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OP – Urologic Surgery – Pediatric – Postoperative [2965]

OP – Urologic Surgery – Pediatric – Postoperative [2965] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Urology


OP - Urologic Surgery - Pediatric - Postoperative [2965]
Post-Op/Phase II
Post-Op Care Orders [92283]
Strain All Urine, Save Fragments [NURELM0019] CONTINUOUS, Starting today, Routine
For:
If Present:
Post-Op/Phase II
Other Post-Op Care Orders [NURCOM0022] CONTINUOUS, Starting today, ***, Post-Op/Phase II
Sucrose for Oral Analgesia [110668]
sucrose (SWEET-EASE) 24% buccal soln
[794009]
Oral, PRN, pain, mild pain or potentially painful
procedures. See Admin Instructions, Post-Op/Phase
II
Outpatient Discharge Orders
Medications - Prescriptions [91630]
sulfamethoxazole-trimethoprim 200-40 mg/5 mL
(BACTRIM) susp - NOTE: Suggested dose 2
mg/kg of trimethoprim (Maximum 800/160
mg/dose) [58784]
starting 3/22/17, Normal, Phase II Discharge
sulfamethoxazole-trimethoprim (BACTRIM) 400-
80 mg per tab - NOTE: Suggested dose 2 mg/kg
of trimethoprim (Maximum 800/160 mg/dose)
[42457]
1 tab, starting 3/22/17, Normal, Phase II Discharge
sulfamethoxazole-trimethoprim (BACTRIM DS)
800-160 MG per tab - NOTE: Suggested dose 2
mg/kg of trimethoprim (Maximum 800/160
mg/dose [46804]
1 tab, starting 3/22/17, Normal, Phase II Discharge
cephalexin (KEFLEX) 250 MG cap [44593] starting 3/22/17, Normal, Phase II Discharge
cephalexin (KEFLEX) 250 MG/5ML susp [44596] 10 mg/kg, starting 3/22/17 until 4/1/17, Normal, Phase
II Discharge
oxybutynin (DITROPAN) 5 MG/5ML SYRP -
NOTE: Suggested dose 0.1 mg/kg (Maximum 5
mg/dose) [45972]
0.1 mg/kg, starting 3/22/17, Normal, Phase II
Discharge
oxybutynin (DITROPAN) 5 mg tab - NOTE:
Suggested dose 0.1 mg/kg (Maximum 5
mg/dose) [40666]
starting 3/22/17, Normal, Phase II Discharge
acetaMINOPHEN alcohol free (TYLENOL) 160
MG/5ML susp - Maximum Dose = 650 mg
[43991]
10 mg/kg, starting 3/22/17, Normal, Phase II
Discharge
acetaMINOPHEN alcohol free (TYLENOL) 160
MG/5ML susp - Maximum Dose = 650 mg
[43991]
15 mg/kg, starting 3/22/17, Normal, Phase II
Discharge
acetaMINOPHEN (TYLENOL) 325 MG tab =
Maximum Dose = 650 mg [34149]
starting 3/22/17, Normal, Phase II Discharge
hydrocodone-acetaMINOPHEN (NORCO) 5-325
mg per tab [71425]
0, starting 3/22/17 until 4/21/17, Normal, Phase II
Discharge
ibuprofen (MOTRIN) 200 MG tab - Maximum
Dose = 600 mg [38353]
starting 3/22/17, Normal, Phase II Discharge
ibuprofen (MOTRIN) 100 MG/5ML susp -
Maximum Dose = 600 mg [45376]
10 mg/kg, starting 3/22/17, Normal, Phase II
Discharge
oxycodone 5 mg/5 mL soln - NOTE: Suggested
dose 0.05-0.15 mg/kg (Maximum 5 mg/dose)
[45975]
0, starting 3/22/17 until 4/21/17, Normal, Phase II
Discharge
Page 1 of 4
Printed by WILLIAMS, HEATHER R S [HRS0] at 3/22/2017 10:46:44 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2017CCKM@uwhealth.org

oxycodone 5 mg tab - NOTE: Suggested dose
0.05-0.15 mg/kg (Maximum 5 mg/dose) [45976]
0, starting 3/22/17 until 4/21/17, Normal, Phase II
Discharge
polyethylene glycol (MIRALAX) POWD [61353] 527 g, 0, starting 3/22/17, Normal, Phase II Discharge
tamsulosin (FLOMAX) 0.4 mg 24 hr ER cap -
1x/d - NOTE: For patients 12 years or older
[140027]
0.4 mg, starting 3/22/17, Normal, Phase II Discharge
bacitracin-polymyxin b (POLYSPORIN) 500-
10000 UNIT/GM ointment [34991]
1 each, starting 3/22/17, Normal, Phase II Discharge
bacitracin-polymyxin b (POLYSPORIN)
ophthalmic ointment [55599]
starting 3/22/17, Normal, Phase II Discharge
Bacitracin 500 UNIT/GM ointment [34986] starting 3/22/17, Normal, Phase II Discharge
doxazosin (CARDURA) tab - NOTE: For patients
3 years and older [45010]
starting 3/22/17, Normal, Phase II Discharge
Belladonna Alkaloids-Opium 16.2-30 MG
suppository [44301]
30 mg, starting 3/22/17, Normal, Phase II Discharge
docusate sodium (COLACE) 50 MG/5ML oral
liquid [74449]
50 mg, starting 3/22/17, Normal, Phase II Discharge
docusate sodium (COLACE) 50 MG cap [36859] 50 mg, starting 3/22/17, Normal, Phase II Discharge
polyethylene glycol (MIRALAX) oral powder
[61353]
starting 3/22/17, Normal, Phase II Discharge
No NSAIDS [138585]
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, No non-steroidal anti-inflammatory
drugs (examples of NSAIDs are ibuprofen, motrin,
advil, aspirin, naproxen, etc.) for *** days.
Activity/Return to School [91671]
Activity (No Restrictions) [NURACT0008] Routine
Discharge Activity: Up As Tolerated
No lifting restrictions.
No bathing, showering or swimming restrictions.
May resume activities and sports as tolerated., Phase
II Discharge
Activity Restrictions - No Straddle Activities
[NURACT0008]
Routine
Discharge Activity:
No straddle activities for two weeks (for example
bicycles or bouncy chairs), Phase II Discharge
Activity Restrictions [NURACT0008] Routine
Discharge Activity:
May return to work/school in ***.
No lifting greater than 10 pounds for ***.
No tub baths for ***, showers are ok after ***
No swimming for ***.
No gym classes for ***.
No sports for ***., Phase II Discharge
Strain All Urine, Collect Any Stones
[NURACT0011]
Routine
Activity-Patients with Hypospadius Repairs [139250]
Activity Restrictions [NURACT0008] Routine
Discharge Activity: See Instructions
No tub baths or swimming until urethral stent is
removed., Phase II Discharge
Nutrition [91663]
Page 2 of 4
Printed by WILLIAMS, HEATHER R S [HRS0] at 3/22/2017 10:46:44 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2017CCKM@uwhealth.org

General Diet Without Restrictions [NUT8888] Routine
General: General (No Modifications)
Diet Modifications:
Other Diet Modifications:
Wound Care [92355]
May Remove Dressing [NURWND0018] Routine, May remove dressing in *** days.
Wear Scrotal Support [NURWND0018] Routine, Wear scrotal support for *** days.
Wear Tight Fitting Briefs [NURWND0018] Routine, Wear tight fitting briefs for *** days.
Apply Antibiotic Ointment [NURCOM0022] Routine, Apply antibiotic ointment to {UROLOGY
APPLY ANTIBIOTIC:3022809}.
Wound Care [NURWND0015] Routine, ***
Apply Bacitracin at Meatal Tip. RN to teach
patient/parents. [NURCOM0022]
Routine, Apply Bacitracin at Meatal Tip. RN to teach
patient/parents.
Wound Care, Penoplasty/Stentless Hypospadias
Repairs [NURWND0018]
Routine, Sitz bath, starting 2nd day after surgery, with
1 oz betadine in water; 3 x day x 1 week, then 2 x day
x 1 week
Follow-Up Diagnostic Tests and Imaging [93826]
X-RAY ABDOMEN AP VIEW (KUB) [R74000] Status: Future, Expires: 5/22/18, Normal, Routine
US ABDOMEN LIMITED - RENAL/BLADDER
[R76705]
Status: Future, Expires: 5/22/18, Normal, Routine
NM KIDNEY SCAN W FLOW & FUNCTION W
RX [R78708]
Status: Future, Expires: 5/22/18, Normal, Routine
Follow-Up Appointments [94012]
Patient to Schedule Appointment (With MD)
[NURCOM0056]
Routine
Purpose: Follow Up/Post Op
With whom: Urology MD
For when:
Patient to Schedule Appointment (With NP)
[NURCOM0056]
Routine
Purpose: Follow Up/Post Op
With whom: Urology NP
For when:
Schedule appointment with MD or NP
[NURCOM0026]
Routine
Reason for Hospital Follow Up Appointment: Follow
Up/Post Op
When do you want appointment:
Which Clinic or Specialty:
Which Provider (Optional): MD or NP
Discharge Instructions [139263]
When to Call Your Doctor [NURCOM0079] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan.
You should include specific instructions on when and
who to call.
You should include actual provider names (i.e. not
'PCP').
You should NOT include the discharging unit as a
contact., Routine, For questions or problems call 608-
263-6420 during business hours. After hours or on
weekends, ask to speak to the Urology resident on
call. Prior to leaving the hospital, please consider
loading the phone number into your contacts in your
cell phone for easy access.
Diagnosis
Page 3 of 4
Printed by WILLIAMS, HEATHER R S [HRS0] at 3/22/2017 10:46:44 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2017CCKM@uwhealth.org

Diagnosis - Pre Op [711]
Pre-operative general physical examination
[255759]
Other specified pre-operative examination
Level of Service
Office Visit - Established Patients [30779]
99211 - Level I LOS Code
99212 - Level II LOS Code
99213 - Level III LOS Code
99214 - Level IV LOS Code
99215 - Level V LOS Code
99211 - w/ Resident (GC) - Level I LOS Code
99212 - w/ Resident (GC) - Level II LOS Code
99213 - w/ Resident (GC) - Level III LOS Code
99214 - w/ Resident (GC) - Level IV LOS Code
99215 - w/ Resident (GC) - Level V LOS Code
Office visit - New Patients [30778]
99201- Level I LOS Code
99202- Level II LOS Code
99203- Level III LOS Code
99204- Level IV LOS Code
99205 - Level V LOS Code
99201- w/ Resident (GC) - Level I LOS Code
99202- w/ Resident (GC) - Level II LOS Code
99203- w/ Resident (GC) - Level III LOS Code
99204- w/ Resident (GC) - Level IV LOS Code
99205- w/ Resident (GC) - Level V LOS Code
Consults [30780]
If Medicare patient, do not use Consult LOS. Choose an Established or New Patient LOS. Add the
appropriate additional E/M Code of 99354-99359 for prolonged office consultations in the LOS
section of the Visit Navigator.
99241 - Level I LOS Code
99242 - Level II LOS Code
99243 - Level III LOS Code
99244 - Level IV LOS Code
99245 - Level V LOS Code
99241- w/ Resident (GC) - Level I LOS Code
99242 - w/ Resident (GC)- Level II LOS Code
99243 - w/ Resident (GC) - Level III LOS Code
99244 - w/ Resident (GC) - Level IV LOS Code
99245 - w/ Resident (GC) - Level V LOS Code
Page 4 of 4
Printed by WILLIAMS, HEATHER R S [HRS0] at 3/22/2017 10:46:44 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2017CCKM@uwhealth.org