Cystectomy with Neobladder

'''Cystectomy with Neobladder '''

VNA:

-please gently flush and aspirate Foley with 60 cc sterile normal saline with instructions to patient. ( it is ok if you get less than 60cc with aspiration).

- Needs bid flushing of Foley

It was a pleasure participating in your care.

-You may shower but do not bathe, swim or immerse your incision.

-Do not lift anything heavier than a phone book.

-Do not drive or drink alcohol while taking narcotics.

-Resume all of your home medications.

-Call your Urologist's office (617-732-6325) to schedule a follow-up appointment in 1 week AND if you have any questions.

-If you have fevers > 101.5 F, vomiting, or increased redness, swelling, or discharge from your incision, call your MD or go to the nearest emergency room.

-Please flush your foley catheter twice a day with 60cc sterile normal saline as instructed by nursing staff and your urologist.

HOSPITAL COURSE:

Patient was admitted to urology service after undergoing a radical cystectomy with creation of neobladder. There were no intraoperative complications; please see dictated operative report for further details. Patient was transferred to the floor from PACU in stable condition. Pain was well managed initially with patient controlled medications then transitioned to orals. With the passage of flatus, diet was slowly advanced starting with sips. *****The ureteral stents were removed on POD****  The foley was flushed and aspirated every 12 hours along with foley self care instructions to patient. VNA services will be provided at discharge. The wounds were healing well with no evidence of erythema, swelling, or purulent drainage. Upon discharge, patients pain was well managed, ambulating independently, and tolerating a house diet. Patient was instructed to follow up in clinic in one to two weeks.

Pathway: (may change)''' '''

N: epidural/PCA until able to tolerate toast/crackers, then convert to orals

<p style="margin: 0in 0in 0pt 0.75in">Cor: home meds

<p style="margin: 0in 0in 0pt 0.75in">Pulm: wean O2, early ambulation, chest PT if needed

<p style="margin: 0in 0in 0pt 0.75in">GI : D/C NGT POD1, NPO POD1, may chew gum, POD2 Clear sips up to 30cc/hr non-carb, usually until flatus, some will start clears on POD3 until flatus. Once they pass flatus, may start clears toast and crackers but always check with the Chief.

<p style="margin: 0in 0in 0pt 0.75in">GU: Ostomy nurse will evaluate on POD1, then nursing will provide remainder of teaching. Ostomy nurse will leave scripts for ostomy supplies in front of chart that need to be signed.

<p style="margin: 0in 0in 0pt 0.75in">Heme: ambulate POD1, pneumoboots, SQH

<p style="margin: 0in 0in 0pt 0.75in">Labs: Basic metabolic, mag until on house diet, CBC, POD 1 and 2, then at      Chief’s discretion.

<p style="margin: 0in 0in 0pt 0.75in"> Replete Kcl with goal of 4.5, replete Mag with goal of 2.3 of course adjusting for renal insufficiency. (evidently repleting to these goals improves return to bowel function).

<p style="margin: 0in 0in 0pt 0.75in">GU: Usually flush neobladder with 40-60 cc bid gentle flushes (to avoid build up of mucus in bladder which can clog off the foley), okay if no return of fluid with aspiration. Usually the stents will put out more than the foley for first few days

<p style="margin: 0in 0in 0pt 0.75in">DISCHARGE MEDS:

<p style="margin: 0in -1.25in 0pt 0.75in">Oxycodone #45

<p style="margin: 0in -1.25in 0pt 0.75in">Colace #60

<p style="margin: 0in -1.25in 0pt 0.75in">Senna 8.7 mg #30 instructions 2 tabs bid prn constipation.

<p style="margin: 0in 0in 0pt 0.75in">If ureteral stents are in place at discharge: Cipro 500mg #2 1 bid to take on day of stent removal. (this is variable based on Attending…usually Dr. Richie’s patients stents are removed prior to discharge.