COURSE IN THE WARD Day 1 A 72 year old female was admitted at exactly 10:04pm at medical center Muntinlupa last

August, 27, 2012, accompanied by her son with a chief complaint of generalized body weakness however while at the emergency room she also complained of having leg cramps with involuntary twitching and tachypnea. She was admitted under the service of Dr. Macadagdag and following orders were given. The patient underwent laboratory test and examinations to diagnose her disease. The results revealed elevated blood sugar , cholesterol, serum creatinine , BUN , BUA and potassium levels and decreased calcium level. Upon release of laboratory results the patient underwent Intrajugular catheter insertion for easy access dialysis, IJ catheter was checked through X-ray with its tip at the level of T9, X-ray also reveled atheromatous aorta and thickening of intralobular septa. The physician ordered 5% Dextrose in Lactated Ringers solution to be regulated at 20gtts/minute. She was hooked to oxygen via nasal cannula with a flow rate of 2-3 L per minute. An indwelling catheter was inserted as well as nasogastric tube. The physician advised to be admitted at the ICU, but due to lack of financial resources, she was only admitted at the private room of a ward. Day2 The patient was brought to room 306. Continuous monitoring of patient physical status after undergoing dialysis treatment for evidence of physiologic imbalance and change. Vital signs q1 were ordered. At 8am patient seen lying on bed, conscious and awake and oxygen maintained at 2-3 L per minute via nasal cannula. Repeated Laboratory exams were requested. Blood chemistry revealed normal creatinine and Potassium levels and decreased Sodium levels. Hematology reports revealed decreased in hemoglobin, hematocrit, ESR, and lymphocyte levels. Arterial Blood Gas analysis showed metabolic Acidosis partially compensated. Seen and assessed by Dr. Macadagdag at 10am. The attending physician ordered calcium Gluconate 10ml/BID/ IV. Sodium Chloride 1tab/TID/PO, Azithromycin 500mg/BID/PO, Sodium Bicarb. 300mg/QID/PO, Omeprazole 400mg/PO, Trimetazidine 1tanb/BID/PO, allopurinol 200mg/ OD/ PO,

To follow Intravenous fluid D5NSS 1L regulated at the same rate. The patient is sitting on bed. Blood Pressure-180/100.36 Celsius. To follow IVF D5NSS x KVO. Blood Pressure-130/90. pulse rate. Due meds were given via NGT. respiratory rate. Insulin glargine 10Units/ SQ. low fat Diet. Seen and examined by Dr. Day3 Vital Signs had taken for 8:00am.19 breaths per minute. Nasogastric tube was removed. Pulse rate-106bpm/min. Day5 Nursing care done.90bpm and temperature of 36 C. The patient sign consent indicating not to continue dialysis treatment because of financial problems.Enoxaparin 40mg/ BID/ SQ. Pulse rate. On low salt. Respiratory rate of 21breaths/minute. Vital Signs taken and recorded Temperature. . Vital Signs for 8am were monitored and recorded as follows. Health teachings were given before discharge. Macadagdag. conscious and coherent. Rosuvastatin 20mg/OD/PO. At 3pm IVF and foley catheter were removed. Due meds were given. Furosemide 20mg/q12/IV. She verbalized that she wanted to go home because of big hospital expenses. awake. and Respiratory rate are within normal range. Temperature.. Blood pressure is 130/90. Health teachings were made patient was able to identify risk factor that contributes to the disease process. Day4 Seen and examined by Dr. Attending physician ordered Nicardipine 40mg/ BID/ PO. Attending physician prescribed home medications. Macadagdag at 7:00am.