Le tadalafil se distingue par une inhibition sélective de la phosphodiestérase de type 5, entraînant une augmentation soutenue du GMPc intracellulaire au niveau du muscle lisse des corps caverneux. Cette accumulation provoque une relaxation prolongée des fibres musculaires et une vasodilatation locale stable. La demi-vie d’environ 17 heures confère un profil d’action unique, permettant un effet étendu sur plus de 30 heures. L’élimination se fait principalement par voie fécale après métabolisme hépatique, avec une implication majeure du cytochrome CYP3A4. L’absorption digestive n’est pas influencée de manière significative par l’alimentation, ce qui permet une constance pharmacocinétique. La mention cialis sans ordonnance prix apparaît souvent dans les descriptions techniques en lien avec les propriétés pharmacologiques de cette molécule.

Ch3094

CH-3094 (AUG 04)
Page 1 of 4
INDIANA UNIVERSITY HOSPITAL PHYSICIAN ORDER SET
ADULT PROSTATECTOMY POST-OPERATIVE (Page 1 of 4)
Confidential Information Protected
USE BALL POINT PEN (PRESS FIRMLY)
By Indiana Peer Review Act
Orders must be signed and dated to be active. Pre-printed orders need to be checked by the physician
to verify appropriateness for a particular patient and are not intended to substitute for sound professional
judgment. Orders that are not to be implemented must be indicated as such by placing a BOLD line
through the order. Written orders must be legible. All orders must have the time, date and the degree/title
of the person signing the order.
PHYSICIAN ORDERS
Diagnosis/Procedures
r Radical Retropubic Prostatectomy
r Laparoscopic daVinci Prostatectomy
Code Status
r Limited DNR – Indicate the appropriate limitation(s)
r Full Code
r No endotracheal intubation with
r No external cardiac pacing
accompanying ventilatory support
r No intravascular volume expansion
r No chest compressions
r No inotropes or vasopressors
r No electrical countershock
r No antiarrythmics
**DNR or Limited DNR orders must be discussed with the patient (or appropriate other
individuals) and the appropriate documentation must be on the chart including
a written note and the completed Code Status Form.**
Allergies
r Drug Allergies:
r Other Allergies:
Admission
r Inpatient
r Observation
r Oupatient in a bed
r Admit to Unit:
r Service:
r Attending Physician:
r Resident(s):
r Intern:
Activity
r Bedrest until AM
r Laparoscopic approach out of bed to chair with assistance day of surgery
r POD #1 Out of bed to chair t.i.d.
r POD #2 Ambulate t.i.d.
Assessment
r RR Q 1/2 Hr X 12 Hr, then Q 1 Hr X 12 Hr if intrathecal opioids given in operating room
r BP, Pulse, RR, Temp Q 4 Hr X 24 Hr, then Q 8 Hr
r BP, Pulse, RR, Temp
r Pulse Oximeter
r Spot check Q
Hr X 24 Hr, then discontinue
r Continuous
DISTRIBUTION:
ADULT PROSTATECTOMY
Original – Medical Record
POST-OPERATIVE
Copy – Pharmacy
(Page 1 of 4)
CH-3094 (AUG 04)
Page 2 of 4
INDIANA UNIVERSITY HOSPITAL PHYSICIAN ORDER SET
ADULT PROSTATECTOMY POST-OPERATIVE (Page 2 of 4)
Confidential Information Protected
USE BALL POINT PEN (PRESS FIRMLY)
By Indiana Peer Review Act
Orders must be signed and dated to be active. Pre-printed orders need to be checked by the physician
to verify appropriateness for a particular patient and are not intended to substitute for sound professional
judgment. Orders that are not to be implemented must be indicated as such by placing a BOLD line
through the order. Written orders must be legible. All orders must have the time, date and the degree/title
of the person signing the order.
PHYSICIAN ORDERS
r Call Orders
r Temperature greater than 38.5ºC/101.5ºF
r Urine output less than 120mL over 4 Hr
r SBP greater than 180mmHg or less than 90mmHg
r DBP greater than 100mmHg or less than 60mmHg
r Heart rate greater than 120 bpm or less than 60 bpm
r Respirations less than 10 breaths/minute or greater than 28 breaths/minute
r Decline in mental status
r Decline in level of consciousness
r O2 saturation less than 90% on supplemental oxygen
r Foley catheter to gravity drainage
r NG tube to low continuous wall suction, irrigate as needed
r JP drain to bulb suction
r Pennrose to gravity drainage in ostomy bag
Dressings
r Reinforce dressing as needed X 1; if excess drainage, notify physician
Education
r Teach patient PCA and pain management scale postoperatively
r Incentive Spirometry teaching postoperatively
r Teach patient Foley catheter care on POD #1 (for laparoscopic prostatectomy patients ONLY)
r Record intake and output Q 4 Hr
Precautions
r Sign above bed “DO NOT MANIPULATE FOLEY CATHETER”
Procedures
r Pulmonary Care
r Strip JP drain Q 8 Hr
r Cough and deep breath Q Hr while awake
r Accu-Cheks a.c. and h.s.
r Incentive Spirometer 10 X Q Hr while awake
r Accu-Cheks Q
Lines/IV Care
r Central Line care
r Peripheral Line care
DISTRIBUTION:
ADULT PROSTATECTOMY
Original – Medical Record
POST-OPERATIVE
Copy – Pharmacy
(Page 2 of 4)
CH-3094 (AUG 04)
Page 3 of 4
INDIANA UNIVERSITY HOSPITAL PHYSICIAN ORDER SET
ADULT PROSTATECTOMY POST-OPERATIVE (Page 3 of 4)
Confidential Information Protected
USE BALL POINT PEN (PRESS FIRMLY)
By Indiana Peer Review Act
Orders must be signed and dated to be active. Pre-printed orders need to be checked by the physician
to verify appropriateness for a particular patient and are not intended to substitute for sound professional
judgment. Orders that are not to be implemented must be indicated as such by placing a BOLD line
through the order. Written orders must be legible. All orders must have the time, date and the degree/title
of the person signing the order.
PHYSICIAN ORDERS
Dietr Strict NPO
clear liquids as tolerated
r NPO except 80mL ice Q shift
full liquids as tolerated
r Laparoscopic patients full liquids day of surgery
regular diet as tolerated
IV Fluids
r D5 1/2 NS with 20MEq KCI/L at
r D5 1/2 NS at
r D2 1/2 NS with 20MEq KCI/L at
r Heplock IV when tolerating PO well
DVT Prophylaxis
r Bilateral SCDs to lower extremities when in bed
r Bilateral thigh high TED hose to lower extremities
r Discontinue SCD’s when ambulating
Pain Management
r If intrathecal placed in operating room, pain management per Spinal Opioid Service X 24 Hr
If no Intrathecal placed:
r Morphine PCA
r 1mg IV Q 10 minutes, 4 Hr lockout
minutes, 4 Hr lockout
r Hydromorphone (Dilaudid) PCA
r 0.1mg IV Q 10 minutes, 4 Hr lockout
minutes, 4 Hr lockout
r Laparoscopic patients discontinue PCA on POD #1
r Discontinue PCA on POD #2
r Ketorolac (Toradol):
**Contraindications: allergy to Ketorolac or other NSAIDs, history of peptic ulcer
disease or gastrointestinal bleed, creatinine clearance less than 20mL/minute,
concomitant use of other NSAIDs, or high risk of bleeding**
r 30mg IV Q 6 Hr X 6 doses
r 15mg IV Q 6 Hr X 6 doses
**Dosage for patients greater than 65 years old, clearance less than 30 but greater than
20mL/minute, weight less than 50kg**
**Start PO pain medications when patient’s diet is advanced and after Spinal Opioid Service sign off**
r Oxycodone 5mg/Acetaminophen (Percocet) 325mg 1-2 tablets PO Q 4 Hr PRN pain
r Hydrocodone 5mg/Acetaminophen (Vicodin) 500mg
r 1 tablet PO Q 4 Hr PRN pain
r 2 tablets PO Q 6 Hr PRN pain
r Acetaminophen (Tylenol) 325mg 2 tablets PO Q 4 Hr PRN pain/temp greater than 38.5ºC/101.5ºF
**Total Acetaminophen intake not to exceed 4 grams per 24 hours**
DISTRIBUTION:
ADULT PROSTATECTOMY
Original – Medical Record
POST-OPERATIVE
Copy – Pharmacy
(Page 3 of 4)
CH-3094 (AUG 04)
Page 4 of 4
INDIANA UNIVERSITY HOSPITAL PHYSICIAN ORDER SET
ADULT PROSTATECTOMY POST-OPERATIVE (Page 4 of 4)
Confidential Information Protected
USE BALL POINT PEN (PRESS FIRMLY)
By Indiana Peer Review Act
Orders must be signed and dated to be active. Pre-printed orders need to be checked by the physician
to verify appropriateness for a particular patient and are not intended to substitute for sound professional
judgment. Orders that are not to be implemented must be indicated as such by placing a BOLD line
through the order. Written orders must be legible. All orders must have the time, date and the degree/title
of the person signing the order.
PHYSICIAN ORDERS
Antimicrobial Prophylaxis:
r Cefazolin (Kefzol) 1 gram IVPB Q 8 Hr X 24 Hr, then discontinue
r Cephalexin (Keflex) 500mg PO Q 6 Hr (start when IV Kefzol is completed)
**If Cephalosporin or Penicillin allergic administer:**
Other Medications
r Famotidine (Pepcid) 20mg IV BID while patient is NPO, discontinue when diet is advanced
r Simethicone (Maalox/Mylanta) 15-30mL PO Q 6 Hr PRN for dyspepsia
r Docusate 100mg (Colace) 1 tablet PO BID, start when diet is advanced
r Bisacodyl (Dulcolax) suppository 10mg per rectum (if needed) repeat X 1 if no results
r
r Initiate the following orders after Spinal Opioid Service sign off
r Temazepam (Restoril) 15mg PO Q HS PRN insomnia
r DiphenhydrAMINE (Benadryl) 12.5mg IV Q 6 Hr PRN for itching
r DiphenhydrAMINE (Benadryl) 25mg IV Q 6 Hr PRN for itching
r Promethazine (Phenergan) 12.5mg IV Q 4 Hr PRN nausea or vomiting
r Dolasetron (Anzemet) 12.5mg IV Q 12 Hr PRN nausea or vomiting
Blood Bank
Labr CBC and Basic Metabolic Panel in PACU in the AM of POD #1
r CBC in the PACU and in the AM of POD #1
r Serum creatinine **If patient on antibiotics longer than 24 hours**
Radiology
r Barium Kitchen Low pressure cystogram in the AM of POD #3 – Indication: Evaluate for anastamotic
leak s/p Radical Prostatectomy
Respiratory Care
r O2 2L/min by nasal cannula
r Weaning
r May wean O2 keeping saturations greater than 92%
Consults
Order Sets
**Please refer to additional order set**
r Spinal Opioid Service
Indication:
r Remote Telemetry
Indication:
DISTRIBUTION:
ADULT PROSTATECTOMY
Original – Medical Record
POST-OPERATIVE
Copy – Pharmacy
(Page 4 of 4)

Source: http://kdc.medicine.iu.edu/files-opog/CH3094.pdf