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MSC – Ophthalmology – Adult – Postoperative [4974]

MSC – Ophthalmology – Adult – Postoperative [4974] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Madison Surgery Center


MSC - Ophthalmology - Adult - Postoperative [4974]
PostOp/Phase II
Do NOT order phase II medications for cases involving anesthesia
Vital Signs [132977]
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
Activities [132978]
Ambulate with Assistance [NURACT0008] CONTINUOUS, Routine
AD LIB:
AMBULATE:
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
Medications - Analgesics [197986]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, EVERY 4 HOURS PRN, pain/fever, Post-
Op/Phase II
Medications - Anti-emetics [132975]
ondansetron (ZOFRAN ODT) disintegrating tab [64224] 4 mg, Oral, ONCE PRN For 1 Doses, nausea/vomiting, First
Line Therapy
Administer if unable to tolerate oral medications. Notify
provider if given to patient.
Post-Op/Phase II
ondansetron (ZOFRAN) injection [132824] 4 mg, Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting, Administer if unable to tolerate oral
medications. Notify provider if given to patient.
Notify provider if given to patient
for 3 Minutes, Post-Op/Phase II
Medications - Non-categorized [197989]
acetaZOLAMIDE (DIAMOX SEQUELS) 12hr ER cap
[75107]
500 mg, Oral, ONCE For 1 Doses, 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 [132974]
ibuprofen (MOTRIN) 200 MG tab [38353] 0, starting 1/14/16, Normal
acetaMINOPHEN (TYLENOL) 325 MG tab [34149] 0, starting 1/14/16, Normal
Medications - Prescriptions - Non-categorized [197991]
acetaZOLAMIDE (DIAMOX SEQUELS) 500 MG 12hr
ER cap [75107]
starting 1/14/16, Normal
Nepafenac 0.3 % SUSP [155621] starting 1/14/16, Normal
Difluprednate 0.05 % ophthalmic emulsion [132748] starting 1/14/16, Normal
Page 1 of 5
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:09:51 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

Outpatient Discharge Orders (Discharge Instructions)
Discharge Instructions - Procedure Specific [132984]
Cataract [132991]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • Your pupil may be dilated up to 24-72 hours
after surgery. Wearing dark glasses may help the eye feel
more comfortable.
• Your doctor will discuss the need for any further eyeglass
prescriptions at your post- operative visit. Wear your old
glasses as needed.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• Avoid strenuous activity, heavy lifting (over 20 pounds)
and bending below the waist for 1 week.
• Exercise (like walking) will not harm the eye if done in
moderation.
• Sexual activities may be resumed as soon as you are
comfortable.
• Depth perception is impaired while wearing an eye patch
and while your pupil is dilated. Be careful on stairs and do
not drive until cleared by your doctor.
• There are no restrictions with using your eye.
• Watching TV, reading, or computer work will not harm the
eye. You may do so if it is comfortable for you.
• Additional instructions may be given to you by your
doctor.
Wound Care [NURWND0015] Routine, • Remove eye shield insert {Shield
Hours:3223602} after surgery and start your prescribed
eye drops.
• Once the eye shield is removed, you no longer need to
wear the shield while awake as long as you keep your eye
protected. Wear the shield at bedtime and when napping
for the next week to protect your eye. Do not sleep on the
operative side for one week.
• You have been given prescriptions for an ANTIBIOTIC
{Ophthalmology Antibiotics:3223600}, and/or STEROID
(Prednisolone), and/or NSAID {Ophthalmology
NSAIDS:3223601}, BEGIN taking these medications after
removal of eye shield. Wait 5 minutes between applying
individual drops. Please follow the directions as printed on
the package of the medication.
• You may shower or bathe as usual. Be careful not to get
soap into the operative eye. Avoid eye makeup for two
weeks after your procedure.
• Additional instructions may be given to you by your
doctor.
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • Continue taking your regular medications unless
otherwise instructed by your doctor.
• Resume any prescribed eye drops for glaucoma in the
operative eye the morning after surgery unless instructed
to hold be your doctor.
• You may have dull pain, aching, burning, itching, or a
scratchy sensation in your eye. Take acetaminophen
("Tylenol") for relief. If "Tylenol" does not control your pain,
call your doctor for instructions.
Eye Muscle Surgery [132993]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• Driving will not be safe for the first two days after surgery
due to blurred vision and, in a few patients, double vision.
Page 2 of 5
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:09:51 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

You may drive if you are free of blurred or double vision.
To play it safe, do not plan to drive for about one week.
• Avoid contact sports for *** days
• Avoid swimming for *** days
• Avoid getting soap or shampoo in the eyes for one week
• There are no restrictions on reading, watching TV,
walking, hiking and other such activities.
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 taking your routine medications,
unless your physician instructs you differently.
Glaucoma Surgery With Implant [132994]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• Do not do any physical activity which makes you strain or
hold your breath.
• Do not lift over 5 pounds.
• Do not bend over from the waist; bend at the knees to
reach low objects.
• You may resume sexual activities in 24 hours
• Be careful for the first few weeks.
• You may shower or bathe in 24 hours.
Wound Care [NURWND0015] Routine, • The patch and shield will stay on the eye for the
first day and night. You will need to see the doctor the next
day and on a regular basis after that.
• Glasses or the eye shield should be worn at all times for
the first few weeks.
• The eye shield should be worn at night to protect the eye.
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • You will be given medicine to help the eye heal
and to prevent swelling and infection at the office
appointment.
• You should stop any glaucoma medicine you were taking
before the surgery. You will be told when to restart them, if
needed.
• Bring all medications and current glasses (if wearing) to
all follow-up appointments.
• You may take acetaminophen (Tylenol) for eye pain as
directed on the label
Ophthalmology General Surgery [133006]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• You may resume normal activity and return to
work/school in *** {DAYS/HRS:10998}.
Wound Care [NURWND0015] Routine, • You may shower or bathe in 24 hours.
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine
Tear Duct Probing [133011]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • You should expect some mild tearing for several
days to one week due to the probing itself. Tearing should
resolve after one week, however. If there is no tearing at
the end of one month, it is very likely that the tear duct will
remain open permanently.
• Some mild bleeding from the nose or the tear duct
opening in the eyelid is not abnormal during the first week.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• Remember that you had a general anesthetic, and you
may continue to notice effects of the anesthetic throughout
Page 3 of 5
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:09:51 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

the day and even into the next morning.
• Normally, there is no need to be in bed after discharge
from the hospital. You may be up and around and may do
quiet tasks throughout the day.
• It is preferable to remain indoors and to stay away from
any type of exertion or strenuous activity for about 3 days
after surgery.
Wound Care [NURWND0015] Routine, • Continue to massage the tear duct 4 times daily
until your postoperative visit in order to keep tears flowing
through the newly opened tear duct.
• If there is any redness or swelling of the lids or eye after
the first postoperative day, Call Dr. Weinstein.
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • If a nose cold occurs before your next visit
(approximately one month after surgery), obtain pediatric
Neo-Synephrine 0.25% nose drops and use one spray
twice daily on the side(s) that had surgery to prevent
swollen nasal tissue from blocking the tear dut.
• Use the Neo-Synephrine for 3 days only, then discontinue
the Neo-Synephrine.
• You may receive antibiotic drops which should be used
twice daily after surgery, then discontinue after one week.
Tear Duct Probing With Intubation [133014]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • Some mild bleeding, either from the nostril or
through the tear duct opening in the lid, is not abnormal
during the first week.
• You may have mild to moderate discomfort for a bout two
days after surgery. Your eye should be comfortable after
that.
• Remember that the lacrimal tubes do not conduct tears
down the tear duct, but only act as a "placeholder" to
prevent the opening of the duct in the nose from closing
after the probing.
• Your first postoperative visit will be one week after the
procedure. Subsequent visits will be once monthly.
• The tubes will be removed in the office at the end of the
four months. This is not painful and only anesthetic eye
drops will be needed.
• The eye may be slightly red on the first day after the
procedure. If there is any redness of the eye or the lids
after that, notify Dr. Weinstein. Also notify Dr. Weinstein if
there is any whiteness of the cornea (the clear part of the
eye covering the iris, or the colored part).
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• Remember that you had a general anesthetic, and you
may continue to notice effects of the anesthetic throughout
the day and even into the next morning.
• Normally, there is no need to be in bed after discharge
from the hospital. You may be up and around and may do
quiet tasks throughout the day.
• It is preferable to remain indoors and to stay away from
any type of exertion or strenuous activity for about one
week after surgery.
Wound Care [NURWND0015] Routine, • Some mild bleeding, either from the nostril or
through the tear duct opening in the lid, is not abnormal
during the first week.
• You may have mild to moderate discomfort for a bout two
days after surgery. Your eye should be comfortable after
that.
• Remember that the lacrimal tubes do not conduct tears
Page 4 of 5
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:09:51 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

down the tear duct, butonly act as a "placeholder" to
prevent the opening of the duct in the nose from closing
after the probing.
• Your first postoperative visit will be one week after the
procedure. Subsequent visits will be once monthly.
• The tubes will be removed in the office at the end of the
four months. This is not painful and only anesthetic eye
drops will be needed.
• The eye may be slightly red on the first day after the
procedure. If there is any redness of the eye or the lids
after that, notify Dr. Weinstein. Also notify Dr. Weinstein if
there is any whiteness of the cornea (the clear part of the
eye covering the iris, or the colored part).
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • You will receive antibiotic drops, which should
be used once daily while the lacrimal tubes are in place.
Wound/Drain Care [133075]
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 you Doctor/Nurse if
this does not get better in 1-2 days or if gets worse.
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 [197903]
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, • an increase in swelling or redness
• an increase in pain or discharge from the eye
• a decrease in vision
• nausea or vomiting
• If you have any other 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.
Page 5 of 5
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:09:51 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