updated d.o

7/27/2019 updated d.o

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Date Medical/Surgical Intervention at the Hospital Implications

April 1, 2013 Discontinue Impact to OF for relatives request

Start Plasil 10mg/tab q8 PRN for hiccups

May Discontinue Plasil IV

Transfer of ET on left side c/o MROD tom

Hiccups are caused by sudden contraction of thediaphragm. Plasil inhibits gastric smooth muscle relaxation

produced by dopamine, therefore increasing cholinergicresponse of the G.I. It stimulates the muscles of the stomachand thereby hastens emptying of solid and liquid meals fromthe stomach and into the intestines.

Repositioning of the tube may aid comfort for the patient andthe tube must be moved frequently from one side of themouth to the other to prevent pressure ulcers.

April 5, 2013 Fast drip 100 cc of PNSS now

Maintain IVF to 100 cc/hr

For Chest X-ray AP high sitting

Hold Carvedilol, Candesartan and Amlodipine

Run IVF at 100 cc/hr x 2 hrs then regulate at 60cc/hr

Decrease IVF to 20 cc/hr

Give due Flixotide Neb

BP of 80/40.The fluid should not be infused too quickly to avoid fluidoverload.

AP high sitting is done because patient is too ill to go to X-ray, usually they are sitting upright in bed

These are all antihypertensive drugs which keeps the bloodpressure at a healthy level. Since the Blood pressure of thepatient is 80/40 these medications are hold to preventfurther hypotension.

The fluid should not be infused too quickly to avoid fluidoverload.

BP: 130/70Blood pressure is now stabilized. So it is regulated back at20 cc/hr

RR:28O2 sat:100%

(-) wheeze



Suggest D-dimer

IVF to follow PNSS 1 L at 20 cc/hr

For CBC

For change FC

For Urine CS

Start Clexane 0.6 Mg BID

Decrease Clexane to 0.6 mg OD

Flixotide is a synthetic corticosteroid and is used to reducethe swelling and irritation of the walls of the small air passages in the lungs and to ease breathing problems.

RR:28

D-dimer is a test performed to check and confirm presence

of thrombosis in the body. It can also indicate the imminenceof a pulmonary embolism as well.

Complete blood count is often used as a broad screeningtest to determine an individual’s general health status.

A foley catheter must be changed on a regular basis toprevent infections.

Urine culture and sensitivity shows if the urine is infectedand determines the specific bacteria as well as theappropriate antibiotic for the treatment

Low molecular weight heparin. It is use to stop blood clotsforming with the vessels.

D-dimer result: 4 ug/ml- increase

To prevent bleeding

April 6, 2013 Start Avelox 400 mg/IV OD

Cefexime (Tergecef) 200 mg/NGT q12

Run Avelox over 1 hour. Flush before and after

infusion

WBC: 12.5 Avelox is an antibiotic that belongs to the group of medications known as quinolones. It is used to treatinfections caused by certain bacteria.

It is used to treat a wide variety of bacterial infections. This medication is known as a cephalosporin antibiotic. Itworks by stopping the growth of bacteria.

Flushing is needed before and after infusion because Avelox

is not compatible to other intravenous substances, additivesor other medications should not be added to Avelox or

http://www.webmd.com/a-to-z-guides/bacterial-and-viral-infections

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Clamp mainline while ongoing infusion infused simultaneously through the same intravenous line.

April 7, 2013 May give 1 amp Aeknil IVT now

IVF to follow PNSS 1 L at 20 cc/hr

Temp:38.2To decrease fever

April 8, 2013 For TPAG to next blood exam

Decrease IVF to KVO

Suggest bladder trainingMay start bladder training

Give Candesartan 8 mg/tab 1 tab now then OD,omit for SBP < 140 mmhgUse Blopress

Give Furosemide (Lasix) 40 mg/tab 1 tab now

Total serum protein test measures the total amount of protein in the blood. It also measures the amounts of twomajor groups of protein in the blood:

Albumin: to check how well the liver and kidneys areworking and find if your diet contains enough protein.Globulin: determines the chances of developing of infection

KVO is use to prevent the blood access from closing for thecompletion of infusion

To restore the normal function of the bladder.

Candesartan is an angiotensin receptor blocker. It is use totreat hypertension. It works by blocking the effect of achemical called angiotensin II which causes the bloodvessels to narrow, so by blocking this effect the drug allowsthe blood vessels to relax and widen. The pressure withinthe blood vessels is reduced.

Bp: 110/60Furosemide is a potent diuretic that is used to eliminatewater and salt from the body. It blocks the absorption of

sodium, chloride and water from the filtered fluid in thekidney tubules, causing a profound increase in the output of urine.

April 9, 2013 For repeat CBC, platelet and urinalysis in AM

Give due salbutamol and Ventolin now

For FC removal in AM

To obtain baseline laboratory data

RR: 28Salbutamol works by opening up the passages in the lungsso that air can flow into the lungs more easily.

To restore the normal bladder function of the client



Include 6-8 egg whites in OF Total protein: 57 Albumin: 23Globulin: 34

Protein is low as well as albumin. Egg whites are rich inprotein, making them an excellent high-protein, cholesterol-free food

April 11, 2013 Refer back to Dr. Fe Bacsal

Increase Keppra to 500mg/tab 1 tab every 6 hours

Decrease Cholinerve to 500mg/tab 1 tab BID

Referred due to jerking movements of both lower extremitiesand upward rolling of the eyeballs

Before it is every 8 hrs. Keppra works by affecting thetransmission of the nerve signals in the brain. It is alsoindicated as adjunctive therapy in the treatment of myoclonicseizures.

Before it is 1000mg/tab. Cholinerve has the ability to protectthe brain and nerve cells from damage when they are

deprived of oxygen. April 12, 2013 Moxifloxacin complete for 7 days It is used to treat different types of bacterial infections.

They are given at a specified period of time to keep the rightamount of the medication in the blood stream.

April 13, 2013 EEG result: Showed severe diffuseencephalopathy without focal slowing nor epileptiform discharges

The patient has on or off myoclonic jerks (a few jerks at a time, unsustained) in left or right upper

or lower extremities but not bilateral synchronousor generalized

Impression:Multifocal myoclonus as a consequence of thehypoxic encephalopathy

No need to treat these myoclonous jerksaggressively.

Electroencephalogram is a test that measures and recordsthe electrical activity of the brain. It is use to diagnoseepilepsy and see what type of seizures are occurring.

Myoclonus is a sudden, brief, involuntary muscle jerk. Myoclonic jerks may occur alone or in sequence, in a

pattern or without pattern. They may occur infrequently or many times each minute.

April 14, 2013 Resume Amlodipine 5mg/tab 1 tab BID. Omit for

SBP ≤ 110

BP: 150/80

It is used to treat hypertension. It works by relaxing blood



vessels which allows blood to circulate more freely aroundthe body. This lowers blood pressure and improvesefficiency of the heart

April 15, 2013 Give extra dose of Blopress 8mg/tab- 1 tab now BP: 160/90It works by blocking the action of angiontensin II thuskeeping the blood vessels relaxed and open bringing theblood pressure down and stabilizing it at a safer level.

April 18, 2013 Discontinue Clexane.

Start Vessel Due F 250 LSU/ cap BID

Give Paracetamol tab now

For urinalysis

Another drug is started to prevent blood clotting.

For treatment of thrombosis. It reduces the ability of blood toclot.

Temp: 38.2To decrease fever.

It is used as a screening or diagnostic tool because it canhelp detect substances or cellular material in the urine

associated with different metabolic and kidney disorders. Itis ordered widely and routinely to detect any abnormalitiesthat require follow up

April 19, 2013 Start UNASYN 750mg/tab 1 tab TID

Start Thrombocil 50mg tab OD

Give Paracetamol 500mg tab NGT for temp > 37.8

every 4 hours

This combination medication is used to treat a wide varietyof bacterial infections. It is known as a penicillin-typeantibiotic. It works by stopping the growth of bacteria.

It reduces the ability of blood to clot.

To decrease fever.

April 21, 2013 May give Blopress now instead of 8 am due BP 190/100It works by blocking the action of angiontensin II thuskeeping the blood vessels relazed and open bringing theblood pressure down and stabilizing it at a safer level.

April 22, 2013 Change NGT now NGT is generally changed once every 4 weeks. Alternatingsides from right to left in placement to prevent sores.

April 23, 2012 Start Erceflora 1 respule BID Contributes to the recovery of the intestinal microbial floraaltered during the course of microbial disorders of diverse

origin. Promotes normalization of intestinal flora

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http://labtestsonline.org/understanding/conditions/kidney



For Fecalysis

Start Calmoseptine

Treatment of acute diarrhea

A series of test done on a stool sample to help diagnosecertain conditions affecting the digestive tract.

Calmoseptine ointment is an analgesic, antiseptic,antipruritic, and skin protectant combination. It works by

temporarily relieving itching and pain. It also decreasesmoisture in the affected area.

May 1, 2013 Discontinue Erceflora

Ivabradine (Coralan) 1 tab now then OD

No abnormal findings in fecal exam

It helps to lower the heart rate, which can be helpful intreating both angina and heart failureSlowing the heart rate reduces the heart’s demand for oxygen, especially in situations when the heart rateincreases and an angina attack is more likely to happen.Ivabradine therefore helps to control and reduce the number

of angina attacksMay 2, 2013 May apply Calmoseptine ointment TID to affected

area+ rednessBeginning to sore both side of the nose

Calmoseptine ointment is an analgesic, antiseptic,antipruritic, and skin protectant combination. It works bytemporarily relieving itching and pain. It also decreasesmoisture in the affected area.

May 5, 2013 Change of dressing done. Dry dressing.(-) discharge

May 8, 2013 Give Paracetamol 500mg 1 tab now

For CBC, Crea, Na, K urinalysis in AM

Refer for recurrence of fever

Temp: 37.9To decrease fever.

Creatinine is used to evaluate kidney function.Sodium and potassium is used to detect abnormalconcentrations of electrolytes in the body.

May 9, 2013 Start Ampicicllin Sulbactam (Unasyn) 750 mg in 50cc D5w to run for 30 mins every 8 hrs (- ANST)

This combination medication is used to treat a wide varietyof bacterial infections. It is known as a penicillin-type

antibiotic. It works by stopping the growth of bacteria.









Include TPAG to blood exam

For urine CS

Shift Unasyn to cefuroxime 750mg IV q12

Hook to IVF : PNSS 1L x 10 gtts/min

Dilute Cefuroxime in 50 cc D5W x 30 min. (-) ANST

Total serum protein test measures the total amount of protein in the blood. It also measures the amounts of twomajor groups of protein in the blood:Albumin: to check how well the liver and kidneys areworking and find if your diet contains enough protein.Globulin: determines the chances of developing of infection

TPAG RESULTS:Total protein: 66 Albumin:28Globulin-38 A/G ratio: 0.74:1

Urine culture and sensitivity shows if the urine is infectedand determines the specific bacteria as well as theappropriate antibiotic for the treatment

Broad spectrum antibiotics. It treats infections by killing or stopping the growth of bacteria.Over 100/HPF- pus cells

May 10, 2013 IVF to consume then shift to heplock To keep the vein open by stopping a clot from forming.

May 11, 2013 Give Paracetamol 500mg/tab 1 tab nowGive Paracetamol 500mg/tab, 1 tab every 4 hoursprn for temp ≥37.8 Aeknil 1 amp/IV every 4 hrs. for temp ≥38.5

Temp: 37.8To decrease fever

May 12, 2013 Give Solucortef 100mg/IV now

Nebulize with Salbutamol now

(+) tachycardia, abdominal breathingSolu-cortef acts by reducing inflammation by acting withincells to prevent the release of certain chemical.

SPO2 94%, BP 120/80, tight air entrySalbutamol works by opening up the passages in the lungs

so that air can flow into the lungs more easily.



Nebulize with Budecort after 30 mins Budecort goes directly to the inner lining of the inflamedairways to reduce the inflammation and hyperactivity(spasm) of the airways

May 13, 2013 Increase FiO2 to 100%

Give Diazepam 10mg/IV now

To consider intractable seizure, generalized tonicclonic every 5 mins

Give Dormicum 5mg/IV now

Start IVF :PNSS 1L at 60 cc/hr

Give Dilantin 100mg/tab 3 tabs now then 3 tabsevery 4 hours total of 3 doses per NGT then 1 tabTID thereafter

Nebulize with Ventolin x 3 doses every 15 mins

Nebulize with Budesonide as well (1 dose)

Give Solucortef 100mg/IV now

Refer recurrence of seizureShift Cefuroxime to Meropenem – HOLD

Generalized tonic clonic seizureOxygen saturation of 86%BP 140/90Cardiac rate of 130 bpm

FiO2 is the percent of oxygen a patient is inhaling. It isincreased to 100% to correct hypoxemia and reduced theoxygen demand on the heart

Benzodiazepines are used for their sedative, anxiety-relieving and muscle-relaxing effects.

Midazolam is used for the emergency management of seizures because it hasthe ability to stop the seizures very quickly

Dilantin works on the brain to reduce the number andseverity of seizures

Oxygen saturation of 86%

It works by opening up the passages in the lungs so that air can flow into the lungs more easily.

Budecort goes directly to the inner lining of the inflamedairways to reduce the inflammation and hyperactivity(spasm) of the airways

Solu-cortef acts by reducing inflammation by acting withincells to prevent the release of certain chemical.

Meropenem works by stopping the growth of bacteria



Repeat CBC, Na, K, iCa, Mg today

For reintubation

CXR post intubation

ABG after 1 hour on Mech vent

Give Diazepam 5mg/IV now

Reintubate patient using E.T 7.5 at level 22

Hook to mech vent: AC Mode, FiO2 60%, BUR 16, TV 500

Ionized calcium is a calcium that is freely flowing in theblood and not attached to proteins. It is important for heartfunction, and helps with muscle contraction, nerve signallingand blood clotting.

(-) clogging of ETTo provide airway for the patient.

Chest X-rays after intubation is indicated to verify the tubeposition. Correct positioning is vital to avoid complications.

ABG results can help pinpoint the adjustments to be madefor the initial ventilator rate.


The endotracheal tube serves as an open passage throughthe upper airway. It permits air to pass freely to and from thelungs in order to ventilate the lungs. Too deep a placementcan cause impingement on the carina and thus sympatheticstimulation leading to tachycardia, hypertension and/or bronchospasm. if the depth of insertion of ET beyond vocalcords is too less, the cuff might impinge on the vocal cordson inflation leading to sympathetic stimulation, trauma,recurrent laryngeal nerve compression and increased risk of accidental extubation.

The initial mode of ventilation should be the assist control(A/C) mode. In this mode, a tidal volume and rate are preset,but whenever the patient makes an inspiratory effort, theventilator senses the effort and delivers the preset tidalvolume. The patient can initiate inspiration and control thebreathing frequency

Tidal volume is the amount of air delivered with each breath

Back-up rate ensures minimum minute ventilation in theevent of apnea.



Suction oral secretions every 1 hr and prn

Moderate to high back rest

Relay labs once available

Change NGT

ABG at 60% :7.45, 33.4, 212, 23.1, 99.5% dFio25%

Decrease FiO2 by 10% every hour until 30% isreached maintain O2 saturation ≥ 95%

Decrease IVF to 20 cc/hr

I and O cc/cc every shift.Relay I and O at 3 pm

Decrease Fio2 to 28%

IVF to follow PNSS 1L at 20 cc/hr

Revise Keppra to 1 gm tab BID

Increase Clonazepam to ½ tab q8

Discontinue Dilantin

Shift Cefuroxime IV to Cefuroxime 500mg/tab 1 tabBID

To clear secretions and maintain patent airway

For lung expansion and clearing, and to cough effectivelyand prevent retention of mucopurulent secretions.

NGT is generally changed once every 4 weeks. Alternatingsides from right to left in placement to prevent sores.

partially uncompensated respiratory alkalosis

For possible weaning.To determine if the patient is ready to demonstrate he/shecan breathe spontaneously

To monitor the amount of fluids a client takes in andcomparing this to the amount of fluid a client takes out.

Antiseizure drug. It inhibits the spread of seizure activity inthe brain


Broad spectrum antibiotics. It treats infections by killing or stopping the growth of bacteria.

May 14, 2013 Discontinue IVFor ET GSCS Gram stain and culture sensitivity of the endotracheal tube is

performed to identify the cause of infection, determine the

type of bacteria present and it allows the doctor to prescribetreatment with an appropriate antibiotic



May 15,2013 ISMN (Montra) 60 mg/tab 1 tab OD 1-0-0

Vestar 35 mg/tab 1 tab BID

Carvid 6.25/tab 0-1-0, omit for SBP ≤100

Discontinue Paracetamol tab and IV , refer for

fever reccurence

Increase OF to 225cc q4

Isosorbide mononitrate dilates blood vessels, making iteasier for blood to flow through them and easier for the heartto pump.

Trimetazidine increases coronary flow reserve, therebydelaying the onset of ischemia,limits rapid swings in bloodpressure without any significant variations in heart rate,

significantly decreases the frequency of angina attacks, andleads to a significant decrease in the use of nitrates.

Carvedilol slows down the activity of the heart by stoppingmessages sent by the nerves to the heart. As a result heartbeats more slowly and with less force. The pressure of bloodwithin the blood vessels is reduced and it also helps reducechest pain.

Patient no longer experience hyperemia.

To provide nutrition for the patient.May 16, 2013 Complete Cefuroxime for 7 days They are given at a specified period of time to keep the right

amount of the medication in the blood stream. Taking the fullprescribed course of antibiotics ensures that the infection iseradicated and won’t recur.

May 18,2013 Decrease Sulodexide to 0-0-1

Increase Cilostazol to 100mg 1-0-0

Vasalat 5mg 0-1/2-1/2 omit for SBP ≤100

Cilostazol improves the flow of blood through blood vessels.

It works by keeping blood from clotting and by dilating or relaxing the blood vessels.

It is used to treat hypertension. It works by relaxing bloodvessels which allows blood to circulate more freely aroundthe body. This lowers blood pressure and improvesefficiency of the heart

May 20.2013 Please update medical abstract care of MIOD

http://en.wikipedia.org/wiki/Coronary_flow_reserve

http://en.wikipedia.org/wiki/Blood_pressure


http://en.wikipedia.org/wiki/Heart_rate

http://en.wikipedia.org/wiki/Glyceryl_trinitrate_(pharmacology)

http://en.wikipedia.org/wiki/Glyceryl_trinitrate_(pharmacology)

http://en.wikipedia.org/wiki/Heart_rate



http://en.wikipedia.org/wiki/Coronary_flow_reserve

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updated d.o