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