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201606170

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

MSC – Gynecology – Adult – Postoperative [4964]

MSC – Gynecology – Adult – Postoperative [4964] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Madison Surgery Center


MSC - Gynecology - Adult - Postoperative [4964]
Post-Op/Phase II
Do NOT order phase II medications for cases involving anesthesia
Vital Signs [132588]
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
Prior To Discharge [132589]
Voiding Trial [NURELM0023] CONTINUOUS, Routine, Back fill bladder with 300 mL normal
saline, then discontinue foley. Prompt the patient to void and
record urine output. Notify MD of result., Post-Op/Phase II
May discharge without voiding [NURCOM0022] ONCE, Post-Op/Phase II
Discontinue Foley [NURCOM0022] ONCE, Post-Op/Phase II
Discharge home with Foley catheter (leg bag)
[NURCOM0022]
ONCE, 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 (Opioid) (Single Response) [132429]
hydrocodone-acetaMINOPHEN (NORCO) 5-325 MG per
tab [71425]
20 tab, , starting 1/14/16, Normal
oxycodone 5 MG tab [45976] 20 tab, , starting 1/14/16, Normal
oxycodone-acetaMINOPHEN (PERCOCET) 5-325 MG
per tab [40668]
20 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 [129457]
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
Outpatient Discharge Orders (Discharge Instructions)
Procedure Specific [135644]
Conization of the Cervix and/or LEEP [132831]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
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•You may resume your usual daily activities including
returning to work as soon as you feel like it.
•Avoid heavy lifting and vigorous exercise for 1 week
•Do NOT drive a vehicle for 24 hours.
Diet [NURDIE0013] Routine, • As soon as you feel like it, you may eat any food
or drink that you desire. Most people eat light food on the
day of the surgery.
• NO alcohol for 24 hours following surgery.
Wound Care [NURWND0015] Routine, •Vaginal discharge may continue for several
weeks. There should be a decreasing amount of drainage.
•Nothing in the vagina for 6 weeks and this includes
intercourse, tampons and douches.
•You may have slight vaginal bleeding and mild cramping.
•Showering is permitted anytime, and bathing can resume
in 1 week.
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine
Endometrial Ablation [196977]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• You may feel faint or nauseated
• You may resume normal activity as you are able
• Call your physician if your period is more than five days
late.
• No driving or operating machinery for 24 hours.
Diet [NURDIE0013] Routine, • You may resume your usual diet as soon as you
are ready.
• DO NOT drink alcohol for 24 hours or if using narcotics.
Wound [NURWND0015] Routine, • Showering is permitted at any time.
• Spotting or light bleeding is normal. If bleeding becomes
heavy and/or bright red color; or you are concerned, please
contact your physician.
• Nothing in the vagina for *** {DAYS/WEEKS:16512}. This
includes intercourse, tampons and douches.
• You MUST stay on some type of contraception (birth
control to prevent pregnancy) until after your 4 month HSG
test.
• Call your physician if your period is more than five days
late.
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • You may experience some cramping after
surgery, if your doctor gave you a prescription for pain
medication, use as directed.
• If no contraindications you may use Ibuprofen for
discomfort.
Essure Procedure [132832]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• You may feel faint or nauseated
• You may resume normal activity as you are able
• Call your physician if your period is more than five days
late.
• No driving or operating machinery for 24 hours.
Diet [NURDIE0013] Routine, • You may resume your usual diet as soon as you
are ready.
• DO NOT drink alcohol for 24 hours or if using narcotics.
Wound [NURWND0015] Routine, • Showering is permitted at any time.
• Spotting or light bleeding is normal. If bleeding becomes
heavy and/or bright red color; or you are concerned, please
contact your physician.
• Nothing in the vagina for *** {DAYS/WEEKS:16512}. This
Page 2 of 6
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:05:43 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

includes intercourse, tampons and douches.
• You MUST stay on some type of contraception (birth
control to prevent pregnancy) until after your 4 month HSG
test.
• Call your physician if your period is more than five days
late.
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • You may experience some cramping after
surgery, if your doctor gave you a prescription for pain
medication, use as directed.
• If no contraindications you may use Ibuprofen for
discomfort.
Post Operative Office Visit [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • IN 3 MONTHS: You will need to visit your
physician to have an evaluation including a test called a
hysterosalpingogram (HSG). The evaluation is performed
to make sure both that both of your tubes are blocked.
• You must use another form of contraception until your
physician tells you that you can rely on the Essure for
contraception.
• If you rely on Essure for contraception before completing
this evaluation, you may get pregnant, or have an ectopic
pregnancy (pregnancy outside your uterus, but inside the
body). Ectopic pregnancies can be life-threatening.
General Gynecology [132834]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• You may resume normal activity as you are able.
• You should NOT drive your vehicle today.
Diet [NURDIE0013] Routine, • As soon as you feel like it, you may resume your
usual diet. Most people prefer light, bland foods the day of
surgery.
• Alcohol should be avoided for 24 hours and while taking
pain medication.
• Drink plenty of fluids - start slowly with small amounts.
Wound Care [NURWND0015] Routine, • You may also experience some vaginal
bleeding. The amount varies from patient to patient. There
should be a decreasing, not increasing, amount of
drainage.
• If you saturate more than one pad per hour for 2
consecutive hours call your physician.
• Showering and bathing is permitted at any time.
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • You may experience some pain after surgery.
Your doctor may give you a prescription for pain
medication.
• You may resume your usual mediations unless otherwise
instructed by your physician.
• Taking your pain medication as prescribed can reduce
discomfort. Remember to take your pain medication with
food to prevent an upset stomach.
Hysteroscopy and/or D&C Procedure [132837]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• You may resume normal activity as you are able.
• You should NOT drive your vehicle today or if on
narcotics.
Diet [NURDIE0013] Routine, • You may resume your usual diet as soon as you
are ready.
• Do NOT drink alcohol for 24 hours.
Wound Care [NURWND0015] Routine, • You may also experience some vaginal
Page 3 of 6
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:05:43 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

bleeding. The amount varies from patient to patient. There
should be a decreasing, not increasing, amount of
drainage.
• Showering is permitted at any time. Resume tub bathing
as per your physician's orders.
• Nothing in the vagina for 2 weeks. This includes
intercourse, tampons and douches.
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • You may experience some cramping after
surgery. Your doctor may give you a prescription for pain
medication. Use as directed on the bottle.
• If its ok with your physician you may use Ibuprofen for
discomfort.
Laparoscopic Procedure [132894]
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 incisions will be sore for a
few days, but should gradually improve.
• You may experience neck, chest, or shoulder pain
because of the carbon dioxide gas that was placed into
your abdomen during surgery. Although most of the gas is
removed after surgery, this pain may continue for 24 hours.
Changing your position and/or taking your pain medication
will help decrease this discomfort.
• You may have a sore throat for the first 24 hours following
surgery due to the airway placed in your windpipe to help
your breathe during surgery. Gargling with warm salt water
several times a day will help relieve this irritation.
• You may experience some light bleeding or spotting
because sometimes a device called a uterine manipulator
is placed in the uterus to help perform the procedure. This
bleeding should stop in 1-2 days.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• You can resume your full activity as you are able with the
restriction of not lifting anything greater than 10-15 pounds
for approximately 1 week.
• You should NOT drive your vehicle for 24 hours.
• Intercourse may be resumed whenever you are
comfortable, unless otherwise instructed by your physician.
Diet [NURDIE0013] Routine, • As soon as you feel like it, you may resume your
usual diet. Most people prefer light, bland foods the day of
surgery.
• Alcohol should be avoided for 48 hours and while taking
pain medication.
Wound Care [NURWND0015] Routine, • You may shower in 24-48 hours.
• You may use ice intermittently to help decrease the
incisional discomfort for the first 24-48 hours.
• INCISIONAL CARE: Frequently the stitches are under the
skin and will dissolve with time. The day after your surgery
you may remove your dressings/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 incisions
should be kept clean and dry and changed daily.
• Always wash your hands before and after changing your
dressings/Band-Aids.
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • MENSTRUATION: Generally, there is no change
in menstrual pattern. If you were on birth control pills, finish
your present package without stopping them. There is no
need to use any other form of birth control.
Tension Free Vaginal Tape Sling [132896]
Page 4 of 6
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:05:43 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

What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • You may feel some abdominal discomfort,
soreness of your stomach muscles.
• You may feel occasional bladder spasms initially. They
may last a month or more. There are antispasmodic
medications to help this.
• You may have some light vaginal bleeding for the first
week after surgery.
• 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 the surgery. Gargling with warm
salt water several times a day will help relieve this irritation.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• You should NOT drive or operate any machinery for the
next 24 hours or while taking prescription (narcotic) pain
medication.
• Take it easy for 1-2 days. You will feel tired at first.
• Increase your activities gradually during your first week at
home.
• Avoid strenuous activities and lifting greater than 30
pounds for 2 weeks.
• No bath tubs, hot tubs or swimming for 2-3 weeks
Diet [NURDIE0013] Routine, • As soon as you feel like it, you may resume your
usual diet. Most people prefer light, bland foods the day of
surgery.
• Alcohol should be avoided for 24 hours and while taking
pain medication.
Wound Care [NURWND0015] Routine, • Nothing in the vagina for ***
{DAYS/WEEKS:16512}. This includes intercourse,
tampons and douches.
• Keep the dressings in place and dry for 24 hours. After
this time, you may gently wash the area with soap and
water. Allow the wounds to air dry at least 10 minutes
before covering with a new dressing. Leave steri-strips on,
they will fall off on their own.
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • You may resume your usual medications unless
otherwise instructed by your physician. Taking your pain
medication as prescribed can reduce discomfort.
• Use a non-prescription pain reliever such as ibuprofen for
muscle discomfort.
When to Call Your Surgeon [NURCOM0022] Routine, • Abdominal cramping/pain is not controlled by
prescribed medication.
• If you are uncomfortable due to the inability to urinate.
• Severe nausea and vomiting
• Heavy vaginal bleeding (greater than a pad an hour)
• An opening in your incision.
• If you have any questions
SIGNS OF INFECTION:
1) Increased lower abdominal tenderness
2) Purulent (pus) or foul-smelling drainage
3) Elevated temperature greater than 101.5
Wound Care/Drain Care [196071]
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.
Page 5 of 6
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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

Wound Care - Other [NURWND0015] Routine
Medications at Home [196984]
NO more than 4 grams (4000 mg) 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
When to Call Your Surgeon [196986]
When to Call Your Surgeon [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine,
• Abdominal cramping/pain is not controlled by prescribed
medication
• If you are uncomfortable due to the inability to urinate.
• Severe nausea and vomiting
• Heavy vaginal bleeding (greater than a pad an hour)
• An opening in your incision.
• If you have any questions
SIGNS OF INFECTION:
1) Increased lower abdominal tenderness
2) Purulent (pus) or foul-smelling drainage
3) Elevated temperature greater than 101.5
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.
Schedule Appointment [132919]
Schedule Appointment [NURCOM0056] Routine
Purpose: Post Surgical Follow Up Appointment
With whom:
For when: 2-4 weeks
Please contact the clinic at @ATTENDPH@, Monday-Friday
between 8:00am and 4:30pm to schedule the above
appointment.
Page 6 of 6
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:05:43 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