10. Course In The Ward

VI.

COURSE IN THE WARD

Day 1 A 48 years old female was admitted at exactly 2:16:07 p.m last August 22, 2008, accompanied by her son, with a chief complaint of body weakness. She was admitted under the service of Dra. Lovely Cacho and Dra. Alice Lojo and following orders were given. Diet as tolerated, temperature, pulse rate and respiratory rate must be recorded every shift, for chest x-ray posterior-anterior, for electrocardiogram x 12 leads, for complete blood count blood typing and for chem. 7. It was done at the same day. The physician ordered a 5% Dextrose in Lactated Ringers 1 liter plus 1 ampule of EC to be regulated at 20 gtts/min. The physician ordered four units of whole blood that are properly typed and cross matched to be run for 4-6 hours. The physician also ordered “Lady L” that may have full diet at 4:40 p.m. The first unit of whole blood with a serial number B-08-4660 started at 10:00 p.m.. Diphenhydramine 1 ampule intravenous 30 min. prior to blood transfusion. Day 2 The above unit of blood finished at August 23, 2008, 2:20 a.m. There is no reaction during and after the blood transfusion. At the same time, the second unit of whole blood with a serial number B-08-4681 was hooked and consumed at 7:20 a.m. The third unit of blood with a serial number B-08-4666 was started at same time. The blood transfusion site was transferred from left to right at 11:20 a.m. At 12:30 p.m., the third unit of whole blood with a serial number B-08-4668 was consumed and followed up of fourth unit of whole blood and consumed at 4:30 p.m. Intravenous fluid number one consumed and followed the number two 5% Dextrose in Lactated Ringers 1 liter plus one ampule of EC regulated at the same rate. By 11:10 p.m. “Lady L” is under nothing per orem. “Lady L” informed about Total Hysterectomy Bilateral Salphingo Oophorectomy with signed consent of her husband and her son at the same day. Anesthesiologist on deck was informed. Cefuroxime 750 mg, intravenous started every 8 hours after negative skin testing. At 11:40 p.m. Valium tablet 5 mg one tablet was given as pre-operative drugs. Day 3 August 24, 2008, at exactly 7:00 a.m. “Lady L” was brought to the operating room. At 4:50 p.m. post-op orders were given. Monitor vital signs every 15 minutes until fully stable. Nothing per orem temporarily. The patient was instructed to lie flat on bed, low back rest for pneumonia precaution. Oxygen inhalation administered at 3 liters per minute. Suction secretion when necessary. Intake and output were recorded hourly. 5% Dextrose Lactated Ringers 1 liter post-op to run at 15gtts/min then to follow 5% Dextrose Lactated Ringers 1 liter at same rate. Last dose of Cefuroxime to consumed, Metronidazole 500 mg slow intravenous push every 6 hours. Tramadol 500 mg after negative skin testing every 6 hour. Intravenous fluid regulated at 30 gtts/min when blood transfusion finished. Repeat hemoglobin and hematocrit. At 5:20 p.m. the operation ended and at 6:40 p.m. patient was bought to the intensive care unit and hooked to ventilator and Furosemide 40 mg IV was given. At around 8:45 p.m Omeprazole 40 mg IV was given. Serum, sodium, potassium, chloride, prothrombin time, partial prothrombin time done and result in “Lady L” was nebulized of Combivent 1 neb and maintained every 8 hours potassium 30 millequivalent incorporate to her intravenous fluid and decrease it to 8 hours. Another one unit of packed red blood cell, Calcium gluconate one ampule was given thru slow intravenous push.

Day 4 August 25, 2008, 5a.m. patient was brought to room 206 and then nebulization started and extubated at the time and secretion suctioned. Oxygen maintained at 4 liters per minutes via nasal canula. Diphenhydramine one ampule was given at 3:30 p.m, 30 minutes prior to blood transfusion. Blood type “B” with a serial # of BO8-445 run at 4-6 hours. At 6:05 p.m “Lady L” was confirmed that she was positive in flatulence. Measuring drained output was recorded shiftly. Day 5 1 a.m. of August 26, 2008, to follow intravenous fluid 5% Dextrose Lactated Ringers 1 liter regulated at same rate and encouraged patient to turn side to side. Serum, creatinine, and complete blood count done. At 9:37 a.m. the physician advised to continue medications. At 10:00 p.m. patients temperature is 38.2˚C and paracetamol 200 mg one ampule was given thru intravenous. At 11:03 a.m. nebulization was stopped. The physician suggests changing Cefuroxime to Tazocin 4.5 grams intravenous every 8 hours. Above intravenous fluid consumed and followed up of 5% Dextrose in Lactated Ringers 1 liter regulated at same rate. At 3:15 p.m. incentive spirometer every 8 hours and two minutes oxygen inhalation was discontinued. Patient was encouraged to ambulate. At 8:30 p.m. intravenous to follow of 5% Dextrose Lactated Ringers 1 liter regulated at same rate. Foley catheter was removed at 9:15 p.m. At 10:45 p.m “Lady L” gargled one tablespoon of Orahex solution plus 30 cc water every 6 hours. Day 6 Nursing care done. Vital signs are monitored and recorded. Intravenous fluid regulated at 15 gtts/min “Lady L” has no further complaint. The patient is ambulatory. Tazocin 4.5 grams intravenous every 8 hours was given. Attending Physician did not visit’s the patient and no new orders were made that day. Day 7 August 28, 2008, patient may have clear liquid then soft diet at 4 p.m., above intravenous fluid consumed and followed up of 5% Dextrose Lactated Ringers 1 liter regulated at the same rate. For possible discharge on the next day. Day 8 August 29, 2008, removal of jackson-pratt drain was done and intravenous fluid was terminated. There is no o objection for discharge. Home medications instructed and patient may go home and start oral medication. At 8 p.m. patient was discharged accompanied by her son via the wheelchair.