ED - Pediatric Fever (30 d - 60 days)
Last Updated: 6/21/2017 1:22:02 PM
Order Set
  Associated Pathway(s)
 Neonatal Fever (30 d - 60 days) - http://www.curbsideup.com/link/3
Feedback (/link/62) | Share (/link/63) | Print (/link/64) | Details (/link/66) | Education (/link/67) | Antibiograms (/link/68)
  Inclusion Criteria
Inclusion Criteria ( Any one criteria present )
  • Fever > 38.0 C (100.4 F) x1 at home, OSH or in ED
  • Hypothermia < 36.0 (96.8 F) x1 at home, OSH or in ED
Exclusion Criteria
  • Immunosuppresed, cancer
  • Central venous catheter
  • Ventriculoperitoneal shuts
  GENERAL
  Monitoring
Vitals per protocol
Weight
ONCE
  Does this patient need to be NPO?
Yes
Diet NPO
Continuous
No
PO Challenge
Diet Regular
MD to RN communication
Make patient NPO for respiratory distress, mental status changes or expectation of pending surgical or other procedure requiring sedation
  Does this patient require isolation?
      All patients with history of MRSA or VRE should receive Contact Isolation order.
Yes
Contact Isolation
(eg. MRSA, VRE, etc.)
Contact/Droplet Isolation
(eg. RSV, Rhinovirus, etc.)
Contact Plus
(eg. C. difficile, Norovirus)
Airborne Isolation
(eg. TB, VZV, Measles, etc.)
  Respiratory Therapy
  Supplemental Oxygen
MD to RN communication
Begin supplemental oxygen therapy for persistent oxygen saturation below 90% awake, 88% asleep or severe respiratory distress.
Pulse Oximetry/O2 Sats
STAT, CONTINUOUS, Indication: When patient is on supplemental oxygen
  LABORATORY
  Labs
CBC with Differential
LAB ONE TIME
Urinalysis With Microscopic
LAB ONE TIME, Source: Catheter
Urine Culture (Catheter)
LAB ONE TIME, Source: Catheter
Blood Culture (Aerobic & Anaerobic Bottles)
LAB ONE TIME
Procalcitonin, Serum
LAB ONE TIME
  IV FLUIDS
  IV Fluids
      Maintenance: 4 ml/kg/hr for the first 10 kg, then additional 2 ml/kg/hr for the second 10 kg, then additional 1 ml/kg/hr for each kg > 20 kg.
Saline Lock and Flush
NS IV bolus
20 ml/kg, Intravenous, Once
D5-NS IV infusion
Intravenous, CONTINUOUS
D5-NS + KCL 20 mEq/L IV infusion
Intravenous, CONTINUOUS
D5-1/2 NS IV infusion
Intravenous, CONTINUOUS
D5-1/2 NS + KCL 20 mEq/L IV infusion
Intravenous, CONTINUOUS
  Medications
  Pain Control
Sucrose 24% (TOOTSWEET) soln 5 drops
5 drops in mouth/throat if pain score is mild (1-2), Used for procedures, PRN
lidocaine (ELA-MAX, LMX) 4% cream
Topical, ONCE, Apply small amount to skin PRN, painful procedure, Note: takes 30 min to reach peak effect,,
  Does patient have any contraindications to acetaminophen?
      Allergy or hypersensitivity, hepatic impairment, severe hypovolemia, PKU or other liver disease, chronic malnutrition
No
Acetaminophen (TYLENOL) oral solution 15 mg/kg (Dosing Weight)
15 mg/kg, Oral, EVERY 4 HOURS PRN, Pain mild, Temp > 38.5 C
Acetaminophen (TYLENOL) suppository
20 mg/kg, Rectal, Every 4 HOURS PRN, Pain mild, Temp > 38.5 C
  PATHWAY QUESTIONS
  Is the patient toxic appearing?
      Additional diagnostic studies and management for toxic appearing neonates
Yes
Metabolic Panel, Comprehensive
LAB ONE TIME
Blood Gases, Venous
LAB ONE TIME
HSV DNA PCR Qual
LAB ONE TIME
CSF, Enterovirus By PCR
LAB ONE TIME, Source: Lumbar Puncture
Glucose, CSF
LAB ONE TIME, Source: Lumbar Puncture
Protein Total, CSF
LAB ONE TIME, Source: Lumbar Puncture
CSF Culture And Gram Stain
LAB ONE TIME, Source: Lumbar Puncture
Ceftriaxone (ROCEPHIN) 100mg/kg PEDIATRIC IV infusion
100 mg/kg, Intravenous, EVERY 24 HOURS
Vancomycin 10 mg/kg in NS 50 ml PEDIATRIC IV infusion
10 mg/kg, Intravenous, EVERY 8 HOURS
  Does the patient have respiratory symptoms?
      Respiratory rate > 50, rales, rhonchi, retractions, wheezing, coryza, grunting, stridor, nasal flaring, cough
Yes
Respiratory PCR NP Swab
LAB ONE TIME, Source: Nasopharynex
XR Chest 1V
Indication: Concern for pneumonia
XR Chest 2V
Indication: Concern for pneumonia
  Does the patient have Diarrhea?
Yes
Stool Culture
LAB ONE TIME, Source: Stool
  Does the patient have a focal skin infection (abscess or cellulitis)?
      Patients with skin infections are at high risk of nosocomial or community acquired MRSA. These patients are NOT considered low risk and will require a lumbar puncture.
Yes
Vancomycin 10 mg/kg in NS 50 ml PEDIATRIC IV infusion
10 mg/kg, Intravenous, EVERY 8 HOURS
http://curbsideup.com/print.asp?dID=32&print_type=3 © 2018 Curbside. All rights reserved.