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/clinical/cckm-tools/content/order-sets/ambulatory/madison-surgery-center/name-98482-en.cckm

201606170

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100

UWHC,UWMF,

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

MSC – General Surgery – Adult – Postoperative [4973]

MSC – General Surgery – Adult – Postoperative [4973] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Madison Surgery Center


MSC - General Surgery - Adult - Postoperative [4973]
Post-Op Phase II
Do NOT order phase II medications for cases involving anesthesia.
Analgesics (Opioids) (Single Response) [134184]
hydrocodone-acetaMINOPHEN (NORCO) 5-325 MG per
tab RANGE [750021]
1-2 tab, Oral, EVERY 4 HOURS PRN, pain, Severe Pain
No more than 4 grams of acetaminophen per 24 hours for
adults or 15 mg/kg per dose for peds < 40kg.
Post-Op/Phase II
oxycodone tab RANGE [750032] 5-10 mg, Oral, EVERY 4 HOURS PRN, pain, Severe pain,
Post-Op/Phase II
oxycodone-acetaMINOPHEN (PERCOCET) 5-325 MG
per tab RANGE [750033]
1-2 tab, Oral, EVERY 4 HOURS PRN, pain, Severe pain
No more than 4 grams of acetaminophen per 24 hours for
adults or 15 mg/kg per dose for peds < 40kg.
Post-Op/Phase II
Analgesics (Non-opioids) [195672]
acetaMINOPHEN (TYLENOL) tab RANGE [750000] 325-650 mg, Oral, EVERY 4 HOURS PRN, pain/fever, Mild
pain/vever or multi-modal therapy
No more than 4 grams acetaminophen per 24 hours for adults
or 15mg/kg per dose for peds <40kg.
Post-Op/Phase II
ibuprofen (MOTRIN) tab [38353] 600 mg, Oral, EVERY 6 HOURS PRN, pain, Mild pain/vever
or multi-modal therapy, Post-Op/Phase II
Vital Signs [132809]
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 [132811]
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
Elevate Extremity [NURACT0010] Extremity:
Equal to (degrees):
Greater than (degrees):
Less than (degrees):
Other options:
Routine, CONTINUOUS, Post-Op/Phase II
Non-Categorized Patient Care Orders [134292]
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Starting today, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral?
Type:
Leave on until dressing change., Post-Op/Phase II
Apply Ice Pack to Affected Area [NURTRT0008] PRN, Starting today, Routine
Page 1 of 8
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Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
01/2016Lee Vermeulen, CCKM@uwhealth.org

Site:
Post-Op/Phase II
Patient Monitoring [132812]
ACCUCHECK GLUCOSE [HCMGLUC] ONCE For 1 Occurrences, Routine
If Conditional, What Condition?
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 - Prescriptions - Analgesics (Opioids) (Single Response) [132532]
hydrocodone-acetaMINOPHEN (NORCO) 5-325 MG per
tab [71425]
50 tab, , starting 1/14/16, Normal
oxycodone-acetaMINOPHEN (PERCOCET) 5-325 MG
per tab [40668]
50 tab, , starting 1/14/16, Normal
oxycodone 5 MG tab [45976] 50 tab, , starting 1/14/16, Normal
Medications - Prescriptions - Analgesics (Non-Opioid) [196236]
acetaMINOPHEN (TYLENOL) 325 MG tab [34149] starting 1/14/16, Normal
ibuprofen (MOTRIN) 200 MG tab [38353] starting 1/14/16, Normal
Medications - Prescriptions - Bowel Management [197487]
senna-docusate (SENOKOT-S) 8.6-50 mg per tab - 2t
2x/d - NOTE: Order if opioids are prescribed [60530]
28 tab, 0, starting 1/14/16, Normal
Medications - Prescriptions - Antiemetics [133769]
ondansetron (ZOFRAN) 4 MG tab [45939] 5 tab, 0, starting 1/14/16, Normal
Medications - Prescriptions - Anti-infectives [132427]
Bacitracin 500 UNIT/GM ointment [34986] 1 Tube, 0, starting 1/14/16, Normal
Outpatient Discharge Orders (Discharge Instructions)
Discharge Instructions - Procedure Specific [132820]
General Breast Surgery [132887]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• Limit physical activity for the first 24-48 hours. No jogging,
aerobics, or vigorous overhead movements.
• Most people can return to work the following day.
• Do not drive the day of your surgery or while taking
narcotics, as your judgement and reflexes may not be
normal, even though you feel fine.
Wound Care [NURWND0015] Routine, • Ice packs can be applied to surgical site for the
first 24 hours rotating 20 minutes on, 20 minutes off.
• You may bathe/shower as usual the day after your
surgery.
• Remove clear plastic bandage 3-5 days after surgery.
• A sports bra should be worn for the first 48 hours and
through the night for additional support.
• Avoid any lotions, creams, or powders near the surgical
site
Hernia Repair [132889]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• You will find yourself becoming fatigued easily. This
fatigue will gradually decrease, but you need to rest when
you become tired.
• You should gradually increase your activities, building
rest times into each day
• Again, fatigue will decrease with time, but you need to
rest when you become tired. Strenuous housework like
Page 2 of 8
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:04:55 PM

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Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
01/2016Lee Vermeulen, CCKM@uwhealth.org

vacuuming, lifting heavy objects (over 30 pounds, including
children) and active sports should be avoided until
permitted by your physician.
• You may climb stairs if you go slowly.
• Use a pillow to splint abdomen while coughing or
sneezing until tolerated.
• You need to consult with your surgeon about returning to
work.
• Sexual activity can be resumed when you are feeling
physically able, but avoid straining. Straining against your
incision can cause recurrence of the hernia.
• Any incisional pain indicates too much stress/straining
against the repaired hernia.
WEIGHT RESTRICTIONS
***
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.
GOOD BODY MECHANICS:
Bend from the knees, not the waist, when picking
something up. Keep your back straight. Grab the object
you want to lift securely with both hands and hold it close
to your body. Straighten your knees, using your leg
muscles to evenly support the weight of the object.
Diet [NURDIE0013] Routine, • Avoiding constipation is important as it may
cause incisional strain. Your diet should include fruits,
vegetables, and plenty of fluids.
Wound Care [NURWND0015] Routine, • It takes approximately six weeks for an incision
to heal. During this time, your body will be expending
energy to repair its damaged tissues.
• You may shower. In 24/48 hours, you can remove the
dressing and leave it off, or you may cover the incision with
a Band-Aid or dressing if you find your clothing is rubbing
against it.
• The covering should be changed daily and kept dry.
Wash your hands before changing the dressing.
• Ice packs can be applied to surgical site for the first 24
hours rotating 20 minutes on, 20 minutes off.
Bowel Habits [NURCOM0022] Routine, It is important to have a bowel movement within
two to three days following surgery. Along with diet the
diet, Milk of Magnesia or Metamucil may be used if
constipation is a problem. However, if diarrhea occurs,
discontinue taking this medication.
Laparoscopic Surgery [132890]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • Your abdomen and incision will be sore for a few
days, but should gradually improve.
• A sore throat may be present for about 24 hours following
surgery due to the airway that was placed in your windpipe
to help you breathe during your surgery. Gargling with
warm salt water several times a day will help relieve this
irritation.
• Men may experience scrotal swelling. This is a common
occurrence and will resolve on its own. However, there is
significant discomfort, please notify the surgeon.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
You may also find that you tire more easily. Your body is
using energy to heal and repair itself. Rest frequently, and
slowly increase your activity.
Page 3 of 8
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Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
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• You may lift to tolerance/comfort.
• Use a pillow to splint abdomen while coughing or
sneezing until tolerated.
• Gradually increase your activity. Take short walks and get
plenty of rest.
• You may shower in 24/48 hours
• Resume your sexual activity when you are comfortable.
BODY MECHANICS:
When lifting, bend at your knees, not at your waist, keeping
your back straight. Keep the object you are lifting close to
your body and straighten your knees, using your leg
muscles to evenly support the weight of the object. To get
from a lying to sitting position; bend your knees up toward
your chest, turn onto your side, and using your arms, push
yourself into a sitting position and proceed to stand.
Wound Care [NURWND0015] Routine, • Frequently the stitches are under the skin and
will dissolve with time. One/Two day(s) after your surgery
you may remove your dressing/Band-Aids and leave them
off. You may cover the incisions with a Band-Aid if your
clothes rub on them. Any dressing over the incision should
be kept clean and dry and changed daily. Always wash
your hands before and after changing your
dressings/Band-Aids.
• Ice packs can be applied to surgical site for the first 24
hours rotating 20 minutes on, 20 minutes off.
Pilonidal Cystectomy [154185]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• Wear loose fitting clothing.
• No strenuous activity until permitted by your surgeon.
• Do not drive while taking pain medications other than
Tylenol or ibuprofen.
Diet [NURDIE0013] Routine, • You may resume your normal diet as tolerated.
• Attempt to eat small, light meals frequently throughout
the day while recovering from surgery.
• Increase fluids and fiber in your diet to keep your stools
soft.
Wound Care [NURWND0015] Routine, * Once wound is healed, use cotton gauze/pad to
wick sweat away from area for six weeks.
{Select Wound Type:22962}
Rectal Surgery [132891]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • It is common to experience an urge to urinate
until the packing is removed.
• You can expect to have a rectal dressing since some
rectal bleeding is normal.
• You may experience burning and/or pain in the rectal
area, especially with a bowel movement.
• Your throat may feel sore due to the airway for
anesthesia; cool liquids will help this.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• You may lie in any comfortable position. Lying on your
side or on your stomach may be most comfortable.
• While sitting, you may wish to sit on a pillow.
• Do not use a donut cushion unless instructed to do so by
your physician.
• Activity may be increased as tolerated.
• DO NOT Drive within 24 hours after your surgery or while
taking pain medications, as your judgement and reflexes
may not be normal even though you may feel fine.
Diet [NURDIE0013] Routine, • To avoid constipation, you should continue with
Page 4 of 8
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:04:55 PM

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Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
01/2016Lee Vermeulen, CCKM@uwhealth.org

a high fiber diet such as fresh fruits, fresh vegetables,
whole wheat and bran.
• Increase your fluid intake.
Wound Care [NURWND0015] Routine, • Rectal dressings will need to be changed as
directed.
• You may use a peri pad for any rectal drainage.
• There may be internal packing. If so, this will pass with
your first bowel movement.
• Sitz baths will promote healing. A sitz bath for 15-20
minutes, 2-3 times a day and after bowel movements, is
recommended.
• Your physician may also prescribe ointment or other
medication to be applied following sitz baths.
Venous Infusion Port [138448]
Procedure Description [NURCOM0022] Routine, • A port is a small rigid disc about the size of a
half-dollar. The center of the port is called the septum. The
septum is made of self-sealing rubber and will reseal itself
after being punctured. The bottom of the port is made of
steel. The entire device is "implanted" underneath your
skin. The device may be left in place for as long as it is
needed. This could be for a few months or years.
• The port can be used to give chemotherapy, fluids, blood
transfusions, antibiotics and other medications. A special
needle goes through your skin and into the septum to
establish blood flow. Blood samples can be drawn from the
catheter; however, this does not always elminate the need
for a needle puncture in your arm. Some lab tests cannot
be drawn through the catheter and have accurate results.
At other times the special type of needle required may not
be in place.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• You should not drive today. Even through you may not
feel tired, your judgement and reflexes may not be normal.
• Your activities will not be limited because you have an
implanted device.
• Normal daily activities such as bathing, showering,
exercise, housework, and sleeping are safe
• Specific questions about vigorous exercise should be
directed to your doctor.
Wound Care [NURWND0015] Routine, INCISION CARE
• After surgery the insertion site should be covered with a
clean dressing or bandage for 3-4 days. Once the skin is
healed, there is no need to cover the incision with a
bandage.
• Your shoulder and the site over your port may feel stiff
and sore for a few days after placement of the port. The
following suggestions may help decrease some of this
discomfort.
• Take your pain medications every 4-6 hours for the first
24 hours.
• Limit the use of the arm for the first 24 hours.
PORT CARE
• Your port will need to be flushed after each use or once a
month to prevent the catheter from closing off.
• A Huber needle must be used each time the catheter is
used (this type of needle does not damage the septum of
the catheter).
• Please carry the port insertion card given to you at the
time of surgery at all times. This card can be shown to any
health care provider to let them know what type of catheter
you have in place and how it should be used.
Page 5 of 8
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Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
01/2016Lee Vermeulen, CCKM@uwhealth.org

AV-Fistula [197567]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • You have just had surgery to create an access
for you hemodialysis. Some pain and swelling is normal for
several days.
• Make sure to elevate your arm above the level of your
heart for the next 1-2 days. You can Use 2-3 pillows to
support your arm. Please use these pillows when you are
sitting and at bedtime.
• Moving your fingers frequently will help minimize the
swelling.
• If your surgeon has instructed you on fistula exercises,
please begin that one week post-operatively. Fistula
exercise will help your fistula enlarge and mature.
• You will feel a "buzzing" sensation or "thrill" through the
bandage. This will increase over the next several days.
Check the fistula for pulsation and thrill.
• You may listen with a stethoscope (if you have one) or
simply feel for the thrill. When a stethoscope is placed over
the fistula you should hear a whooshing sound called a
bruit. If you do not hear the bruit, call your surgeon's office
during business hours to speak with a nurse.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• Tonight you should plan on resting. Tomorrow you may
be up and about, but NO strenuous activity.
• Do NOT perform any strenuous activity such as yard
work, sports, running, pushing or pulling type activities until
you return for your follow up visit.
• No lifting over 10 pounds for 2 weeks.
• You may drive when you are no longer taking prescription
pain mediation.
• Do NOT sleep or lie on the access arm.
• Do NOT wear tight clothing over the access arm.
• Do NOT carry a purse, bags or plastic grocery bags on
the access arm.
• Do NOT wear a watch or jewelry on your arm until healing
is complete and the swelling is completely gone.
• Do NOT let anyone draw blood samples or take a blood
pressure reading on the access arm.
Wound Care [NURWND0015] Routine, • Keep the incision site clean and dry.
• Sutures are usually left in place for about 2 weeks. After
they are removed you may resume tub baths or shower.
• The dressing will be changed at your doctor's
appointment or by your dialysis nurse.
• A small amount of oozing from the incision the first 24
hours is normal. If bleeding seems excessive, apply light
pressure where it is bleeding and contact your surgeon.
• If you are currently receiving dialysis treatments and the
bleeding occurs please contact your nephrologists on call.
Nutrition [197581]
Diet [NUT0006] Routine
Diet: Other (Comment Required)
General:
Liquids and Modified Consistency:
Fluid Restriction:
Sodium:
Dysphagia:
Fat:
Renal:
Potassium:
Page 6 of 8
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:04:55 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

Micronutrients:
Infant Formula Product:
Infant Formula Concentration:
• You can return to your usual diet as soon as you are ready.
• Avoid drinking alcohol for 24 hours or if taking narcotic pain
medications.
Wound/Drain Care [197582]
IV Site [NURWND0015] 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.
Medication Instructions [197488]
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine,
• Pain medications may be prescribed by your physician.
• Taking the pain medications with food may prevent an upset
stomach.
• Stool softeners and/or a mild laxative may also be ordered.
• Resume your usual daily medications as directed.
• If taking aspirin or aspirin-type products, check with your
physician before resuming them.
No more than 4 grams of acetaminophen per 24 hour
period [NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine
No Post Operative Medications Prescribed
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine
When to Call Your Surgeon [197583]
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.
• Foul smelling or excessive bloody drainage
• Increased pain that is not relieved by medication
• Constipation lasting longer than two days.
• You have an elevated temperature (greater than 101.5
degrees) for 2 consecutive readings 4 hours apart.
• You have any questions
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 [132815]
Schedule Appointment at 1 South Park Street - General
Surgery [NURCOM0026]
Routine
Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty: 1 South Park Street - General
Surgery
Which Provider (Optional):
1 South Park Street
Page 7 of 8
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:04:55 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

Madison, WI
(608) 287-2100
Schedule Appointment - Other [NURCOM0026] Routine
Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty:
Which Provider (Optional):
Nurse will call patient for follow up in 5-7 days
[NURCOM0083]
This order should be used by providers to communicate
appointment instructions directly to the patient. This order will
appear on the After Hospital Care Plan. This orders does
NOT go to the HUC for follow-up. If you would like the HUC
to schedule an appointment, you should use the Schedule
Appointment order., Routine
Keep Previously Scheduled Appointment
[NURCOM0083]
This order should be used by providers to communicate
appointment instructions directly to the patient. This order will
appear on the After Hospital Care Plan. This orders does
NOT go to the HUC for follow-up. If you would like the HUC
to schedule an appointment, you should use the Schedule
Appointment order., Routine
Page 8 of 8
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:04:55 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