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EDICAL MANAGEMENT
The medical management of patient RPs condition focused on alleviating of the
symptoms and treating its underlying causes. The following is a table presenting the ideal
management of the patients condition as well as the actual management given to the patient
during his hospital stay.

IDEAL MANAGEMENT

ACTUAL MANAGEMENT

MANAGEMENT FOR ACUTE

NECROTIZING PANCREATITIS:
1. Restoration of circulating blood volume
with IV crystalloid or colloid solutions
or blood products

Venoclysis of PNSS 1 L, moderate fast

drip then regulated at 40 drops per
minute, followed by Lactated Ringers
solution and regulated according to
patients requirement at left arm
Venoclysis
of Lactated Ringers
solution @ right arm
CVP insertion at patients bedside,
reading was 9 cm H2O
Endotracheal intubation of the patient
Mechanical ventilation
O2 inhalation of 5 L/min following
endotracheal extubation
Chest X-ray PA
Monitoring of the patients Arterial
Blood Gas

2. Invasive
monitoring
in
severe
pancreatitis
3. Maintenance of adequate oxygenation
reduced by pain, anxiety, acidosis,
abdominal
pressure,
or
pleural
effusions; and adequate respiratory care
because of the risk for elevation of the
diaphragm, pulmonary infiltrates and
effusion, and atelectasis.

4. Pain control to alleviate pain and

anxiety, which increases pancreatic
secretions
5. Rest of the GI Tract
a. Withhold oral feedings to decrease
pancreatic secretions
b. Nasogastric intubation and suction
to relieve gastric stasis and
distention

No pain management given

Patient was NPO temporarily

6. Maintenance of alkaline gastric pH

with H2 antagonists and antacids to

Intubation of the patient with a French

16, opened to drain
Administration
of
Bactidol
(Hexetidine) TID for oral care
Administration of Ranitidine 50 mg
IVTT q12h

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suppress acid drive of pancreatic
secretions and to prevent stress ulcer
complications of illness.

7. Nutrition provided with parenteral

feedings, as needed
8. Pharmacotherapy
a. Electrolyte replacement as needed
and Sodium bicarbonate to reverse
metabolic acidosis

b. Regular
insulin
hyperglycemia

to

treat

c. Antibiotic therapy for sepsis

MANAGEMENT FOR ACUTE
RESPIRATORY FAILURE
1. Oxygen therapy to correct hypoxemia

Administration
of
Ianzoprazole
(Prevacid) 30 mg 1 tab OD / NGT
Administration
of
Pantoprazole
(Ulcepraz) 40 mg IVTT OD
Nasogastric feeding with Osteurized
Formula, 60 cc
Administration of Potasssium Chloride
60 mg IVTT to treat hypokalemia
Administration of NaHCO3 50 mEq in
3 vials IVTT
Administration of NaHCO3 drip: 4 vials
with 250 cc D5W at 10 drops/ minute
Insulin Aspart (Novorapid) 10 u SQ
before each feeding
Insulin Glargine (Lantus) 30 u SQ
before 8 am feeding
Administration
of
Ciprofloxacin
(Ciprobay), 200 mg IV drip q12h

Endotracheal intubation of the patient

Mechanical ventilation
O2 inhalation of 5L/min following
endotracheal extubation

2. Mobilization of secretions

3. Bronchodilators
to
reduce
bronchospasm
4. Corticosteroids to reduce inflammation

Suctioning of the Oral Cavity and

Endotracheal tube PRN
Administration of Duavent 1 nebule
plus nebule Asmavent q6h
Administration Hydrocortisone 100 mg
vial IVTT q8h

MANAGEMENT FOR DIABETES

MELLITUS TYPE 2
1. Diet
a. Dietary control with caloric
restriction of carbohydrates and
saturated fats to maintain ideal
body weight
2. Exercise
Regularly scheduled exercise to
promote
the
utilization
of
carbohydrates, assist with weight

Full diabetic diet at 1800 kcal/g in 3

meals and 2 snacks, with the following
specifications:
a. CHO 60 %
b. CHON 20 %
c. Fat 20 %

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control, enhance the action of
insulin, and improve cardiovascular
fitness
3. Medication
a. Oral antidiabetic agents if glucose
control is not achieved with diet
and exercise only
b. Insulin therapy when unresponsive
to diet, exercise and oral
antidiabetic therapy

4. Monitoring of control blood glucose

No oral antidiabetic
administered

Administration of the following

Insulins:
a. Insulin Glargine (Lantus) 30 u
SQ before 8 am feeding
b. Insulin Aspart (Novorapid) 10 u
SQ before each feeding
Hemoglucose tests TID, pre-breakfast,
pre-lunch and pre-dinner

agent

was

MANAGEMENT FOR HOSPITAL

ACQUIRED PNEUMONIA
1. Antimicrobial therapy upon laboratory
identification of causative organism
and
sensitivity
to
specific
antimicrobials

2. Oxygen therapy if patient

inadequate gas exchange

has

3. Pulse oximetry and Arterial Blood Gas

Analysis to determine the need for
oxygen and to evaluate the therapy

MANAGEMENT FOR PULMONARY

EDEMA
1. Treatment of underlying disorder

2. Oxygen therapy to correct hypoxemia

3. Administration of morphine to reduce

anxiety and control pain

Administration of Ciprofloxacin, 200

mg IV drip q12h
Administration of Cefepime 1g ICTT
OD
Administration
of
Imipinem
+
Cilastatin (Tienam) 500 mg IVTT q12h
Administration
of
PiperacillinTazobactam (Tazocin)4.5 IVTT noe
then 2.75 mg q12h
Endotracheal intubation of the patient
Mechanical ventilation
O2 inhalation of 5L/min following
endotracheal extubation
Patient was constantly hooked to a
pulse oximeter
Arterial Blood Gas Analysis was
conducted
Management of acute necrotizing
pancreatitis
Endotracheal intubation of the patient
Mechanical ventilation
O2 inhalation of 5L/min following
endotracheal extubation
No pain management

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MANAGEMENT FOR ACUTE RENAL
FAILURE
1. Maintenance of fluid balance. Be alert
for and correct underlying fluid
excesses or deficits
2. Restore maintain blood pressure

3. Maintain nutrition.

4. Hemodialysis, peritoneal dialysis or

continued renal replacement
5. Diuretic agents to control fluid volume
MANAGEMENT OF HYPOKALEMIA
1. Restoration of potassium levels
a.administration of 40 to 80 mEq/ Day
of potassium

MANAGEMENT OF HYPOALBUMINEMIA
1. Correction of low albumin levels

Intake and Output monitoring and

recording every shift
Measurement of central venous
pressure, 9 cm H2O
Administration of Dopamine 2 grams
WITH 300 cc D5NSS
Correction of hypotension through the
administration of:
a. 1.5 L Lactated Ringers solution at
moderate fast drip then regulating
@ 60 drops per minute
b. Administration of 1 L Normal
Saline Solution at 40 drops per
minute on the left arm after
administered IVF was consumed
c. Administration of 1 L Lactated
Ringers Solution at 50 drops per
minute as follow-up to administered
intravenous fluid
Total Parenteral Nutrition after
temporary NPO then
Nasogastric feeding with Osteurized
Formula, 60 cc
No dialysis or renal replacement was
indicated for the patient
Administration of Furosemide (to run
for 2 hours) BID
Incorporation of 40 mEq Potassium
Chloride to patients intravenous fluid
STAT
Administration
of
Potassium
Chloride,60 mg IVTT
Administration of Albuminar 25% 50
cc stat
Addition of 6 egg whites to daily food
intake

DRUG STUDY
Generic Name: ALBUMIN 25 %
Name: ALBUMINAR 25
Classification: BLOOD DERIVATIVE
Dosage/ Administration/ Route: 50 cc STAT
INDICATION
S
Treatment of
hypoalbumine
mia

THERAPEUT
IC EFFECTS

MECHANISM
OF ACTION

Brand

CONTRAPHARMACO
SIDE
INDICATIONS - KINETICS/ EFFECTS
AND
PHARMACO
CAUTIONS
DYNAMICS
Restoration of Provides
Contraindicate Directly
Headache
albumin to
intravascular
d in
enters the Nausea
normal levels oncotic measure
hypersensitivit circulation Vomiting
in a 5:1 ratio,
y to the drug
following IV Urticaria
shifting fluid
and in those
infusion.

Rash
from interstitial
with severe
Back pain
spaces to the
anemia, or

circulation and
cardiac failure.

slightly
increasing the

plasma protein
level.

ADVE
EFFE

Vascular
Overload
Hypoten
Tachyca
Altered
respiratio
Dyspnea
Pulmona
edeme
Chills