Course in the Wards.

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Presentation transcript:

Course in the Wards

On Admission DAT then NPO past midnight IVF: D5NR 1L x 8h once on NPO Meds: Cefazolin (Stancef) 1g/IV ANST 1h prior to OR Atenolol 50mg/tab Midazolam 15mg/tab, 1/2 tab Fleet enema and abdominal prep reserve 1 unit PRBC for possible OR use scheduled for e-lap + TAHBSO at 8am

1st Hospital Day Transfused 1 unit PRBC with repeat CBC post BT Underwent ELAP + TAHBSO + PFC + partial omentectomy + adhesiolysis + palpation of liver & spleen Patient tolerated the procedure well Vital signs were stable EBL: 2000cc, UO: 100cc Post-op orders: NPO and IVF: D5NR, D5NM, D5W Cefazolin 500mg/IV q6, Metronidazole 500mg/IV q8, Ketorolac 30mg/IV q8, Paracetamol 300mg/IV q6 x 4 doses, Dolcet 1 tab TID, epidural morphine Tight abdominal binder Transfuse another unit if PRBC then CBC post BT

2nd Hospital Day S> (-) flatus, awake & comfortable (+) chest pain relieved by passing out of gas O> stable VS, clear & adequate urine output A> s/p ELAP + TAHBSO P> Continue post-op care SBE, crackers & gelatin for lunch, maintain on clear liquids, soft diet once flatus >3x or (+) BM 2 glycerine suppository per rectum at night Epidural morphine 2mg/IV given then epidural catheter pulled out completely Esomeprazole 40mg/tab once

3rd Hospital Day S> multiple flatus, voiding freely, (+) epigastric pain O> stable VS A> s/p ELAP + TAHBSO P> Continue post-op care May have soft diet for breakfast then low salt & low fat diet once soft diet tolerated Remove foley catheter Esomeprazole 40mg/tab Shift Metronidazole to 500mg/tab q8 Increase OFI

4th Hospital Day S> Px comfortable w/ slight headache, (-) BM O> Stable VS A> s/p ELAP + TAHBSO P> Continue post op care Possible d/c tom COD w/ tegaderm: wound dry & well coaptated

5th Hospital Day S> Px slightly tense & was unable to sleep last night, voiding freely, multiple flatus , (-) BM O> Stable VS A> s/p ELAP + TAHBSO P> MGH THM: - Neurobion (Vit. B complex) 1 tab OD - Paracetamol + Tramadol (Dolcet) 1 tab 3x/day as needed for pain