/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-98492-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 – Urology – Adult – Postoperative [4952]

MSC – Urology – Adult – Postoperative [4952] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Madison Surgery Center


MSC - Urology - Adult - Postoperative [4952]
Documentation
Progress Notes [1731]
Note Dictated NOTE DICTATED
Post-Op Phase II
Do NOT order phase II medications for cases involving anesthesia.
Vital Signs [133136]
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
Analgesics (Opiod) (Single Response) [132396]
hydrocodone-acetaMINOPHEN (NORCO) 5-325 MG per
tab RANGE [750021]
1-2 tab, Oral, ONCE PRN For 1 Doses, pain, Severe pain
No more than 4 grams acetaminophen per 24 hours for adults
or 15mg/kg per dose for peds <40kg
Post-Op/Phase II
oxycodone tab RANGE [750032] 5-10 mg, Oral, ONCE PRN For 1 Doses, pain, Severe pain,
Post-Op/Phase II
oxycodone-acetaminophen (PERCOCET) 5-325 mg per
tab RANGE [750033]
1-2 tab, Oral, ONCE PRN For 1 Doses, pain, Severe pain
No more than 4 grams acetaminophen per 24 hours for adults
or 15 mg/kg per dose for peds <40kg
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) [132401]
hydrocodone-acetaMINOPHEN (NORCO) 5-325 MG per
tab [71425]
50 tab, , starting 1/14/16, Normal
oxycodone 5 MG tab [45976] starting 1/14/16, Normal
oxycodone-acetaMINOPHEN (PERCOCET) 5-325 MG
per tab [40668]
50 tab, , starting 1/14/16, Normal
Medications - Prescriptions - Analgesics (Non-opioids) [195863]
ibuprofen (MOTRIN) tab RANGE [750024] 200-800 mg, Oral, EVERY 6 HOURS PRN, pain, Mild pain,
Phase II Discharge
Medications - Prescriptions - Bowel Management [129457]
senna-docusate (SENOKOT-S) 8.6-50 mg per tab - 2t 28 tab, 0, starting 1/14/16, Normal
Page 1 of 12
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Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
01/2016Lee Vermeulen, CCKM@uwhealth.org

2x/d - NOTE: Order if opioids are prescribed [60530]
Medications - Prescriptions - Anti Infectives - Order clindamycin if patient if patient is allergic to penicillin [132423]
cephalexin (KEFLEX) 500 MG cap [44594] 12 cap, 0, starting 1/14/16, Normal
ciprofloxacin (CIPRO) 500 MG tab [61500] 6 tab, 0, starting 1/14/16, Normal
ciprofloxacin (CIPRO) 750 MG tab - Note: Order for
patients >160kg [61501]
6 tab, 0, starting 1/14/16, Normal
clindamycin (CLEOCIN) 150 MG cap [35962] starting 1/14/16, Normal
Outpatient Discharge orders (Discharge Instructions)
Discharge Instructions - Procedure Specific [133142]
Circumcision / Penile Surgery [132578]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• DO NOT drive for 24 hours or while taking narcotic pain
medications.
• You can return to work or school tomorrow, and you can
resume your usual activities as you feel like it.
• Sexual intercourse may be resumed in 6 weeks and when
incisions are fully healed.
Diet [NURDIE0013] Routine, • You may resume your normal diet as tolerated.
Most people prefer a light meal on the day of surgery.
• DO NOT drink alcohol for 24 hours or while taking
narcotic pain meds.
Wound Care [NURWND0015] Routine, • You can remove dressing in *** hours
• Use ice pack for 24-48 hours intermittently
• You can shower in 24-48 hours
• You may loosen dressing as needed
• If dressing fall off, there is no need to call surgeon
• Bacitracin may be placed at wound site
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • The amount of discomfort you may feel varies
from person to person.
• Take prescribed pain medication as directed by your
physician.
• You may resume your normal medications.
• Check with your physician before using aspirin, ibuprofen
or other blood thinners.
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, • Pain is not relieved by rest, ice and medication
• Increased redness, swelling, discharge, or drainage from
your incision
• Increased bleeding/blood clots in urine
• Difficulty or inability to urinate
• Burning /pain with urination, not relieved by increasing
fluids
• Elevated temperature above 100 degrees
• Call if you have any questions or problems.
Vaginal Surgery [138488]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, POST-OPERATIVE INFORMATION FOR
PATIENTS WHO HAVE RECENTLY UNDERGONE
VAGINAL SURGERY
• Congratulations on recently completing your vaginal
surgery. Once the catheters and bandages have been
removed, you should understand that healing is still in
process. It often takes several weeks before normal
bladder function returns. It is common for many patients to
experience symptoms of urgency and frequency and some
mild leakage for some time after surgery. Still, if this is
extraordinary, please contact your physician's office.
Page 2 of 12
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:13:52 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

COMMON POST OPERATIVE SYMPTOMS
• Vaginal Drainage or Discharge:
- Discharge is normal for several weeks after surgery.
- It is normal to have small amounts of spotting of blood. -
If the drainage is thick, yellow, or green and has a bad
odor, it may signify an infection and the office should be
called so it can be examined.
- Occasionally, you may notice some small sutures passing
vaginally. They are absorbable and this is part of the
normal healing process.
• Spasms, Pressure, Urgency:
- A variety of symptoms like this may occur and may simply
be part of the healing process of the bladder after surgery.
If this is extraordinary, then please contact your
physician's office.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• No heavy lifting (i.e. over 10 pounds) until OK with your
physician.
• No high impact exercise for at least 6 weeks after
surgery.
• You may return to work when you feel up to it; however,
generally, after 2 to 4 weeks from the date of your surgery.
• Refrain from any sexual activity for 6 weeks after surgery
and then use water soluble lubricants for a short time when
you resume sexual relations. Most discomfort that is
experienced early improves with time; however, report any
long-standing discomfort to your physician.
• You must abstain from driving a car or operating
machinery while taking narcotic (i.e. Percocet, Darvocet,
Vicodin, oxycodone) pain medications.
Diet [NURDIE0013] Routine, • Resume a regular diet and maintain a good
overall fluid intake.
Wound Care [NURWND0015] Routine, • Remove dressing and replace with a clean
dressing after shower. Avoid prolonged tub baths as they
submerge the incisions under water and may not allow
optimal healing.
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, • Vaginal discharge with an odor
• Bright red vaginal bleeding greater in quantity than a
typical period
• Temperature greater than 101.5 degrees (38.5 C)
• Persistent vomiting
• Worsening pain not relieved by prescription pain
medication
Cystoscopy / Bladder Biopsy [131207]
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 some stinging or burning the first
few times you urinate.
• Drinking an increased amount of fluid will help to
eliminate this.
• You may notice some blood in your urine.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• Limit your activity the first 24 hours to allow the
medication to wear off, then resume your normal activities.
• Do not drive for 24 hours.
Diet [NURDIE0013] Routine, • You may resume your normal diet as tolerated.
• Most people prefer a light diet on the day of surgery.
• Increase the amount of liquids you drink - aim for 1 glass
of fluid per hour for the next few days.
Page 3 of 12
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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

• Do not drink alcoholic beverages for 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, • You can resume your usual medications.
• Check with your physician before using aspirin, ibuprofen
or other blood thinners.
• Take your prescribed pain medication as directed by
your physician.
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, • Pain is not relieved by rest, ice and medication
• Increased redness, swelling, discharge, or drainage from
your incision
• Increased bleeding/blood clots in urine
• Difficulty or inability to urinate
• Burning /pain with urination, not relieved by increasing
fluids
• Elevated temperature above 101.5 degrees
• Call if you have any questions or problems
Microsurgical Denervation of the Spermatic Cord
[132579]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• During your recovery, your body will be expending energy
to heal itself. You may 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.
• Strenuous housework like 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.
• You need to consult with your surgeon about returning
back to work.
• Sexual activity can be resumed when you are feeling
physically able, but avoid straining.
• Any incisional pain indicates too much stress/straining
against the incision.
• 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, • You can return to your usual diet as soon as you
are ready.
• Avoiding constipation is important as it may cause
incisional strain.
• Your diet should include fruits, vegetables, and plenty of
fluids.
Wound Care [NURWND0015] Routine, • You may notice scrotal swelling. However, if
there is significant discomfort, please call your doctor's
office.
• After 24 hours you can remove the dressing and
shower.You may leave the dressing off or 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.
• "Steri-Strips" will be present on the skin underneath your
Page 4 of 12
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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

dressing. These typically fall off on their own after about a
week.
•• You should use ice for about the first 24-48 hours
intermittently to help decrease discomfort.
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 you are using aspirin, ibuprofen or blood
thinners. You will need to check with your surgeon prior to
resuming these medications.
• Take your prescribed pain medications as directed by
yoru physician.
• If pain medication has been prescribed, take as directed.
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, • Pain is not relieved by rest, ice and medication
• Increased redness, swelling, discharge, or drainage from
your incision
• Increased bleeding/blood clots in urine
• Difficulty or inability to urinate
• Burning /pain with urination, not relieved by increasing
fluids
• Elevated temperature above 101.5 degrees
• Call if you have any questions or problems.
Microsurgical Varicocelectomy [132618]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• During your recovery, your body will be expending energy
to heal itself. You may 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.
• Strenuous housework like 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.
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.
• 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.
• Any incisional pain indicates too much stress/straining
against the incision.
• 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.
Wound Care [NURWND0015] Routine, • You may notice scrotal swelling. However if
there is significant discomfort, please notify your surgeon.
• After 24 hours you can remove the dressing and shower.
You may leave the dressing off or 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.
• "Steri-Strips" will be present on the skin underneath your
dressing. These typically fall off on their own after about a
week.
• You should use ice for the first 24-48 hours to help
decrease discomfort.
Page 5 of 12
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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

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 you are using aspirin, ibuprofen or blood
thinners. You will need to check with your surgeon prior to
resuming these medications.
• Take your prescribed pain medications as directed by
your physician.
• If pain medication has been prescribed, take as directed.
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, • Pain is not relieved by rest, ice and medication
• Increased redness, swelling, discharge, or drainage from
your incision
• Increased bleeding/blood clots in urine
• Difficulty or inability to urinate
• Burning /pain with urination, not relieved by increasing
fluids
• Elevated temperature above 101.5 degrees
• Call if you have any questions or problems.
Microsurgical Vasosvasostomy or Epididymovasostomy
[132620]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• You SHOULD NOT drive today. Even though you may
not feel tired, your judgment and reflexes may not be
normal.
• It is imperative that you be extremely careful following
your vasectomy reversal. In general, this means protecting
the testicles and scrotum for at least a period of three (3)
weeks.
• No jogging, running, or playing physical sports for at least
three (3) weeks.
• No sexual intercourse for 2 weeks.
• It is then important to resume regular sexual activity after
the two weeks of abstinence.
• No other physical activities where the testicles would
move up and down.
• You may resume work about one week after your
surgery, taking into account the restriction on your physical
activity.
• DO NOT drive if you are taking narcotic pain medications.
Diet [NURDIE0013] Routine, • Do NOT drink alcohol for 24 hours after your
surgery or while taking narcotics.
• You may resume your normal diet as tolerated.
Wound Care [NURWND0015] Routine, • You should wear a jock strap or scrotal support
for three (3) weeks after surgery.
• Ice should be applied intermittently on the scrotum for
approximately 48 hours to cut down on the amount of
bleeding and swelling that you might have.
• Remove your dressing and shower after 24 hours
• Use 4x4 gauze dressings as needed.
• Shower daily
• No tub bathing until incisions are fully healed.
• Sutures will dissolove on their own after about 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, • You can resume your usual medications.
• Check with your physician before using aspirin, ibuprofen
or blood thinners.
• Take your prescribed pain medications and antibiotics as
directed by your physician.
• You will be given a prescription for a narcotic pain
medication to take as needed. You may use
Page 6 of 12
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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

Acetaminophen instead of the prescribed pain medication
but do NOT take both, since the narcotic pain medication
also contains acetaminophen.
Post Operative Office Visits [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • You next post-operative visit is at 6 weeks at the
Generations Fertility Care clinic. You will be asked to bring
in a semen sample the day of your visit, or you may
perform a semen analysis in a private collection room in
the clinic on the day of your visit. You may also bring in a
semen sample to the clinic the week prior to your visit.
If you choose to perform a semen sample at home (instead
of in the clinic), it is imperative that you bring the semen
sample to the Generations Fertility Care clinic. The hours
for drop off are 8am-4:30pm. Call the clinic ahead of time
at (608) 824-6160 to confirm that the office is open and
that someone is there to pick up your sample. The sample
must be delivered within one hour after ejactulation so teh
results will be accurate.
If the drive makes it difficult to get to the clinic within one
hour, please call the office, adn we will arange for you to
use a private collection room at your convenience.
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, • Pain is not relieved by rest, ice and medication
• Increased redness, swelling, discharge, or drainage from
your incision
• Increased bleeding/blood clots in urine
• Difficulty or inability to urinate
• Burning /pain with urination, not relieved by increasing
fluids
• Elevated temperature above 101.5 degrees
• Call if you have any questions or problems.
Scrotal and Testicular Surgery [132623]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• Resting in bed or on the couch is essential for 48 hours. •
You may be up for necessary activities only. You may
resume showering in 24 hours.
• Sexual intercourse may be resumed in 3 days.
• DO NOT drive for at least 24 hours after taking pain
medication.
Diet [NURDIE0013] Routine, You may resume your usual diet as tolerated
Wound Care [NURWND0015] Routine, • Keep the incision dry for 24 hours.
• You may shower after 24 hours.
• No dressing is necessary after 24 to 48 hours.
• If you have a drain (also called a "Penrose" drain),
change your dressings as necessary, and check with your
doctor about when the drain is to be removed.
• Scrotal supporter should be worn for at least 2 weeks.
• Sutures will not need to be removed as they dissolve on
their own after about 1 weeks.
• Ice should be applied to the scrotum for 48 hours (20-30
minutes on, 20-30 minutes off - you do not need to apply
when sleeping).
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • The amount of discomfort you may feel varies
from person to person and from surgery to surgery.
• Pain medication may be ordered for you to take at home.
Resting (as described below), will also help to decrease
the swelling, thus keeping you more comfortable.
Page 7 of 12
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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

• You can resume your usual medications.
• Check with your physician before using aspirin, ibuprofen
or blood thinners.
• Take your prescribed pain medication as directed by your
physician.
• Antibiotics may be prescribed - take as instructed.
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, • Pain is not relieved by rest, ice and medication
• Increased redness, swelling, discharge, or drainage from
your incision
• Increased bleeding/blood clots in urine
• Difficulty or inability to urinate
• Burning /pain with urination, not relieved by increasing
fluids
• Elevated temperature above 101.5 degrees
• Call if you have any questions or problems.
Transurethral Resection of Bladder Tumore (TURBT)
[132624]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
During the first week at home.
• Do not lift anything weighing more than 5 pounds.
• No strenuous activities (i.e. aerobics, jogging, swimming).
• Limit stair climbing to 1-2 times per day.
• No sexual activity.
• Do not drive until okay with your doctor.
During the second week at home
• You may gradually increase your activity, but rest when
you get tired.
• Do not overexert yourself.
• You may resume sexual activity after the second week.
• You may drive if you are not taking prescription pain
medication and if it is okay with your doctor.
You may return to work during the third week or when your
doctor allows.
Diet [NURDIE0013] Routine, • Drink plenty of fluids, 10-12 (8-oz) glasses per
day
• Gradually resume your normal diet.
• You can prevent constipation by drinking fluids and
adding fruit and vegetables to your diet.
• DO NOT drink alcohol for 24 hours or while taking
narcotic pain meds.
Wound Care [NURWND0015] Routine, • Your urine may be bloody, but it should clear 2-4
days after you are home. Blood in your urine may last up to
4-6 weeks after your surgery.
• You may have some irritation and burning with urination.
• Avoid letting your bladder get too full; it will increase the
pressure in your bladder.
• Avoid straining and constipation; increased pressure can
cause more bleeding.
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 prescribed, when
needed.
• Stool softeners or a mild laxative may be prescribed by
your doctor.
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, • Pain is not relieved by rest, ice and medication
• Increased redness, swelling, discharge, or drainage from
your incision
Page 8 of 12
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:13:52 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

• Increased bleeding/blood clots in urine
• Difficulty or inability to urinate
• Burning /pain with urination, not relieved by increasing
fluids
• Elevated temperature above 101.5 degrees
• Call if you have any questions or problems.
Discharge Instructions - Vasectomy [132625]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• You should NOT drive today. Even though you may feel
tired, your judgement and reflexes may not be normal.
• Rest for 24-48 hours.
• Gradually increase activity after 24-48 hours.
Diet [NURDIE0013] Routine, • Do NOT drink alcohol for 24 hours after your
surgery or while taking narcotics.
• You may resume your normal diet as tolerated.
Wound Care [NURWND0015] Routine, • Apply ice pack to the scrotum for 24-48 hours
intermittently.
• Utilize scrotal support for 1 week and then tight,
supportive underwear for 2-4 weeks.
• Shower as desired. Clean incisions with soap and water.
No tub baths for 2 weeks.
• Apply bacitracin or triple antibiotic ointment to incisions,
1-2 times daily for 1 week.
• No intercourse for 1 week. No unprotected intercourse
until negative result is obtained.
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, except for blood thinners, unless your
physician instructs you differently. Please check with your
physician when to resume your Coumadin, Plavix, or
aspirin (if you take any of these medications).
• Take Acetaminophen: 2 tablets every 4 hours as needed
for mild pain. DO NOT TAKE ASPIRIN OR IBUPROFEN.
• A prescription for Tylenol with codeine or Hydrocodone
with Acetaminophen will be given. Take as directed if your
pain is not controlled by Tylenol, however do NOT take
both Tylenol and Hydrocodone/Acetaminophen or Tylenol
and Tylenol/Codeine.
Collection of Semen Samples After Vasectomy
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, 1. One specimen must be examined after 3
months from the date of your surgery
• One negative sample must be obtained before use of
contraceptives can be discontinued. If sperm are detected,
additional samples must be collected until negative results
are obtained.
2. Collect specimen directly into the sterile container given
to you at the time of your surgery. The specimen may be
collected by masturbation or coitus interruptus. Do not use
a condom.
3. Specimens must be delivered to the lab as soon as
possible and no more than 1 hour after collection. Keep
specimen at body temperature and ensure the lid is
securely fastened on the container.
4. Specimens are accepted at UW Health Lab locations
listed on the attached sheet, Monday - Friday from 8:30am
- 4:30pm.
5. Results will be available the next day by calling UW
Page 9 of 12
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:13:52 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

Health Urology (608) 287-2900.
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, Call your physician at 608-287-2900 for:
• Pain that is not controlled with Tylenol, Tylenol with
codeine, or Hydrocodone/Acetaminophen.
• Swelling of golf ball size or greater
• Unusual warmth or redness of scrotum
• Any drainage from incisions other than clear or blood
tinged
• Fever of 101.5 degrees or greater
Tension Free Vaginal Tape Sling [132896]
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
Page 10 of 12
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:13:52 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

SIGNS OF INFECTION:
1) Increased lower abdominal tenderness
2) Purulent (pus) or foul-smelling drainage
3) Elevated temperature greater than 101.5
Prostate Biopsy Procedure [196068]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • Initially, you may have blood dripping from the
penis. You will be provided with a pad. Pad should not be
saturated with blood and you should not need additional
pads.
• You may experience burning or pressure in rectum, blood
in urine and stool which should resolve in the next several
days. Blood in urine may be pink to bright red.
• May have blood in semen for 2-3 months. May be red to
brown in color.
• Dr. Graf will call you with results ***. Follow up in clinic
will be baed on results
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• No heavy lifting, strenuous activity for remainder of today
as it may increase bleeding.
Diet [NURDIE0013] Routine, • Increase fluid intake for next several days.
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care Plan.,
Routine, • Please hold aspirin and other medications listed
on "Medications to avoid" list for another 5-7 days.
When to Call Your Doctor [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, • If fever, chills, significant bleeding or problems
passing uring please call clinic. 608-287-2900
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.
Wound Care - Other [NURWND0015] Routine
Medications at Home [196074]
Bowel Management [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine,
• Due to the use of anesthetics and narcotics during and after
surgery, patients often experience constipation
postoperatively. Therefore it is highly recommended to start
taking an over-the-counter stool softener/laxative preparation
such as colace, docusate, pericolace/senna, or miralax -- per
specific instructions, prophylactically following surgery for
about 2 weeks.
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
Take additional ciprofloxacin tablet as instructed
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine
Other Discharge Instructions [132573]
Discharge Home with Foley Catheter [NURCOM0022] Routine
Contact Information [135666]
Page 11 of 12
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:13:52 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

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 [132402]
Schedule Appointment at Generations [NURCOM0056] Routine
Purpose:
With whom: Generations Fertility Care
For when:
Generations Fertility Care
2365 Deming Way
Middleton, WI 53562
(608) 824-6160
Schedule Appointment at UW Hospital and Clinics -
Urology [NURCOM0056]
Routine
Purpose:
With whom: UW Hospital and Clinics - Urology
For when:
UW Hospital and Clinics
600 Highland Avenue
Madison, WI
(608) 263-4757
Schedule Appointment at 1 South Park Street - Urology
[NURCOM0056]
Routine
Purpose:
With whom: 1 South Park Street - Urology
For when:
1 South Park Street - Urology
Madison, WI
(608) 287-2900
Schedule Appointment at Madison Surgery Center
[NURCOM0026]
Routine
Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty: Madison Surgery Center
Which Provider (Optional):
1 South Park Street
Madison, WI
(608) 287-2200
Page 12 of 12
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:13:52 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