anticipated LOS 2 midnight or more
	Admit to Observation Status
		T;N
	Admit to Critical Care Observation Status (MH)
		T;N
Diet
	Sodium Restricted Diet
		
	Renal Diet
		
	Fluid Restriction
		1500 ml/per day
Laboratory
	Comprehensive Metabolic Panel
		Routine, spec type = Blood
		Stat, spec type = Blood
	CBC with Diff
		Routine, spec type = Blood
		Stat, spec type = Blood
	Magnesium Level
		Routine, spec type = Blood
		Stat, spec type = Blood
	Phosphorus
		Routine, spec type = Blood
		Stat, spec type = Blood
	TSH
		Routine, spec type = Blood
		Stat, spec type = Blood
	ANA Screen
		Routine, spec type = Blood
		Stat, spec type = Blood
	Basic Metabolic Panel
		Routine, spec type = Blood
		Stat, spec type = Blood
	UA (Culture if Positive)
		Routine, Routine, spec type = Urine
		Stat, Stat, spec type = Urine
	Sodium Urine Random
		Routine, Routine, spec type = Urine
		Stat, Stat, spec type = Urine
	Creatinine Urine Random
		Routine, Routine, spec type = Urine
		Stat, Stat, spec type = Urine
	Urea Urine Random
		Routine, Routine, spec type = Urine
		Stat, Stat, spec type = Urine
	Osmolality Urine Random
		Routine, Routine, spec type = Urine
		Stat, Stat, spec type = Urine
	Protein Urine Random
		Routine, Routine, spec type = Urine
		Stat, Stat, spec type = Urine
	Eosinophil Urine
		Routine, Routine, spec type = Urine
		Stat, Stat, spec type = Urine
	Protein Creatinine Ratio Urine
		Routine, Routine, spec type = Urine
		Routine, Routine, spec type = Urine
	Renal Function Panel
		Routine, spec type = Blood
		Stat, spec type = Blood
	Ionized Calcium
		Routine, spec type = Blood
		Stat, spec type = Blood
Diagnostic Tests
Radiology
	US Renal Retro Complete
		Acute Renal Failure, Abnormal Findings
	US Duplex Abd Pelvis Renal Scrotum Complete
		Acute Renal Failure, Routine, Abnormal Findings
	US Duplex Abd Pelvis Renal Scrotum Limited
		Acute Renal Failure, Routine, Abnormal Findings
Patient Care

	Resuscitation Status
		Full Code
		No Code
	Foley Catheter
		Foley, Insert, Once
	Intake and Output
		Q6H-Sch
	Do not give medication
		T;N, Blood pressure medications if SBP less than 100.
			Comment: Blood pressure medications if SBP less than 100.
	No NSAIDS (non steroidal anti-inflamatory)
		
	No ACE (angiotensin converting enzyme) inhibitors
		
	No ARB (angiotensin receptor blocker)
		
	Do Not Notify Nephrologist
		Results of critical BUN and creatinine
Consults/Follow-up
	Consult Nephrologist
		Reason for Referral: Renal failure
	Consult Vascular Surgeon
		Reason for Referral: Vascular Access

Dialysis
IV Solutions
	Sodium Chloride 0.9%
		1,000 mL, IV, 2 Dose(s)/Time(s), 20 ml/hr
Medications
	HEParin 1000 units/mL injectable soln
		10,000 units, Injection, IV PUSH, Once
	HEParin 5000 units/mL SUBCUTANEOUS
		5,000 units, Injection, SUBCUTANEOUS, Q1H, PRN, dialysis
			Comment: during dialysis only.
	Zemplar
		2.5 mcg, Injection, IV PUSH, Once
			Comment: during dialysis
		5 mcg, Injection, IV PUSH, Once
			Comment: during dialysis
		10 mcg, Injection, IV PUSH, Once
			Comment: during dialysis
	Venofer
		100 mg, Injection, IV Push, Once
			Comment: administered slow IV injection (undiluted, directly into dialysis line)
		200 mg, Injection, IV Push, Once
			Comment: administered slow IV injection (undiluted, directly into dialysis line)
	sodium ferric gluconate complex
		125 mg, INT, IVPB, Once, infuse over 1 hr, T;N
		250 mg, INT, IVPB, Once, infuse over 2 hr, T;N
	Procrit
		1,000 units, Solution, IV Push, Once
			Comment: adjusted to maintain hemoglobin concentrations between 10-11g/dL
		2,000 units, Solution, IV Push, Once
			Comment: adjusted to maintain hemoglobin concentrations between 10-11g/dL
		3,000 units, Solution, IV Push, Once
			Comment: adjusted to maintain hemoglobin concentrations between 10-11g/dL
		4,000 units, Solution, IV Push, Once
			Comment: adjusted to maintain hemoglobin concentrations between 10-11g/dL
		5,000 units, Solution, IV Push, Once
			Comment: adjusted to maintain hemoglobin concentrations between 10-11g/dL
		6,000 units, Solution, IV Push, Once
			Comment: adjusted to maintain hemoglobin concentrations between 10-11g/dL
		8,000 units, Solution, IV Push, Once
			Comment: adjusted to maintain hemoglobin concentrations between 10-11g/dL
		10,000 units, Solution, IV Push, Once
			Comment: adjusted to maintain hemoglobin concentrations between 10-11g/dL
	HEParin 5000 units/0.5 mL injection (MH/WH)
		5,000 units, Syringe, Catheter, DAILY, PRN, see comment
			Comment: fill with sodium chloride 0.9% to a volume based on catheter lumen size as stated on catheter lumen.

Electrophoresis
Laboratory
	Protein Electrophoresis Serum w/Reflex to Immunofixation
		
	Protein Electrophoresis Serum with Immunofixation
		
	Protein Electrophoresis Serum
		
	Kappa Lambda Free Light Chains Quant w/ Ratio
		
	Bence Jones Urine (Immunofixation).
		
	Protein Electrophoresis CSF
		
	Hgb Eval Rflx EP/RBC Solubility
		
Chemistry
		Recommended screening orders are Serum Protein Electrophoresis with Immunofixation and the Kappa Lambda Free Light Chains Quant with Ratio.(NOTE)*
		Serum Electrophoresis orderables include orders with Immunofixation, Reflexing to Immunofixation (if a suspicious band is detected), and without Immunofixation.(NOTE)*
		Urine Electrophoresis Order Bence Jones (Preferred sample is a 24 Hour Urine)(NOTE)*

VTE Prophylaxis
Medications

	Lovenox
		40 mg, Syringe, SUBCUTANEOUS, DAILY, T;N
			Comment: (CrCl>30) Pharmacy to adjust dose based on pt weight. VTE Prophylaxis
		40 mg, Syringe, SUBCUTANEOUS, DAILY, T;N+480
			Comment: (CrCl>30) Start 8 hours after admission. Pharmacy to adjust dose based on pt weight. VTE Prophylaxis
		40 mg, Syringe, SUBCUTANEOUS, DAILY, T+1;0900
			Comment: (CrCl>30) Pharmacy to adjust dose based on pt weight. VTE Prophylaxis
	HEParin 5000 units/mL SUBCUTANEOUS
		5,000 units, Injection, SUBCUTANEOUS, Q8H-Sch, T;N
			Comment: VTE Prophylaxis
		5,000 units, Injection, SUBCUTANEOUS, Q8H-Sch, T;N+480
			Comment: Start 8 hours after admission. VTE Prophylaxis
		5,000 units, Injection, SUBCUTANEOUS, Q8H-Sch, T+1;0600
			Comment: VTE Prophylaxis
Patient Care
		Sequential Compression Device and Anti Embolism Device orders will not suppress the VTE Advisor(NOTE)*
	Sequential Compression Device
		T;N, Apply, Once
	Anti Embolism Stockings
		T;N, Apply, Once
			Comment: knee high
	VTE Prophylaxis Contraindication
		High Risk of Bleeding
		Procedure Planned
		ASA order meets prophylaxis requirement
		If patient is low risk or further evaluation needed, complete advisor:(NOTE)*
	VTE Advisor
		Medical

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase