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Patient name: __________________________________________________ 1. D/C home when awake, oriented and vital signs stable. 4. Provide Rx when patient goes home. These are located on the last page of Dr. Watson's Discharge Instruction form or on the chart. 5. Have patient and family READ and SIGN Dr. Watson's Discharge Instruction form and provide a copy for the permanent chart and provide the original to the patient to take home. Please go over these specific instructions with the patient and family, especially concerning all items "checked off" on the form. The form is located on the chart. ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________ ___________________________________________ H. Stephen Watson, M.D. 985‐345‐5500 (office) 985‐345‐2700 (service) 985‐345‐5555 (fax) Patients: As soon as you get home pick‐up your telephone receiver, listen for a dial tone, dial *87 then hang‐up. This is very important so please do not forget. Please read this entire form and sign it only after you understand everything. Follow all checked items very carefully. The other items may not apply to you. If you have questions, ask now. Nurses: Please have patient read and sign this form. Then photocopy form for the hospital chart and provide patient with the original form to take home. I have read and understand Dr. Watson's instructions and all my questions have been answered: patient signature X ______________________________________________ [ ] No lifting greater than 5 pounds or similar activity for ______ weeks. [ ] No driving for _____ weeks. [ ] Drink extra fluids to keep urine running as clear as possible. [ ] Strain urine EVERY time you urinate. Save any stone(s) or sand like material. Bring it to Dr. Watson's nurse at your appointment. [ ] No suppositories. Do not put anything into the rectum. [ ] No intercourse or similar for _____ weeks or until further instructed by the doctor. [ ] Do NOT inflate / deflate the prosthesis until further instructed by Dr. Watson. If your prosthesis should automatically inflate call the doctor during working hours the next day. Automatic inflation of the prosthesis is expected and is not unusual. [ ]‐‐*87 (star eight seven)‐‐Unknown to most patients who are BellSouth telephone customers is what BellSouth terms "Anonymous Call Rejection". BellSouth says that this is an "optional calling feature". Most patients accept this telephone feature not realizing that the feature causes them to miss important telephone calls. Commonly patients have this feature on their telephones, not realizing that the feature is active! Apparently, this feature comes as part of a particular caller ID "package" of services. Having this "Anonymous Call Rejection" feature turned on means that your telephone will NOT even ring when the doctor calls. It is commonly necessary for Dr. Watson to call patients at home. Your caller ID will read "Unidentified Number" or "Blocked Number" when Dr. Watson calls. However, unless you have dialed *87 (or 1187 from a rotary phone) to turn off this optional calling feature, your doctor may NOT be able to contact you. (Note: Bell South says that if you have their "Prestige Service" you will have to dial *68 (or 1168 from a rotary phone), instead of *87, to turn off this feature.) Dr. Watson strongly suggests that you dial *87 as soon as you get home so that you may receive calls concerning your health care. (See www.bellsouth.com/instructions). [ ]‐‐PROBLEMS‐‐‐‐‐‐‐‐‐‐‐‐‐‐Call (985) 345‐5500 for any problems such as fever, vomiting, uncontrolled pain or other concerns. If you have an emergency, call anytime. Otherwise, call during working hours (8am‐4pm) Monday through Friday. The earlier during the week and the earlier in the day (not before 8am), the better. [ ]‐‐APPOINTMENT‐‐‐‐‐‐‐‐‐‐‐‐‐Call (985) 345‐5500 to make a followup appointment, for ______________________________________, according to Dr. Watson's instructions. Dr. Watson will never want you to wait more than 6 weeks before seeing him again. The appointment is very important, however, YOU must call to arrange it. That is, the appointment is NOT automatically made for you. If you fail to call, you may not receive the care that you need. Make the call as soon as you get out of the hospital. Do not wait. This is YOUR responsibility. If (985) 345‐5500 is long distance for you, use 800‐346‐3837. When you call to make the appointment, make certain to tell Dr. Watson’s receptionist if you will need anything else before or at the time of your appointment, such as x‐ray(s), ultrasound, cystoscopy, stent removal or anything else (see below). [ ]‐‐X‐RAYs‐‐You need to schedule x‐ray(s) called ____________________________________. Ultrasound studies are usually performed in Dr. Watson’s office, at the time of your follow‐up appointment. Other x‐rays are usually performed elsewhere (such as the hospital) before the followup appointment. Ask Dr. Watson's receptionist to schedule the x‐ray(s) and other studies, when you call to schedule your appointment. She will ask you to read from this paper, so have it in hand. YOU must pick‐up ALL of your x‐ray films from wherever they are performed. (Note: Your North Oaks x‐rays are usually available to Dr. Watson on‐line so it may not be necessary to acquire North Oaks x‐rays.) Make CERTAIN that you are provided with ALL of your x‐ray images / films, not just the new ones. Radiology personnel commonly tell patients that the x‐rays "will be sent to your doctor." Do NOT believe this! Please, do NOT "drop‐off" x‐ray images / films at Dr. Watson's office! Your x‐ray images must be WITH YOU at the time of the appointment. Failing to have all of your x‐rays with you WILL delay your appointment. [ ]‐‐INCISION‐‐You may remove all the bandages and shower or sponge bathe starting 48 hours after surgery. It’s OK to get the incision wet but do not soak the incision in water (such as in a bath tub) for at least 10 days after surgery. If clots / scabs form on the stitches, moisten them with Neosporin or Bacitracin ointment before washing the scabs off in the shower. However, you do not otherwise need to apply ointments. [ ]‐‐PENILE BANDAGES‐‐The outer, brown colored, elastic portion of a penile bandage (usually with a circumcision) is a special case however. It should be removed 2 or 3 hours after surgery or sooner if you are unable to urinate or if the penis turns a darker color than usual. If the dressing falls off, leave it off. Also, after circumcision, the incision commonly bleeds when the dressing is removed. If so, gently squeeze the penis with a warm wet cloth for 5‐10 minutes until the bleeding stops. You may need to repeat this several times. If clots / scabs form on the stitches, moisten them with Neosporin or Bacitracin ointment before washing off the clots / scabs in the shower. [ ]‐‐STAPLES AND STITCHES‐‐You have stitches or staples in the skin which must be removed by the doctor or nurse or home health nurse (7‐ 14 days after surgery in most cases). Call to arrange this. These should be removed only by the direct order of the doctor. [ ]‐‐HEMATURIA‐‐Blood in the urine is normal after urology surgery. However, if the urine has heavy clots that are stopping urine flow, call. The earlier in the day (8‐9 am), the better. PATIENTS WITH STENTS AND CATHETERS HAVE BLOOD IN THE URINE. This is normal. [ ]‐‐PAIN MEDS‐‐Do NOT drive, operate machinery or perform any similar activity while taking any type of pain medication. The medicine will make you drowsy and you might possibly have an accident. Be aware that pain medications also cause difficulty with bowel movements.
[ ]‐‐CONSTIPATION‐‐Hospitalization causes normal changes in bowel habits due to the use of pain medications and changes in activity level and diet. Usually, patients have few, if any, bowel movements for several days after going home. Unless you have been told otherwise, you may use stool softeners (Surfak, Colace, Correctol), laxatives (Milk of Magnesia, Dulcolax, Ex‐Lax), bulk fiber laxatives (Metamucil, Konsyl, Citrucel, Fiberall), suppositories (Dulcolax), or enemas (Fleets). You may buy all of these at the drug store and no prescription is needed. Call the doctor if your abdomen is swollen and you are vomiting or if you have other concerns. Otherwise, it is NOT necessary to notify your doctor about not having regular bowel movements. Do NOT use suppositiories or enemas if you had prostate cancer surgery or cryotherapy! [ ]‐‐STENT‐‐You have a stent / tube in your ureter / kidney which MUST be removed by the doctor within 12 weeks of surgery. In most cases the stent / tube will be removed within 1‐2 weeks. Dr. Watson plans to remove your stent ____________________________________________. YOU must call (985) 345‐5500 to schedule the appointment to have the stent removed. When you call to schedule your followup appointment, YOU must tell Dr. Watson’s receptionist about the need for stent removal. Otherwise, it may not be possible to remove the stent when you arrive. Make certain you understand when the doctor plans to remove the stent and keep your appointment to do so. When in doubt, ask or call. This is YOUR responsibility. If the stent remains in too long it can cause very serious complications such as severe bleeding, stones and kidney failure. STENTS ALWAYS CAUSE SOME PAIN in your side / flank area and they make you feel discomfort as if you need to urinate, even though you have little or no urine in the bladder. PAIN IS NORMAL WITH STENTS. These symptoms may mimic symptoms of urine infections although usually there is no infection to be concerned about. However, if pain continues despite taking FULL DOSES of your pain medication, call. [ ]‐‐CATHETER‐‐You have a catheter in your bladder which will be removed in the urology clinic in _____________________________________. When you call to schedule your followup appointment, YOU must tell Dr. Watson’s receptionist about the need for stent removal. Otherwise, it may not be possible to remove the stent when you arrive. The CATHETER WILL CAUSE PAINFUL SPASMS of the bladder and a very strong urge to urinate, even when the catheter is in normal position and draining well. These SPASMS WILL CAUSE URINE FLOW THROUGH THE URETHRA OR AROUND THE CATHETER rather than through the catheter on some occasions. THIS IS NORMAL. Spasms are a normal part of having a catheter. Medications are available which may reduce the painful spasms but medications usually do not help very much. The spasms will stop when the catheter is removed. If your bladder is overfull and no urine at all is flowing through the catheter, call. Do NOT pull on the catheter or put yourself in a position that might pull on the catheter. Do NOT allow anyone to remove the catheter without the doctor's direct order. Your present and future ability to urinate and stay dry depend on the catheter! Take special care of it! Some blood in your urine is normal with all catheters but heavy clots that plug the catheter are not normal. If the catheter should plug‐up with blood clots or fall out (rare), call your UROLOGIST. Sometimes two different types of catheter bags are provided. The small "leg bag" may be used during the day. Its small size helps conceal it under clothing. You must not let it overfill. Use the large bag at night or any time you sleep. Its large size will allow you to sleep without fear of the bag becoming too full. Keep catheter bags below the level of your bladder at ALL times. Keep the catheter tubing on top of your leg at ALL times (i.e. do NOT sit on the catheter tubing). Uncircumcised men MUST KEEP FORESKIN PULLED DOWN covering the head of the penis when a catheter is in place! Failure to do so will cause swelling and very painful complications. [ ]‐‐PROSTATE CRYOSURGERY AND RADICAL PROSTATE CANCER SURGERY‐‐ It it is very important that you do NOT allow just anyone to place a catheter into your bladder. If you become unable to urinate or if your catheter falls out, call your UROLOGIST. ONLY your UROLOGIST is familiar with your circumstances. Do not allow youself to develop constipation or difficult bowel movements. Use metamucil and a stool softener daily for at least six months to avoid problems. Failure to strictly follow these instructions may destroy your surgery. [ ]‐‐PROSTATE CRYOSURGERY‐‐Make certain that you have been given a catheter plug before leaving the hospital but not use the plug until further instructied. About two (2) weeks after cryosurgery your doctor will ask you to begin to plug the suprapubic catheter intermitantly. Doing so will allow your bladder to fill naturally afterwhich you may be able to urinate through the urethra (penis). After urinating you should drain the suprapubic catheter and record the residual urine volume. We call this PVR (post void residual). When the residual urine volume is consistantly less than 100 cc, call Dr. Watson’s office to arrange removal of the catheter. However do not allow anyone to remove the catheter without a direct order from Dr. Watson. Do NOT strain to urinate. If the residual urine volumes are greater than 100 cc and you are straining to urinate relatively small amounts, hook‐up the catheter bag again for at least 3 days before trying again. Call for any quewstions or problems. Failure to follow these instructions may result in an abnormal fistula opening between the urinary tract and the bowel! Additional surgery would likely be required in such a circumstance. [ ]‐‐DRAIN‐‐You have a drain tube through the skin in the area of the surgery. The nurses must show you how to manage it before you leave the hospital. If the drain has a collection bulb, it should be emptied before it is full and at least 2 times per day. You should recharge the suction on the drain (ask the nurse to show you how) unless the doctor has instructed you otherwise. If there is a dressing around the drain, you should change the gauze as often as needed before it is totally soaked. The drain will be removed when the drainage stops but the DRAIN MUST BE REMOVED by the doctor or nurse within 2 weeks. Often the drain will be removed sooner than 2 weeks. Therefore, make sure you understand when the doctor plans to remove the drain. Tell the doctor and the nurse about the drain when you next see them. [ ]‐‐SUPRAPUBIC CATHETER‐‐This is the name for the bladder drain tube in the midline of your lower abdomen. Very carefully read all of the information under the heading 'CATHETER'; this information applies to you. Take great care to avoid pulling on the catheter. If the catheter is pulled out, call the doctor immediately. (If you do not have a catheter through the skin, these instructions do not apply to you.) Never allow a catheter to be removed, without a direct order from the doctor. It is normal to see some redness and fluid around the catheter. Often the stitch which connects the catheter to the skin pulls out. Do not be alarmed if the stitch pulls out. The catheter has a balloon on the inside which will keep it inside your bladder. Do NOT THINK THAT THE SUPRAPUBIC CATHETER IS FALLING OUT just because it looks like it is a little farther out than you thought it was originally. [ ]‐‐VASECTOMY—Undergoing vasectomy does NOT mean that you are sterile / infertile. Do NOT have unprotected sexual intercourse until further instructed by Dr. Watson as you may well continue to be fertile after vasectomy. You should deliver the first of two (2) semen specimens to Dr. Watson after twenty (20) ejaculations. Call the office before delivering a specimen to make certain Dr. Watson will be in the office that day. Otherwise, your efforts will be wasted. Dr. Watson will examine the specimen under the microscope to look for any evidence of sperm. You should call during working hours (before 4pm) for the results. The semen specimens may be collected in any clean glass or plastic container and should be delivered within thirty (30) minutes of collection if possible. After Dr. Watson sees that two (2) consecutive semen specimens show NO sperm and after he discusses the semenanalysis results with you, there should be an acceptably low risk of fertility/pregnancy. However, remember that you should also have additional semen specimens checked on a regular, lifelong basis (1‐2 times per year), in order to assure (as much as is possible) sterility. Dr. Watson will re‐check your semen sample in the future only when you call to arrange it.
THIS RECORD DOES NOT LIST ALL OF YOUR INSTRUCTIONS AND POSSIBLE COMPLICATIONS. IF YOU HAVE ANY QUESTIONS, ASK NOW. MEDICATIONS: Remember, if you feel that your medication is causing a problem, STOP the medicine and inform your doctor. If you may be pregnant, if you are breast feeding or if you are taking medications other than the medications prescribed by Dr. Watson, consult your pharmacist before taking any new medication. If there is an emergency, call or go to the nearest emergency room. FOR ADULTS: [ ] Lortab (hydrocodone) tablets, one (1) whole tablet or (for severe pain) two (2) whole tablets up to every 4 hours IF needed for pain. Do not drive or perform similar activities. Do not use Tylenol (acetaminophen) with Lortab. Expect to have some constipation and nausea. This prescription cannot be refilled without a new order from YOUR doctor. ONLY YOUR DOCTOR (whose name is on the prescription) may refill it. Do NOT CALL at NIGHT or ON WEEKENDS or HOLIDAYS for REFILLS. However, call if you have uncontrolled pain, the doctor who is 'on call' will direct you to go to the emergency room. [ ] Darvocet‐N‐100 (propoxyphene naphthalate) tablets, one (1) or two (2) tablets up to every 4 hours IF needed for pain. Do not drive or perform similar activities while taking this. Do not use Tylenol (acetaminophen) with this medication. [ ] Cipro XR (antibiotic): one (1) tablet daily. Start this today. Finish the entire prescription. [ ] Keflex (antibiotic): one (1) tablet, three (3) times per day. Start this today. Finish the entire prescription. [ ] Levoquin (antibiotic): one (1) tablet, once daily. Start this today. Finish entire prescription. [ ] Urelle or Uromar‐T (antispasmodic for bladder and stent / catheter irritation): one (1) tablet, four times per day. [ ] Detrol LA or Ditropan XL (antispasmodic for bladder): one (1) tablet per day. Expect to have some dryness of the mouth. Do NOT use this medication if you have glaucoma. FOR CHILDREN: [ ] Tylenol with Codeine elixir (12mg codeine per 5cc): The dosage depends on age and weight. Do not use Tylenol (acetaminophen) with this. [ ] Keflex liquid (25‐50mg/kg/d)‐‐‐(antibiotic): The dosage depends on age, weight and intended use. Start this today. Finish the entire prescription. [ ] Ditropan liquid (1mg or cc/yr. BID or 0.5mg/kg/d)‐‐‐(antispasmodic for the bladder): The dosage depends on age, weight and intended use. [ ] Phenergan suppositories (for nausea): 1 in rectum, up to every 6 hours, IF needed for nausea. [ ] Tylenol: Use regular over the counter Tylenol (acetaminophen) for possible pain. If Tylenol does not relieve the pain, call the doctor. FOR ADULTS OR CHILDREN: (These medications do NOT require a prescription. Follow the label directions and consult the pharmacist with questions.) [ ] Surfak (stool softener): one (1) capsule, once or twice per day. You may use other brands. Generally, use these until you return to see the doctor. Cut back or stop these for very loose stool. [ ] Metamucil (bulk fiber laxative): one (1) level tablespoon in water daily. You may use other brands (Konsyl, Citrucel, others) or eat plenty of whole grain / bran foods. [ ] Acidophilus (lactobacilli): two (2) tablets, twice daily before meals for 10 days. This is to replace the natural bacteria in the intestine which are killed by antibiotics. This will help with loose stools. [ ] Blephamide Ointment: Obtain this by prescription and take it with you to your follow‐up appointment with Dr. Watson. You will be instructed how to use Blephamide at that time. Do NOT use this medication before you receive further instruction. Do NOT forget to take Blephamide with you to your follow‐up appointment or it will be necessary to reschedule the appointment. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Name: __________________________________________________________________________________________________ Date: _________/__________/______________ Rx
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Product selection permitted unless otherwise indicated. ________________________________________ office: (985) 345‐5500 service: (985) 345‐2700

Source: http://www.lepa.org/Data/Sites/7/documents/Orders--DischargewithInstructions.pdf