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DISCHARGE INSTRUCTIONS
POST THESE INSTRUCTIONS IN AN OBVIOUS PLACE AND REVIEW IN THE AM

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.

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___________________________
PHYSICIAN
___________________________
PHONE NUMBER

I hereby accept and understand all of the above instructions.

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PERSON RESPONSIBLE FOR PATIENT / DATE

________________________________
RELATIONSHIP, IF NOT PATIENT

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NURSE GIVING INSTRUCTIONS

________________________________
DATE & TIME

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