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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,General Surgery

IP – General Surgery (CRS) – Adult – Discharge [4861]

IP – General Surgery (CRS) – Adult – Discharge [4861] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, General Surgery


IP - General Surgery (CRS) - Adult - Discharge [4861]
Patient Care Orders
Confirmed Discharge Date/Time [151653]
Confirmed Discharge Date/Time [ADT0013] Confirmed Discharge Date:
Confirmed Discharge Time:
Conditions for Discharge:
Provider to be Present at Discharge?
Reason For Hospitalization [130444]
Why You Were Hospitalized [NURCOM0073] Please complete in PATIENT FRIENDLY terms.  This
order will appear on the patient's After Hospital
Care Plan., Routine
Activity [130445]
Activity [NURACT0008] Routine
Discharge Activity:
Activity - Up as Tolerated [NURACT0008] Routine
Discharge Activity: Up As Tolerated
Please walk early and often. It is important to have
light activity in your day and keep moving. Do not
lift more than 10 lbs until cleared by your provider
at your follow-up appointment.
Lifting Restrictions [NURACT0011] Routine, Do not lift greater than 10 pounds for 6
weeks
Driving Instructions [NURACT0011] Routine, You may not drive while on narcotic pain
medication. Once you are off narcotics, you must
also be aware of your limitations from abdominal
pain. You may drive when you can safely look in
your blind spot and can slam on the brakes in an
emergency. Be aware of fatigue and do not travel
long distances initially. You should also refrain from
driving if you are having trouble with distance
vision, blurred vision, or sensory hearing loss. If you
have any questions about ability to drive after
finishing narcotic pain medications, you should
consultation with your Primary Care Provider or the
DMV for assessment.
Nutrition [130447]
Diet - Low Fiber [NUT8888] Routine
General:
Diet Modifications:
Other Diet Modifications: -
Solid Consistency:
Liquid Consistency:
Liquid:
Esophagectomy:
Fat Controlled:
Fiber: Low Fiber
Fluid Restriction:
Heart Healthy:
Metabolic:
Renal:
Sodium Controlled:
NPO:
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Diet - High Fiber [NUT8888] Routine
General:
Diet Modifications:
Other Diet Modifications: -
Solid Consistency:
Liquid Consistency:
Liquid:
Esophagectomy:
Fat Controlled:
Fiber: High Fiber
Fluid Restriction:
Heart Healthy:
Metabolic:
Renal:
Sodium Controlled:
NPO:
Diet - General (No Modifications) [NUT8888] Routine
General: General (No Modifications)
Diet Modifications:
Other Diet Modifications:
Nutrition Instructions [NURDIE0013] Routine, Do not eat foods that are irritating to your
bowel.  Try to limit highly acidic foods: Coffee, beer,
wine, Coca-Cola and ALL soft drinks/carbonated
drinks, tomato products, cranberry products,
oranges and orange juice. Refer to your education
materials regarding diet.
Wound Care [130448]
Wound Care [NURWND0015] Routine, No matter how your incision is closed
please follow these instructions.  Wash incision daily
with soap and water.  Do not rub or scrub site.  Pat
dry with a towel.  Do not use lotions and/or
ointments on incision.  Monitor wounds for signs
and symptoms of infection (redness, swelling,
drainage, odor).
Bathing Instructions [NURWND0018] Routine, You may shower.  No bath tubs for 14
days.  Do not soak incision in water (no swimming,
no hot tubs, no baths).
Steristrips [NURWND0015] Routine, The steri-strips that we applied to your
incision will dry and fall off on their own. Please do
not pull at them or try to peel them off. If the
corners start to peel and are bothering you, you can
simply use clean scissors to snip the edges. You may
shower. Let clean/soapy water run over the incision
site. Do not scrub incision site.
Dermabond [NURWND0015] Routine, Your incision is closed with Dermabond®
(skin glue). Please do not try to peel off the glue.  It
will fall off on its own.
Staples [NURWND0015] Routine, Your staples will usually be removed at
your first follow up appointment in Surgery Clinic.
Heat Packs [NURWND0015] Routine, You may be sore or feel stiff after your
surgery. The use of heating packs is OK. Please use
heat on the lowest setting, for no more than 15
minutes at a time.
Line Care [NURWND0018] Routine, Your dressing needs to be changed every
*** days.  Your line should be removed ***.
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Drain Care [NURWND0018] Routine, Dressing change ***.  Your drain should be
removed ***.
Abdominoperineal Resection instructions
[NURWND0015]
Routine, Do not sit on perineal (bottom) wound for
more than 10 minutes at a time. You may sit to
transition from laying to standing, but do not
extend the amount of time that you are sitting for
longer than needed. When you sit, you do not get
as much blood perfusion to your wound and this
can impair healing. You may stand and ambulate as
much as you can tolerate. When you are laying,
please frequently reposition yourself to avoid
placing pressure on your bottom for an extended
period of time. Keep wound clean and dry. Cover
with an absorbant dressing at all times to wick
moisture. Change pad every 4 hours or as needed
to limit wetness.
Rectal Care [NURWND0015] Routine, Take a sitz bath at least three to four times
a day and after each bowel movement (BM) for
several days. This can be done in two ways. Sit in
bathtub filled with 3-5 inches of warm water. Add
nothing to the water. Relax for at least 10-20
minutes. OR you can use a plastic tub that you place
on your toilet. Sitz baths help you heal, and lessen
the pain of rectal spasms. For comfort, you may
want to sit on a towel in your bathtub.
Avoid toilet paper. Instead clean the area after a BM
by spraying with warm water. We will give you a
spray bottle or you may want to use a hand held
shower. Gently pat dry with a baby wipe, (free of
perfume, dyes and alcohol).
You will have yellow-red drainage for at least 7-14
days. Expect to wear pads (free of perfume and
dyes) in (cotton) underwear (best to use fragrance
and dye free detergent) to monitor drainage.
Change pads every 4 hours or as needed to limit
wetness and to help prevent itching in this area. You
may see more bloody drainage with increased
activity and BMs.
Pursestring Ostomy Closure [NURWND0015] Routine, You do not need to pack the wound. Gauze
dressing to site while draining. You may discontinue
this if it is no longer draining. Over time, your
pursestring closure will contract and get smaller.
The center will fill in over time.
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Wet to Dry Dressings [NURWND0015] Routine, DEFINITION
A wet-to-dry dressing is used for wounds requiring
removal of damaged tissue. The wet portion of the
dressing effectively cleans an infected wound. The
moist gauze directly absorbs all exudate and wound
debris. The dry outer layer helps pull moisture from
the wound into the dressing.
DRESSING CHANGE FREQUENCY: {Dressing Change
Frequency:23091}
EQUIPMENT
Gloves and/or thoroughly washed hands, scissors,
drape (optional), gauze dressing (thin mesh) and/or
pads, normal saline solution, tape, ties or bandage
as needed
PROCEDURE
1. Wash hands and gather equipment.
2. Place disposable bag or trash within reach of your
work area.
3. Put on clean disposable gloves if able and
remove tape or ties and old bandage.  
4. Remove tape by loosening end and pulling
gently, parallel to skin and toward dressing.
  If adhesive remains on skin, it may be removed
with wipe
5. With clean/gloved hand, lift old outer secondary
cover dressing off first.
  Gently remove this inner dressing
6. Observe the dressing for amount of drainage,
color and odor on dressing.
7. Dispose of soiled dressings in proper container.
8. Remove disposable gloves(if applicable) and
dispose of them properly then wash hands.
9. Inspect wound.  
  Note condition, color, odor, depth, width and
margins or wound placement of drain, integrity of
sutures or skin closure and character of drainage
10. Prepare dressing supplies on a clean surface
  Pour the prescribed solution into the gauze
package
  Tightly ring out saline solution from gauze so that
gauze is only slightly dampened
11. Apply moist Kerlix gauze directly on wound
surface. Pack wound by gently feeding packing
material into wound to all surfaces of wound are in
contact with packing material.
12. Gradually feed gauze into wound so all surfaces
of wound are in contact with moist gauze.
13. Apply dry gauze (4 x4) over wet gauze.
14. Cover with gauze, Surgipads, or ABD pad.  
15. Apply paper tape over dressing or secure with
Montgomery ties, bandage or binder.
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Dry to Dry Dressings [NURWND0015] Routine, DEFINITION: A dry dressing helps pull
moisture from the wound into the dressing.
DRESSING CHANGE FREQUENCY: {Dressing Change
Frequency:23091}
EQUIPMENT
Gloves and/or thoroughly washed hands, scissors,
drape (optional), gauze dressing (thin mesh) and/or
pads, tape, ties or bandage as needed
PROCEDURE
1. Wash hands and gather equipment.
2. Place disposable bag or trash within reach of your
work area.
3. Put on clean disposable gloves if able and
remove tape or ties and old bandage.  
4. Remove tape by loosening end and pulling
gently, parallel to skin and toward
dressing. If adhesive remains on skin, it may be
removed with wipe
5. With clean/gloved hand, lift old outer secondary
cover dressing off first. Gently remove this inner
dressing
6. Observe the dressing for amount of drainage,
color and odor on dressing.
7. Dispose of soiled dressings in proper container.
8. Remove disposable gloves(if applicable) and
dispose of them properly then wash
hands.
10. Inspect wound.  Note condition, color, odor,
depth, width and margins or wound placement of
drain, integrity of sutures or skin closure and
character of drainage
11. Prepare dressing supplies on a clean surface
12. Apply fine-mesh gauze directly on wound
surface. Pack wound by gently feeding packing
material into wound to all surfaces of wound are in
contact with packing material.
13. Gradually feed gauze into wound so all surfaces
of wound are in contact with gauze.
14. Apply dry gauze (4 x4) over dry gauze.
15. Cover with gauze, Surgipads, or ABD pad.  
16. Apply tape over dressing or secure with
Montgomery ties, bandage or binder.
Bladder Care [130449]
Bladder Routine [NURELM0067] Routine, Monitor for evidence of urinary retention
(inability to void) or signs of Urinary Tract Infection
(painful urination, frequency, urgency, foul smelling
urine).
Urinary Catheter Care at Home (with leg bag)
[184769]
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Urinary Catheter Care at Home (with Leg Bag)
- General Information [NURCOM0022]
Routine, 1. Always wash your hands before and
after handling your catheter or drainage bag.
2. Use alcohol to wipe the catheter and tubing
ends before reconnecting the catheter to the
tubing.
3. Keep the catheter taped to your thigh. Keep
some slack in the catheter so that it does not pull
tight. Don't let the catheter pull tight or kink.
Never pull on the catheter.
4. Make sure that the catheter keeps draining. You
should notice more urine collecting in the bag
every few hours.
5. ALWAYS KEEP THE DRAINAGE BAG BELOW THE
LEVEL OF YOUR BLADDER.
6. Keep the tubing from the catheter to the
drainage bag coiled to prevent having a big loop
of tubing where urine can collect rather than
flowing into the drainage bag.
7. Wash around your catheter twice a day. Use
mild soap and water. RINSE OFF ALL OF THE SOAP
- to prevent irritation. If your doctor has not
restricted your fluid intake, you should drink 8-12
glasses of fluid each day--fruit juice or water is
recommended.
8. Contact your doctor if you have any problems
such as urine leakage around the catheter, pain or
fullness in your abdomen, scanty urine flow, or a
blocked catheter.
9. You {Should/Should Not:322353} remove your
catheter on ***.
10. You will have your catheter removed on *** at
Dr. *** office.
Urinary Catheter Care at Home (with Leg Bag)
- Using the Leg Bag [NURCOM0022]
Routine, The leg bag is designed for use during
the day. It is smaller and allows you to move
around easier, however, you must empty it every
three to four hours or when it gets half full. If you
are going to have your catheter in for an extended
period of time, such as at night, you'll need to
connect the catheter to a bedside drainage bag.
1. Wash your hands
2. Disconnect the bedside drainage bag from the
catheter, remove the cap from the upper end of
the leg bag. Cleanse the end of the catheter and
the upper end fo the leg bag with alcohol and
then connect them together. Cleanse the end of
the drainage bag tubing with alcohol, and then
place the cap from the leg bag over the end of the
tubing on the bedside bag to keep it clean.
3. Adjust the straps to fit your thigh.
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Urinary Catheter Care at Home (with Leg Bag)
- To Empty the Leg Bag [NURCOM0022]
Routine, 1. Wash your hands
2. Unstrap the button from around your leg.
3. Remove the cap, open the clamp and drain all
the urine into the toilet or a measuring container.
Do not touch the drain port with your fingers, the
toilet or the container. If by accident you do touch
the drain, clean it with alcohol.
4. After the urine is drained out, close the clamp
and replace the cap.
Urinary Catheter Care at Home (with Leg Bag)
- Using the Bedside Bag [NURCOM0022]
Routine, 1. Before you go to bed at night, replace
the leg bag with the bedside drainage bag. (You
won't have to empty this bag during the night
because it holds more urine.)
2. Wash your hands.
3. Empty the leg bag.
4. Disconnect the leg bag, cleanse the end of the
catheter and the end of the bedside bag with
alcohol, and then connect the bedside drainage
bag to the catheter.
5. Cleanse the port of the leg bag with alcohol and
then put the cap which you had put on the tubing
of the bedside bag onto the upper port of the leg
bag.
6. Hang the drainage bag on the side of your bed
and coil the tubing on the bed.
Urinary Catheter Care at Home (with Leg Bag)
- Emptying the Bedside Bag [NURCOM0022]
Routine, 1. Wash your hands
2. Remove the drain tube from its sleeve, without
touching the tip. Unclamp the drain tube.
3. Drain the urine into the toilet or measuring
container. Do not let your fingers, the container or
the toilet touch the drain tube.
4. Reclamp the tube and insert it into the sleeve of
the drainage bag.
Urinary Catheter Care at Home (with Leg Bag)
- Cleaning the Urinary Bag [NURCOM0022]
Routine, 1. Wash your hands.
2. Empty the urine out of the bag.
3. Using a funnel, fill the bag with soapy water.
Shake and then drain. Rinse the bag with plain
water. Cleanse the outside of the bag with soapy
water.
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Urinary Catheter Care at Home (with Leg Bag)
- Removing Your Catheter [NURCOM0022]
Routine, If you have been instructed to remove
your catheter at home, you will need the following
supplies: 20 cc syringe, drainage collection
container or toilet, and waste container or plastic
bag to be thrown in the garbage. You can do this
while sitting on the toilet, a chair, or lying in bed.
1. Leave the catheter hooked to the drainage bag.
Using a twisting motion, put the syringe without
the needle into the small port at the end of the
catheter. Gently pull back on the plunger and
allow the syringe to fill with the water from the
balloon on the end of the catheter. After the
syringe fills, remove it from the catheter port and
empty the water into the sink or toilet. Re-connect
the syringe to the catheter port and again pull
back to remove the remainder of the water from
the balloon on the end of the catheter.
2. Gently remove the catheter from your body. If
resistance is met, reinsert the syringe into the
catheter port and recheck to make sure all of the
water has been removed from the balloon port.
3. Empty the drainage bag and discard the bag
and catheter in the garbage.
IF YOU ENCOUNTER A PROBLEM, CALL YOUR
SURGEON AT 608-287-2900
Bowel Care [130450]
Bowel Care [NURELM0068] Routine, Narcotic pain medications can cause
constipation.  If you experience constipation while
on narcotic pain medication, you should (1) try to
discontinue or decrease the narcotic pain
medication to the smallest dosage that you can
take, (2) supplement with {Tylenol or
Ibuprofen:23093} according to manufacturers label
for how much is recommended per day, (3) and
walk as often as possible.  Frequent activity will help
prevent constipation.
Change in Bowel Habits [NURELM0068] Routine, You may initially experience some
difference in bowel function- different than what
your normal bowel function has been. This
difference will be experienced because a portion of
your bowel has been removed. Over time, your
body will adapt and your bowel function should
return/improve to YOUR normal. Please have
patience with your bowels as your body learns to
accommodate the new change. You may have
normal bowel function in a few weeks OR it may
take up to 6 months. Our bodies are all different, so
we all require a different amount of time to adapt to
new changes after an operation.
Diarrhea [NURELM0068] Routine, You may experience diarrhea in the
beginning. Hopefully as you eat more solid food
this will improve. We will discuss addition of fiber
and any anti-diarrheal medication at your follow up
appointment
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Fiber Supplement [NURELM0068] Routine, Once you are having regular bowel
movements you may start Metamucil. Do not do
this if you are not having bowel movements as it
will contribute to constipation. Be sure you are
drinking plenty of fluid if you are taking Metamucil.
Ileostomy [NURELM0068] Routine, Measure all urine output and all ostomy
output and record this daily until your follow up
appointment.  Your nurse will give you a
urinal/urine hat and a graduated cylinder to
measure the output and a paper to record the
output. If ostomy output is greater than 1200 ml
each day for 2 days or if your urine output is less
than 700 ml each day for 2 days call the Digestive
Health Center at 608-890-5000 or on
weekends/evenings/holidays call 608-263-6400 and
ask for the colorectal surgery resident on call.
 Monitor for signs of dehydration(fatigue, weakness,
shakiness, lightheaded/dizziness, dry mouth, fast
heart rate).
Anticoagulation Follow Up [130462]
PROTHROMBIN TIME/INR [PT] Status: Future Approximate, Expires: 10/1/17,
Normal, Routine, To be drawn on ***
Discharge Medication Monitoring
[NURCOM0072]
Details
Other Patient Care Instructions [130451]
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, Please refer to your education
materials for further information.  
Nausea: If for any reason you should become
nauseated while eating, please step back down to a
full liquid diet until your symptoms resolve.  Your
bowels are healing, so please do not force yourself
to eat if you are not hungry.  You may experience
times when you are not hungry at meal times.  It is
OK to have something light instead.
Steroid Taper [NURCOM0071] Please complete in PATIENT FRIENDLY terms.  This
order will appear on the patient's After Hospital
Care Plan., Routine, A steroid taper minimizes the
effect of steroid withdrawal. Withdrawal symptoms
include weakness, fatigue, decreased appetite,
nausea, vomiting, dizziness, joint pain, fever, and/or
mood changes. You may experience subtle
symptoms when you decrease your dose of
prednisone. Call the surgery clinic if your symptoms
do not start to improve after 1-2 days of a lower
dose.
Dehydration [NURCOM0071] Please complete in PATIENT FRIENDLY terms.  This
order will appear on the patient's After Hospital
Care Plan., Routine, Monitor for signs of
dehydration (fatigue, weakness, shakiness,
lightheaded/dizziness, dry mouth, fast heart rate).
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Prescription Medications [NURCOM0071] Please complete in PATIENT FRIENDLY terms.  This
order will appear on the patient's After Hospital
Care Plan., Routine, Take all medication as directed.
Most opioid pain medications cannot be called in to
your pharmacy, so please be sure to bring your pain
medication bottles with you to every clinic
appointment and discuss any refill needs at your
clinic visit.
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Ulcerative: Ileostomy Takedown Instructions
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms.  This
order will appear on the patient's After Hospital
Care Plan., Routine, Information that may be of
benefit to you after the surgery.
BOWEL MOVEMENTS
After the takedown you will have multiple loose
stools and possibly some urgency initially for the
first few months. By 2 weeks you should be down to
8-12 liquid to pasty stools. At 2 weeks post op we
will have you add a probiotic to your medication
regimen, along with a multivitamin with iron. If your
stools are still very liquidy and the frequency is still
at 15 bowel movements per day we may have you
try a fiber supplement or have you try imodium.. At
two weeks post-op you will start to go back to a
regular diet. but as you know this will be trial by
error to see what foods will help you firm up your
stools versus foods that will cause loose stools. This
is a learning process over time, meaning months to
one year to one and one half years. (You may have
less stools because you have had the ostomy for a
longer period of time.)
MEDICATIONS
1. You will need to take a Multivitamin with iron
every day for the rest of your life.
2. You will also need to take a probiotic such as
Florajen #3 .  There are many kinds of probiotics.
Some of the  probiotics you may use are Culturelle,
VSL#3 DS, Florastar, Ultimate flora critical care. If
your stool is liquid then you may want to add a fiber
or bulking supplement like Benefiber, metamucil.
Imodium or lomotil can be used to help slow the
bowel if traveling or if going to an event.  The
Probiotic will hopefully prevent pouchitis.
POSSIBLE COMPLICATIONS
1. Obstruction:  A blockage of the bowel.  An
obstruction can occur with an ileostomy or after the
ileostomy takedown.
•  Partial Obstruction: the bowel is not completely
blocked.  Treatment is IV fluids and a nasogastric
tube into your stomach. You will not be able to eat
or drink until the blockage opens.
•  Complete Obstruction:  a total blockage of the
bowel.  This is treated surgically.  A high white
blood cell count, worsening pain and x-rays that
show air under the diaphragm and/or strangulation
of the bowel are symptoms of this problem.
•  Surgical evaluation is mandatory for either type of
obstruction to decide whether the type of
obstruction warrants operative repair.
•  Causes of an Obstruction:
- Adhesions:  bands of scar tissue that form after
surgery and grow across sections of the bowel.
- Hernia:  a weakness in the wall of the abdomen
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where intestines protrude through.
- Twisted or kinked bowel
•  Symptoms of an Obstruction
- Tender and distended abdomen  
- Cramp-like pain in the abdomen
- Nausea, possible vomiting
- Low grade fever
- Failure to pass gas or stool
•  An obstruction can still occur even though liquid
or mucous is passing through, because fluid and
mucous can get around a blockage of stool.  If an
obstruction occurs, you will need to call your doctor
and go to the emergency room promptly.
2. Pouchitis : Inflammation of the pouch.  
•  People with a history of ulcerative colitis
experience pouchitis.  This is a very common
problem (about 40%) of patients with pouches.
 Those with a history of familial polyposis rarely
develop this condition.  Treatment for pouchitis is
antibiotics, Ciprofloxacin or Flagyl, and / or the
probiotic Lactobacillus tablets.
•  Call your surgeon or the surgeon’s nurse
practitioner if you have these symptoms
- Increasing frequency of bowel movements
- Nighttime stool leakage
- Feeling like you have colitis again
- Bleeding
- Urgency
- Pressure sensation in the pouch area
- Fever
•  Please follow the following recommendations to
prevent inflammation of your pouch (pouchitis):
- Eat yogurt daily. It can be any yogurt you enjoy as
long as it has "live" or "active" cultures.
- Take a multivitamin with iron daily. The
multivitamin may be made with iron in it. Check the
nutrition label to ensure that it has at least 100
percent of your daily value of iron.
- Take a probiotic daily. We recommend Florajen 3,
which you can buy at most grocery stores or natural
food stores.
-  Use moist wipes to clean yourself after bowel
movements, so that your skin does not become
irritated.
- When having a bowel movement, use the toilet
once, then wait 5-20 minutes and have a second
bowel movement. This will completely empty your
pouch.
3. Anal Pouch Suture Line Stricture: This is a
narrowing caused by scar tissue where the pouch
and anus are connected.  Stool can back up in the
pouch.  Dilating or stretching the scar tissue treats
the stricture.  This is usually a short outpatient
procedure with anesthesia.
•  Symptoms of Anal Pouch Suture Line Stricture
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- Increasing frequency and small bowel movements
or leakage
- Sensation that you don’t completely empty out
your pouch when you have a Bowel movement
- Straining to empty
Ileostomy Takedown after Cancer Surgery
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms.  This
order will appear on the patient's After Hospital
Care Plan., Routine, You will have multiple stools
after your ileostomy takedown and you may have
urgency (needing to get to the bathroom quickly).
 Because you have had radiation you may have the
phenomenon called "clustering" of stools.  With
clustering you will have multiple stools over several
hours.  Then you should be OK, hopefully, for the
rest of the day.  We do not have the answer to stop
this from happening but one Imodium or increasing
your fiber may help. We recommend adding fiber to
your diet first before starting any antidiarrheal
medications. If this does not help, take one
Imodium first to see what happens to your stools.
 Do not take some after every loose stool initially.
 You can increase the dose after you know what one
pill will do.
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08/2017CCKM@uwhealth.org

Enhanced Recovery After Surgery
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms.  This
order will appear on the patient's After Hospital
Care Plan., Routine, •  ERAS Handout
- You have participated in the Enhance Recover
After Surgery Program. Please take your orange
handout home with you and fill out as appropriate.
Please bring this sheet to clinic. Thank you!
•  Great job meeting your milestones!  It is time to
go home.  The pharmacist, nursing staff, and
physicians will meet with you before you leave to
discuss your medications and instructions.  You still
have more work to do before you are back at 100%.
ACTIVITY
•  Remember to include daily activity as part of your
recovery process.  Staying active will help with the
healing process, allow you to regain your strength
faster, and can help prevent constipation after
surgery.  You should be out of bed and sitting
upright in a chair for most of the day and take at
least four walks per day.
- You should not lift more than 10 pounds for 6
weeks or no more than a gallon of milk
- Short walks (indoor or outdoor) and going up and
down stairs are okay  
- You are encouraged to increase exercise each day,
but do not overexert yourself
- While it is important to avoid activities that require
lifting such as laundry or carrying groceries, you can
still do some of your regular activities.  It is okay to
wash dishes or run a vacuum cleaner (as long as you
don't lift).  You can also go to the grocery store as
long as someone else is helping to load the cart,
etc.
NUTRITION
•  Stay Hydrated
- Drinking plenty of fluids is important to help your
body heal after surgery.  Your immune system is
working hard to get you back on track and using up
lots of resources.  You should aim for at least 8-10
glasses of water a day.
FOLLOW UP
•  About 2 weeks after surgery you will see your
doctor in clinic.  We will assess your diet, stool
output, and make changes to your recovery plan as
needed.  Please bring your list of questions and
your log to this appointment so that we can
evaluate your progress.
WHEN TO CALL
•  Please do not hesitate to call us if you are
experiencing any of the following symptoms.
 Letting your care team know as soon as you
experience any of these symptoms means early
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treatment and possible prevention of further issues.
- You have a fever over 101 °F
- Your belly is swollen.
- You feel sick to your stomach, are throwing up a
lot, or cannot keep food down.
- You have not had a bowel movement 4 days after
leaving the hospital.
- You have been having bowel movements and they
suddenly stop.
- You have black or tarry stools, or there is blood in
your stools.
- You are having belly pain that is getting worse,
and pain medicines are not helping to ease the
pain.
- You are short of breath or are having chest pain.
- You have swelling in your legs.
- There are changes to the incision such as the
edges are pulling apart, green or yellow drainage is
coming from it or bandage is soaked with blood.
When to Call Your Doctor [130452]
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, 1. Any wounds for  signs and
symptoms of infection, including redness, swelling,
drainage, or odor.
2. Call your doctor if you have any of these
symptoms: increased pain not relieved by
medication, fever over 100.5 degrees for 24 hours,
signs of infection listed above, increased shortness
of breath, persistent nausea, vomiting, or
constipation, weight gain as directed.
3. Call your doctor if you have any of the following
signs and symptoms of blood clots: swelling,
redness, warmth, or discoloration of the affected
area, pain or tenderness may be present in the area
where a clot has formed, chest pain, shortness of
breath, a rapid pulse and/or rapid breathing.
CALL 911 FOR EMERGENCIES
Call your Primary Care Provider/Clinic or provider
on-call with questions or problems.  Contact
Digestive Health Center at 608-890-5000 with
questions or problems Monday - Friday 8am -
4:30pm.  If after hours, contacting the paging
operator at 608-263-6400 and ask for the resident
on call.
Follow-Up Care
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08/2017CCKM@uwhealth.org

Follow-Up Apoointments [130455]
Schedule Appointment [NURCOM0026] Reason for Hospital Follow Up Appointment:
Which Provider:
Schedule Appointment [NURCOM0026] Reason for Hospital Follow Up Appointment:
Which Provider:
Facility Therapy Needs [131631]
Continue Physical Therapy at Next Facility
[NURCOM0022]
Routine
Continue Occupational Therapy at Next Facility
[NURCOM0022]
Routine
Continue Speech Therapy at Next Facility
[NURCOM0022]
Routine
Discharge - Home Care [137330]
Both of the following orders MUST be completed in order for this patient to receive home
care.
Discharge - Home Care [DC0001] Routine
Type (Each Agency Requires a Separate Order):
Agency:
Agency City:
Agency Phone:
Agency Fax:
Discharge - Home Care Justification [DC0032] Details
Discharge - Outpatient Therapy [DC0002] Routine
Type(Each Agency Requires a Separate Order):
Diagnosis:
Facility:
Facility City:
Facility Phone:
Facility Fax:
Discharge Labs [134929]
Page 16 of 18
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08/2017CCKM@uwhealth.org

Please use the table below to determine what type of order to use to place discharge
lab orders.
Who is Responsible for the
Result?
Where Will Labs be
Completed?
What Order Should You
Use?
Current Attending Provider UW Health Lab Specific lab orders (A)
Non-UW Health Lab
Specific lab orders with
order class changed to
OUTSIDE (B)
Current Consulting Provider
UW Health Lab
Specific lab orders with
AUTHORIZING PROVIDER
CHANGED TO
CONSULTANT (A)
Non-UW Health Lab
Specific lab orders with
order class changed to
OUTSIDE and
AUTHORIZING PROVIDER
CHANGED TO
CONSULTANT (B)
Another Provider
UW Health Lab
Recommended Discharge
Labs (C)
Non-UW Health Lab
Recommended Discharge
Labs (C)
(A) SPECIFIC LAB ORDERS:
These orders should be used if the CURRENT ATTENDING OR CONSULTING
PROVIDER will be responsible for the result of the lab AND the patient will have the labs
completed at a UW HEALTH LAB.
If a CONSULTING PROVIDER currently involved in the patient's care will be responsible
for the result, you must change the AUTHORIZING PROVIDER on the order to the
CONSULTING PROVIDER before signing the order. To do this, click the Providers
button near the top of the Review, Sign & Hold tab of the discharge navigator. Update
the authorizing provider to the consulting provider.
(B) SPECIFIC LAB ORDER WITH ORDER CLASS CHANGED TO OUTSIDE:
These orders should be used if the CURRENT ATTENDING OR CONSULTING
PROVIDER will be responsible for the result of the lab AND the patient will have labs
completed at a NON-UW HEALTH LAB.
If a CONSULTING PROVIDER currently involved in the patient’s care will be responsible
for the result, you must change the AUTHORIZING PROVIDER on the order to the
CONSULTING PROVIDER before signing the order. To do this, click the Providers
button near the top of the Review, Sign & Hold tab of the discharge navigator. Update
the authorizing provider to the consulting provider.
The patient will receive a paper order to take to the lab.
(C) RECOMMENDED DISCHARGE LABS:
This order should be used to recommend to another provider labs that a patient should
have completed after discharge. The provider designated in the 'Send Recommendations
To' field is responsible for PLACING the lab orders AND will be responsible for the
RESULTS of any ordered labs.
Page 17 of 18
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Discharge Labs Workflow URL: https://uconnect.wisc.edu/growth/training--
education/health-link/10-minutes/inpatient-
discharge-consult/resources/name-82993-
en.file
Recommended Discharge Labs
[NURCOM0075]
Details
Page 18 of 18
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org