DATE PROBLEM MANAGEMENT

Sept. 24, 2010 -For possible transfer to the

1:20 pm female neurology ward.
-Shift Omeprazole N to
omeprazole 40mg I tab OD.
-Start head and neck feeding as
follows: 1000kcal in same
volume, divided into 6 equal
feedings.

Fever -If fever persists until tomorrow,

repeat CXR in A.M.
-Will follow plan

HTN, uncontrolled -Increase Nicardipine drip to

17gtts/min.

4 pm BP=180/80 -IVF to ff:PNSS 1L + 20 meqs KCL

->150cc per hour.

Sept. 24, 2010 -Nicardipine drip to ff:

6:55 pm Nicardipine 20mg/amp,1 amps
+D5W 250 CC to regulate at 15
gtts/min.
-Fast drip 200cc of IVF now then
regulate back to 150 cc/hr.
-IVF to ff. PNSS 1L +20 meqs KCL
->150 cc/hr.
-Increase Nicardipine drip to 18
gtts/min. Nicardipine drip to ff.
Nicardipine 10mg/amp. 1 amp in
250 cc N-> 180gtts/min.

Sept. 25, 2010 HTN -Increase Nicardipine drip

9:00am to20gtts/min. To maintain SBP
below 150 mmhg.

SAH secondary to ruptured -Nicardipine drip as ordered.

aneurysm -Run remaining 600cc of IVF to
ff:PNSS + 20 meqs KCL->150
cc/hr.

10:20 am -Start amlodipine 10mg 1 tab

now then OD.
-Start captopril 25mg 1 tab now
then q6.
-Start turning schedule q2.
 Medicine:

11:30 am -May hold repeat CXR.

-Inform MROD of OR plans.

Sept. 25, 2010 Febrile episodes -Repeat CBCP, urinalysis today.

-Give paracetamol K+C

7:30 pm -IVF to follow PNSS 1L + 20 meq

KCL-> 150cc/hr.
-Repeat serum Na, K, BUN and
RBS on Monday.
9:00 pm -IVF to ff:PNSS 1L-> 125cc/hr.

Sept. 26, 2010 CBG-209 Give HR 4 ‘u’ SQnow.

6:15 am
IVF to ff: PNSS 1L-> 125cc/hr.

3:40 pm -May have trial of soft diet once

tolerated may shift h/n feeding
to low salt, low fat diet.
-Please do trial of administering
meds per orem.
-Mannitol to 150cc q6.
-Start olmesartan + hctz
20/12.5mg 1 tablet now then
OD.

Episodes of chest heaviness -For 12-1 ECG and ES.

-For tryonin I.
-Transderm patch 10mg OALW.
-D/C RBS monitoring.
-D/C Dipenhydramine IV.
-May give celecoxib 400mg 1cap
-OD PRN for headache.

8 pm -Facilitate troponin I
determination.

Sept. 27, 2010 -IV to ff:PNSS 1L -> 125cc/hr.

-Decrease nicardipine drip to
8gtts/min.

9am General order:

-Remove NGT
-May have soft diet per orem,
-strict aspiration precaution
please.
 -Decrease nicardipine drip to
6gtts/min.
-May have 02 via nasal cannula,
on PRN basis.

12:40pm -Rounds with Dr. Chua

-Decrease mannitol to 150cc IV
q8.
-Consume nicardipine drip.
-Plan is to do a 4-vessel
angiogram. Awaiting relatives
consent.
-Give dulcolax 1tab now (on top
of lactulose)