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/clinical/cckm-tools/content/order-sets/ambulatory/transformations-surgery-center/name-98460-en.cckm

20170109

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100

UWHC,UWMF,

Tools,

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

TSC - Hysteroscopy - Adult - Postoperative [4768]

TSC - Hysteroscopy - Adult - Postoperative [4768] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Transformations Surgery Center


TSC - Hysteroscopy - Adult - Postoperative [4768]
for Adult Patients OnlyIntended
Post-Op/Phase II
Analgesics - Non-Opioids [194177]
ibuprofen (MOTRIN) tab RANGE [750024] 400-600 mg, Oral, ONCE PRN For 1 Doses, pain,
mild pain or multi-modal therapy, Post-Op/Phase II
Analgesics - Opioids (Single Response) [128917]
hydrocodone-acetaMINOPHEN (NORCO) 5-325
MG per tab [71425]
Oral, ONCE PRN For 1 Doses, pain, severe pain,
Post-Op/Phase II
oxycodone-acetaMINOPHEN (PERCOCET)
5-325 MG per tab [40668]
Oral, ONCE PRN For 1 Doses, pain, severe pain,
Post-Op/Phase II
oxycodone tab RANGE [750032] 5-10 mg, Oral, ONCE PRN For 1 Doses, pain, severe
pain, Post-Op/Phase II
Anti-emetics [128918]
ondansetron (ZOFRAN ODT) disintegrating tab
[64224]
4 mg, Oral, ONCE PRN For 1 Doses,
nausea/vomiting, First Line Therapy, Post-Op/Phase
II
ondansetron (ZOFRAN) injection [132824] 4 mg, Intravenous, ONCE PRN For 1 Doses, First
Line Therapy if unable to tolerate orally, for 3 Minutes,
Post-Op/Phase II
prochlorperazine (COMPAZINE) tab [41372] 10 mg, Oral, ONCE PRN For 1 Doses,
nausea/vomiting, Second Line Therapy if
unresponsive to First Line Therapy within 30 minutes,
Post-Op/Phase II
prochlorperazine (COMPAZINE) injection [41369] 10 mg, Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting, Second Line Therapy if unable to
tolerate orally, Post-Op/Phase II
Patient Care Instructions [128904]
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 [128909]
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) [129456]
hydrocodone - acetaMINOPHEN (NORCO)
5-325 mg per tab - 1-2t q4-6hp #40 [71425]
1-2 tab, 40 tab, 0, starting 1/9/17, Normal, Phase II
Discharge
Page 1 of 4
Printed by LIND, JANNA S [JSL237] at 1/9/2017 10:11:57 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

oxycodone 5 mg tab - 1-2t q4-6hp #40 [45976] 5-10 mg, 40 tab, 0, starting 1/9/17, Normal, Phase II
Discharge
oxycodone-acetaMINOPHEN (PERCOCET)
5-325 mg per tab - 1-2t q4-6hp #40 [40668]
1-2 tab, 40 tab, 0, starting 1/9/17, Normal, Phase II
Discharge
Medications - Prescriptions - Bowel Management [194174]
senna-docusate (SENOKOT S) 8.6-50 MG per
tab - NOTE: order if opioids are prescribed
[60530]
2 tab, starting 1/9/17, Normal, Post-Op/Phase II
Outpatient Discharge Orders (Discharge Instructions)
Activity [128903]
Activity [NURACT0008] Routine
Discharge Activity:
• Rest and quiet activity for the first 24 to 48 hours.
Excessive activity may increase your risk of bleeding.
• Showers only for the first two weeks.
• Do not use tampons, douche, or have sexual
intercourse for one week or as directed by your
physician.
• Do not use heating pad, as this may increase the
chance of bleeding.
• Do not drive for 24 hours or while on narcotics.,
Phase II Discharge
Diet [129704]
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:
Eat small well balanced meals, and drink plenty of
fluids. DO NOT drink alcoholic beverages for 24
hours or while on pain medications.
Wound Care [129006]
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 [129855]
No More that 4 grams of acetaminophen per day
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine
Page 2 of 4
Printed by LIND, JANNA S [JSL237] at 1/9/2017 10:11:57 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

Do not take Non-steroidal anti-inflamatory
(NSAIDs) for 3 days. This includes ibuprofen,
motrin, advil, aspirin, naproxen. [NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine
When to Call Your Doctor [129858]
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, • You get dizzy or lightheaded.
• You develop abnormal vaginal discharge
• The pain medication doesn’t work
• Bleeding that is heavier than a normal menstrual
period or you have blood clots
• Your oral temperature is over 102, not controlled by
medication
• You have increasing cramps or pains not relieved by
pain medication
• You develop abdominal pain in a different area then
you previously had abdominal pain or cramping
• You develop pain in the tops of your shoulders
(shoulder strap area)
• You develop chest pain or shortness of breath
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 [129859]
Contact Information [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, • Generations Fertility Care: (608)
824-6160 (M-F 8:00 am to 4:00 pm)
Follow-Up Appointments [129860]
Schedule Appointment at Generations Fertility
Care [NURCOM0056]
Routine
Purpose:
With whom:
For when:
Generations Fertility Care
2365 Deming Way
(608) 824-6160
Page 3 of 4
Printed by LIND, JANNA S [JSL237] at 1/9/2017 10:11:57 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

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 4 of 4
Printed by LIND, JANNA S [JSL237] at 1/9/2017 10:11:57 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org