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/clinical/cckm-tools/content/order-sets/ambulatory/transformations-surgery-center/name-98465-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 - Face -Adult - Postoperative [4809]

TSC - Plastic Surgery - Face -Adult - Postoperative [4809] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Transformations Surgery Center


TSC - Plastic Surgery - Face - Adult - Postoperative [4809]
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 (Discharge Instructions)
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 14
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:45:59 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
Discharge Instructions - Procedure Specific [129291]
Blepharoplasty [134723]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• It is important that you stay quiet and do little
talking for the first 24 hours; excess movement may
cause bleeding.
• No strenuous activity for 1-2week(s).
• When you sleep, prop your head up on three or
more pillows (sleeping in a recliner works well too).
Keeping your head above your heart will help
decrease soreness and swelling., Phase II
Discharge
Wound Care [NURWND0015] Routine, • Use iced gauze pads to help reduce
swelling and discomfort. When you arrive home, put
gauze pads/ washcloth in a bowl of ice water. Place
a cold gauze pad on each eye, then place iced eyed
compress over gauze pad. Change pads as needed
to keep them cold (about every 10 to 20 minutes).
Continue this until bedtime for 2 days.
• Apply ophthalmic ointment to incisions as
instructed.
• Once in the middle of your first night home, you or
someone else should check your incisions. Call your
doctor if you notice excess bleeding or swelling or
decreased vision in your eyes.
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 medicine as
ordered. Do not take any aspirin or anti-
inflammatory products until your doctor approves it.
Brow Lift [134724]
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 2 of 14
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:45:59 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
• 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. To
get out of bed, roll on your side first and push up with
your arms.
• Do not fly for 1 week following surgery
• Generally, there should be no rigorous exercise for
one month following surgery. Walking daily is
acceptable.
• No tub baths, swimming or whirlpool for 2 weeks.
• When we see you after surgery, we will tell you
when 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 must not go into the sun for 2 weeks following
surgery.
• Do not apply any makeup or lotions to your face
during the first week., Phase II Discharge
Wound Care [NURWND0015] Routine, • Cold compresses 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.
Dermabrasion [134725]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, • Oozing of clear, yellow or
bloody drainage is to be expected for the first 24
hours. This is normal.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• It is not necessary to stay in bed., Phase II
Discharge
Page 3 of 14
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:45:59 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, • You should keep the area clean with a
mild soap and lukewarm water four times daily. Do
not allow the oozing to form a scab. If there is
bleeding when you wash, do not be concerned, this
is common.
• After all areas are healed and oozing has stopped,
apply Lubriderm lotion. This should occur in about 7
to 10 days. Apply a thin film 4 times daily after
washing. You may continue with antibiotic ointment
at bedtime.
• If you have any unusual rash or skin irritation,
please discontinue all topical medications and
contact our office.
• After all skin areas are healed, normal washing of
your face should be followed by Vitamin E or Cocoa
Butter. Gently rub into skin.
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, • Take the Valtrex prescription
given to you.
Face Lift [134726]
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 36 hours and then very slowly decrease
in 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 14
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:45:59 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
• 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.
• Generally, there should be no heavy exercise for
one month following surgery.
• 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.
• When we see you after surgery, we will tell you
when 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 must not go into the sun for 2 weeks following
surgery.
• Do not apply any makeup or lotions to your face
during the first week., Phase II Discharge
Wound Care [NURWND0015] Routine, • You will be seen at the office for removal
of dressings, and possibly for drain removal.
• You may wish to bring a scarf to cover your hair the
day the dressing is removed.
• Cold compresses should be applied to your face
and neck for the first 48 hours after surgery to help
minimize the bruising and swelling.
• 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 OR
and they will instruct you on how to milk the drain.
Otoplasty [134728]
Page 5 of 14
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:45:59 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
• 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 2-3 days if you feel
strong enough.
• After your sutures are removed, you may shampoo
your hair as usual. If you normally use a hair dryer,
be sure it is on the cool setting., Phase II Discharge
Wound Care [NURWND0015] Routine, • For 4-6 weeks, wear a stocking cap or
headband to protect your ears.
• A bulky bandage will be wrapped around your head
to cover your ears. Leave the bandage on until your
clinic visit. Do not shower or get this bandage wet. If
the bandage is very loose or very tight, call the
doctor.
• When the bandage is first removed, the ears may
seem to be overcorrected or too close to the head.
This is normal. The ears will begin to take their new
position within a few days to weeks.
• There may be some drainage from the suture lines
for 2-3 days. Nondissolvable sutures will be removed
10-12 days following surgery.
Reconstructive Facial Flaps and Grafts [134729]
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 flap or
graft to feel weak or numb after surgery. This will
resolve over the next few weeks.
• Your flap or graft may appear pink, purplish or
dusky. There may be some exposed tissue covered
by Vaseline or other moist dressing.
Page 6 of 14
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:45:59 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
• 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.
• Generally, there should be no exercise for one
month following surgery.
• 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.
• Please refrain from tobacco and nicotine
replacement for at least 2 weeks before and after
surgery.
• When we see you after surgery, we will tell you
when 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 if your flap
or graft is near the hairline.
• Do not apply any makeup or lotions to your face
during the first week.
• Avoid sun exposure to your flap/ graft site for at
least 3 months., Phase II Discharge
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:
Tube Feeding:
It is best to eat a soft diet for the first week, such as
things that don't require much chewing. Avoid spicy
or thermal hot foods which can cause flushing.
Wound Care [NURWND0015] Routine, • You will be seen at the office for removal
of dressings, and possibly for drain removal.
• Keep area clean and dry. Change dressing as
directed by your surgeon.
Page 7 of 14
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:45:59 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Rhinoplasty [134730]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, • 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.
• Expect nasal drainage for the first 2-3 days.
• Directly after surgery, you may feel sick to your
stomach due to the drainage that you have
swallowed during the surgery. If you vomit, it is not
unusual for it to be bloody.
LONG TERM CARE:
• 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 two weeks.
• Numbness over your nose is also very common
and will resolve in about 3 months.
• Breathing through 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.
• No sun exposure to the nose/ face for 3 months
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.
Page 8 of 14
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:45:59 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
• Do NOT hit or move any portions of your nose or
packing.
• Do NOT use a straw. This can create suction in
the back of your throat, which could cause a higher
risk of bleeding or swelling.
• DO NOT BLOW YOUR NOSE.
• Do not hold back a sneeze. Sneeze with your
mouth open.
• 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.
• Only light activity after your surgery for one 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 two 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.
• No aerobics, jogging or swimming for 2-3 weeks, or
until ok with your Surgeon.
• No tub baths, swimming or whirlpools for 1-2
weeks., Phase II Discharge
Wound Care [NURWND0015] Routine, • You will need to change the small gauze
dressing under your nose when it becomes soiled.
The first day the drainage will be bloody. It will
change to pink-yellow color after the first day or so.
• 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 Ziploc bag. Place this
pack diagonally across the eyes and the nasal
bridge.
• For the first week after surgery, cleanse the nose
and ear incisions with a Q-tip saturated with
hydrogen peroxide. 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.
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, • Do not use decongestants or
antihistamines unless your Surgeon has
recommended them.
• Start using the Deep Sea Nasal Spray that is in
your take home supplies 4 times a day starting the
day after surgery.
Septoplasty [134731]
Page 9 of 14
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:45:59 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, • Expect nasal stuffiness. This
is caused by post-operative swelling that will
decrease over the next few weeks.
• Expect crusting in the nose for 3 to 6 weeks while
the incision is healing.
• Expect to have some nasal bleeding after your
surgery.
• Directly after surgery, you may feel sick to your
stomach. This is due to the drainage that you
swallow during surgery. This drainage is irritating to
the stomach and may cause you to vomit. If you
vomit, it may be bloody.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• Do not hit or move any portions of your nose or
packing.
• Do not use a straw to drink fluids. This can create
suction in the back of your throat, which could cause
a higher risk of bleeding or swelling.
• 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.
• Do not hold back a sneeze. Sneeze with your
mouth open.
• Keep your head thirty degrees above your heart for
the next few weeks. Do not lie flat in bed. Sleep with
extra pillows under your head.
• Do not pick the inside of your nose.
• For one week after surgery, you may engage in
light activity only, and then you may resume normal
activity as tolerated.
• You may wear your lightest weight glasses and
lightly rest them on your nasal cast, or taped to your
forehead. You may insert your contact lenses two
days after surgery. After removal of your nasal
splint, you should limit the time that glasses are
worn.
• No aerobics, jogging or swimming for 2-3 weeks.
• Avoid stressful activities and situations., Phase II
Discharge
Page 10 of 14
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:45:59 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, • You will need to change the small gauze
dressing under your nose when it becomes soiled.
Your nurse will show you how to do this before you
go home. Heavy bleeding (soaking more that one
pad per hour) should be reported to your physician.
• Change the dressings as needed. You may stop
using the dressings when the drainage has stopped.
• At first, nasal drainage will be bloody. It will
gradually change to a pink-yellow color by the
following day.
• Cold packs can be used to decrease nasal
drainage, reduce swelling, and relieve discomfort.
Please use the ice packs for the first 48 hours.
• For the first week after surgery, cleanse the nasal
and ear incisions with a Q-tip saturated with
hydrogen peroxide. Use a rolling motion along the
length of the incision and allow drying. Roll a thin
layer of antibiotic ointment over the incision. Start
this the day after surgery and cleanse 3 times a day.
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, • Your doctor may prescribe a
nasal saline spray to loosen crusting and make you
more comfortable.
• Do not use decongestants or antihistamines unless
your doctor recommends them.
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]
Page 11 of 14
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:45:59 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

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 [195150]
Page 12 of 14
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10/2017CCKM@uwhealth.org

Medication Instructions [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.
• You may be prescribed a low-dose steroid to help
reduce swelling. This medication should be started the
day after surgery.
• If antibiotics have been prescribed, take them as
directed. These should start the day after your
surgery.
Do NOT take aspirin for 7 days after your surgery
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine
Do NOT take ibuprofen for 7 days after your
surgery [NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine
Do NOT use decongestants or antihistamines
unless your doctor recommends them
[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 of acetaminophen per day
[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 13 of 14
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:45:59 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 14 of 14
Printed by WILLIAMS, HEATHER R [HRS0] at 10/17/2017 9:45:59 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org