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/clinical/cckm-tools/content/order-sets/ambulatory/transformations-surgery-center/name-98458-en.cckm

20170109

page

100

UWHC,UWMF,

Tools,

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

TSC - ENT - Adult - Postoperative [4787]

TSC - ENT - Adult - Postoperative [4787] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Transformations Surgery Center


TSC - ENT - Adult - Postoperative [4787]
PostOp/Phase II
Medications (Single Response) [129482]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, EVERY 4 HOURS PRN For 24 Hours,
pain, mild pain, Post-Op/Phase II
hydrocodone-acetaMINOPHEN (NORCO) 5-325
MG per tab RANGE [750021]
1-2 tab, Oral, EVERY 4 HOURS PRN For 24 Hours,
pain, severe pain, Post-Op/Phase II
oxycodone-acetaminophen (PERCOCET) 5-325
mg per tab RANGE [750033]
1-2 tab, Oral, EVERY 4 HOURS PRN For 24 Hours,
pain, severe pain, Post-Op/Phase II
Patient Care Instructions [128944]
Vital Signs [NURMON0013] SEE COMMENTS, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 1-2 hours until discharge, Post-Op/Phase II
Activity [128950]
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
Outpatient Discharge Orders (Medications)
Medications - Prescriptions - Analgesics (Single Response) [135222]
hydrocodone-acetaMINOPHEN (NORCO) 5-325
mg per tab - 1-2t q4h prn [71425]
1-2 tab, 40 tab, 0, starting 1/6/17, Normal, Phase II
Discharge
Hydrocodone-Acetaminophen 7.5-325 MG/15ML
SOLN [74885]
10-20 mL, 100 mL, 0, starting 1/6/17, Normal, Phase
II Discharge
oxycodone-acetaminophen (PERCOCET) 5-325
mg per tab - 1-2t q4h prn [40668]
1-2 tab, 40 tab, 0, starting 1/6/17, Normal, Phase II
Discharge
oxycodone 5 MG/5ML soln - 5-10 mg q4hr prn
[45975]
5-10 mg, 200 mL, 0, starting 1/6/17, Normal, Phase II
Discharge
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]
2 tab, 28 tab, 0, starting 1/6/17, Normal, Phase II
Discharge
Medications - Prescriptions - Anti-infectives [89294]
amoxicillin (AMOXIL) 500 mg cap - 3x/d 7d
[34524]
500 mg, 21 cap, 0, starting 1/6/17 until 1/13/17,
Normal, Phase II Discharge
amoxicillin (AMOXIL) 250 mg/5 mL susp - 10 mL
3x/d 7d [34527]
250 mg, 0, starting 1/6/17 until 1/13/17, Normal,
Phase II Discharge
amoxicillin-clavulanate (AUGMENTIN) 875-125
mg per tab - 2x/d 7d [70053]
1 tab, 14 tab, 0, starting 1/6/17 until 1/13/17, Normal,
Phase II Discharge
amoxicillin-clavulanate (AUGMENTIN) 400-57
MG/5ML susp [70055]
10 mL, 200 mL, , starting 1/6/17, Normal, Phase II
Discharge
Page 1 of 11
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azithromycin (ZITHROMAX) 250 mg tab [57023] 6 tab, 0, starting 1/6/17 until 1/11/17, Normal, Phase
II Discharge
azithromycin (ZITHROMAX) 200 MG/5ML SUSR
[51547]
38 mL, 0, starting 1/6/17 until 1/11/17, Normal, Phase
II Discharge
cephalexin (KEFLEX) 500 mg cap - 4x/d 7d
[44594]
500 mg, 28 cap, 0, starting 1/6/17 until 1/13/17,
Normal, Phase II Discharge
Outpatient Discharge Orders (Discharge Instructions)
Discharge Instructions - PROCEDURE SPECIFIC [128872]
Brow Lift [198746]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After
Hospital Care Plan., Routine, - It is normal for your
face, neck, or ears to feel weak or numb after
surgery. This will resolve over the next few weeks.
- Do not be alarmed by the swelling and bruising of
the face. This will increase for the first 48 hours and
then very slowly decrease over the next two weeks.
Activity - Brow Lift [NURACT0008] Routine
Discharge Activity: See Instructions
- You can shower the next day after surgery but
keep your head dry.
- No tub baths, swimming or whirlpool for 2 weeks.
- Keep your head elevated for at least the first
week. This requires using pillows, etc., or actual
elevation of the head of the bed or mattress.
(Sleeping in a recliner also works well.) Do not
engage in activities where you bend over, making
you head lower than your heart. Bend at the knees
and squat down instead of bending over at the
waist.
- Engage in only sedate activity for the first few
days. It is not necessary to stay in bed during this
time.
- No driving for 48 hours or while you are taking
pain medication.
- Do not fly for 1 week following surgery
- Do not lift more than 15 lbs for 2 weeks.
- Generally, there should be no rigorous exercise
for 3 weeks following surgery. Walking daily is
acceptable., Phase II Discharge
Page 2 of 11
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Wound Care - Brow Lift [NURWND0015] Routine, - Once your head wrap has been removed
you can Shampoo.
- You can take a shower and shampoo your hair
with any mild shampoo, such as Johnson’s Baby
Shampoo. There may be clotted blood in your hair,
most of which will come out with the first shower
and shampoo, but may require 2 or more
shampoos. The entire head can be shampooed, but
it should be done very gently in the area of the
stitches and staples. It is best to face away from the
showerhead. Use only the COOL setting on a
hairdryer.
- Cold compresses or ice should be applied to your
eyes for the first 48 hours after surgery to help
minimize the bruising and swelling.
- You may wish to bring a scarf to cover your hair
the day the dressing is removed.
- You should minimize the sun for 2 weeks
following surgery.
- Do not apply any makeup or lotions to your face
during the first week.
Face Lift [194221]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After
Hospital Care Plan., Routine, • Do not be alarmed
by the swelling and bruising of the face. This will
increase for the first 48 hours and then very slowly
decrease in the next two to twelve weeks.
• It is normal for your face, neck or ears to feel
weak or numb after surgery. This will resolve over
the next few weeks.
Activity - Face Lift [NURACT0008] Routine
Discharge Activity: See Instructions
• Keep your head elevated for at least the first
week. This requires using pillows, etc., or actual
elevation of the head of the bed or mattress.
(Sleeping in a recliner also works well.) Do not
engage in activities where you bend over, making
you head lower than your heart. Bend at the knees
and squat down instead of bending over at the
waist.
• Do not lift more than 15 lbs for 2 weeks.
• Generally, there should be no heavy exercise for
3 weeks following surgery. You can start walking
POD #2. You can do light cardio (elliptical or
stationary bike) at POD #14. All other exercise can
be started POD #21.
• Engage in only sedate activity for the first few
days. It is not necessary to stay in bed during this
time. To get out of bed, roll on your side first and
push up with your arms.
• No driving for 48 hours or while you are taking
pain medication. Do not fly for one week following
surgery., Phase II Discharge
Page 3 of 11
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Wound Care - Face Lift [NURWND0015] Routine, • You will be seen at the office for removal
of dressings and possibly for drain removal on POD
#2.
• When the dressing is removed you can take a
shower and shampoo your hair with any mild
shampoo, such as Johnson’s Baby Shampoo.
There may be clotted blood in your hair, most of
which will come out with the first shower and
shampoo, but may require 2 or more shampoos.
The entire head can be shampooed, but it should
be done very gently in the area of the stitches and
staples. It is best to face away from the
showerhead. Use only the COOL setting on a
hairdryer.
• You may apply {bacitracin/vaseline:3004787} to
incisions *** times a day for *** days.
• Applying ice to the incisions is
{recommended:3004792}.
• You will be provided with a Velcro removable
dressing that I would like you to wear for 1 week
(day and night). After that it can worn if comfortable
but is not required.
• When the drain is removed you should apply the
anti-biotic ointment to the incision lines around your
ears and under your chin. This should be done for 7
days.
• You may wish to bring a scarf to cover your hair
the day the dressing is removed.
• Avoid direct sun exposure for 2 weeks following
surgery.
• Do not apply any makeup or lotions to your face
during the first week.
• If you have a drain you will be instructed on how
to care for it by the nursing staff.
• If the drain stops functioning please call the clinic
and they will instruct you on how to milk the drain.
Local Flap or MOHS Repair [194222]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After
Hospital Care Plan., Routine, • Do not be alarmed
by the swelling and bruising of the face. This will
increase for the first 48 hours and then very slowly
decrease over the next two weeks.
• It is normal for your face, neck or ears to feel
weak or numb after surgery. This will resolve over
the next few weeks.
Page 4 of 11
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Activity - Local Flap or MOHS Repair
[NURACT0008]
Routine
Discharge Activity: See Instructions
• You may shower in {hours:3004790}.
• Keep your head elevated for at least the first
week. This requires using pillows, etc., or actual
elevation of the head of the bed or mattress.
(Sleeping in a recliner also works well.) Do not
engage in activities where you bend over, making
you head lower than your heart. Bend at the knees
and squat down instead of bending over at the
waist.
• Engage in only sedate activity for the first few
days. It is not necessary to stay in bed during this
time.
• No driving for 48 hours or while you are taking
pain medication.
• Do not fly for 1 week following surgery
• Do not lift more than 15 lbs for 1 weeks.
• Generally, there should be no rigorous exercise
for 3 weeks following surgery.
Walking daily is acceptable.
• No tub baths, swimming or whirlpool for 2 weeks.,
Phase II Discharge
Wound Care - Local Flap or MOHS Repair
[NURWND0015]
Routine, • Keep the dressing clean and dry until
removed.
• May remove dressing in: {hours:3004789}.
• You may apply {bacitracin/vaseline:3004787} to
incisions *** times a day for *** days.
• Applying ice to the incisions is
{recommended:3004788}.
• If you are having a two stage repair we will review
with you how to care for the flap and what to expect
for your second stage surgery
Otoplasty [194223]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After
Hospital Care Plan., Routine, • A bulky bandage will
be wrapped around your head to cover your ears.
Leave the bandage on until your clinic visit on POD
#2 Do not shower or get this bandage wet. If the
bandage is very loose or very tight, call the doctor.
• Leave the bandage on until your clinic visit on
POD #2.
• We will instruct you to wear a removable dressing
at night for the next 3 weeks.
• There may be some drainage from the suture
lines for 2-3 days. Non-dissolvable sutures will be
removed 10-12 days following surgery.
Page 5 of 11
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01/2017CCKM@uwhealth.org

Activity - Otoplasty [NURACT0008] Routine
Discharge Activity: See Instructions
• Keep your head elevated for at least the first
week. This requires using pillows, etc., or actual
elevation of the head of the bed or mattress.
(Sleeping in a recliner also works well.) Do not
engage in activities where you bend over, making
your head lower than your heart. Bend at the knees
and squat down instead of bending over at the
waist.
• Engage in only sedate activity for the first few
days. It is not necessary to stay in bed during this
time.
• Do not pull on your ears
• Sleep with your head elevated for 2-3 weeks.
• Be careful when pulling clothing over your head.
You may prefer to wear shirts and blouses that
button up the front.
• Do not wear earrings for 3 weeks after surgery.
• Glasses should be placed with care. Do not let
your glasses rest on the suture line. Try to place
them so they rest in the hairline.
• You may return to work within 4-7 days if you feel
well.
• No driving for 48 hours or while you are taking
pain medications.
• Do not fly for 1 week following surgery., Phase II
Discharge
Wound Care - Otoplasty [NURWND0015] Routine, • When the dressing is removed you can
take a shower and shampoo your hair with any mild
shampoo, such as Johnson’s Baby Shampoo.
There may be clotted blood in your hair, most of
which will come out with the first shower and
shampoo, but may require 2 or more shampoos.
The entire head can be shampooed, but it should
be done very gently in the area of the stitches. It is
best to face away from the showerhead. Use only
the COOL setting on a hairdryer.
Septoplasty and Rhinoplasty [213399]
Page 6 of 11
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What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After
Hospital Care Plan., Routine, • Directly after your
surgery, you may feel sick to your stomach due to
the drainage that you have swallowed during
surgery. If you vomit, it is not unusual for it to be
bloody.
• Expect nasal drainage for the first 2-3 days.
• The first day the draining will be bloody. It will
change to pink-yellow color after the first day or so.
• Expect crusting in the nose for 3-6 weeks while
the incision is healing.
• Swelling and bruising of your nose and the
surrounding area is a normal result of nasal
surgery. The swelling will gradually resolve over
time.
• You may have swelling under your upper lip and
at the bottom of your nose. This mild tenderness
and swelling should be gone within 2 weeks.
• Expect nasal stuffiness. This is caused by
swelling and will decrease over the next few weeks.
It is normal to have numbness over your nose.
• You will be breathing through your mouth until the
swelling is resolved. This may cause some
dryness and irritation in your mouth and throat.
Use a humidifier or vaporizer along with brushing
your teeth may make you feel more comfortable.
• Breathing thorough your nose will gradually
improve after we clean your nose several days after
surgery. By the week after surgery your breathing
should be much improved.
Page 7 of 11
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Activity - Septoplasty and Rhinoplasty
[NURACT0008]
Routine
Discharge Activity: See Instructions
• Only light activity after your surgery for 1 week.
• You may wear your lightest weight glasses lightly
resting on your nasal cast, or taped to your
forehead. You may insert your contact lenses 2
days after surgery. After removal of your nasal
splint, you should limit the time that glasses are
worn. If your glasses have small “feet”, you may
wish to ask your optician to install larger or softer
“feet”. You may have tenderness on the sides of
your nose after wearing glasses for a prolonged
period of time. Remove your glasses for an hour or
two for relief. This is normal and should resolve in
3-4 months.
• Do NOT hit or move any portions of your nose or
packing.
• DO NOT BLOW YOUR NOSE.
• Do not hold back a sneeze. Sneeze with your
mouth open.
• Do not use decongestants or antihistamines
unless your surgeon has recommended them.
• Do not pick the inside of your nose.
• No sun exposure to the nose/face for 3 month
following surgery. Sun exposure can cause
swelling and slow the healing process. You should
wear a sunscreen with at least SPF 15 and a
brimmed hat when outdoors.
• No lifting over *** pounds for *** weeks.
• Keep your head elevated at least 30 degrees
(use 2 pillows or sleep in a recliner) for the next few
weeks. This helps to keep swelling to a minimum.
• NO aerobics, jogging, or swimming for *** week
(s), or until ok with your Surgeon.
• You may drive only if you are not taking pain
medication.
• Cold packs should be used for the first 48 hours
to decrease nasal drainage, to reduce swelling, and
relieve discomfort. To make your own ice packs;
place frozen peas or corn in a Ziplock bag. Place
this pack diagonally across the eyes and the nasal
bridge.
• You may shower in {hours:3004790}.
• NO tub baths, swimming or whirlpools for ***
weeks., Phase II Discharge
Page 8 of 11
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Wound Care - Septoplasty and Rhinoplasty
[NURWND0015]
Routine, • Change the small gauze under your
nose when it becomes soiled.
• For the first week after surgery, cleanse the nose
and ear incisions with a Q-tip saturated with water.
Use a rolling motion along the length of the incision
and allow drying. Roll a thin layer of antibiotic
ointment over the incision. Do this 3 times a day.
• Directly after your surgery, you may feel sick to
your stomach due to the drainage that you have
swallowed during surgery. If you vomit, it is not
unusual for it to be bloody.
• Keep splint/dressing dry and in place for
{until:3004791}.
• Swelling and bruising of your nose and the
surrounding area is a normal result of nasal
surgery. The swelling will gradually resolve over
time.
• You may have swelling under your upper lip and
at the bottom of your nose. This mild tenderness
and swelling should be gone within 2 weeks.
• Expect nasal stuffiness. This is caused by
swelling and will decrease over the next few weeks.
It is normal to have numbness over your nose.
• Cold packs should be used for the first 48 hours to
decrease nasal drainage, to reduce swelling, and
relieve discomfort. To make your own ice packs;
place frozen peas or corn in a Ziplock bag. Place
this pack diagonally across the eyes and the nasal
bridge.
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.
Diet [194214]
Diet - General (No Modifications) [NUT8888] Routine
General: General (No Modifications)
Diet Modifications:
Other Diet Modifications:
You may resume normal diet. It is best to eat a softer
diet for the first week, such as things that don't require
heavy chewing.
Wound/Drain Care [195812]
J-P Drain Instructions [NURWND0080] Routine
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.
Medications at Home [194213]
Page 9 of 11
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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
scheduled for the first 48 hours. The medication can
then be used on an as needed basis.
• You may be prescribed a low dose steroid to help
reduce swelling. Start taking this the day after surgery
as directed.
• If antibiotics have been prescribed, take them as
directed. These should start the day after surgery.
• You may resume taking your routine medications
when you arrive home.
Maximum acetaminophen dose per 24 hours
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, No more than 4 grams acetaminophen
per 24 hours for adults or 15 mg/kg per dose for peds
<40 kg.
No NSAIDs (ibuprofen, aspirin, etc.) for 7 days
after surgery [NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine
Resume steroid taper [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, Steroid Taper Instructions are: ***
Start using the Deep Sea Nasal Spray that is in
your take home supplies 4 times a day starting
the day after surgery [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 [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 [129015]
Page 10 of 11
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01/2017CCKM@uwhealth.org

Contact Information [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, For any questions or concerns after
your surgery, please call: 608-836-9990 or Toll Free
1-866-477-9990, Monday through Friday from 8 a.m.
to 5 p.m. to speak with a nurse or have a call returned
to you. After hours, weekends or holidays, please call
the same number and give the operator your name,
surgeon's name and your phone number including
area code. A physician will return your call.
Dr. Marcus Contact Information [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, • It is my pleasure to have you as a
patient. If you have any question or concerns please
feel free to call me on my cell phone at 608-213-5035.
You can also email me at marcus@surgery.wisc.edu
Schedule Appointment [129012]
Schedule Appointment with ENT Resident
[NURCOM0056]
Routine
Purpose:
With whom:
For when:
Schedule Appointment at Transformations
[NURCOM0056]
Routine
Purpose:
With whom:
For when:
Transformations Clinic
2349 Deming Way
(608) 836-9990
Schedule Appointment at UW Hospital and
Clinics [NURCOM0056]
Routine
Purpose:
With whom:
For when:
UW Hospital and Clinics
600 Highland Avenue
(608) 263-7502
Page 11 of 11
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2017CCKM@uwhealth.org