/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-98490-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 – Plastic Surgery – Breast – Adult – Postoperative [4978]

MSC – Plastic Surgery – Breast – Adult – Postoperative [4978] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Madison Surgery Center


MSC - Plastic Surgery - Breast - Adult - Postoperative [4978]
PostOp/Phase II
Do NOT order phase II medications for cases involving anesthesia.
Vital Signs [133048]
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 [133050]
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
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 - Antiemetics [133769]
ondansetron (ZOFRAN) 4 MG tab [45939] 5 tab, 0, 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
Medications - Prescriptions - Anti-infectives [133054]
amoxicillin-clavulanate (AUGMENTIN) 500-125 MG per
tab [70052]
20 tab, 0, starting 1/14/16, Normal
cephalexin (KEFLEX) 250 mg cap - 3x/d-7d [44594] 21 cap, 0, starting 1/14/16 until 1/21/16, Normal
clindamycin (CLEOCIN) 300 mg cap - 3x/d-7d [44723] 21 cap, 0, starting 1/14/16 until 1/21/16, Normal
Medications - Prescriptions - Non Categorized [133053]
MethylPREDNISolone (MEDROL, PAK,) 4 MG TABS
[39614]
1 Kit, 0, starting 1/14/16, Normal
diazepam (VALIUM) 5 mg tab - q6-8hp #15 [36679] 15 tab, 0, starting 1/14/16 until 2/13/16, Normal
Outpatient Discharge Orders (Discharge Instructions)
Page 1 of 6
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:12:22 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

Discharge Instructions - Procedure Specific [133056]
Augmentation Mammoplasty [128907]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • Twinges or shooting pains in the nipple are
normal and can last 3-4 weeks. Muscles also go into
spasm after surgery. This can cause some discomfort and
un-natural looking breasts. This will decrease in 3-4 weeks.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• Keep your head elevated as much as possible for 24-48
hours to help reduce swelling and discomfort. A lounger is
a good place to rest. If you lay on a sofa or bed, use a
couple of pillows to elevate head and chest. Keep legs
elevated to avoid getting light-headed.
• Breast exercises need to be done; they will be explained
to you by your physician at one of your post-op visits.
• Avoid heavy lifting, excessive bending over, jogging,
aerobics, swimming for 2-3 weeks after surgery. If you feel
good and want to begin these earlier, consult with your
doctor during your next office visit.
Wound Care [NURWND0015] Routine, • Watch for any unusual sudden bleeding
(dressing and ace bandage saturated with bright red blood)
and/or swelling. The breast should feel soft to the touch. If
one side should get more swollen, hart to touch and
extremely painful, CALL AT ONCE.
• Keep ace/bra on at home until your next visit. Remember
when your dressing first comes off, you breasts will be
swollen and unnatural looking. This swelling will gradually
decrease the next 3-4 weeks. Your breasts will look more
natural as time goes on, usually within 3-6 weeks.
• Do NOT wear underwire bras for 6 weeks to avoid
irritating incision.
• Keep ACE bandage on until office follow-up. Wear
surgical bra for 1 week. Then you will wear a bra during the
day and a 4 inch ace wrap at night to hold the implants
down for 2 weeks after surgery.
• You may use ice packs intermittently over the incision site
for the first 48 hours to decrease swelling and discomfort.
Breast Augmentation [128908]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • If you have a dressing, you may see some
bloody drainage up to the size of a quarter. There may also
be a small amount of swelling. If there is excessive
bleeding, call your surgeon.
• Do not become overly concerned if you notice decreased
sensation in your nipples. The sensation usually returns to
normal in a few weeks to a month.
• You may hear a sloshing sound in the breasts if you had
saline implants. This is caused by the fluid and air in the
implants. This will stop within a week.
Activity [NURACT0008] Routine
Discharge Activity:
• Keep your head elevated as much as possible for the first
48 hours to help reduce swelling and discomfort. A lounger
is a good place to sleep and rest. Use extra pillows while
you lie in bed to elevate your head and chest.
• Stay quiet, resting the first 24 hours. Excessive activity
may cause you to bleed. You may gradually increase your
activities as tolerated. Do not do any activities that cause
strenuous use of your arms such as pushing, pulling,
vacuuming, or reaching above your head for the first 2
Page 2 of 6
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:12:22 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

weeks.
• Avoid any strenuous exercise, swimming, running, or
lifting more than 10 pounds for the first 2 weeks.
• Do not drive for the first 2 days, or while taking narcotics.
Wound Care [NURWND0015] Routine, • Continue wearing the surgical bra for 24 hours
(overnight). You may remove it tomorrow to shower and
then put it back on. Wear loose comfortable clothing.
• Do not wear an underwire bra for 2 weeks.
• Look at the surgical area every 4-6 hours for the first day.
Then check your incisions twice daily for any signs of
infection.
• DO NOT massage your breasts. These implants do not
require massage.
• Clean your incisions gently twice a day with mild soap
and water. This will prevent infection and keep the
incisions clear of crusting.
Breast Reduction [128910]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • Pain/Discomfort is common after this surgery
and will last up to a week. You may also have some
numbness and tingling in your hands and fingers for the
next few days.
• You may experience some dizziness the first time you
take the garment off. You need to have someone with you.
Take the garment off slowly while sitting down.
• Bruising is common and may increase before going away
completely.
• Most of your stitches will dissolve. If you have stitches
that need to be removed, this will be done at your post
operative appointment. They may feel prickly at first, this is
normal.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• You should NOT drive today or while taking narcotics.
Even though you may not feel tired, your judgment and
reflexes may be impaired.
• Avoid strenuous exercise for 2 weeks. Slowly increase
your normal activity as you are able. Do not lift more than
10 pounds for 2 weeks.
• No tub baths, swimming or hot tubs for 2 weeks.
Wound Care [NURWND0015] Routine, • You will have a special support bra put on after
surgery. Wear the surgical bra for 2 weeks or until
instructed differently by your surgeon. Do not wear an
underwire bra for 2 weeks.
• You may shower in 24 hours.
• You may have “drains” or tubes placed during surgery to
drain away excess fluid from your breasts. The fluid will
collect in a bulb attached to the tube. These will be
removed in clinic in 1-2 days. Record the amount of
drainage from the drains and bring the results with you to
your clinic visit. You MAY shower with the tubes in.
• Clean incisions gently with soap and water once a day.
• Remove dressings before showering. If you notice a large
steri-strip over the incision leave this in place until this falls
off on its own. Put a thin layer of bacitracin or Vaseline
over the incision twice daily for one week. You may need to
use gauze bandages over the incisions for a few days until
the incisions stop weeping. Wound drainage will be bloody
at first but will turn to a straw color as it decreases in
amount. Once incisions are dry you do not need to use
bandages.
• Ice packs should be used for the first 48 hours over the
incision site to help reduce swelling and discomfort.
Page 3 of 6
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:12:22 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

• Change gauze dressings over drain sites when they
become wet.
Gynecomastia [128911]
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 have increased or decreased
sensation in your nipples. The sensation usually returns to
normal in a few weeks to a month.
• Most of your stitches will dissolve. If you have stitches
that need to be removed, this will be done at your post
operative appointment. They may feel prickly at first, this is
normal.
• Swelling and bruising is common and may increase
before going away completely.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• You may shower 24 hours after your surgery.
• Plan to take it easy for the next week or two.
• You must not drive today or while you are taking pain
medications. Even though you may not feel tired, your
judgment and reflexes may be impaired.
• Avoid strenuous exercise for 3-4 weeks. Slowly increase
your activity. Limit activities that bring your arms over your
head like pulling on clothes or lifting items to shelves for 1-
2 weeks.
• Do not lift anything more than 15 pounds for 2 weeks.
• Do not massage your breasts.
• Sleep with your head elevated for 5 days.
Wound Care [NURWND0015] Routine, • Continue wearing your compression vest or
binder for 24 hours (overnight). Remove the vest for
showering and dressing changes, and then put it back on.
• Clean incisions gently with soap and water once a day.
This will prevent infection and keep the incisions clear of
crusts.
• Vaseline may be applied to keep the skin supple.
• Look at the surgical area every 4-6 hours the first day.
You should change the gauze pads as needed. The
drainage will decrease each day. You may also notice
some swelling, this is normal. If there is excessive bleeding
or swelling (having to change the gauze pads every hour),
then you need to call your surgeon.
• Wound drains, which may have been placed under each
breast, will be removed in the clinic.
• Cold packs should be applied intermittently over the
operative site for the first 48 hours, to reduce swelling and
discomfort.
Mastopexy [128912]
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 have decreased sensation in your
nipples. The sensation usually returns in a few weeks to a
month.
• Most of your stitches will dissolve. If you have stitches
that need to be removed, this will be done at your post
operative appointment. They may feel prickly at first, this is
normal.
• Swelling and bruising is common and may increase
before going away completely.
Activity [NURACT0008] Routine
Discharge Activity:
• You may shower 24 hours after your surgery.
• Plan to take it easy for the next week or two.
• You must not drive today or while you are taking pain
medications. Even though you may not feel tired, your
Page 4 of 6
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:12:22 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

judgment and reflexes may be impaired.
• Avoid strenuous exercise for 3-4 weeks. Slowly increase
your normal activity. Limit activities that bring your arms
over your head like pulling on clothes or lifting items to
shelves for 1-2 weeks.
• Do not lift anything more than 15 pounds for 2 weeks.
• Your surgeon will discuss increasing activity at your post-
op visit.
• Sleep with your head elevated for the first 3-5 days.
Wound Care [NURWND0015] Routine, • Continue to wear the surgical bra for 24 hours
(overnight). Remove the bra for showering and dressing
changes, and then put it back on. DO NOT wear an under
wire bra for 2 weeks.
• Do not massage your breasts.
• Clean incisions gently with soap and water once a day.
This will prevent infection and keep the incisions clear of
crusts.
• Look at the surgical area every 4-6 hours the first day.
You should change the gauze pads as needed. The
drainage will decrease each day. You may also notice
some swelling, this is normal. If there is excessive bleeding
or swelling (having to change the gauze pads every hour),
then you need to call your surgeon.
• Wound drains, which may have been placed under each
breast, will be removed in the clinic.
• Cold packs should be applied intermittently over the
operative site for the first 48 hours to reduce swelling and
discomfort.
Nutrition [197677]
Nursing Communication - Diet [NURDIE0013] Routine, • Do not drink alcohol for 24 hours after your surgery
or while you are taking narcotics (pain medications).
• Increase your diet as tolerated. Eat a well balanced diet and
drink plenty of fluids. A healthy diet helps wound healing after
surgery.
Wound/Drain Care [132822]
IV Site Care [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 you
Doctor/Nurse if this does not get better in 1-2 days or if gets
worse.
Medications at Home [197678]
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine,
• Take your pain medications as directed by your doctor. Do
not drive while taking pain medication.
• Most narcotic pain medications may cause constipation. We
recommend that you take a daily stool softener (ie. Docusate
sodium) while taking the pain medication. If you continue to
have problems with constipation you may also try a dulcolax
suppository or Miralax daily until you are able to move your
bowels. All of these medications may be purchased without a
prescription at your local pharmacy. Increasing your fluid
intake and activity level may also help.
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 postoperative medication 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 [197679]
When to Call Your Surgeon [NURCOM0079] Please complete in PATIENT FRIENDLY terms. This order
Page 5 of 6
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:12:22 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.
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, • Excessive bleeding.
• Persistent nausea and vomiting.
• Pain not relieved with pain medication.
• Fever over 101.5° F (by mouth) for two readings taken four
hours apart.
• Problems urinating or emptying your bladder.
• Incision or drain sites become more painful, swollen, red
and/or feel warmer than usual.
• Severe Chest Pain or Shortness of Breath - Call 911.
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 [133055]
Schedule Appointment at UW Hospital and Clinics
[NURCOM0056]
Routine
Purpose:
With whom:
For when:
UW Hospital and Clinics
600 Highland Avenue
Madison, WI
(608) 263-7502
Schedule Appointment at UW Health - 1 S. Park Clinic
[NURCOM0056]
Routine
Purpose:
With whom:
For when:
UW Health Clinic
1 S. Park St.
Madison, WI 53715
Phone: (608) 287-2000
Page 6 of 6
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:12:22 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