ACTIVITY
- Limit your activity for the remainder of the day.
- You should not drive or operate any equipment on the day of your procedure.
- You should not drink alcoholic beverages until the day after your procedure.
- Do not smoke until you are fully alert.
- This may be as much as 6 hours after the procedure is over.
- Do not make any important decisions until the following day.
- Notify your physician if you have any questions concerning your instructions.
DIET:
You may resume oral intake upon dismissal unless otherwise instructed. For the rest of the day you should take only liquids or a light meal. Unless otherwise instructed, you can resume a regular diet the day after the procedure if you are feeling well and have no abdominal symptoms related to the procedure.
MEDICATIONS:
- If a polyp was removed, do not use any aspirin or anti-inflammatory drugs for 2 weeks, unless directed by your
physician. (Tylenol is OK).
- Anticoagulants (such as Coumadin, Plavix, Heparin) should not be resumed until
________________
- Unless otherwise instructed, you may resume your medications after you are dismissed.
- Additional medications:
_______________________________________________________________
- Discontinue the following medications:
___________________________________________________
NOTIFY YOUR PHYSICIAN FOR ANY OF THE FOLLOWING:
- Severe abdominal pain or tenderness.
- Chest pain.
- Rectal bleeding, more than a few spots of blood on the toilet tissue or in a bowel movement.
- Chills or fever greater than 100 degrees F.
- Nausea or vomiting.
- If you experience any symptoms that concern you, contact your physician.
- Please go to the nearest Emergency Room if unable to contact your physician.
FOLLOW UP:
- Make an appointment to see your physician in
____________________________.
- A biopsy was obtained today. It is your responsibility to call your physician for results in
________day(s).
- A nurse from Medical Center Endoscopy will attempt to call you as early as 7:00 a.m.
the day after your procedure to inquire about your recovery and answer questions.
ADDITIONAL INSTRUCTIONS:
Although your physician spoke with you after your procedure you may not remember.
Call their office if you have questions.
__________________________________________
__________________________________________ |
__________________________________________
__________________________________________ |
__________________________________________
__________________________________________ |
___________________________
PHYSICIAN
|
___________________________
PHONE NUMBER |
I hereby accept and understand all of the above instructions. |
________________________________
PERSON RESPONSIBLE FOR PATIENT / DATE |
 |
________________________________
RELATIONSHIP, IF NOT PATIENT |
________________________________
NURSE GIVING INSTRUCTIONS |
________________________________
DATE & TIME |
|
