7/31/2019 Surgery Hypothetical Case
1/3
This is a case of a 34 year old female, married, Filipino, Roman
Catholic, born onAugust 7, 1977. Patient came in due to her
scheduled cesarean section underDr. Pamittan.
Past medical history includes: Had previous hospital admissions
due to
appendectomy (1998), and dehydration due to gastroenteritis for
severaloccasions with latest admission last 2001.
Family history reveals:Mother side: (+) HPN, (+) DMFather side:
(+) TB, (+) gastric cancer, grandmother
Patient had no hypogastric pain, no vaginal bleeding, no
vomiting, BOW notruptured yet and 90% effaced when she arrived at
the OR. This is her secondpregnancy with first pregnancy also under
CS (2005) due to cephalicdisproportion. Patient had regular
prenatal care and is being treated for
Gestational diabetes and had been taking insulin injections with
titrated dose 2xa day from 4th month of pregnancy until
present.
Pre-op assessments are all normal including HGT. The patient
tolerated theepidural anesthesia and the procedure well last July
3, 2012. The patients chartindicates this final diagnosis: PUFT
Cephalic in Labor with alive Baby Boy G2P2(2-0-0-2) ; GDM.
Post Cesarean Section Orders are as follows;A. Transfer to post
partum ward when stable.B. Vital signs monitoring q4h x 24 hours, I
and O.
C. Bed rest x 6-8 hours, then ambulate; keep patient flat on
back x 8 hoursIncentive spirometer q1h while awake.D. Diet: NPO x
8h, then sips of water. Advance to clear liquids, then DAT once
w/
flatus.E.IV Fluids: IV D5 LR or D5 NS at 125 cc/h. Foley to
gravity;
discontinue after 12 hours. I and O catheterize prn.
F.Medications1. Cefazolin (Ancef) 500 mg IV q 8 hrs x 2 days.2.
Nalbuphine (Nubain) 5 to 10 mg SC or IV q2-3h4. Hydroxyzine
(Vistaril) 25-50 mg IM q3-4h prn nausea.
G.Labs: CBC in AM -done
Postoperative Management for Day 1 post-opA. Assess pain, lungs,
cardiac status, fundal height, lochia, passing
Of flatus, bowel movement, distension, tenderness, bowelsounds,
incision.
B. Discontinue IV when taking adequate PO fluids Change meds
to
