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TSC - Eye and Strabismus Surgery - Adult - Postoperative [4706]

TSC - Eye and Strabismus Surgery - Adult - Postoperative [4706] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Transformations Surgery Center


TSC - Eye and Strabismus Surgery - Adult - Postoperative [4706]
PostOp/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 [144601]
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:
Outpatient Discharge Orders (Medications)
Medications - RIGHT Eye [144603]
neomycin-polymyxin-dexamethasone
3.5-10000-0.1 ophthalmic susp [142696]
1 drop, 5 mL, 2, starting 1/6/17, Normal, Phase II
Discharge
neomycin-polymyxin-dexamethasone
3.5-10000-0.1 ophthalmic ointment [142697]
3.5 g, 0, starting 1/6/17, Normal
sulfacetamide-prednisolone (BLEPHAMIDE)
10-0.2 % ophthalmic susp [66422]
1 drop, 5 mL, 2, starting 1/6/17, Normal
Or other medication per insurance coverage or
product availability:
- May interchange to sulfacetamide-prednisolone
0.23%
Phase II Discharge
sulfacetamide-prednisolone (BLEPHAMIDE)
10-0.2 % ophthalmic ointment [46645]
3.5 g, 2, starting 1/6/17, Normal
Or other medication per insurance coverage or
product availability:
- May interchange to sulfacetamide-prednisolone
0.23%
Phase II Discharge
prednisolone (PRED FORTE) 1 % ophthalmic
susp [41271]
1 drop, 5 mL, 2, starting 1/6/17, Normal, Phase II
Discharge
tobramycin-dexamethasone (TOBRADEX)
0.3-0.1 % ophthalmic susp - NOTE - order for
patients with allergy/intolerance for neomycin
[46771]
1 drop, 5 mL, 2, starting 1/6/17, Normal, Phase II
Discharge
tobramycin-dexamethasone (TOBRADEX)
0.3-0.1 % ophthalmic ointment - NOTE - order for
patients with allergy/intolerance for neomycin
[46770]
3.5 g, 0, starting 1/6/17, Normal
Medications - LEFT eye [144604]
neomycin-polymyxin-dexamethasone
3.5-10000-0.1 ophthalmic susp [142696]
1 drop, 5 mL, 2, starting 1/6/17, Normal, Phase II
Discharge
Page 1 of 5
Printed by LIND, JANNA S [JSL237] at 1/6/2017 4:34:14 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

neomycin-polymyxin-dexamethasone
3.5-10000-0.1 ophthalmic ointment [142697]
3.5 g, 0, starting 1/6/17, Normal, Phase II Discharge
sulfacetamide-prednisolone (BLEPHAMIDE)
10-0.2 % ophthalmic susp [66422]
1 drop, 5 mL, 2, starting 1/6/17, Normal
Or other medication per insurance coverage or
product availability:
- May interchange to sulfacetamide-prednisolone
0.23%
Phase II Discharge
sulfacetamide-prednisolone (BLEPHAMIDE)
10-0.2 % ophthalmic ointment [46645]
3.5 g, 2, starting 1/6/17, Normal
Or other medication per insurance coverage or
product availability:
- May interchange to sulfacetamide-prednisolone
0.23%
Phase II Discharge
prednisolone (PRED FORTE) 1 % ophthalmic
susp [41271]
1 drop, 5 mL, 2, starting 1/6/17, Normal, Phase II
Discharge
tobramycin-dexamethasone (TOBRADEX)
0.3-0.1 % ophthalmic susp - NOTE - order for
patients with allergy/intolerance for neomycin
[46771]
1 drop, 5 mL, 2, starting 1/6/17, Normal, Phase II
Discharge
tobramycin-dexamethasone (TOBRADEX)
0.3-0.1 % ophthalmic ointment - NOTE - order for
patients with allergy/intolerance for neomycin
[46770]
3.5 g, 0, starting 1/6/17, Normal
Medications - BOTH Eyes [144607]
neomycin-polymyxin-dexamethasone
3.5-10000-0.1 ophthalmic susp [142696]
1 drop, 5 mL, 2, starting 1/6/17, Normal, Phase II
Discharge
neomycin-polymyxin-dexamethasone
3.5-10000-0.1 ophthalmic ointment [142697]
3.5 g, 0, starting 1/6/17, Normal
sulfacetamide-prednisolone (BLEPHAMIDE)
10-0.2 % ophthalmic susp [66422]
1 drop, 5 mL, 2, starting 1/6/17, Normal
Or other medication per insurance coverage or
product availability:
- May interchange to sulfacetamide-prednisolone
0.23%
Phase II Discharge
sulfacetamide-prednisolone (BLEPHAMIDE)
10-0.2 % ophthalmic ointment [46645]
3.5 g, 2, starting 1/6/17, Normal
Or other medication per insurance coverage or
product availability:
- May interchange to sulfacetamide-prednisolone
0.23%
Phase II Discharge
prednisolone (PRED FORTE) 1 % ophthalmic
susp [41271]
1 drop, 5 mL, 2, starting 1/6/17, Normal, Phase II
Discharge
tobramycin-dexamethasone (TOBRADEX)
0.3-0.1 % ophthalmic susp - NOTE - order for
patients with allergy/intolerance for neomycin
[46771]
1 drop, 5 mL, 2, starting 1/6/17, Normal, Phase II
Discharge
tobramycin-dexamethasone (TOBRADEX)
0.3-0.1 % ophthalmic ointment - NOTE - order for
patients with allergy/intolerance for neomycin
[46770]
3.5 g, 0, starting 1/6/17, Normal
Outpatient Discharge Orders (Discharge Instructions)
Activity [143730]
Page 2 of 5
Printed by LIND, JANNA S [JSL237] at 1/6/2017 4:34:14 PM
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
- Progressive ambulation as tolerated
- No swimming, bathing, soaking or washing face with
pooled water for 3 weeks.
- When showering, face away from the water and do
NOT get soap or shampoo in the eyes for the first
week.
- Do not drive for 24 hours or while taking narcotics.,
Phase II Discharge
When to Return to School [NURACT0008] Routine
Discharge Activity:
You may return to school *** days after going home.,
Phase II Discharge
When to Resume Work [NURACT0008] Routine
Discharge Activity:
You may resume work next week as discussed with
your physician, Phase II Discharge
When to Return to Contact Sports
[NURACT0008]
Routine
Discharge Activity:
NO contact sports for *** days.
Diet [144592]
Diet [NURDIE0013] Routine, - Resume preoperative diet as tolerated.
- Do NOT drink alcohol for 24 hours or while taking
narcotics.
Wound Care [144594]
Wound Care [NURWND0015] Routine, - An ice pack can be applied to the eye,
once per hour for 3-5 minutes each time for first 48
hours to help reduce swelling and discomfort.
- If the eyes are sore, remain quiet the first evening
with your head raised to reduce swelling, bleeding,
and soreness.
- If you wear glasses, they should be worn when you
are up and around.
- You may have possible red eye for 1 month.
IV Site Care [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 you Doctor/Nurse if this does
not get better in 1-2 days or if gets worse.
Medications at Home [144608]
Page 3 of 5
Printed by LIND, JANNA S [JSL237] at 1/6/2017 4:34:14 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@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 take your normal
medicines, unless the doctor has told you not to do
so.
- You were given an ointment or drops that will help
healing and prevent infection. Follow these steps
1) Wash your hands well with soap and water. You
may want to run the tube under a hot tap for a few
seconds to soften the medicine to make it easier to
apply.
2) Do not touch the tip of the tube or bottle. This will
keep the ointment or drops clean.
3) Tilt your head back and up.
4) Hold the tube or bottle between your thumb and
forefinger and place it as close to the eyelid and
eyeball.
5) Squeeze a small amount of ointment, or instill 1-2
drops into the pocket.
6) Wipe any extra ointment off with a tissue.
7) Cover the ointment tube or eye drop bottle and
place it in a clean, safe place.
NOTE: The ointment may cause blurry vision for a
few minutes until it dissolves.
- Often only acetaminophen (Tylenol) is needed for
pain relief, but if you have questions about your need
for pain medicine call your doctor.
When to Call Your Surgeon [143737]
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, Call your surgeon if
- Sudden loss of vision
- Any double vision
- Increased pain or discharge in the eye.
- A large increase in redness or swelling.
- Nausea or vomiting.
- The operated eye turns in one direction and then
does not move.
- if you have any other questions or problems.
Contact Information [144609]
Contact Information [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, Your surgeon’s name is
@ATTPROV@ and can be reached at
@ATTENDPH@, Monday-Friday between 8:00 am
4:30pm. All other times please call the number listed
above and you will be routed to a provider on call.
Follow up Appointments [144610]
Page 4 of 5
Printed by LIND, JANNA S [JSL237] at 1/6/2017 4:34:14 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

Schedule Appointment at Transformations
[NURCOM0056]
Routine
Purpose:
With whom:
For when:
Eye Care Services
2349 Deming Way Clinic (Transformations)
(608) 824-3937 / (888) 703-2778
Schedule Appointment at University Station
Clinic [NURCOM0056]
Routine
Purpose:
With whom:
For when:
Lions Pediatric Eye and Adult Strabismus Clinic
2880 University Avenue (University Station Clinic)
(608) 263-6414 / (800) 323-8942
Page 5 of 5
Printed by LIND, JANNA S [JSL237] at 1/6/2017 4:34:14 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org