/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/transformations-surgery-center/,

/clinical/cckm-tools/content/order-sets/ambulatory/transformations-surgery-center/name-98463-en.cckm

201710291

page

100

UWHC,UWMF,

Tools,

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

TSC - Plastic Surgery - Body - Adult - Postoperative [4789]

TSC - Plastic Surgery - Body - Adult - Postoperative [4789] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Transformations Surgery Center


TSC - Plastic Surgery - Body - Adult - Postoperative [4789]
Post-Op/Phase II
Medications (Single Response) [128914]
oxycodone-acetaminophen (PERCOCET) 5-325
mg per tab RANGE [750033]
1-2 tab, Oral, ONCE PRN For 1 Doses, pain, Severe
pain, Post-Op/Phase II
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 tab RANGE [750032] 5-10 mg, Oral, ONCE PRN For 1 Doses, pain, Severe
pain, 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-Non-Opioids (Oral) Scheduled [200906]
acetaMINOPHEN (TYLENOL) 325 MG tab - 2t
q6h x7d [34149]
650 mg, starting 10/17/17 until 10/24/17, Normal,
Phase II Discharge
naproxen (NAPROSYN) 500 MG tab - 1t 2x/d x7d
[40052]
500 mg, 0, starting 10/17/17 until 10/24/17, Normal,
Phase II Discharge
Medications - Prescriptions - Opioid (Oral) PRN (Single Response) [143581]
oxycodone 5 MG tab - 1t q4hprn #5 [45976] 5 mg, 5 tab, 0, starting 10/17/17, Normal, Phase II
Discharge
oxycodone 5 mg tab - 1-2t q4hprn #15 [45976] 5-10 mg, 15 tab, 0, starting 10/17/17, Normal, Phase II
Discharge
oxycodone 5 mg tab - 1-2t q4hprn #25 [45976] 5-10 mg, 25 tab, 0, starting 10/17/17, Normal, Phase II
Discharge
Medications - Prescriptions - Bowel Management [143582]
senna-docusate (SENOKOT-S) 8.6-50 mg per tab
[60530]
2 tab, 30 tab, 0, starting 10/17/17, Normal, Phase II
Discharge
docusate sodium (COLACE) cap [36857] 100 mg, 30 cap, 0, starting 10/17/17, Normal, Phase II
Discharge
polyethylene glycol (MIRALAX) oral powder
[61353]
17 g, starting 10/17/17, Normal, Phase II Discharge
Medications - Prescriptions - Anti-infectives [143583]
cephalexin (KEFLEX) 250 mg cap - 4x/d-7d
[44594]
500 mg, 28 cap, 0, starting 10/17/17 until 10/24/17,
Normal, Phase II Discharge
Page 1 of 7
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:30:47 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

amoxicillin-clavulanate (AUGMENTIN) 875-125
MG per tab - 2x/d x7d [70053]
1 tab, 0, starting 10/17/17 until 10/24/17, Normal,
Phase II Discharge
clindamycin (CLEOCIN) 300 MG cap - 3x/d x7d
[44723]
300 mg, starting 10/17/17 until 10/24/17, Normal,
Phase II Discharge
Medications - Prescriptions - Non-categorized [141907]
methylprednisolone 4 MG tab pack [170928] 1 each, 0, starting 10/17/17, Normal, Phase II
Discharge
diazepam (VALIUM) 5 mg tab - q6-8hp #12
[36679]
5 mg, 12 tab, 0, starting 10/17/17, Normal, Phase II
Discharge
ondansetron (ZOFRAN) tab [45939] 4 mg, 10 tab, 0, starting 10/17/17, Normal, Phase II
Discharge
Outpatient Discharge Orders (Discharge Instructions)
Discharge Instructions - Procedure Specific [128928]
(Activity and orders based on patient can be found in the appropriate groups below Unique
Wound Care)
Abdominoplasty [134703]
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 experience some
dizziness the first time you take the garment off. You
need to have someone with you. Take the garment
off slowly while sitting down.
• You may be walking slowly and bent over at the
waist to start with, this is very common. You will
slowly begin to walk more upright over the next
week.
• Pain/Discomfort is common after this surgery and
will last up to a week. You may also have some
numbness and tingling in your hands and fingers for
the next few days.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• Wear the abdominal binder (or girdle) for 2 weeks
or until instructed differently by your surgeon. You
may remove the binder only to shower.
• You should have someone help you when you get
out of bed the first few times.
• You may find that you tire quickly. You should walk
around your house and have planned rest periods.
• Wear loose fitting clothing for a few days.
• Do not tub bath, swim or whirlpool for 2 weeks.
• No sports or strenuous activity for 2-3 weeks.,
Phase II Discharge
Arm Lift [134704]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, • Pain/Discomfort is common
after this surgery and will last up to a week. You may
also have some numbness and tingling in your
hands and fingers for the next few days.
• Your scar will be long and may be slow to heal: it is
not unusual to have scabbing along the scar for
several weeks and fluid under the skin.
• Your arms will be swollen for about 3-4 weeks.
Your final result will not be totally complete for 3-6
months.
Page 2 of 7
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:30:47 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• You need to rest for the next 48 hours. Keep your
arms elevated above your heart as much as
possible. Most people feel more comfortable to have
someone stay with them the first few days after
surgery.
• Avoid strenuous activity. At the end of the first
week you may begin to gradually increase your
activity, but no sports or strenuous activities for 3-4
weeks.
• You must not soak in the bathtub, whirlpool, or
swimming pool for the next 2-3 weeks or until the
incisions have completely healed.
• You will wear the arm compression wraps for 2
weeks to keep the swelling and bruising to a
minimum., Phase II Discharge
Liposuction [134705]
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 weak, tired and
sore for 2-3 weeks after surgery.
• Plan to be off work for about 1 week after surgery.
• You will have bruising and swelling that may last for
1-2 months.
• It is not uncommon to see a large amount of
pinkish watery drainage from your incisions. If it
becomes a more concentrated red drainage, you
should call the doctor.
• The suctioned areas will be swollen and bruised,
and you may feel some burning. The bruises may
get worse for 1-2 days and last for several weeks.
The swelling may last for 3 months. This is
NORMAL. Please be patient as it may take 3 months
to see your final results.
Page 3 of 7
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:30:47 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

Activity [NURACT0008] Routine
Discharge Activity: See Instructions
•No tub baths, swimming or whirlpools for 7 days.
• Plan rest periods throughout the day for the first
couple of weeks.
• Do not do strenuous activities/exercise for 2-3
weeks or until approved by your doctor (usually
about 3 weeks).
• Do not cross your legs or sit for more than 1 hour in
the same position.
• Do not fly for 10 days.
PRESSURE GARMENT (GIRDLE, BINDER):
• You must wear your pressure garment for two
weeks after surgery.
• You may remove the garment to shower. Wear the
garment again after your shower.
• The garment has special openings for elimination.
• You may feel dizzy the first time you take your
garment off. Have someone with you. Take the
pressure garment off slowly while sitting. After
removal, wear loose comfortable clothing., Phase II
Discharge
Thighplasty [134706]
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
numbness and tingling in your legs and feet for the
next few days. This is normal.
• Your legs will be swollen for about 3-4 weeks. Your
final result will not be totally complete for 3-6
months.
• Your scar will be long and it may be slow to heal; it
is not unusual to have scabbing along the scar for
several weeks and fluid under the skin.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• You need to rest for the next 24-48 hours. Keep
your legs elevated as much as possible. Most people
feel more comfortable having someone stay with
them the first few days after surgery.
• Avoid strenuous activity. At the end of the first
week you may gradually increase your activity. After
about 2 weeks you may increase your activity but do
not do vigorous activity until instructed by your
surgeon (usually 3-4 weeks).
• You must not soak in the bathtub, whirlpool, or
swimming pool for the next 3-4 weeks and at least
until incisions are completely healed and dry., Phase
II Discharge
Activity [195146]
Lifting Restrictions [NURACT0008] Routine
Discharge Activity: See Instructions
• Avoid lifting more than *** pounds for *** weeks,
Phase II Discharge
Page 4 of 7
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:30:47 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

Driving Restrictions [NURACT0008] Routine
Discharge Activity: See Instructions
• Do not drive, operate machinery, or do anything in
which you or someone under your supervision could
get hurt while taking narcotic pain medication or for
the first 24 hours after surgery., Phase II Discharge
Shower Restrictions [NURACT0008] Routine
Discharge Activity: See Instructions
• You may shower in {hours:3004790}., Phase II
Discharge
Nutrition [195147]
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:
• DO NOT drink alcoholic beverages for the first 2
days or while taking pain medication
• Eat small balanced meals, and drink plenty of fluids
Wound/Drain Care [195148]
Drain Care [NURWND0015] Routine, - You may have "drains" or tubes placed
during surgery to drain away excess fluid. The fluid will
collect in a bulb attached to the tube. This drain will
stay in for a short while. Record the amount of
drainage from the drains and bring the results with you
to your clinic visit.
- You may shower with the tubes in.
Incision Care [NURWND0015] Routine, • Remove dressings in {hours:3004790}. If
you notice a large steri-strip over the incision, leave
this in place until it falls off on its own. You may need
to use gauze bandages over the incisions for a few
days until the incisions stop weeping.
• You may apply {bacitracin/vaseline:3004787} to
incisions *** times a day for *** days.
• Applying ice to the incisions is
{recommended:3004792}.
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 [195149]
Page 5 of 7
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:30:47 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@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 may resume your routine
medications unless instructed differently by your
surgeon.
• You have been given a prescription for pain
medication. Usually the first 1 or 2 days are the most
uncomfortable; we suggest taking the pain medication
as ordered. ALSO, remember that you must not drive
while you are taking this medication.
• Most narcotic pain medications may cause
constipation. We recommend that you take a daily
stool softener (ie. Docusate sodium) while taking the
pain medication. If you continue to have problems with
constipation you may also try a dulcolax suppository
or Miralax daily until you are able to move your
bowels. All of these medications may be purchased
without a prescription at your local pharmacy.
Increasing your fluid intake and activity level may also
help.
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
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 [129298]
Page 6 of 7
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:30:47 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@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.
Follow-Up Appointments [128913]
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
Schedule Appointment at UW Health - 1 S. Park
Clinic [NURCOM0056]
Routine
Purpose:
With whom:
For when:
UW Health Clinic
1 S. Park St.
Madison, WI 53715
Phone: (608) 287-2000
Schedule Appointment at UW Health at The
American Center [NURCOM0056]
Routine
Purpose:
With whom:
For when:
UW Health at The American Center
4602 Eastpark Blvd
Madison, WI 53718
Page 7 of 7
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:30:47 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org