ID

10682

Beskrivning

Routine documentation of university hospital muenster. This form serves the purpose of documenting and ordering medications and syringe pumps in a specific pediatric ICU.

Nyckelord

  1. 2015-06-08 2015-06-08 - Julian Varghese
Uppladdad den

8 juni 2015

DOI

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Licens

Creative Commons BY-NC 3.0 Legacy

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Order form pediatric intensive care unit UKM

Order form pediatric intensive care unit UKM- Physician's order

Patient Information
Beskrivning

Patient Information

Alias
UMLS CUI-1
C1955348
Name of the Patient:
Beskrivning

Patient's name

Datatyp

text

Alias
UMLS CUI-1
C1299487
Date of birth:
Beskrivning

Date of birth

Datatyp

date

Alias
UMLS CUI-1
C0421451
Please enter the weight of the patient:
Beskrivning

Weight

Datatyp

float

Alias
UMLS CUI-1
C0005910
Please enter the height of the patient:
Beskrivning

Height

Datatyp

float

Alias
UMLS CUI-1
C0005890
Please enter the body surface area of the patient:
Beskrivning

Body surface area

Datatyp

float

Alias
UMLS CUI-1
C0005902
Date of entry:
Beskrivning

Date

Datatyp

date

Alias
UMLS CUI-1
C0807937
Parameters to be monitored, please include the measuring intervals and threshholds for the respective parameters
Beskrivning

Parameters to be monitored, please include the measuring intervals and threshholds for the respective parameters

Alias
UMLS CUI-1
C0449381
Blood pressure (RR)/ Mean arterial pressure (MAP):
Beskrivning

Blood pressure

Datatyp

text

Alias
UMLS CUI-1
C0005823
Central venous pressure (CVP):
Beskrivning

Central venous pressure

Datatyp

text

Alias
UMLS CUI-1
C0428640
Pulmonary arterial pressure (PAP)/ Left atrial pressure (LAP):
Beskrivning

Pulmonary arterial pressure

Datatyp

text

Alias
UMLS CUI-1
C1168098
Transcutaneous carbon dioxide (TcPCO2):
Beskrivning

Transcutaneous carbon dioxide

Datatyp

text

Oxygen saturation (SaO2):
Beskrivning

Oxygen saturation

Datatyp

text

Alias
UMLS CUI-1
C0237753
Weight
Beskrivning

Weigh

Datatyp

float

Alias
UMLS CUI-1
C0005910
Electrolyte Balance
Beskrivning

Electroylte balance

Datatyp

text

Alias
UMLS CUI-1
C0013831
Neurological monitoring:
Beskrivning

Neurological monitoring

Datatyp

text

Alias
UMLS CUI-1
C0150281
Special positioning of the patient:
Beskrivning

Special positioning

Datatyp

text

Alias
UMLS CUI-1
C1561964
Physiotherapy:
Beskrivning

Physiotherapy

Datatyp

text

Alias
UMLS CUI-1
C0949766
Aspiration:
Beskrivning

Aspiration

Datatyp

text

Alias
UMLS CUI-1
C0349707
Special needs or comments::
Beskrivning

Special needs or comments

Datatyp

text

Alias
UMLS CUI-1
C0947611
Record of liquid and nutrition of the patient:
Beskrivning

Record of liquid and nutrition of the patient:

Patient's total body liquid volume (ml/ 24h):
Beskrivning

Total body liquid volume

Datatyp

float

Please input the patient's liquid record from the previous day as follow- Intake, Excretion, Perspiration, balance and diuresis (all in ml/ kg/ h):
Beskrivning

Previous day liquid measurement

Datatyp

text

Alias
UMLS CUI-1
C0025102
Enteral nutrition (kcal/ 100 ml):
Beskrivning

Enteral nutrition

Datatyp

float

Alias
UMLS CUI-1
C0014327
Please mention the nutrition record as follow when applicable- Total amount, Enteral, Parenteral (all in kcal/ kg)
Beskrivning

Nutrition

Datatyp

text

Alias
UMLS CUI-1
C2596652
Please enter the liquid measurement as follow when applicable- Total, Enteral, Parenteral (all in ml/ kg):
Beskrivning

Liquid measurement

Datatyp

text

Medication
Beskrivning

Medication

Alias
UMLS CUI-1
C0013227
Name of the medication:
Beskrivning

Medication name

Datatyp

text

Alias
UMLS CUI-1
C2360065
Dose:
Beskrivning

Dose

Datatyp

text

Alias
UMLS CUI-1
C3174092
Drug administration route:
Beskrivning

Drug administration route

Datatyp

text

Alias
UMLS CUI-1
C0013153
Time of drug administration:
Beskrivning

Time

Datatyp

time

Alias
UMLS CUI-1
C0040223
Drug administration accomplished?
Beskrivning

Task accomplishment

Datatyp

text

Name of the physician:
Beskrivning

Physician's name

Datatyp

text

Syringe pumps
Beskrivning

Syringe pumps

Alias
UMLS CUI-1
C0181332
Name of the drug:
Beskrivning

Drug name

Datatyp

text

Alias
UMLS CUI-1
C2360065
Dose:
Beskrivning

Dose

Datatyp

text

Alias
UMLS CUI-1
C3174092
Dilution:
Beskrivning

Dilution

Datatyp

text

Alias
UMLS CUI-1
C1504362
Other related informations:
Beskrivning

Related informations

Datatyp

text

Therapy instructions
Beskrivning

Therapy instructions

Alias
UMLS CUI-1
C0087111
Type of therapy:
Beskrivning

Therapy type

Datatyp

text

Alias
UMLS CUI-1
C1514463
UMLS CUI-2
C1516607
UMLS CUI-3
C0805701
UMLS CUI-4
C1527021
Time:
Beskrivning

Time

Datatyp

time

Alias
UMLS CUI-1
C0040223
Name of the physician:
Beskrivning

Physician's name

Datatyp

text

Name of the nurse:
Beskrivning

Nurse's name

Datatyp

text

Diagnosis order
Beskrivning

Diagnosis order

Alias
UMLS CUI-1
C0011900
Diagnosis
Beskrivning

Diagnosis

Datatyp

text

Alias
UMLS CUI-1
C0011900
Time:
Beskrivning

Time

Datatyp

time

Alias
UMLS CUI-1
C0040223
Name of the physician:
Beskrivning

Physician's name

Datatyp

text

Name of the nurse:
Beskrivning

Nurse's name

Datatyp

text

Laboratory tests and examination
Beskrivning

Laboratory tests and examination

Alias
UMLS CUI-1
C0022885
UMLS CUI-2
C0260877
Laboratory tests:
Beskrivning

Laboratory tests

Datatyp

text

Alias
UMLS CUI-1
C0022885
Examination:
Beskrivning

Examination:

Datatyp

text

Alias
UMLS CUI-1
C0260877

Similar models

Order form pediatric intensive care unit UKM- Physician's order

Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Patient Information
C1955348 (UMLS CUI-1)
Patient's name
Item
Name of the Patient:
text
C1299487 (UMLS CUI-1)
Date of birth
Item
Date of birth:
date
C0421451 (UMLS CUI-1)
Weight
Item
Please enter the weight of the patient:
float
C0005910 (UMLS CUI-1)
Height
Item
Please enter the height of the patient:
float
C0005890 (UMLS CUI-1)
Body surface area
Item
Please enter the body surface area of the patient:
float
C0005902 (UMLS CUI-1)
Date
Item
Date of entry:
date
C0807937 (UMLS CUI-1)
Item Group
Parameters to be monitored, please include the measuring intervals and threshholds for the respective parameters
C0449381 (UMLS CUI-1)
Blood pressure
Item
Blood pressure (RR)/ Mean arterial pressure (MAP):
text
C0005823 (UMLS CUI-1)
Central venous pressure
Item
Central venous pressure (CVP):
text
C0428640 (UMLS CUI-1)
Pulmonary arterial pressure
Item
Pulmonary arterial pressure (PAP)/ Left atrial pressure (LAP):
text
C1168098 (UMLS CUI-1)
Transcutaneous carbon dioxide
Item
Transcutaneous carbon dioxide (TcPCO2):
text
Oxygen saturation
Item
Oxygen saturation (SaO2):
text
C0237753 (UMLS CUI-1)
Weight
Item
Weight
float
C0005910 (UMLS CUI-1)
Electrolyte Balance
Item
Electrolyte Balance
text
C0013831 (UMLS CUI-1)
Neurological monitoring
Item
Neurological monitoring:
text
C0150281 (UMLS CUI-1)
Special positioning
Item
Special positioning of the patient:
text
C1561964 (UMLS CUI-1)
Physiotherapy
Item
Physiotherapy:
text
C0949766 (UMLS CUI-1)
Aspiration
Item
Aspiration:
text
C0349707 (UMLS CUI-1)
Special needs or comments
Item
Special needs or comments::
text
C0947611 (UMLS CUI-1)
Item Group
Record of liquid and nutrition of the patient:
Total body liquid volume
Item
Patient's total body liquid volume (ml/ 24h):
float
Previous day liquid measurement
Item
Please input the patient's liquid record from the previous day as follow- Intake, Excretion, Perspiration, balance and diuresis (all in ml/ kg/ h):
text
C0025102 (UMLS CUI-1)
Enteral nutrition
Item
Enteral nutrition (kcal/ 100 ml):
float
C0014327 (UMLS CUI-1)
Nutrition
Item
Please mention the nutrition record as follow when applicable- Total amount, Enteral, Parenteral (all in kcal/ kg)
text
C2596652 (UMLS CUI-1)
Liquid measurement
Item
Please enter the liquid measurement as follow when applicable- Total, Enteral, Parenteral (all in ml/ kg):
text
Item Group
Medication
C0013227 (UMLS CUI-1)
Medication name
Item
Name of the medication:
text
C2360065 (UMLS CUI-1)
Dose
Item
Dose:
text
C3174092 (UMLS CUI-1)
Drug administration route
Item
Drug administration route:
text
C0013153 (UMLS CUI-1)
Time
Item
Time of drug administration:
time
C0040223 (UMLS CUI-1)
Item
Drug administration accomplished?
text
Code List
Drug administration accomplished?
CL Item
Yes (1)
CL Item
No (2)
Physician's name
Item
Name of the physician:
text
Item Group
Syringe pumps
C0181332 (UMLS CUI-1)
Drug name
Item
Name of the drug:
text
C2360065 (UMLS CUI-1)
Dose
Item
Dose:
text
C3174092 (UMLS CUI-1)
Dilution
Item
Dilution:
text
C1504362 (UMLS CUI-1)
Related informations
Item
Other related informations:
text
Item Group
Therapy instructions
C0087111 (UMLS CUI-1)
Therapy type
Item
Type of therapy:
text
C1514463 (UMLS CUI-1)
C1516607 (UMLS CUI-2)
C0805701 (UMLS CUI-3)
C1527021 (UMLS CUI-4)
Time
Item
Time:
time
C0040223 (UMLS CUI-1)
Physician's name
Item
Name of the physician:
text
Nurse's name
Item
Name of the nurse:
text
Item Group
Diagnosis order
C0011900 (UMLS CUI-1)
Diagnosis
Item
Diagnosis
text
C0011900 (UMLS CUI-1)
Time
Item
Time:
time
C0040223 (UMLS CUI-1)
Physician's name
Item
Name of the physician:
text
Nurse's name
Item
Name of the nurse:
text
Item Group
Laboratory tests and examination
C0022885 (UMLS CUI-1)
C0260877 (UMLS CUI-2)
Laboratory tests
Item
Laboratory tests:
text
C0022885 (UMLS CUI-1)
Examination:
Item
Examination:
text
C0260877 (UMLS CUI-1)

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