Unique Plan Description: NICU Whole Body Cooling (WBC)
Plan Selection Display: NICU Whole Body Cooling (WBC)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2011-11-08 21:11:43
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-05-10 14:19:37
Available at all facilities: Yes

NICU Whole Body Cooling (WBC)
Vital Signs
	Vital Signs
		T;N
			Comment: Document skin and rectal  temperatures q15 min x4, then q30min x 2, then q1h through out cooling.
Activity
	Activity-Position
		T;N
			Comment: May prop infant side to side during cooling.  No abdominal positioning during cooling.
Diet
	NPO
		T;N
Laboratory
STAT Lab
	Bilirubin Direct
		T;N, Stat, spec type = Blood
	Blood Gases Arterial (ABG) - MH/WH/JE
		T;N, Stat, spec type = Blood
	Calcium Ionized
		T;N, Stat, spec type = Blood
	CBC with Diff
		T;N, Stat, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
	Lactate
		T;N, Stat, spec type = Blood
Tomorrow's Lab
	Bilirubin Direct
		T+1;0400, Routine, spec type = Blood
	Calcium Ionized
		T+1;0400, Routine, Q24H, spec type = Blood
	Blood Gases Arterial (ABG) - MH/WH/JE
		spec type = Blood
	Lactate
		T+1;0400, Routine, spec type = Blood
	CBC with Diff
		T+1;0400, Routine, Q24H, spec type = Blood
	Comprehensive Metabolic Panel
		T+1;0400, Routine, Q24H, spec type = Blood
	Magnesium Level
		T+1;0400, Routine, spec type = Blood
	Phosphorus
		T+1;0400, Routine, spec type = Blood
Diagnostic Tests

	Chest 1 View
		T;N, Stat, Cath Placement F/U
	US Head Complete
		T;N+1728, Routine, Neonatal Encephalopathy
	MRI Brain w/o Contrast
		Routine, Neonatal Encephalopathy
IV Solutions
	fentaNYL  200 mcg/D5W 20 mL (NICU)
		20 mL, IV, Routine
			Comment: May bolus with 1 hour worth of drug Q1H prn agitation
		200 mcg, EVERY BAG, 1 mcg/kg/hr
	midazolam 10 mg/D5W 20 mL (NICU)
		20 mL, IV, Routine
			Comment: May bolus with 1 hour worth of drug Q1H prn agitation
		10 mg, EVERY BAG, 0.5 mcg/kg/min
Medications
	fentanyl (NICU)
		1 mcg/kg, Syringe, IV Push, Once, agitation
Patient Care
	Whole Body Cooling
		T;N, Once
			Comment:  Initiate and Begin Cooling , NOW
		T;N
			Comment: Rewarming ProtocolBegin rewarming 72 hours after onset of whole body cooling or sooner if ordered by MD/NNP.  During rewarm
	Esophageal Temp Probe
		T;N, Once
			Comment: Insert
	Glucose POC - NICU
		T;N, Q1H, 4, Dose(s)/Time(s)
			Comment: while cooling
		If patient has arterial line, order POC WB Glucose Nurse Collect - NICU.(NOTE)*
	POC WB Glucose Nurse Collect - NICU
		T;N, Q1H, 4, Dose(s)/Time(s)
			Comment: while cooling
	Newborn Hearing Screening
		T;N
			Comment: must be done prior to discharge.
	Cerebral Function Monitor (CFM)
		T;N
			Comment: Now, Place low impedance needles per CFM instruction manual.  Begin CFM monitoring at_______.  Continue CFM throughout the re-warming period, only discontinuing upon MD/NNP order
	Notify MD/NNP
		T;N, Neonatologist, immediately for clinical suspicion of seizures, heart rate <80, mean arterial pressure <40, POarterial pressure <40, POC gluc
	Foley Catheter
		T;N, Insert, Once
	Discharge Instructions Other
		T;N, Follow up at Women's Hospital NICU Developmental Clinic at 6 months of age
Consults/Follow-up
	Consult Neurologist
		Reason for Referral: Whole Body Cooling, Refer to/Consult with: Hannah Klein, MD

NICU Coagulation (WH)
Laboratory
	.Protime - MH/WH/JE
		T;N, Stat, spec type = Blood
	PTT - MH/WH/JE
		T;N, Stat, spec type = Blood
	Fibrinogen Level - MH/WH/JE
		T;N, Stat, spec type = Blood
	Platelet Count
		T;N, Stat, spec type = Blood
	Thrombin Time
		T;N, Stat, spec type = Blood
	D-Dimer - MH/WH/JE
		T;N, Stat, spec type = Blood

NICU Coagulation (WH) Tomorrow
	.Protime - MH/WH/JE
		T+1;0400, Routine, spec type = Blood
	PTT - MH/WH/JE
		T+1;0400, Routine, spec type = Blood
	Fibrinogen Level - MH/WH/JE
		T+1;0400, Routine, spec type = Blood
	Platelet Count
		T+1;0400, Routine, spec type = Blood
	Thrombin Time
		T+1;0400, Routine, spec type = Blood
	D-Dimer - MH/WH/JE
		T+1;0400, Routine, spec type = Blood

*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