/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/order-sets/,/clinical/cckm-tools/content/order-sets/ambulatory/,/clinical/cckm-tools/content/order-sets/ambulatory/madison-surgery-center/,

/clinical/cckm-tools/content/order-sets/ambulatory/madison-surgery-center/name-98478-en.cckm

201606170

page

100

UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Ambulatory,Madison Surgery Center

MSC – ENT – Pediatric – Postoperative [4998]

MSC – ENT – Pediatric – Postoperative [4998] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Madison Surgery Center


MSC - ENT - Pediatrics - Postoperative [4998]
Post-Op/Phase II
Do NOT order Phase II medications for cases involving anesthesia.
Vital Signs [133431]
Vital Signs [NURMON0013] EVERY 30 MINUTES, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Post-Op/Phase II
Activity [132399]
Activity [NURACT0008] CONTINUOUS, Routine
AD LIB:
AMBULATE: with assistance
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Post-Op/Phase II
Diet [133432]
Advance Diet as Tolerated [NURDIE0013] ONCE, Post-Op/Phase II
Diet - Tonsils/Adenoids - Soft [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question 25):
Liquids & Modified Consistency (If Dysphagia Protocol see
questions 21-24): TONSILS/ADENOIDS-SOFT;
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat:
Sodium:
Potassium:
Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO):
Research:
Metabolic:
Other Modifiers:
Infant Nutrition (Select product and calories per ounce):
Infant Formula (Calories per Ounce):
Dysphagia Protocol:
Dysphagia Protocol-Modified Consistency (Also select
Dysphagia Protocol Liquid Consistency and Dysphagia
Protocol-Supervision):
Dysphagia Protocol-Liquid Consistency:
Dysphagia Protocol-Supervision:
Tube Feeding (Use Tube Feeding Order Set to indicate order
detail):
Tube Feeding Management:
Page 1 of 9
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:16:06 PM

Copyright © 2015 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
01/2016Lee Vermeulen, CCKM@uwhealth.org

Room Service Class:
Post-Op/Phase II
Analgesics - Non-Opioids [133362]
Note: No NSAIDS [950012] EVERY 8 HOURS, Post-Op/Phase II
acetaMINOPHEN alcohol free (TYLENOL) susp - NOTE:
Suggested dose 10 mg/kg (Maximum 500mg/dose)
[43991]
10 mg/kg, Oral, EVERY 4 HOURS PRN, pain, Post-Op/Phase
II
Analgesics - Opioids [133364]
Note: No Narcotics [950013] 4 X DAILY (NOTE ACKNOWLEDGE), Post-Op/Phase II
MORPHine PF injection - NOTE: Suggested 0.05 mg/kg
(Maximum 2 mg/dose) [156564]
0.05 mg/kg, Intravenous, EVERY 2 HOURS PRN, pain, for 4
Minutes, Post-Op/Phase II
oxycodone soln - NOTE: Suggested dose 0.1
mg/kg/dose (Maximum 5 mg/dose) [45975]
0.1 mg/kg, Oral, EVERY 4 HOURS PRN, pain, Post-
Op/Phase II
Anti-emetics [133366]
ondansetron (ZOFRAN) injection - NOTE: Suggested
dose 0.1 mg/kg (Maximum 4 mg/dose) [132824]
0.1 mg/kg, Intravenous, EVERY 24 HOURS PRN,
nausea/vomiting, for 3 Minutes, Post-Op/Phase II
Anti-emetics - 2nd Line - For Patients 2 Years or Older [133367]
ondansetron (ZOFRAN) injection - NOTE: Suggested
dose 0.1 mg/kg (Maximum 4 mg/dose) [132824]
0.1 mg/kg, Intravenous, EVERY 24 HOURS PRN,
nausea/vomiting, for 3 Minutes, Post-Op/Phase II
promethazine (PHENERGAN) injection - NOTE:
Suggested dose 0.25-1 mg/kg/dose (Maximum 25
mg/dose) [41412]
0.25 mg/kg, Intravenous, EVERY 6 HOURS PRN,
nausea/vomiting
Administer dose in a free flowing IV. Suggest dilution in 10-
20 mL of sodium chloride 0.9% and administration over 10
minutes if given IV push. Alternatively, when administered by
a CENTRAL LINE may be diluted in a 50 mL sodium chloride
0.9% mini-bag and administered over at least 10 minutes. Do
NOT use hand or wrist veins
Post-Op/Phase II
Patient to be discharged to home when deemed stable per MSC Discharge from Phase II Recovery to Home Policy
[135357]
Patient to be discharged to home when deemed stable
per MSC Discharge from Phase II Recovery to Home
Policy [NURCOM0022]
ONCE, Phase II Discharge
Outpatient Discharge Orders (Medications)
Medications - Non-opioids - Prescriptions (Scheduled) [92701]
NOTE: Order BOTH if ordering from this group
acetaMINOPHEN alcohol free (TYLENOL) 160 mg/5 mL
susp - NOTE: Suggested dose 15 mg/kg (Maximum
1000 mg/dose) [43991]
starting 1/14/16, Normal
ibuprofen (MOTRIN) 100 MG/5ML susp - NOTE:
Suggested dose 10 mg/kg (Maximum 600 mg/dose)
[45376]
starting 1/14/16, Normal
Medications-Prescriptions-Oxycodone (Single Response) [124303]
oxycodone soln - 50 mL - NOTE: Order for age 2-4 yrs
(12-15 kg) [45975]
50 mL, 0, starting 1/14/16, Normal
oxycodone soln - 75 mL - NOTE: Order for age 5-8 yrs
(16-25 kg) [45975]
75 mL, 0, starting 1/14/16, Normal
oxycodone soln - 100 mL - NOTE: Order for age 9-12
yrs (26-40 kg) [45975]
100 mL, 0, starting 1/14/16, Normal
oxycodone soln - 150 mL - NOTE: Order for age 13-15
yrs (41-55 kg) [45975]
150 mL, 0, starting 1/14/16, Normal
oxycodone soln - 200 mL - NOTE: Order for age greater
than 15 yrs (greater than 55 kg) [45975]
200 mL, 0, starting 1/14/16, Normal
Medications - Prescriptions - Analgesics - Liquids [134194]
acetaMINOPHEN alcohol free (TYLENOL) 160 mg/5 mL
susp - q4h prn - NOTE: Suggested dose 15 mg/kg
(Maximum 650 mg/dose) [43991]
1 Bottle, 1, starting 1/14/16, Normal
Page 2 of 9
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:16:06 PM

Copyright © 2015 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
01/2016Lee Vermeulen, CCKM@uwhealth.org

oxycodone 5 MG/5ML soln - NOTE: Suggested dose
0.05-0.15 mg/kg oxycodone (Maximum 5 mg/dose)
[45975]
0, starting 1/14/16, Normal
ibuprofen (MOTRIN) 100 mg/5mL susp - q6-8h prn -
NOTE: Suggested dose 10 mg/kg (Maximum 800
mg/dose) [45376]
1 Bottle, 0, starting 1/14/16, Normal
Medications - Prescriptions - Analgesics - Tablets [124305]
acetaMINOPHEN (TYLENOL) 325 mg tab - q4h prn -
NOTE: Suggested dose 15 mg/kg (Maximum 650
mg/dose) [34149]
100 tab, 0, starting 1/14/16, Normal
hydrocodone-acetaMINOPHEN (NORCO) 5-325 mg per
tab - q4h prn - NOTE: Suggested dose 0.05-0.15 mg/kg
hydrocodone (Maximum 10 mg hydrocodone/dose)
[71425]
40 tab, 0, starting 1/14/16, Normal
oxycodone-acetaminophen (PERCOCET) 5-325 mg per
tab - q4h prn - NOTE: Suggested dose 0.05-0.15 mg/kg
oxycodone (Maximum 10 mg oxycodone/dose) [40668]
40 tab, 0, starting 1/14/16, Normal
ibuprofen (MOTRIN) 200 mg tab - q6-8h prn - NOTE:
Suggested dose 10 mg/kg (Maximum 2400 mg/day) Do
not order for patients < 6 months old. [38353]
100 tab, 0, starting 1/14/16, Normal
Medications - Analgesics - Suppositories (Single Response) [93680]
acetaMINOPHEN (TYLENOL) 80 mg suppository - q4h
prn [43994]
20 suppository, 0, starting 1/14/16, Normal
acetaMINOPHEN (TYLENOL) 120 mg suppository - q4h
prn [34151]
20 suppository, 0, starting 1/14/16, Normal
acetaMINOPHEN (TYLENOL) 325 mg suppository - q4h
prn [34152]
20 suppository, 0, starting 1/14/16, Normal
acetaMINOPHEN (TYLENOL) 650 mg suppository - q4h
prn [34153]
20 suppository, 0, starting 1/14/16, Normal
Medications - Prescriptions - Otic [124308]
ciprofloxacin-dexamethasone (CIPRODEX) 0.3-0.1%
otic susp - 3drp 3x/d [73602]
10 mL, 0, starting 1/14/16 until 1/17/16, Normal
ciprofloxacin (CETRAXAL) 0.2 % otic soln - 5 drp 2x/d-
7d [136381]
14 each, 0, starting 1/14/16 until 1/21/16, Normal
ofloxacin (OCUFLOX) 0.3 % ophthalmic soln - 3drp
3x/d-3d [55774]
5 mL, 0, starting 1/14/16 until 1/17/16, Normal
Medications - Prescriptions - Anti-emetics [134202]
ondansetron (ZOFRAN) 4 mg/5 mL soln - NOTE:
Suggested dose 0.1 mg/kg (Maximum 4 mg/dose)
[54843]
0, starting 1/14/16, Normal
promethazine (PHENERGAN) 12.5 mg rectal
suppository - q8h prn #5 - NOTE: For patients 2 years or
older. Suggested dose 0.25-1 mg/kg (Maximum 25
mg/dose) [46328]
5 suppository, 0, starting 1/14/16 until 2/13/16, Normal
promethazine (PHENERGAN) 25 mg rectal suppository -
NOTE: For patients 2 years or older. Suggested dose
0.25-1 mg/kg (Maximum 25 mg/dose) [46329]
5 suppository, 0, starting 1/14/16 until 1/19/16, Normal
Medication Instructions [132422]
Resume taking Floxin ear drops [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine,
3-4 drops, 3 times per day for 3 days.
Resume taking Ciprodex ear drops [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine,
3-4 drops, 3 times per day for 3 days.
Use a Saline Spray [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine,
Use a saline spray 6 times per day starting tomorrow.
No NSAIDS (ibuprofen, motrin, advil, aspirin, naproxen Routine
Page 3 of 9
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:16:06 PM

Copyright © 2015 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
01/2016Lee Vermeulen, CCKM@uwhealth.org

etc) for 4 days after surgery [NURCOM0022]
No NSAIDS (ibuprofen, motrin, advil, aspirin, naproxen
etc) for 7 days after surgery [NURCOM0022]
Routine
No more than 4 grams of acetaminophen in any 24 hour
period [NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine
Outpatient Discharge Orders (Discharge Instructions)
Discharge Instructions - Procedure Specific [133434]
Tonsillectomy [134377]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • Throat pain is common after a tonsillectomy and
may increase on the 3rd-4th day after surgery.
• You may experience pain in your ears. Do not be
alarmed, as this is a common occurrence. This ear ache is
referred from the throat pain and swelling does not usually
indicate an ear problem.
• If a pain medication was prescribed, take as ordered.
• If no pain medication was prescribed, take
acetaminophen (Tylenol) as directed on label.
• This pain will subside, along with the throat pain, in 7-10
days.
• It is normal to have some bloody discoloration of your
saliva. If this develops into actual bleeding or persists more
than five days, please call your physician.
• You may notice white spots or patches in the back of your
throat after surgery. This is expected and is part of the
normal healing process.
• You may have a slight elevation of body temperature (up
to 100.5 degrees) for the first few days following surgery.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• REST!!! Your body needs additional rest after surgery for
healing. Take it easy for the first week, then return to
normal activity.
• Children will generally self-limit their activity.
• If any questions please check with your physician.
• Elevating your head slightly with extra pillows while lying
down will make you more comfortable.
• DO NOT drive for 24 hours after your surgery or while
taking pain medications, as your judgment and reflexes
may not be normal even though you may feel fine.
Diet [NURDIE0013] Routine, • It is very important to drink fluids so as not to
become dehydrated.
• Even though swallowing may cause throat pain, be sure
to maintain an adequate fluid intake, approximately 8-10
glasses of fluids per day.
• Cool liquids are a good choice, as this does have a
soothing effect on the mucous membranes of the throat.
• POPSICLES are an easy way to get fluids and sugar for
energy.
• Fruit juices that are acidic could increase throat pain.
Therefore, it is a good idea to try a few sips to determine
your response to those juices.
• You may want to avoid hard foods such as crackers,
chips, pretezls, etc., as they may irritate the throat.
• Rinsing your mouth frequently with a mouthwash/gargle
will also add to your comfort.
• AVOID ALCOHOL for 24 hours or if taking pain
medications.
Wound Care [NURWND0015] Routine, • Avoid any activity that causes excessive
exertion, as this may increase your tendency to bleed.
• Try to avoid excessive coughing or clearing of your throat.
• You may notice white spots or patches in the back of your
Page 4 of 9
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:16:06 PM

Copyright © 2015 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
01/2016Lee Vermeulen, CCKM@uwhealth.org

throat after surgery. This is expected and is part of the
normal healing process.
• You may have a slight elevation of body temperature (up
to 100.5 degrees) for the first few days following surgery.
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • You can resume your usual medications after
surgery, unless your physician instructs you otherwise.
• If pain medication has been prescribed, take as directed.
Adenoidectomy or Middle Ear Ventilation Tubes
[134378]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• The patient has had a general anesthetic and may
continue to notice effects through the day. A responsible
adult should remain with the patient all day. Normally there
is no need for the patient to be in bed after discharge from
the surgery center. The patient should be up and around
but doing quiet things, preferably indoors. A definite period
of rest should be taken during the first day.
Diet [NURDIE0013] Routine, • Initially the patient's diet is restricted to liquids
and soft foods until they have overcome the effects of
anesthesia. Later in the day, there is no need for restriction
in the diet. The intake of fluids should be encouraged
during the first two post op days. No damage will occur
eating a normal diet.
Wound Car [NURWND0015] Routine, EAR tube patients should not be alarmed by a
small amount of bleeding or drainage from the ears after
tube insertion. Your doctor may give you ear drops to use a
few days after surgery. You should avoid water exposure in
the ear canal while using ear drops. You can do this by
using cotton soaked in Vaseline or ear plugs. If doctor
gives you different instructions, follow them.
ADENOIDECTOMY patients may notice a small amount of
bleeding from the nose which is not serious. HEAVY
bleeding from the nose or throat is a rare complication that
should be quickly reported to the physician.
Adenoidectomy patients often have a foul smelling nasal
discharge, which is normal and may last 7-10 days.
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • Pain in the ears or throat may be experienced
for 1-2 weeks with either procedure. Patients are often
given some pain medication in the operating room,
however they may require more at home.
• Tylenol (acetaminophen) liquid or tablets may be given
as needed. PLEASE FOLLOW THE INSTRUCTIONS ON
THE LABEL CAREFULLY.
Nasal / Sinus Surgery [132511]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • You will have some discomfort after surgery. It
will be more of an ache and pressure, rather than actual
pain.
• This may increase as the week progresses due to
increased swelling and accumulation of secretions in the
sinus.
• Initially after surgery, you will notice an increase in nasal
discharge. There may be a small amount of bright red
bleeding, so do not be alarmed.
• A small amount is normal and may continue through the
first week.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
Page 5 of 9
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:16:06 PM

Copyright © 2015 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
01/2016Lee Vermeulen, CCKM@uwhealth.org

• REST -- even though your surgery may seem minor, your
body needs additional rest for healing.
• Take it easy for the first week after surgery.
• After the first week you can return to normal activity.
• If you work, your physician will advise you on the time you
need to take off.
• Hold off on Physical activity until your follow up visit.
• If bright red bleeding occurs with these activites, cut back
and progress as tolerated.
• DO NOT drive or operate any machinery for the next 24
hours or while taking narcotics.
• DO NOT LIFT HEAVY OBJECTS - Avoid lifting heavy
objects and bending over during the first week. Both of
these activities may increase blood flow to the operative
site.
Diet [NURDIE0013] Routine, • Advance your diet as tolerated.
• You should not drink alcohol for the next 24 hours or
while taking narcotics.
Wound Care [NURWND0015] Routine, • Use an ice pack intermittently for the next 24 to
48 hours
• A small dressing may be placed on your upper lip to
absorb any drainage.
• It may be necessary to change this drip pad several times
a day.
• Any heavy bleeding should be reported to your physician
• Old blood that accumulated during surgery is reddish
brown in color. It will drain for a week or more and is of no
concern.
• After this initial period the drainage may continue for
several weeks.
• The character of this drainage may change, becoming
thicker and yellowish-green in color. This is normal after
surgery and is not a sign of infection.
• You will feel stuffy and will have some swelling of the
mucous membranes of your nose. This is normal and
expected.
• While increasing during the first week after surgery, this
stuffiness will gradually decrease over the next few weeks,
so be patient.
• After this initial period, you should notice improvement in
your nasal breathing.
• You may lightly blow your nose according to your doctor's
instructions.
• Keeping your head elevated and sleeping with an extra
pillow will help you feel more comfortable. This position will
help decrease swelling and allow for better drainage of
nasal discharge.
• The use of a cool mist humidifier (when the air is dry) will
help loosen secretions and prevent crusting of the nose.
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • You can resume your usual medications after
surgery, unless your physician instructs you otherwise.
• If pain medication has been prescribed, take as directed.
• DO NOT TAKE ASPIRIN OR ASPIRIN PRODUCTS
• Do not use medicated nasal sprays until cleared by your
Doctor.
• You may re-start nasal steroids after one week.
• If you need to travel by airplane, you may do so. Taking a
decongestant pill (e.g., Sudafed) or nasal spray (Afrin,
Neosynephrine) may help to assure your comfort.
Airplanes are dry, so use the saline nasal spray frequently
during your flight.
Tympanoplasty - With or Without Mastoidectomy
Page 6 of 9
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:16:06 PM

Copyright © 2015 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
01/2016Lee Vermeulen, CCKM@uwhealth.org

[143525]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
- You should NOT drive until cleared by your surgeon.
- Your body needs additional rest for healing.
- Take it easy for the first week after surgery, and then
gradually return to normal activities.
- Avoid lifting heavy objects and strenuous activity or
exercise.
- You may experience mild dizziness after surgery. Mild
dizziness or unsteadiness is common, so do not be
alarmed.
- Avoid any sudden movements or standing up quickly, as
this can cause or increase your dizziness.
- If you are experiencing severe dizziness or vertigo
(spinning sensation), notify your physician. If this does
occur, assume a safe position; sitting or lying down.
- If a medication for dizziness was prescribed, take as
ordered.
Diet [NURDIE0013] Routine, - Advance your diet as tolerated.
- You should not drink alcohol for the next 24 hours or
while taking narcotics.
Wound Care [NURWND0015] Routine, - Bloody drainage in the ear canal is normal for 4-
5 days after surgery. Excessive drainage after this period
may indicate infection. Please notify your physician if this
occurs.
- Other signs of infection may be; elevated temperature,
pus in the incision line, redness of the area, or severe
throbbing or persistent pain.
- Keep the band-aid over the ear in place for 1-2 days after
the surgery. After this time, you may remove and/or
replace the band-aid.
- If suture strips are in place over the incision line, leave in
place until after the first post-operative visit. If these strips
come off when removing the band-aid, do not be alarmed;
the area will be evaluated during your first office visit.
- A cotton ball may be placed in the ear canal at the time of
surgery. You may change this cotton ball as needed to
keep the ear clean and dry. This cotton ball does not need
to be sterile.
- Avoid getting water in your ear until your physician states
otherwise. To prevent this, you may place a cotton ball
coated in Vaseline in the ear canal while showering or
washing your hair.
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • Mild incisional pain is common for 2-3 days after
surgery. Severe pain may be a sign of infection. Contact
your physician if you are experiencing severe pain.
• If a pain medication was prescribed , take as ordered.
If no pain medication was prescribed, take
acetaminophen (Tylenol) as directed on the label.
Tube Removal with Paper Patch [143598]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
The patient has had a general anesthetic and may
continue to notice effects through the day. A responsible
adult should remain with the patient all day. Normally there
is no need for the patient to be in bed after discharge from
the surgery center. The patient should be up and around
but doing quiet things, preferably indoors. A definite period
of rest should be taken during the first day.
Diet [NURDIE0013] Routine, - Initially the patient's diet is restricted to liquids
and soft foods until they have overcome the effects of
Page 7 of 9
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:16:06 PM

Copyright © 2015 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
01/2016Lee Vermeulen, CCKM@uwhealth.org

anesthesia. Later in the day, there is no need for restriction
in the diet. The intake of fluids should be encouraged
during the first two post op days. No damage will occur
eating a normal diet.
Wound Care [NURWND0015] Routine, • Ear tube patients should not be alarmed by a
small amount of bleeding or drainage from the ears after
tube removal.
• Your doctor will NOT be giving you a prescription for any
ear drops.
• You should avoid any water exposure in the ear canal
until post follow-up visit. You can do this by using cotton
soaked in Vaseline or ear plugs during baths or showers.
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • Mild incisional pain is common for 2-3 days after
surgery. Severe pain may be a sign of infection. Contact
your physician if you are experiencing severe pain.
• If a pain medication was prescribed , take as ordered.
If no pain medication was prescribed, take
acetaminophen (Tylenol) as directed on the label.
Wound/Drain Care [195817]
IV Site [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine,
• Sometimes redness, warmth, or soreness occurs at the (IV)
Intravenous site. This can be relieved by putting a warm, wet
washcloth on the site 4 times a day. Call your Doctor/Nurse if
this does not get better in 1-2 days or if gets worse
When to Call Your Surgeon [196997]
When to Call Your Surgeon [NURCOM0079] Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan.
You should include specific instructions on when and who to
call.
You should include actual provider names (i.e. not 'PCP').
You should NOT include the discharging unit as a contact.,
Routine, • Redness, swelling or warmth at the surgery site.
• Increased tenderness.
• Increased drainage.
• Increased pain that is not relieved by medication.
• Constipation lasting longer than two days.
• Call your physician for a temperature increase over 101.5
degrees. (Dehydration may cause an elevated body
temperature, so be sure to drink ample amounts of fluids).
Signs and symptoms of dehydration may include the
following: decrease or absence of tears, lethargy or fatigue,
dry lips/mucus membranes, possible decrease in urine output
or concentrated urine..
• You develop shortness of breath.
• You experience a persistent cough.
• Ear Pain accompanied by ear drainage should be reported
to your physician.
• You are uncomfortable due to the inability to urinate.
• You have any questions.
MOST QUESTIONS following surgery can be answered by
our office between the hours of 8:00 a.m. and 5:00 p.m. at
(608) 287-2200 or toll free at 1-800-921-3444.
Other Discharge Instructions [133433]
Voice Rest [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This order
Page 8 of 9
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:16:06 PM

Copyright © 2015 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
01/2016Lee Vermeulen, CCKM@uwhealth.org

will appear on the patient's After Hospital Care Plan., Routine,
Voice rest for *** hours
Contact Information [135666]
Contact Information [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine,
Your Surgeon's name is @ATTPROV@ and can be reached
at @ATTENDPH@, Monday - Friday between 8:00am and
4:30pm. After 4:30pm or on weekends please call the after
hours clinic at 262-2122.
Follow-Up Appointments [132521]
Schedule Appointment at 1 South Park ENT
[NURCOM0026]
Routine
Reason for Appointment: Follow-up appointment
When do you want appointment: 1 week
Which Clinic or Specialty: 1 South Park ENT
Which Provider (Optional):
Madison Surgery Center
1 South Park
Madison, WI
(608) 287-2500
Schedule Appointment at UWHC (University of
Wisconsin Hospital and Clinics) ENT [NURCOM0026]
Routine
Reason for Appointment:
When do you want appointment: 1 week
Which Clinic or Specialty: UWHC (University of Wisconsin
Hospital and Clinics) ENT
Which Provider (Optional):
UWHC (University of Wisconsin Hospital and Clinics) ENT
600 Highland Avenue
Madison, WI
(608) 263-0192
No Follow-up Appointment Needed [NURCOM0022] Routine
Page 9 of 9
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:16:06 PM

Copyright © 2015 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
01/2016Lee Vermeulen, CCKM@uwhealth.org