COURSE IN THE WARD Date and Time 08/12/2011 11:30pm -Admitted to surgery ward under the care of Dr.

Peralta/Dr. Rasalan -Secure consent -DAT -Labs: CBC Typing, Na, K, ECG, RBS -Drugs: Tramadol 50mg IV q8 -Apply skin testing with 7 lbs. counter weight -Monitor v/s q4 08/13/2011 1:00am -IVF PNSS x 30 gtts/ml -Clonidine 75mg 1 tab PRN for BP > 140/90 -Amlodipine 10 mg 1 tab PO -Request for : Lipid Profile and SGPT -decrease IVF 08/13/2011 5 am 08/13/2011 8:05am -(-) chest pain -(-) dyspnea -BP:90/60 mmHg -Monitor v/s hourly -refer if still hpotensive 08/13/2011 8:20 am 08/13/2011 9:00 am -(+) pain -for ORIF on tuesday -for cefuroxime -continue medication -still no funds available for skin traction -for BT x 2u PRBC PNSS -Bitagen 500ml for q8 OD

08/13/2011 11:30 am 08/14/2011

-we will do final CP clearance once anemia is corrected -(+) pain on right thigh

8am

-still no funds -continue medication -refer

08/15/2011 7am

-(+) pain on right thigh -follow up post CBC -continue medication -refer

08/15/2011 8am 08/15/2011 3:40 pm

-Insert IFC

-BP: 130/90 mmHg -(-) chest pain -(-) orthopnea -secure ECG done August 12 -request for PT, PTT -relay result

08/15/2011 4pm

-NPO -prepare for OR use: Midazolam #1, Fentaryl #1, Morphine #1, Eptudru#1, Sensorcairu heavy #1, Profolol #1, Isoflurans 50 cc, syringe( 10 cc, 5 cc, 3cc) #2

08/15/2011 8pm 08/16/2011 7am

Refer for OR tomorrow

-(-) dyspnea/orthopnea/chest pain -no episodes of BP elevation -BP:130/90mm Hg -decrease IVF for KVO -secure ECG

08/16/2011 4:15pm

-no absolute contraindication to contemplated procedure, patient is stratified as moderate to develop cardio-pulmonary complication.

08/17/2011 7:30am

-(+) pain -(+)cast -still no funds

-continue medication -refer 08/17/2011 7:40am -still no fund for surgery -facilitate referral to social service

08/18/2011 7am

-(+) pain on left thigh -(+) cast -still for referral to social service

08/18/2011 3:45pm

-BP:140/80 -Clonidine 75mg 1 tab PRN for BP > 140/90 -Amlodipine 5mg 1 tab OD

08/19/2011 5:45 am 08/20/2011 4:40 pm

-BP: 120/70 mm Hg -continue Amlodipine 5mg tab OD -(+) pain on right thigh -(+) skin traction -facillitate referral regarding plan for ORIF

08/21/2011 8:00 am

-(+)pain on right thigh -still no funds for OR -(+) skin traction -facilitate referral to social service regarding plan for ORIF -maintain skin traction -kindly place pillows between right thigh to maintain alignment -refer

08/22/2011 7:30pm

-(+) pain -(+) skin traction -refer to social service

08/22/2011 9am

-BP:140/90 mmHg -CR: 79 -(-) orthopnea, chest pain -continue Amlodipine 10 mg a tab OD

-decrease IVF to KVO -repeat creatinine and K 08/22/2011 1pm 08/22/2011 3pm 08/23/2011 7am -patient referred to social service awaiting for support. -IFC and UB -refer to social service for disposition -(+) pain -(+) skin traction -refer 08/24/2011 7:20am -(+) pain -(+) skin traction -refer 08/25/2011 7:10am -(+)pain at right leg -(+) skin traction -still no fund -follow up referral to social service regarding plan for patient -refer 08/26/2011 7:15am -(+)pain -(+)skin traction -still no fund s for OR -refer 08/27/2011 7:05am -(+)pain -(+)skin traction -still no fund s for OR -refer -continue medication if available -refer to helping hands 08/28/2011 8:20am -(-)pain -(+)skin traction -still no fund s for OR -refer 08/29/2011 -(-)pain

8:00am

-(+)skin traction -still no fund s for OR -refer

08/30/2011 8:05am

-(+)pain -(+)skin traction -still no fund s for OR -refer -maintain traction

09/01/2011 7:30 am

-(+) abdominal pain -(-)fever -(+) skin traction -Maintain traction -continue medication -refer -give tramadol 50mg IV now

09/02/2011 7:50am

-(-)pain -(+)skin traction -continue medication -DAT -maintain traction -refer

09/03/2011 7:30am

-(+)pain -(-)fever -(+)skin traction -maintain traction -refer -no fund for OR

09/05/2011 7am

-(+)pain -(-) fever -(+)skin traction -Still for ORIF -refer

09/06/2011

-v/s: 120/70mmHg, 93bpm,20cpm,36.3C

12:00 pm 09/06/2011 4:15pm 09/07/2011 7am

-refer Na, K, Crea results once available -refer -continue medication -secure consent -notify OR -NPO -Prepare the following:PD5O #1, Chromic plain #1, sills #1, elastic bandage #3

09/07/2011 4:50pm

-lab results within normal limit -v/s: 110/80mmHg, 80bpm, 20cpm, 36.9C -no absolute CI to underlying contemplated procedure -risk stratified as moderate risk for developing cardio-pulmonary complication

09/07/2011

-Pre-op orders: NPO after 2am -prepare the following for OR case: PNSS 1L #2, PLRS 1L #1, Syringe(5cc #2, 3cc #4, 1cc #1) -give anti-hypertensive drugs -give pre-meds at OR

09/08/2011 12:30am 09/08/2011

-cefuroxime 1.5g IV -1 hr prior to OR ANST -reschedule ORIF at hip first case on Tuesday (09/13/2011) -notify OR -secure consent

09/09/2011 7am

-(+)pain -continue medication -still for ORIF

09/09/2011 7:10am

-(-)pain -continue medication -still to ran consent for OR -for ORIF on 9/13/2011

-refer 09/12/2011 7:30 am -(-)pain -still no consent -continue medication -refer 09/12/2011 9am -NPO -Prepare the ff. for OR use: Bupiralarion #1, Ephearion#1, nidazolem #1, Nubain #, BT set #1, Syringe(10cc, 5cc, 3cc, 1cc)#2 -Pre-op meds: Promothazen 50g and Nubain 5g IM prior to OR 09/12/2011 7am -continue medication -on NPO -for ORIF -secure consent 09/13/2011 -Post-op orders: to RR, resume diet after 6 hrs starting with liquids -v/s -encourage deep breathing exercise when fully awake -PLR 20gtts/min. -report hgb and hct result after 1st BT -Ketorolac 30g OD q6hrs -Ranitidine 50g OD q8 hrs -refer accordingly 09/13/2011 1:30pm 09/13/2011 4:20 pm -for x-ray right knee -may transfer to ward -(+) bleeding -fully soaked dressing -change dressing done