Physician Orders | Urology Residency | Residents & Fellows | Dartmouth-Hitchcock
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Physician Orders

History and physicals

Pre-op done by the resident or intern. Fill out the Same Day Program Physician Record or a pre-op note written in CIS, and do the consent. See the surgical coordinator before seeing the patient to obtain the surgical date and procedure to be done, and to review specific directions written on the booking sheet. It is also useful to review the urologist's notes in CIS. After the H&P has been completed, direct the patient to Pre-Admission Testing if required. The service sheet needs to be filled out and given to the nurses. If the attending saw the patient on the same day that you are doing the H&P, give the service sheet to them.

SWL protocols

KUB pre-op if the stone is visible. Recent noncontrast CT scan or renal ultrasound for nonopaque renal stones that will be visualized by ultrasound. Any patient with a stent will receive Gentamycisn 80-mg IV OCTOR. Patients are all sent home with a narcotic for pain meds. Stented patients are sent home with three days of antibiotics (macrobid or bactrim).

Radical prostatectomy

Pre-op instructions: Only clear liquids 48 hours prior to surgery. Fleets enema prep kit #3 at 2:00 p.m. Nothing by mouth (solids or liquids) after midnight the evening before surgery.

PV sling protocol

Emphasize that they will stay in the hospital overnight and most likely go home on the day after surgery. They should practice performing clean (not sterile) self-intermittent catheterization at home prior to surgery (the urology nurses show patients how to do this). They will initially have a vaginal pack and foley catheter which will usually be removed the day after surgery.

  • Pre-op orders: No lab work (if young and healthy), ECG and CXR, if required by anesthesia or complicated medical disease present. TEDS and venodynes OCTOR. Kefzol, 1gm, OCTOR. (If heart valve or artificial joint, then Ampicillin and Gentamicin).
  • Post-op orders: Anti-emetic given in the OR. Ambulate ASAP and D/C venodynes when ambulating. IVF at not more than maintenance. Regular diet, Toradol 30 mg IV, q6h x 3 doses (not PRN), first dose on arrival of PACU (if patient is frail or over 65, then 15 mg IV q 6 hours). Percocet, 1-2 tabs, po q 4 hours, PRN, Kefzol, 1gm, IV q 8 hours x2 doses post-op (not x 24 hours). No post-op labs unless there was an unusual amount of bleeding.

TRUS (transrectal ultrasound with biopsy)

Patient is given a "Transrectal Prostate Biopsy" brochure with information, and a prescription for #6 Cipro, 500 mg tablets, one tablet at bedtime the night before biopsy, one tablet the morning of biopsy and two tablets daily for two days post biopsy. Patient to administer a Fleets enema one hour before leaving home. Inform patient to cease all medications that contains aspirin or blood thinners seven days prior to ultrasound.

Urine results

Urine results anticipated to come in on the weekend will be the responsibility of the resident on call. The nurses inform the resident on call on Friday which patients have outstanding results to be addressed on Saturday or Sunday. Treatments will be documented in CIS (both on the patient's drug list and as a phone note in CIS).

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