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201712341

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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Ambulatory,Ophthalmology

OP - Oculoplastic Surgery - Adult - Postoperative [2903]

OP - Oculoplastic Surgery - Adult - Postoperative [2903] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Ophthalmology


OP - Oculoplastic Surgery - Adult - Postoperative [2903]
for Adult Patients OnlyIntended
PostOp/Phase II
Analgesics (Single Response) [129016]
hydrocodone-acetaMINOPHEN (NORCO) 5-325
MG per tab [71425]
1 tab, Oral, ONCE PRN For 1 Doses, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
No more than 4 grams acetaminophen per 24 hours
for adults or 15mg/kg per dose for peds <40kg
Post-Op/Phase II
oxycodone-acetaMINOPHEN (PERCOCET)
5-325 MG per tab [40668]
1 tab, Oral, EVERY 4 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
No more than 4 grams acetaminophen per 24 hours
for adults or 15mg/kg per dose for peds <40kg
Post-Op/Phase II
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, ONCE PRN For 1 Doses, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
No more than 4 grams acetaminophen per 24 hours
for adults or 15mg/kg per dose for peds <40kg
Post-Op/Phase II
Anti-emetics [128918]
Adult - Standard - Anti-emetics [241791]
ondansetron (ZOFRAN ODT) disintegrating tab
[64224]
4 mg, Oral, ONCE PRN For 1 Doses,
nausea/vomiting
Use first line agent
Post-Op/Phase II
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting
Use first line if unable to take medications by mouth
or enteral tube OR if immediate effect is needed.
Post-Op/Phase II
prochlorperazine (COMPAZINE) tab [41372] 10 mg, Oral, ONCE PRN For 1 Doses,
nausea/vomiting
Use second line if there is inadequate response to
first line anti-emetic within 30 minutes. If there is no
response to second line therapy within 30 minutes,
notify provider.
Post-Op/Phase II
prochlorperazine (COMPAZINE) injection [41369] 10 mg, Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting
Use second line. Use if there is inadequate
response to first line anti-emetic within 30 minutes
and if unable to take medications by mouth or
enteral tube OR if immediate effect is needed. If
there is no response to second line therapy within 30
minutes, notify provider.
Post-Op/Phase II
Prior to Discharge [92767]
Patient Must Be Seen by Attending Prior to
Discharge [NURMON0083]
ONCE, Starting today For 1 Occurrences, Routine,
Post-Op/Phase II
Page 1 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:26:22 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Patient Must Be Seen by Resident Prior to
Discharge [NURMON0082]
ONCE, Starting today For 1 Occurrences, Routine,
Post-Op/Phase II
Outpatient Discharge Orders (Medications)
Medications - Prescriptions - Analgesics - Opiods -3 Day Supply (Single Response) [194209]
hydrocodone-acetaMINOPHEN (NORCO) 5-325
MG per tab [71425]
1-2 tab, 20 tab, 0, starting 12/7/17, Normal, Phase II
Discharge
oxycodone-acetaMINOPHEN (PERCOCET)
5-325 MG per tab [40668]
1-2 tab, 20 tab, 0, starting 12/7/17, Normal, Phase II
Discharge
traMADOL (ULTRAM) 50 MG tab [50258] 50 mg, 20 tab, 0, starting 12/7/17, Normal, Phase II
Discharge
Medications - Prescriptions - Analgesics - Opiods -5 Day Supply (Single Response) [223853]
hydrocodone-acetaMINOPHEN (NORCO) 5-325
MG per tab [71425]
1-2 tab, 30 tab, 0, starting 12/7/17, Normal, Phase II
Discharge
oxycodone-acetaMINOPHEN (PERCOCET)
5-325 MG per tab [40668]
1-2 tab, 30 tab, 0, starting 12/7/17, Normal, Phase II
Discharge
Medications - Prescriptions - Bowel Management [128916]
polyethylene glycol (MIRALAX) oral powder
[61353]
17 g, starting 12/7/17, Normal, Phase II Discharge
Medications - Prescriptions - Non-categorized [194210]
fluticasone (FLONASE) 50 MCG/ACT nasal spray
[112183]
1 Bottle, , starting 12/7/17, Normal, Phase II Discharge
methylprednisolone (MEDROL DOSE PAK) 4 MG
tab [170928]
21 tab, 0, starting 12/7/17, Normal, Post-Op/Phase II
ondansetron (ZOFRAN) 4 MG tab [45939] 4 mg, 10 tab, , starting 12/7/17, Normal, Phase II
Discharge
Medications - Prescriptions [129014]
prednisone (DELTASONE) 10 mg tab - 4t 1x/d
[41278]
40 mg, 16 tab, 0, starting 12/7/17 until 12/11/17,
Normal, Pre-Day of Procedure
cephalexin (KEFLEX) 500 mg cap - 4x/d-7d
[44594]
500 mg, 28 cap, 0, starting 12/7/17 until 12/14/17,
Normal, Pre-Day of Procedure
clindamycin (CLEOCIN) 300 mg cap - 4x/d-7d
[44723]
300 mg, 28 cap, 0, starting 12/7/17 until 1/6/18,
Normal, Pre-Day of Procedure
bacitracin-polymyxin b (POLYSPORIN)
ophthalmic ointment [55599]
1 Tube, 1, starting 12/7/17 until 1/6/18, Normal, Pre-
Day of Procedure
neomycin-polymyxin-dexamethasone ophthalmic
ointment [142697]
1 Tube, 2, starting 12/7/17 until 1/6/18, Normal, Pre-
Day of Procedure
neomycin-polymyxin-dexamethasone ophthalmic
susp [142696]
1 Bottle, 2, starting 12/7/17 until 1/6/18, Normal,
Phase II Discharge
tobramycin-dexamethasone (TOBRADEX)
0.3-0.1% ophthalmic ointment - NOTE: Order for
patients allergic to neomycin-polymyxin-
dexamethasone [46770]
1 Tube, 2, starting 12/7/17 until 1/6/18, Normal, Phase
II Discharge
tobramycin-dexamethasone (TOBRADEX)
0.3-0.1% ophthalmic susp - NOTE: Order for
patients allergic to neomycin-polymyxin-
dexamethasone [46771]
1 Bottle, 2, starting 12/7/17 until 1/6/18, Normal,
Phase II Discharge
polymyxin-trimethoprim (POLYTRIM) ophthalmic
soln - 4x/d-7d [46801]
1 drop, 10 mL, 1, starting 12/7/17 until 12/14/17, No
Print, Pre-Day of Procedure
Outpatient Discharge Orders (Discharge Instructions)
Tear Duct Surgery [129011]
Page 2 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:26:22 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

If you had Tear Duct Surgery [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, • Hot/spicy food or beverages should
be avoided for several days after tear duct surgery.
• Avoid blowing nose or sneezing. If unavoidable,
sneeze with your mouth open.
• Avoid picking in the nasal cavity or inner corner of
eye as this may dislodge the silicone tube. Do not
poke a Qtip in the nose to clean it.
• Over the counter nasal saline sprays may be used to
help clean and open up the nasal passages.
Activity [223026]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
-You must rest quietly for 48 hours after surgery. Too
much activity may cause bleeding. Be sure to avoid
bending, lifting more than 15 lbs., or straining for one
week. You can then slowly increase your activity, but
avoid vigorous exercise for 1 week.
-For the first 48 hours after surgery, do not drive a car
or engage in activities that depend on your
coordination. The medication and/or anesthetic agents
may affect your judgment and coordination.
-You may shower in 24 hours, but keep the water from
hitting the face directly. No tub bath, swimming, or
whirlpool for 1 week.
-No sun exposure to surgical site for 2 weeks.
-No contact lenses for 2 weeks.
-You may wear make-up after 1 week.
-Swelling should be expected after surgery. To help
reduce it, use cold, wet compresses.
To make a cold compress, place a tray of ice
cubes into a bowl and add a quart of water. Soak a
washcloth in the ice water, wring about half of the
water out, fold washcloth in half, and gently place it on
your eyelids. Repeat the process when the washcloth
becomes warm. Do this as much as possible for the
first 48 hours.
-Sleep for the first week with two or three pillows
behind you, or in a recliner to keep your head above
your heart. This will also help to reduce swelling.
-No makeup on incision line for 2 weeks., Phase II
Discharge
Diet [129326]
Page 3 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:26:22 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Diet [NUT8888] Routine
General:
Diet Modifications:
Other Diet Modifications: -
Solid Consistency:
Liquid Consistency:
Liquid:
Esophagectomy:
Fat Controlled:
Fiber:
Fluid Restriction:
Heart Healthy:
Metabolic:
Renal:
Sodium Controlled:
NPO:
Start with liquids after surgery. Add more food to your
diet as tolerated.
Wound Care [129324]
Wound Care [NURWND0015] Routine, • You can expect a small amount of bleeding.
In most cases the bleeding will be reduced by the
cold, wet compresses. Propping your head up with
extra pillows when you lie down also reduces
bleeding. Call your Surgeon if you have brisk bleeding.
• Bruising will take 2 to 3 weeks to clear. Cold
compresses for the first 48 hours after surgery will
help to reduce it. After 48 hours, warm compresses
may reduce bruising.
• Your stitches may be absorbable. To absorb, they
must be kept moist with ointment. Non-absorbable
stitches will be removed within the first two weeks
after surgery.
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 your Doctor/Nurse if this does
not get better in 1-2 days or if gets worse.
Medications at Home [210045]
Page 4 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:26:22 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

For patients taking pain medication
[NURCOM0052]
ONCE For 1 Occurrences, Routine
Order Name (Only necessary if something other than
"Nursing Communcation" is preferred.):
All pain medications may cause constipation and/or
straining with bowel movements. Try to limit pain
medication use for severe pain and supplement with
acetaminophen (Tylenol®) according to the
manufacturer's label for how much is recommended
each day. Increase your activity and walk as often as
possible to help prevent constipation. Also increase
fluid and fiber in your daily diet. Try to aovid fluids that
contain caffeine or alcohol.
For constipation and/or straining with bowel
movements, you may take:
1. Over-the-counter Docusate (Colace®) : 100 mg
tablets, 1-2 tables by mouth 1-2 times a day as
needed. (Stop/hold for loose stools)
2. Over-the-counter Polyethylene Glycol (Miralax®):
17 grams (1 capful) by mouth daily as needed. (Stop
or do not take with loose stools)
And/Or
3. Over-the-counter Docusate/Senna (Senokot®): 1-2
tables by mouth 1-2 times a day as needed. (Hold for
loose stools), Phase II Discharge
When to Call Your Surgeon [129009]
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, • Excessive bleeding.
• Persistent nausea and vomiting.
• Pain not relieved with pain medication.
• Fever over 100° 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.
Other Discharge Instructions [129018]
Other Discharge Patient Care Instructions
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine
Surgery and Smoking [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, • Research and experience with
smoking patients have shown the supply of blood to
small capillaries in the tissue is reduced, so the risk of
bad healing, failure to heal, or even death of some
tissue, increased scarring or other complication
increases.
Contact Information [223028]
Contact Information [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, Notify the on-call Surgeon at (608)
263-7171 if painful swelling around surgical site. After
hours or on weekends call (608) 263-6400 and ask for
the Ophthalmology resident on call.
Follow-Up Appointments [129709]
Page 5 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:26:22 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Schedule Appointment at Transformations
[NURCOM0056]
Routine
Purpose:
With whom:
For when:
Transformations Clinic
2349 Deming Way
Madison, WI
(608) 836-9990
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
Page 6 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:26:22 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org