CYSTECTOMY WITH ILEAL LOOP

Cystectomy, ileal loop

HOMECARE INSRUCTIONS VNA: Ostomy care per protocol 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.

HOSPITAL COURSE: Patient was admitted to urology service after undergoing a radical cystectomy with ileal loop diversion. 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 ostomy was pink, patent and productive. Ostomy training was provided by ostomy nurse. The wound was 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 with Dr. *** in one to two weeks.

PATHWAY (rough sketch…often changes based on who attending is and their changes in preferences with time) N: epidural/PCA until able to tolerate toast/crackers, then convert to orals Cor: home meds Pulm: wean O2, early ambulation, chest PT if needed GI: D/C NGT POD1, NPO POD1, may chew gum, POD2 Clear sips up to 30cc/hr non-carb. 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. 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. Heme: ambulate POD1, pneumoboots, SQH Labs: Basic metabolic, mag until on house diet, CBC, POD 1 and 2, then at      Chief’s discretion. 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). Discharge home with VNA usually POD6-7.

DISCHARGE MEDS: Oxycodone #45 Colace #60 Senna 8.7 mg #30 instructions 2 tabs bid prn constipation. If 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)