Your Stay on the General Surgery Unit HF#7192

Welcome to the University of Wisconsin Hospitals and Clinics General Surgery Unit

If you or your family has any questions throughout your stay do not hesitate to ask.  Our nursing staff and health care team are here to support you during your stay.

 

Your Health Care Team

 

During your hospital stay, you will meet many people who are part of your health care team.  YOU are the most important member of the team.  Together we will create a Plan for the Day and a Plan for Your Stay that will be updated and changed to meet your health care needs.  If you have any questions or concerns let one of the team members know.  Our number one goal is to help you feel confident and comfortable from the day of admission till discharge.

 

Your team members include:

 

Attending Surgeon is the doctor who directs all your medical care.

 

Interns and Residents are doctors who work with your Attending Surgeon and you.  You can expect to see these doctors each day to assess your progress.  Ask your nurse if you have any concerns and write down any questions so you do not forget to ask your doctors when you see them.

 

Medical Students are in training to be doctors.  They help your doctor with your care and learn from you as a patient.

 

Primary Nurse works with you and your health care team to create a plan for the stay.  Your Primary Nurse or your nurse for the day will make changes to your plan for the stay and will update you on any changes.  Let your nurse know what is important to you as it will help him/her to take better care of you.  The Primary Nurse will also coordinate your care with all members of the health care team and will tell them about your needs and concerns. They are a “go to” person for questions about your treatment and discharge plans.

 

Team Nurses/Registered Nurses are assigned to care for you around the clock while on the unit.  Your nurse will assess your body systems, pain, symptoms, provide medicine, and create and follow your plan for the day/plan for your stay.  The nursing staff will have the most contact with you during your stay and will update you on any changes throughout your stay.  Your nurses will do teaching with you throughout the day so that you become comfortable with caring for yourself.

 

Nursing Assistant (NA) works directly with your nurse to help care for you by taking vital signs, walking, bathing, and helping you use the bathroom.

You can expect to see 2-3 Nurses and 2-3 NAs in a 24 hour period.  They will check on you every hour during the day and at least every two hours at night.  Use the call light to let us know any other needs, questions, or concerns you may have.

 

Pharmacists will review your home medicines and hospital medicines when you arrive on the unit.  On your discharge day, they will again review with you any changes with your medicines.  They will also do teaching about the new medicines you are going home with.

 

Case Management Staff is a team made up of a Nurse Case Manager and a Social Worker.  They will help with your discharge process which begins on the day you arrive and continues until you go home.  They will review your medical records and meet with you, when needed, to create a discharge plan for you.  The plan may consist of getting special equipment, arranging Home Health care, infusions, lab draws, dressing changes, drain care, and placement at a skilled nursing facility, and helping with any insurance needs.

 

Phlebotomists draw blood for lab tests.

 

Respiratory Therapists assess and treat breathing disorders related to your history, surgical needs, or when the need arises.  They are specialists in air-way management and mechanical ventilation.  They work closely with your surgical team.

 

Dietitians will be consulted to help guide your diet through your hospital stay.  They will help you with any nutritional needs.

 

Primary Supports

 

We are committed to a patient and family centered approach to care.  YOU are the most important part of the team.  We want you to provide us with names of people that support you and who you want involved in planning your care.  Primary Supports are the people that you are closest to.

 

Visiting Policy and Hours

Visiting hours are from 8am – 9pm.  One visitor is allowed to stay overnight with you.  If your visitors are planning to stay overnight they must be 18 years of age or older.  If you know that your family will be staying with you, tell your nurse and we will provide your visitor with a cot to sleep on as long as one is available.  Also, visitors must have a visitors pass to allow them to stay overnight, ask your nurse how to get a visitors pass.

 

Parking and Validation

 

One visitor can have a parking pass validated before leaving the hospital.  You can have this validated at the Admissions Desk/Information Desk during normal business hours.

 

After Surgery

 

In your hospital room, your nurse will check on you often.  You may have:

• Dressing over your incision that the nurse will check.
• Intravenous catheter line (IV) in your hand or arm to provide fluids and medicine until you are able to drink fluids well.
• Tube under your nose to give you oxygen.
• Plastic clip on your finger to check your oxygen level.
• Catheter to drain urine from your bladder. 
• Nasogastric (NG) tube in your nose to your stomach to drain fluid and air from your stomach, to prevent nausea and vomiting.
• Wound drains to help you heal.
• Leg wraps (SCDs) that inflate and deflate and elastic stockings (TEDs) to improve blood flow in your legs to prevent clots that could travel to your brain or lungs.
   

Medicines

 

When you arrive on the unit, a pharmacist will meet with you to confirm the medicines you take at home.  Nurses will give you medicines throughout the day.  After surgery, you will receive most of your medicine through your IV until you are able to eat or drink.  Once the doctor allows you to eat and drink, many of your medicines will be switched to pill form.

 

You will likely get medicines in the hospital that you may or may not take at home.

 

• Antacids reduce the amount of acid in your stomach to prevent stomach irritation that can cause ulcers and heartburn.  Common types are Zantac® (ranitidine) or Protonix® (pantoprazole).
• Stool softeners prevent constipation caused by pain medicines and help make it easier to go so that you do not have to push so hard when you go to the bathroom.
• Heparin prevents blood clots from forming in your legs and traveling to your lungs or brain.  Heparin is given as an injection (shot) either in the back of the arm or in the belly 2 to 3 times a day.  
• Dalteparin is another form of heparin that may be given to some patients.  This is mostly used for patients that were on Coumadin® pre-hospital while we are working to get them back onto a dosage of Coumadin®.

Equipment You May Have after Surgery

 

Urine Catheter

 
You may have a urine catheter placed.  The urine catheter is also called a “Foley” and will remain in place for 1-2 days.  If you have an epidural, to control your pain, your Foley will be removed after your epidural is removed.  This tube constantly drains urine from your bladder.  You may still have the urge to pass urine.  If you have a full feeling, let your nurse know right away, your catheter may need to be repositioned to allow it to drain.  Once your urine catheter is removed, we will measure your urine, by using a urinal or a “hat” placed in the toilet.  Your nurse will show you how this is done.  Sometimes, patients cannot pass urine when the Foley is removed and it will need to be put back in.  We rarely leave it in place when you go home.  If that happens, the nurse will teach you how to care for your Foley at home. 

 

Nasogastric (NG) Tube

This is a tube placed through your nose and into your stomach.  It drains fluid and air to prevent nausea and vomiting.  It stays in place until your bowel begins working again.  The NG tube will be removed before you start eating.  You will not go home with it.

 

Drains

A drain may be placed to prevent fluid from collecting in your abdomen.  These drains will be emptied every 8 hours or more often if needed.  Let your nurse know if your drain fluid needs emptying.  Sometimes, patients go home with a drain in place.  If this occurs, the nurse will teach you how to care for your drain at home.  Most of the time, the doctors will remove the drain while you are still in the hospital.
 

Compression Stockings/TEDs/SCDs/Ace Wrapping

To prevent blood clots, the doctor may order you to wear TED hose on your legs while you are in the hospital.  This puts pressure on the deep veins and helps with blood flow.  You will wear these stockings all day and night except for an hour during the day when we give your legs a break.  During the time you’re lying in bed, you also will wear SCDs that provide a constant massage to your lower legs.  This helps blood return to your heart.  If we are not able to fit you with the proper TED hose, your nurse will wrap your legs with ace bandages to control any swelling you may have in your legs.

 

Coughing and Deep Breathing

Your nurse will ask you to breathe deeply, cough, and use an incentive spirometer.  Pain may prevent you from wanting to take deep breaths.  Deep breathing prevents pneumonia.  Pain medicine can be given to help you take deep breaths more easily.

 

To cough and deep breathe

1. Place a pillow over your chest/abdomen to lessen the pain when coughing.
2. Breathe in deeply and slowly through your nose.  Hold it. 
3. Exhale slowly through your mouth.
4. Repeat two more times. 
5. Breathe in again, and hold it, and then cough.
6. Repeat every hour while you are awake.

 

Incentive Spirometer

1. Exhale and place your lips tightly around the mouthpiece.
2. Take a deep breath.  As you breathe you slowly raise the Flow Rate Guide between the arrows.
3. Hold it as long as you can.  Try to keep, the guide as high as you can for as long as you can, or as directed by your nurse or respiratory therapist (RT).
4. Exhale and relax.  Remove the mouthpiece and breathe out as usual. 
5. Slowly, repeat 10 times per hour while you are awake.

Heart Monitor/Telemetry

This is a small battery pack that has 5 electrodes with wires that connect to your chest wall.  It allows nurses and doctors to monitor your heart 24 hours a day.  You will be able to move around in the hallway, but you will have to stay on this unit.  If you get too far away it will no longer monitor your heart rhythm.

 

Possible Complications after Surgery

 

Pressure Ulcer is an injury to the skin and the tissue under it.  It is caused by constant pressure in one area.  Pressure on a small area of skin can block the tiny vessels that supply your skin and tissues with oxygen and nutrients.  If tissue is starved for too long it begins to die causing a pressure ulcer to form.  Pressure ulcers may form on the lower back below the waist (tailbone), hips, heels, knees, ankles, shoulder blades, back of the head, and spine.  One of the most important things that you can do to prevent a pressure ulcers is to change position at least every two hours.  If you can’t turn by yourself, your nurse will help you.  Other things you can do to prevent pressure ulcers are eating a healthy diet, moving around your room, getting out of bed, walking in the halls, and keeping your skin clean and dry.

 

DVT (Deep Vein Thrombosis) is a blood clot that forms in the deep veins of the body, mostly in the legs.  DVTs alone are not life threatening.  If the clot breaks free and moves to the lungs it can lodge in vessels there.  This is called a PE (Pulmonary Embolism).  A PE is dangerous and can be life-threatening.  The risk of developing a PE is fairly low.  We work to prevent DVTs or a PE by asking you to wear compression stockings, SCDs, and take frequent walks.  These help to increase blood flow in your legs and decrease your chances of a blood clot.  Your doctor will prescribe a blood thinner (heparin) that is often given as an injection into your abdomen or the back of the arm.

 

Ileus is a blockage of the intestines (bowel).  The ileus prevents movement of food, fluid, and gas through the intestines.  An ileus may be caused by any type of surgery or can be due to pain medicines.  A lack of activity also may cause an ileus.  Signs and symptoms of an ileus iare listed below. 

• nausea
• vomiting
• stomach cramps
• bloating
• lack of bowel movements and gas

 

  

We treat an ileus by not letting you eat, IV fluids to keep you hydrated, and a NG tube in your stomach to relieve any pressure and prevent vomiting.  It is important to be as active as you can while you recover from your ileus.  Activity will help your intestine to wake up.  Signs and symptoms that your ileus has healed include doctors and nurses hearing normal bowel sounds, only small amounts of liquid coming out of your NG tube, passing gas, having bowel movements, decreased bloating, a soft abdomen, no nausea or vomiting, and being able to eat a clear liquid diet.

 

Infection can occur after surgery.  Here is a list of symptoms.

• Redness
• Swelling
• Drainage
• Odor
• Pain not controlled by pain medicine
• Fever over 100.4°F for 2 readings taken four hours a part

 

An infection may require antibiotics or having your incision opened to allow it to drain.  If you have any of these symptoms, call the clinic at 608-263-7502 during normal business hours 8am-4:30pm.  Call the doctor on call 608-262-0486 after hours and on weekends.

 

Preventing Infection

You and your family can do a lot to prevent the spread of infection in hospitals, clinics, and communities.  Hand hygiene is the number one way to prevent the spread of germs and infections from spreading.  You should encourage your visitors and expect your health care team members to use alcohol gel or wash their hands with soap and water before they enter your room and after they leave to help prevent the spread of germs. 

 

Isolation

Some patients will be placed in isolation to help prevent the spread of infection to staff and other patients.  Family will be advised to wear a gown and gloves when visiting.  Ask your nurse, what your family should wear when entering the room.  Your family will also be asked to wash their hands before entering the room and upon leaving the room.

 

After Surgery

 

The day after surgery, your nurse will write goals for the day and the plan for your hospital stay on your white board.  This will include walking and sitting in a chair which is a vital part of your recovery.  Today, your nurse will help you to sit in a chair and will help you when you walk in the hallway.  You will be encouraged to try to walk three times a day and try to sit in the chair three times each day.  Walking helps the bowels begin moving and helps you pass gas and stool.  Walking also helps your lungs expand and improves your overall body strength.  Always remember to call your nurse for help before getting out of bed unless your nurse has told you it is okay to do so on your own.

 

Pain Control

 

Good pain control helps you heal faster, leave the hospital sooner, and prevent problems.  Drug and non-drug treatments can help prevent and control pain.

You will be asked to rate your pain on this scale.

 

 

 

The goal is to be at a level that will allow you to deep breathe, eat, walk, and sleep.  This may mean that you may not be pain-free but your pain should not prevent you from being able do these things.  We need to ask you what your pain level is, so that we know how well the medicine is working.  Tell us about your pain, especially if it is not going away.  Do not worry about being a “bother”.  Pain medicine may cause you to become drowsy, dizzy, or lightheaded.  You are the only one who can tell us about your pain, so be honest so we can help keep your pain under control and manage side effects.

 

PCA

Some patients will be placed on Intravenous Patient Controlled Analgesia (IV PCA).  This device allows you to give your own dose of pain medicine.  PCA is based on the belief that the patient is the best judge of how much pain he is feeling and that each person may need a different amount of medicine to relieve their pain.  PCA allows you to take the medicine when you feel like you need it.

 

 

To receive a dose of medicine, all you need to do is press the green button.  When you press the button the medicine goes into your IV.  Your nurse will let you know how often you can push your button to get pain medicine.  Normally, it is every 6 to 10 minutes.  You will only get pain medicine when the green button is lit, so you cannot overdose with the PCA.  Your nurse will check with you to make certain you are comfortable and that you are using the pump as you should.  Please tell your doctors and nurses if you feel you cannot control your pain.  You must tell your nurse how your pain medicine is working so they can make changes to your medicine.  You will no longer use the PCA when your doctors feel your pain can be controlled with pills.

 

Epidural

During surgery, some patients will have an epidural with Patient Controlled Epidural Analgesia (PCEA) to control your pain.  Pain medicine from the pump goes through tubing into your epidural space in your back.  This pump is set to give you pain medicine continuously.  You will have a button to push as needed every 30 minutes.

 

If you have both an epidural and PCA, use the epidural first.  The epidural button is black, and does not change colors when you push the button.  For your safety it is important that only you, the patient, press the button to receive the pain medicine.

 

Oral

Your nurse will explain to you how much medicine your doctor has prescribed for you while you are in the hospital.  Your nurse will also explain how often you can receive these medicines.  Take pain meds when pain first begins.  Do not wait.  Pain pills take 20-30 minutes to work.  Do not drive, operate machinery, or drink alcohol while taking pain medicine once you go home.  Addiction to pain medicine is rare, if you take the medicine as prescribed, unless you have a history of substance abuse.  If you are concerned, talk with your health care team.

 

Non-pharmacologic pain relief

These include relaxation, imagery, distraction, and skin stimulation, hot and cold compresses, music, massage, and acupuncture.  Ask your nurse about alternative pain therapy that is available in the hospital.  Some may include a personal cost to the patient (massage and acupuncture).

 

Diet

 

After surgery you will be given IV fluids to keep you hydrated.  To keep your mouth moist, you can use swabs dipped in ice chips and water.  Nurses and doctors may listen for sounds from your abdomen, ask if you are passing gas or stool, if you have any nausea or vomiting, and about your appetite.  This is to see if your bowel function is improving after surgery.  You can expect that your bowel function will return after a few days.  The time it takes for the bowel to start working varies with each person.

 

As you and the healthcare team feel you are ready, you will be allowed to eat.  You will start slowly with clear liquids.  These include juice, jello, broth, popsicles, etc.  You will then move on to full liquids such as milk products, creamed soups, pudding, Ensure®, protein drinks.  Then, you will move on to “real food”.  For some, that will be a general diet with no restrictions on what you are allowed to eat.  The key to advancing your diet is to start out slowly.  Eat only what feels good and tastes good.  If you begin to feel sick to your stomach or full, you should stop eating and tell your nurse.

 

If you were on a special diet at home (Diabetes, Low Sodium, Lactose Free, etc) or have food allergies, please talk to your Health Care Team about this to make sure we provide you with a similar diet during your stay.

 

Some patients will be placed on a Low Fiber diet.  This diet is suggested for surgical patients with bowel resections and new ostomies.  It helps you have fewer and smaller bowel movements with less pressure, cramping, and pain.  Fiber in foods increases the amount of stool and gas you produce and how often you have bowel movements.  Recommended foods without fiber are white breads (no wheat, bran or whole grains), peeled or cooked fruits (no dried fruits), cooked vegetables (no raw vegetables), no smoothies made with fruits or grains, no seeds, and no beans. For most patients who leave the hospital on a Low Fiber diet, the doctor will change your diet to a general diet without restrictions at your 2-week follow up visit.

 

Constipation

 

Pain medicine can cause constipation.  Pain medicine slows down bowel movements moving through the intestine.  This causes the stool to become hard.  If you have hard bowel movements, have trouble passing bowel movements, and the movements are not often enough, then you are constipated.

 

Once you are home, you will need a plan to avoid constipation.  Stick to the plan as long as you are taking pain medicine.  Review your plan with your doctor or nurse.  Here are some things that could be included in your plan.  Some patients will be discharged on special diets, please talk to your doctor before making any changes to your diet.

 

• Eat foods that have helped you to relieve constipation in the past.
• Eat foods high in fiber, as long as they have been approved by your doctor.  This includes foods such as uncooked fruits, raw vegetables, and whole grains and cereals.  Try prune juice.  If you are not hungry, do not force yourself to eat fiber.
• Drink plenty of liquids.  Eight to ten 8-ounce glasses of fluid each day will help keep your stools soft.  Warm liquids often help your bowels to move.
• Exercise as much as you are able each day or at least every other day.  Increase the amount you walk as you can.  Check with your doctor or nurse about the exercises that are best for you.
• Plan your bowel movements for the same time each day, if you can.  Set aside time for sitting on the toilet.
• Aim for a bowel movement every second or third day rather than every day.

 

High Fiber Foods

Cereals & flours	Bran cereals, whole-wheat bread, rye bread and crackers, wheat germ, corn, cornmeal, wild rice, brown rice, barley
Fruits	Fresh, canned, or dried fruits, especially those with skin or seeds (apples, plums, pears, peaches, tomatoes, berries, raisins, and dates)
Vegetables	Any raw or cooked vegetable (not overcooked) such as carrots, cabbage, peas, dry beans, and lentils

Stool softeners and laxatives

Many people taking pain medicine need the help of a stool softener.  This alone may not work.  You may need to add a gentle laxative.  Be sure to check with your doctor before taking any of these on your own.

 

Your doctor or nurse may suggest taking a laxative on a regular schedule rather than waiting for constipation to happen.  There are many types and brands of laxatives, and most are over-the-counter.  Talk to your doctor about which may work best for you.

 

Bulk Laxatives and Fiber, like Metamucil®

Bulk laxatives and fiber medicine, like Metamucil®, absorb water and expand to increase bulk and moisture in the stool.  They are not the best to use for constipation from narcotics.  They should only be used if you are able to drink plenty of fluids throughout the day.

 

Call your doctor before taking any stool softeners or laxatives.

 

Wound Care

 

Smoking/Tobacco and Wound Healing

Smoking or tobacco use causes blood vessels to become smaller.  The smaller vessels have a hard time carrying oxygen, nutrients, and healing factors to the wound.  This can cause the wound-healing process to take longer.  Carbon monoxide is a poison from smoking and tobacco use (such as “chew”) that enters your blood cells.  This poison lowers the level of oxygen in your blood.  Smoking and tobacco use can increase the risk of an infection of your wound.  Quitting tobacco is the best choice you can make to help your incision heal faster, safer, and with fewer problems.  If you are interested in quitting, please let your nurse know.  We can get you information on how to quit smoking.

 

Surgical Incision

Some patients will have only steri strips (taped bandages) over their incision, while other patients will have a stapled incision.  Your doctor and nurse will check your incision to make sure there are no signs or symptoms of infection (redness, warmth, pus-like drainage, excess swelling or bleeding, pain not controlled by pain pills, and/or temperature of 100.4°F for 2 consecutive times four hours a part).  If you have any of these symptoms, call the clinic at 608-263-7502 during normal business hours 8am-4:30pm.  Call the doctor on call 608-262-0486 after hours and on weekends.

 

If you have steri strips (taped bandages) on your incision, allow them to fall off on their own.

 

If you have staples your doctor will remove them during your clinic visit about 2 weeks after you go home.  To clean the incision, gently wash the incision with soap and water.  Let it air dry.  It is okay to shower when you are at home.  Soaking, swimming, or taking baths is to be avoided for at least two weeks or until further advice from your surgeon.

 

Open Wound

If you have a wound that is being packed, you will receive written instructions on how to care for your wound before you go home.  We will teach you how to change your dressing while you are in the hospital.  If you are not able to change the dressing, we will teach a family member or friend how to change it for you.  We will send you home with supplies to keep packing the wound as ordered by your doctor.  After you go home, home health care may be set up to check on your wound and help with any needs that you may have. 

 

Emotional Changes

 

You may be feeling worried, sad, angry, or scared.  These and many other feelings can occur while in the hospital.  It takes time to deal with your new diagnosis, treatment, and the new changes in your life.  Every person copes in their own way.  Some have found it helpful to talk about their feelings with the people close to them and to ask for their support.  Talk to your doctor, nurse, or other members of the Health Care Team as you are comfortable.  We have resources at UW Hospital and support groups in the community that we can connect you with, if you would find that helpful.

 

Discharge/Going Home

 

The length of your hospital stay depends on your surgery and how long it takes you to recover.  You may need to have a family member or friend learn about your home care before you leave the hospital.  You will receive prescriptions for new medicines.  Please bring your insurance card if you plan to fill your prescriptions at the hospital.

 

You will need a responsible person to drive you home and stay with you as needed.  Your case manager will help make plans for Home Health or a nursing home stay, if needed.

 

There are 6 standards that must be met before you go home.  These are

• Be able to eat and tolerate a diet.
• Be able to walk by yourself or move around as you did before being in the hospital.
• Control your pain with oral pain pills. 
• Be able to pass urine.
• Be passing gas and stool (you may have loose stools).
• Be able to safely take care of yourself at home or have someone able to take care of you.

 

Once these standards are met, one of your doctors will write an order for you to be discharged. At that point the nurse and the pharmacist will review your discharge instructions.  Your paperwork will be done, prescriptions will be written, and appointments will be made.  All of this often takes a few hours.

The pharmacist will meet with you to review the medicines you will be taking at home.

 

The nurse will review your discharge instructions which include:

• Activity orders.
• Lifting restrictions.
• Your diet at home.
• Wound care instructions.
• Follow up appointments.
• Any special instructions.
• Phone numbers if you have questions or concerns.

 

You can help in your discharge process, if you alert us early on to any special circumstances about your discharge, such as long rides home, limits to when you can be picked up, etc.

 

Activity Restrictions after You Go Home

 

Slowly increase your level of activity.  Based on your surgery you will have some activity restrictions.  Most patients will have to avoid lifting greater than 10 pounds for 2 weeks.

 

Make sure you are active when you go home.  The best way to do this is to keep walking.  Slowly resume your normal routine.  Be sure that you stay within your lifting limits.  You can find them on your discharge instructions.  Check with your doctor if you are not sure if an activity is right for you.  Listen to your body.  Let comfort be your guide.  If it hurts, stop.

 

Check with your doctor about when you may:

• Resume driving.  DO NOT DRIVE if you are taking narcotic pain medicine.  These include Percocet®, oxycodone, Vicodin®, Tylenol® #3, Dilaudid®, morphine. 
• Go back to work.
• Resume sexual activity.

 

When to Call the Doctor

 

• Unusual pain that you haven’t had before.
• Pain not controlled by pain medicine.
• Nausea.
• Vomiting.
• Severe fatigue that doesn’t go away.
• Unusual drainage at the incision.
• Redness at the incision site that appears to be spreading.
• Fever of 100.4°F or 38°C for 2 readings taken four hours a part.
• Any unusual or prolonged bleeding.
• Abdominal bloating/distention.
   

Important Phone Numbers

 

Surgery Clinic                 608-263-7502
Outpatient Pharmacy       608-263-1280
Hospital Paging Operator  608-263-0486
Patient Relations              608-263-8009
UW Emergency Room       608-262-2398
Toll-Free                         1-800-323-8942

 

If you think you are having symptoms of an emergency, call 911.

 

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 08/17/2011

Copyright © 08/17/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7192

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