Turp transurethral Resection of the Prostate Post Op Orders



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#48460



PLACE LABEL HERE

TURP

(Transurethral Resection of the Prostate)

POST-OP ORDERS



The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.

Initial all handwritten order modifications and the bottom of each page when indicated (multipage).
1. Do you expect that the patient’s condition will require a hospital stay that will cross two midnights (includes the time spent in outpatient- ED, surgery, OBS) and the patient has medical necessity for an inpatient admission?

Yes, admit as inpatient, proceed to # 2 No, place in observation No, outpatient, DC home



2. If admitted as inpatient, Inpatient Physician Certification:

Diagnosis: ________________________________________________________________________

Level of Care:  Critical  Intermediate  Acute Care Location/Specialty Unit Preference_______

  1. Telemetry: If patient Medical/Surgical, must complete form # 36084

  2. Isolation:  Contact  Droplet  Airborne For: _________________

  1. Vital signs per unit routine

  2. Diagnostics:  H&H at 2100 tonight  H&H in am  Chem 7 in am

  3. Foley to bedside bag

  4. Continuous bladder irrigation with NS, titrate to keep pink to clear. Do not interrupt irrigation while transporting patient.

  5. Irrigate Foley with normal saline to prevent clot retention prn

  6. Incentive spirometry q 2 hrs while awake

  7. Diet:  Regular  Cardiac  Diabetic______ calories  Renal

  8. Oral Nutrition Supplement Standing Order (form # 31417), initiate if patient meets criteria

  9. Bedrest x 4 hrs then OOB to chair  Other: _______________________________________________


SCHEDULED MEDIATIONS:

  1. IVF:  NS  LR  D5NS  D5 ½ NS with 20 KCl at __________ ml/hr

Discontinue IVF when tolerating PO fluids

  1. Antibiotic: Post-op antibiotic will be automatically stopped within 24 hrs unless indication is documented

 Cipro (ciprofloxacin) 500 mg po bid x 2 doses

or  continue > 24 hrs for _______________________ (Reason REQUIRED)

or  Bactrim (sulfamethoxazole 800 mg/Trimethoprim 160mg) DS, 2 tabs po bid x 2 doses

or  continue > 24 hrs for _______________________ (Reason REQUIRED)
The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.

Initial all handwritten order modifications and the bottom of each page when indicated (multipage).
PRN MEDICATIONS: See policy 520-06 for range orders and pain intensity guidelines.

Prior to administering pain medications, assess for difficulties with continuous bladder irrigation.
16. Spasms:  B&O (Belladonna & Opium) suppository 1 per rectum q 6 hrs prn

  1.  Electrolyte Replacement Protocol (form # 21340)

  2. Mild Pain, Temp >100.5F, HA:  Tylenol (acetaminophen) 650 mg po or PR q 4 hrs prn

  3. Moderate Pain:

 Norco (HYDROcodone/acetaminophen) 5/325 mg or 10/325mg 1 tab po q 4 hrs prn. DC if Percocet ordered.

or If patient cannot take tablet, Hycet elixir (HYDROcodone/acetaminophen 7.5/325 mg/15 ml) 15 ml po q 4 hrs prn instead of Norco. DC if Percocet ordered.

or  Percocet (oxyCODONE/acetaminophen) 5/325 mg or 10/325 mg 1 tab po q 4 hrs prn. DC if Norco ordered.



and/or  Toradol (ketorolac) 30 mg IV (or IM if no IV access) q 6 hrs prn (15 mg if CrCl 31-50, > 65 y/o old or < 50 kg) or 10 mg po q 6 hrs prn (max combined duration of IV and po ketorolac is 5 days). DC if CrCl < 30.

  1. Severe Pain (Begin when Epidural or PCA has been discontinued)

 Morphine 1-2 mg IV q 3 hrs prn, DC if CrCl < 30. Hold for excessive sedation. DC if Dilaudid ordered.

or  Dilaudid (HYDROmorphone) 0.25-0.5 mg IV q 3 hrs prn. If CrCl < 30, dose at 0.25 mg. Hold for excessive sedation. DC if Morphine ordered.

  1. Nausea/Vomiting:  Zofran (ondansetron) 4 mg IV or po q 6 hrs prn

 If N/V persists, add Reglan (metoclopramide) 10 mg IV q 6 hrs prn (5 mg if > 65 y/o)

  1. Sleep:  Ambien (zolpidem) 5 mg (female or males ≥ 65 y/o) or 5-10 mg (male < 65 y/o) po at HS prn

  2. Indigestion:  Maalox XS (aluminum/magnesium/simethicone) 30 ml po four times daily prn

  3. Stool Softener:  Colace (docusate) 100 mg po bid prn; if patient has not had a bowel movement

  4. Constipation:  Milk of Magnesia (MOM) 30 ml po daily prn

If no BM after 48 hrs,  Dulcolax (biscodyl) 10 mg per rectum daily prn

and/or  Senokot-S (docusate/senna) 2 tablets po at bedtime nightly

26. Cough:  Robitussin (guaifenesin) 15 ml po q 4 hrs prn

27. Sore Throat:  Chloraseptic (phenol/sodium phenolate) throat spray q 2 hrs prn



ADDITIONAL ORDERS:

________________________________________________________________________________________

________________________________________________________________________________________
______________ ________________ _________________________________ ___________

Date Time Physician Signature PID Number



Copy to pharmacy Order writer’s initials _______
*3-18191* FORM 3-18191 REV. 07/2015 Page 1 of 2


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