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/clinical/cckm-tools/content/order-sets/ambulatory/transformations-surgery-center/name-98464-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 - Breast - Adult - Postoperative [4772]

TSC - Plastic Surgery - Breast - Adult - Postoperative [4772] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Transformations Surgery Center


TSC - Plastic Surgery - Breast - Adult - Postoperative [4772]
PostOp/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 9:42:56 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 [128906]
(Activity, Nutrition, orders based on patient can be found in the appropriate groups below Unique
Home). Wound Care, Medications at
Breast Augmentation/Mammoplasty [134669]
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 become overly
concerned if you notice a decrease sensation in your
nipples. The sensation usually returns in a few
weeks to a month.
• You may hear a sloshing sound in the breasts if
you had saline implants. This is caused by the fluid
and air in the implants. This will stop within a week.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• Continue wearing the surgical bra for 24 hours
(overnight). Wear loose comfortable clothing. DO
NOT wear an under wire bra for 2 weeks. Instead,
wear a sports bra or the surgical bra given at
discharge.
• Keep your head elevated as much as possible for
the first 48 hours to help reduce swelling and
discomfort. A lounger is a good place to sleep and
rest. Use extra pillows while you lie in bed to elevate
your head and chest.
• Stay quiet, resting the first 24 hours. Excessive
activity may cause you to bleed. You may gradually
increase your activities as tolerated. Do not do any
activities that cause strenuous use of your arms
such as pushing, pulling, vacuuming and limit
reaching above your head for the first 2 weeks.
• Avoid any strenuous exercise, swimming, or
running for first two weeks.
• DO NOT massage your breasts. These implants do
not require massage., Phase II Discharge
Page 2 of 7
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:42:56 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Wound Care [NURWND0015] Routine, • Remove dressings prior to showering.
After showering, pat incisions dry and apply clean
dressings.
• If you have a dressing, you may see some bloody
drainage up to the size of a quarter. There may also
be a small amount of swelling. If there is excessive
bleeding or swelling, call your surgeon
• Check your incisions twice daily for any signs of
infection. Redness at the incision site is normal, but
redness extending beyond the incision (greater than
1 cm) or over the breast may indicate an infection. If
your sutures are not dissolvable they will be
removed at your one week post op appointment.
Breast Reduction [134672]
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.
• You will have a special support bra put on after
surgery.
• Wear the surgical bra for 2 weeks or until instructed
differently by your surgeon.
• 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.
• Bruising is common and may increase before going
away completely.
• Most of your stitches will dissolve. If you have
stitches that need to be removed, this will be done at
your post operative appointment. They may feel
prickly at first, this is normal.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• No tub baths, swimming or hot tubs for 2 weeks.
• Remove dressings prior to showering. After
showering, pat incsions dry and apply clean
dressings.
• Keep your head elevated as much as possible for
the first 48 hours to help reduce swelling and
discomfort. A lounger is a good place to sleep and
rest. Use extra pillows while you lie in bed to elevate
your head and chest., Phase II Discharge
Wound Care [NURWND0015] Routine, • Do not wear an underwire bra for 2 weeks.
• Only remove the bra for your shower and during
dressing changes.
• Change gauze dressings over drain sites when
they become wet.
Gynecomastia [134674]
Page 3 of 7
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:42:56 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

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 increased or
decreased sensation in your nipples. The sensation
usually returns to normal in a few weeks to a month.
• Swelling and bruising is common and may increase
before going away completely.
• Most of your stitches will dissolve. If you have
stitches that need to be removed, this will be done at
your post operative appointment. They may feel
prickly at first, this is normal.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• Continue wearing your compression vest or binder
for 24 hours (overnight). Remove the vest for
showering and dressing changes, and then put it
back on.
• Plan to take it easy for the next week or two.
• Avoid strenuous exercise for 3-4 weeks. Slowly
increase your activity. Limit activities that bring your
arms over your head like pulling on clothes or lifting
items to shelves for 1-2 weeks.
• Do not massage your breasts.
• Sleep with your head elevated for 5 days., Phase II
Discharge
Wound Care [NURWND0015] Routine, • Look at the surgical area every 4-6 hours
the first day. You should change the gauze pads as
needed. The drainage will decrease each day. You
may also notice some swelling, this is normal. If
there is excessive bleeding or swelling (having to
change the gauze pads every hour), then you need
to call your surgeon.
• Vaseline may be applied to keep the skin supple.
Mastopexy [134684]
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 decreased
sensation in your nipples. The sensation usually
returns in a few weeks to a month.
• Swelling and bruising is common and may increase
before going away completely.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• Plan to take it easy for the next week or two.
• Avoid strenuous exercise for 3-4 weeks. Slowly
increase your normal activity. Limit activities that
bring your arms over your head like pulling on
clothes or lifting items to shelves for 1-2 weeks.
• Your surgeon will discuss increasing activity at your
post-op visit.
• Do not massage your breasts.
• Sleep with your head elevated for the first 3-5
days., Phase II Discharge
Page 4 of 7
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:42:56 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Wound Care [NURWND0015] Routine, • Continue to wear the surgical bra for 24
hours (overnight). DO NOT wear an under wire bra
for 2 weeks.
• Look at the surgical area every 4-6 hours the first
day. You should change the gauze pads as needed.
The drainage will decrease each day. You may also
notice some swelling, this is normal. If there is
excessive bleeding or swelling (having to change the
gauze pads every hour), then you need to call your
surgeon.
• Most of your stitches will dissolve. If you have
stitches that need to be removed, this will be done at
your post operative appointment. They may feel
prickly at first, this is normal.
Activity [195146]
Lifting Restrictions [NURACT0008] Routine
Discharge Activity: See Instructions
• Avoid lifting more than *** pounds for *** weeks,
Phase II Discharge
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.
Page 5 of 7
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:42:56 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

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]
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
Page 6 of 7
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:42:56 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

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 [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 9:42:56 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org