Download Radical Prostatectomy Post-Operative Order Set

ADDRESSOGRAPH
GREY BRUCE HEALTH NETWORK
Page 1 of 2
SITE: __________________
Allergies: □ NKA or: __________________________
Weight (kg) _____________ Height (cm) ______________
Radical Prostatectomy Post-Operative Order Set
______ Admission Diagnosis: Post-Operative Radical Prostatectomy
IN PACU:
______  CBC with diff, Electrolytes, Creatinine
Diet
On Admission:
______  Sips to Clear Fluids OR
Energy controlled Clear Fluids
When passing flatus:
______  Regular Diet
OR
______  Activity as tolerated
Energy controlled Diet
Activity
 Out of bed day of surgery
 Ambulate TID Post-Op Day 1
Vital Signs
______  VS + O2 sats Q4H x 24 hours, QID x 24 hours then BID when stable
______  Notify Authorized Provider:






for temp greater than 38.5° C
systolic blood pressure less than 90 mmHg or greater than 160 mmHg
diastolic blood pressure greater than 100 mmHg
pulse less than 50 bpm or greater than 120 bpm
True Urine output less than 120 mL in 4 hours
O2 sats less than 92%
Patient Care
Tubes/Drains
______  Urinary catheter to straight drainage. Manual irrigation PRN
______
Catheter traction overnight. Discontinue catheter traction Post-Op Day 1
______
NS bladder irrigation at a rate of 125 mL/h Or at a rate to maintain catheter patency
Adjust rate to keep urine clear or light pink
______  Intake and Output Q4H x 24 hours, then QSHIFT and PRN
______  Snyder drain to suction. Empty and record volume QSHIFT and PRN
Incision/Wound Care
______  Change Dressing 24 hours Post-Op, then PRN
POC
______
POC Capillary Glucose:
BID before meals or
TID before meals or
______  If POC ordered – Authorized Provider to reassess after 72 hours
TID AC and QHS
Laboratory
______  CBC with diff, Electrolytes, Creatinine Day 1 Post-Op
Day 1 and Day 2 Post-Op
Authorized Provider’s Signature ______________________ Date ______________ Time __________ Page 1/2
GBHN/Radical Prostatectomy Post op/MD/06-15/v6
Copyright © 2007-2015 Grey Bruce Health Network
NOTE: this is a CONTROLLED document as are all files on this server. Any documents appearing in paper form
are not controlled and should ALWAYS be checked against the server file versions (electronic version) prior to use.
ADDRESSOGRAPH
GREY BRUCE HEALTH NETWORK
Page 2 of 2
SITE: __________________
Allergies: □ NKA or: __________________________
Weight (kg) _____________ Height (cm) ______________
Radical Prostatectomy Post-Operative Order Set
IV Solutions
______ IV Fluid:
______
______
 Ringers Lactate 125 mL/h
2/3 1/3
NS
With 20 mEq KCl per L of IV fluid
With 40 mEq KCl per L of IV fluid
Rate ___________________ mL/h
______  Saline lock IV when drinking well
Medications
______  Belladonna and Opium suppository Rectally Q6H PRN (Not to be discontinued when Spinal/Epidural
Analgesia Post-Operative Order Set is used)
______  bisaCODYL suppositories 10 mg Daily Rectally, starting Post-Op Day 1, until flatus
______  Docusate Sodium 100 mg PO BID
______  Hyoscine Butylbromide 20 mg IV or Subcutaneous Q4H PRN
______
Home medications as per Medication Reconciliation History sheet when signed by Authorized Provider
Antibiotic Prophylaxis
______
______
______
______
______
Cephalexin 500 mg PO BID
Nitrofurantoin SR 100 mg PO Daily
Diabetes Management
Hypoglycemia Clinical Protocol greater than or equal to 18 years
Subcutaneous Insulin Order Set
Nicotine Replacement Therapy
Nicotine Replacement Therapy (NRT) Order Set
VTE Prophylaxis Management
______ Patient has been assessed for VTE Prophylaxis Management: Bleeding Risk
______
VTE Prophylaxis Order Set if indicated to be signed by Authorized Provider
LOS less than 48 hours
Admission/Discharge/Transfer
______  Plan for Post-Op Day 1 – 3 discharge
______  Follow up in 2 weeks for catheter removal after cystogram
Consults
______  CCAC for catheter care, wound care and supplies
______
Physiotherapy
Other
______  Order Set Orderable – (Automatic order for statistical reports)
Authorized Provider’s Signature ______________________ Date ______________ Time __________ Page 2/2
GBHN/Radical Prostatectomy Post op/MD/06-15/v6
Copyright © 2007-2015 Grey Bruce Health Network
NOTE: this is a CONTROLLED document as are all files on this server. Any documents appearing in paper form
are not controlled and should ALWAYS be checked against the server file versions (electronic version) prior to use.