Routine Newborn Admission Orders by mikeholy


									                                                                                           PLACE LABEL HERE


Gestational age _________ weeks
                                                                                        Orders with a “” are choices and
1. Admit as inpatient           Weight:_____lbs._____oz. _______grams                   are NOT ordered unless checked.
2. Newborn hearing screen per protocol                                                  All may be altered at physician’s
3. Assess hepatitis status. Notify physician if unknown or positive.                    discretion.
4. Serum glucose screen (if indicated per risk assessment). Refer to neonatal
     hypoglycemia protocol for further interventions.
5. Total and direct bilirubin if infant appears jaundiced. Ordered for: Date________ Time________
6. Metabolic screen at 24 Hrs of age or greater
Assessments / Interventions / Monitoring:
7. Vital signs at 30 minutes of age, then every 30 minutes until 2 Hrs of age, then every Hr x 2, then every 8 Hrs and
8. Upon admission, place the infant under radiant warmer until his/her temperature is 97.1° - 98.6°F
9. All temperatures taken axillary unless otherwise ordered by the physician.
10. May bathe infant when temperature is 98°F (36.7°C)
11. Weigh after delivery and at 48 Hrs of age
12. 100% O2 per blow-by for central cyanosis. Notify physician if not resolved or problems reoccur.
13. Pulse oximetry check per protocol
14. Jaundice assessment per protocol. Total and direct bilirubin ordered for: Date________ Time________
15. Notify physician for positive DAT only if cord bilirubin is equal to or greater than 2.0
16. Remove cord clamp when cord appears hardened and dry
17. Diet: 20 cal/oz formula, if not breastfeeding. Feeding interval not to exceed 4 Hrs in term infants, 3 Hrs in
     premature infants (36 weeks or less than 2500 gms). Feeding interval not to exceed 3 Hrs in breast-fed infants.
18. Activity: position on back
Scheduled Medications:
19. AquaMephyton 1 mg IM x 1 dose within 1st Hr of age
20. Erythromycin ointment to each eye within 1st Hr of age
21. Hepatitis B vaccine 0.5 ml IM per protocol
21. Pain: Acetaminophen 10 mg/kg orally following surgical procedure every 4 Hrs x 4 doses
PRN Medications:
22. Pain:      Sucrose 24% oral solution 1-2 ml orally for painful procedures prn
23. Dry skin: Emollient ointment applied topically every 4 Hrs prn
24. Rash/skin breakdown:         Diaper rash cream topically with diaper change prn diaper area
                                 Other: ___________________________________
25.  Discharge: if greater than 24 Hrs of age and meets the following outcomes:
        a. Only followed Routine Newborn Admission Orders, no additional orders written
        b. Respiratory rate 40-60 with easy work of breathing; HR 110-160; axillary temp. 97.1°-98.6°F
        c. Tolerating feedings
           d. Voiding/stooling patterns within normal limits
26. Additional orders: ____________________________________________________________________________

 ___________        ______________       ___________________________________             _____________________
 Date               Time                 Physician Signature                             MD Number

                                                                             Send copy to pharmacy _________ (initials)

*1-1294*                       FORM 1-1294 REV. 05/2007

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