Neonatal Intensive Care Unit (NICU) Admission [30400554] If appropriate for patient condition consider orderset : Neonatal TPN #555

Height __________ Weight ___________ Allergies ___________________________________________________________________________ General Level of Care-NICU REQUIRED: Diagnosis: ___________________________________ [X] Admit Newborn/Infant to Inpatient [ ] Other SAH, SCH, SFH, SJMC & Highline Code Status (Single Response) REQUIRED: This code status was determined by: _________________ ( ) Full code ( ) Full treatment WITH intubation but WITHOUT ACLS ( ) Full treatment WITHOUT intubation and WITHOUT ACLS ( ) Comfort Care [ ] Other Harrison Code Status (Single Response) ( ) Full code ( ) Full treatment WITH intubation but WITHOUT ACLS ( ) Full treatment WITHOUT intubation but WITH ACLS ( ) Full treatment WITHOUT intubation and WITHOUT ACLS ( ) Comfort Care [ ] Other Vital Signs [X] Vital signs [X] Frequent vital signs

[X] BP check on specific side/area

[X] Continuous Pulse Oximetry

[X] [X] [X] [X]

Transcutaneous monitoring, continuous Daily weights Measure length Measure abdominal circumference

REQUIRED: This code status was determined by: _________________ REQUIRED: This code status was determined by: _________________ REQUIRED: This code status was determined by: _________________

REQUIRED: This code status was determined by: _________________ REQUIRED: This code status was determined by: _________________ REQUIRED: This code status was determined by: _________________ REQUIRED: This code status was determined by: _________________ REQUIRED: This code status was determined by: _________________

Routine, As needed, Starting today, Per unit routine Q15 minutes x (# of occurrences): Q30 minutes x (# of occurrences): 2 Q1 hour x (# of occurrences): Q2 hours x (# of occurrences): Q4 hours x (# of occurrences): Then: Per unit routine Until discontinued, Starting today Routine, Once, Starting today For 1 Occurrences NICU Blood Pressure check on specific side: Right Arm 4 extremity blood pressure on admission. Nurse to document available extremity. Routine, Until discontinued, Starting today Gestational saturation ranges: Hi/Low alarm settings: Check o2 sat and document per unit routine. Consider changing targets on VLBW infants after 1st ROP exam for infants born