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20170109

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TSC - Oculoplastic Surgery - Adult - Postoperative [4810]

TSC - Oculoplastic Surgery - Adult - Postoperative [4810] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Transformations Surgery Center


TSC - Oculoplastic Surgery - Adult - Postoperative [4810]
PostOp/Phase II
Analgesics (Single Response) [129016]
hydrocodone-acetaMINOPHEN (NORCO) 5-325
MG per tab RANGE [750021]
1-2 tab, Oral, ONCE PRN For 1 Doses, pain, severe
pain, Post-Op/Phase II
oxycodone-acetaMINOPHEN (PERCOCET)
5-325 MG per tab [40668]
1 tab, Oral, EVERY 4 HOURS PRN, pain, severe
pain, Post-Op/Phase II
acetaMINOPHEN (TYLENOL) tab [34149] 650 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) [194209]
hydrocodone-acetaMINOPHEN (NORCO) 5-325
MG per tab [71425]
1-2 tab, starting 1/9/17, Normal, Phase II Discharge
oxycodone-acetaMINOPHEN (PERCOCET)
5-325 MG per tab [40668]
1-2 tab, starting 1/9/17, Normal, Phase II Discharge
traMADOL (ULTRAM) 50 MG tab [50258] 50 mg, starting 1/9/17, Normal, Phase II Discharge
Medications - Prescriptions - Bowel Management [128916]
Page 1 of 5
Printed by LIND, JANNA S [JSL237] at 1/9/2017 10:12:43 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

polyethylene glycol (MIRALAX) oral powder
[61353]
17 g, starting 1/9/17, Normal, Phase II Discharge
Medications - Prescriptions - Non-categorized [194210]
fluticasone (FLONASE) 50 MCG/ACT nasal
spray [112183]
1 Bottle, , starting 1/9/17, Normal, Phase II Discharge
methylprednisolone (MEDROL DOSE PAK) 4
MG tab [170928]
21 tab, 0, starting 1/9/17, Normal, Post-Op/Phase II
Medications - Prescriptions [129014]
prednisone (DELTASONE) 10 mg tab - 4t 1x/d
[41278]
40 mg, 16 tab, 0, starting 1/9/17 until 1/13/17, Normal,
Pre-Day of Procedure
cephalexin (KEFLEX) 500 mg cap - 4x/d-7d
[44594]
500 mg, 28 cap, 0, starting 1/9/17 until 1/16/17,
Normal, Pre-Day of Procedure
clindamycin (CLEOCIN) 300 mg cap - 4x/d-7d
[44723]
300 mg, 28 cap, 0, starting 1/9/17 until 2/8/17,
Normal, Pre-Day of Procedure
bacitracin-polymyxin b (POLYSPORIN)
ophthalmic ointment [55599]
1 Tube, 1, starting 1/9/17 until 2/8/17, Normal, Pre-
Day of Procedure
neomycin-polymyxin-dexamethasone ophthalmic
ointment [142697]
1 Tube, 2, starting 1/9/17 until 2/8/17, Normal, Pre-
Day of Procedure
neomycin-polymyxin-dexamethasone ophthalmic
susp [142696]
1 Bottle, 2, starting 1/9/17 until 2/8/17, 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 1/9/17 until 2/8/17, 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 1/9/17 until 2/8/17, Normal, Phase
II Discharge
polymyxin-trimethoprim (POLYTRIM) ophthalmic
soln - 4x/d-7d [46801]
1 drop, 10 mL, 1, starting 1/9/17 until 1/16/17, No
Print, Pre-Day of Procedure
Outpatient Discharge Orders (Discharge Instructions)
Tear Duct Surgery [129011]
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 [129322]
Page 2 of 5
Printed by LIND, JANNA S [JSL237] at 1/9/2017 10:12:43 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

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 1 week.
• 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.,
Phase II Discharge
Diet [129326]
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]
Page 3 of 5
Printed by LIND, JANNA S [JSL237] at 1/9/2017 10:12:43 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

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 [129327]
No more than 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
Medications at Home - Oculofacial
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, • If you have pain, take
acetaminophen (Tylenol) 325 mg x 2 tablets every 4
hours as needed for mild pain. If necessary, a
stronger medicine will be prescribed for you.
•• You will need to use the prescribed ointment on
the stitches three times a day for the first seven days,
then two times a day for an additional week. The
ointment may be put on with a Q-Tip or with your
finger after washing your hands. Continue your
regular medications and eye drops, unless told
otherwise. Ibuprofen, Naproxen, Motrin, Nuprin, Aleve
and other anti-inflammatory drugs should be stopped
for 5-7 days after surgery.
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]
Page 4 of 5
Printed by LIND, JANNA S [JSL237] at 1/9/2017 10:12:43 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

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 [129298]
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.
Follow-Up Appointments [129709]
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 5 of 5
Printed by LIND, JANNA S [JSL237] at 1/9/2017 10:12:43 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org