VIII.

Course in the Ward

November 14, 2023, 5:30 am

A 22-year-old woman was admitted at exactly 5:30 am accompanied by her common law
husband with a chief complaint of labor. The physician prescribed an intravenous line filled to
800 cc with 1 liter of D5LR fluid. The designated physician recommended Furosemide 40 mg for
IV stat use, Hydrositisme 250 mg IV Stat, ECG loading, CXR - PA with extra shields. For
co-urgent care and oxygen inhalation at 3-5 LPM via PC, she must refer to IM-COD.

Patient LAR must secure the culvert and alert staff in accordance with the doctor's orders.
Medications prescribed by the doctor included metodopramide 1 mg IV before to OR, ranitidine
1 mg IV pain relief, and ceftriaxone 2g IV drip OD. The patient and watcher are well informed on
the patient's LAR state, the doctor claims.

3:40 PM The patient LAR is classified as LTCS I for pre-eclampsia under the sentinel node
biopsy with intrathecal morphine, according to the assigned physician. Patient LAR must
proceed to the PACU today to be hooked up to standard monitors and oxygen plus 2-3 lpm via
nasal cannula until her dyspnea resolves. As prescribed, Kutomzc 30 mg IV Q8 x 3 doses; first
dose at 4:30 p.m.; Paracetamol 600 mg IV 66 x 4 doses; first dose at 5:00 p.m.; Tramadol
(primadol) 50 mg IV Q6 x 2 doses; slow IV push X 30 seconds; first dose at 7:30 p.m.; first dose
at 7:30 p.m.; ranitidine 50 mg IV Q8 X 3 doses; prescription Ceftriaxone IV as directed. In
addition, the doctor prescribed a somewhat high backrest for the patient and advised deep
breathing before starting early ambulation.

Day 1 of Hospitalization (November 15, 2023

12:15 AM. The anesthesiologist advises patient LAR to use a somewhat high backrest. The
doctor has prescribed furosemide 40 mg Q8 with BP restrictions, and she is to have her vital
signs checked every four hours.

12:25 AM. The patient LAR had dyspnea on her first day of hospitalization, thus a face mask
was used to give her an oxygen inhalation of 8–10 LPM. After going on a diet, Dra. Claribel
prescribed 1 OD pill and 5 mg of amlodipine.

12:30 AM. Patient LAR received 100 mg of hydrocortisone IV today from the anesthesiologist.
The doctor recommended returning the patient to IM for co-management. Even with oxygen
support, if oxygen saturation falls below 90%, go back to breathing and take a standby breath.
Patient LAR must maintain current medication and management while obtaining approval for
intubation.
Day 2 of Hospitalization (November 16, 2023)
The patient's medication needs to be taken as directed. The patient LAR has been diagnosed
with follow-up CXR; NA, K. Patient LAR can be transferred to a normal room.

1:00 PM. The doctor continued the current call for patient LAR and directed that furosemide be
changed to 40 mg 1 tab twice a day.

Day 3 of Hospitalization November 17, 2023

7:00 AM. The physician instructed the patient to continue taking furosemide 40 mg twice a
day and to repeat the ECG for patient LAR.

9:30 AM. The Physician prescribed to remove IFC and ordered current medication and intake
every shift, the physician had a direct antiglobulin test to present for the patient LAR. The
patient should follow the doctor's advice on hygiene.

Day 4 of Hospitalization November 18, 2023

The physician ordered furosemide 40 mg IV today, then every eight days for BP < 90/60, as well
as for repeating FT4, FT3, TSH, Na, K, iCa, and iMg. A PC repeat of the CBC is required.
Patient LAR must keep their nasal cannula in place for two to three liters of fluid each day.

Day 5 of Hospitalization November 19, 2023

The physician gave the patient LAR instructions for a low-fat, low-sodium diet, continued
prescription medication, and vital sign monitoring.

Day 6 of Hospitalization November 20, 2023

9:20AM. Today's physician relay for 2D echo. Additionally, the patient (LAR) needs to
change their wound dressing and keep taking their medication as prescribed.

The assigned physician reviews the 2D echo data because the patient is still having chest pain. To
continue taking the current medication and add Na and K to the next barium enema base excess.

Day 7 of Hospitalization November 21, 2023

7:00 AM. The doctor ordered the patient to continue taking medication as directed, to repeat
serve mg# after mg SO4 drip, to relay creatinine results, and to follow up with a 2D echo.

Day 8 of Hospitalization November 22, 2023

8:40 AM. For patient LAR, the doctor prescribed heplock and IVF on this particular day.
advised to follow doctor's advice regarding daily perineal care and good cleanliness.

Day 9 of Hospitalization November 23, 2023

8:15 AM. A patient LAR complained of chest pain today, so the physician ordered the
continuation of the current medications, checked vital signs, and gave advice about
breastfeeding and daily hygiene.

Day 10 of Hospitalization November 24, 2023

10:05 AM The doctor recommended IM misc no object for discharge and added the THMS
for chemical compounds that may arise after disinfecting the water. The medications suggested
were furosemide 40 mg 1 tab twice a day, spironolactone 25 mg 1 tab ODHS, and carvedilol
6.25 mg 1 tab, 1 ⁄ 2 twice a day.

2:00 PM Dr. Leslie, the doctor, mentioned seeking cardiology consultation. She placed an
order for Furosemide 320 mg once a day for a month and for Celaxib 200 mg twice a day for
discomfort. The doctor says that after a month, the patient LAR should have a follow-up
check-up at OB/OPD.

3:00 PM. The doctor indicated that the patient needed to be referred to multiple organ
dysfunction for clearing and that they should check with LAR for cardiology. For a duration of
one month, patient LAR is prescribed to take 200 mg of celecoxib twice a day and 320 mg of
ferrous sulfate once a day. She requires another consultation at OB-OPD after a month.

Day 11 of Hospitalization November 25, 2023

6:00 PM. The patient was discharged.

X. Discharge Plan

Environmental
● Instruct patients to provide a safe and clean environment.
● Instruct patients to provide a comfortable and stress free environment.

Treatment
● Discuss the importance of strict medication regimen to ensure complete healing.
● Instruct the patient to take the medication at the right time and route.
● Instruct patients to understand and follow discharge instructions accurately.
 ● Instruct to notify physician if undesired feeling was experienced.

Caring at Home
● Rest as directed.
● Shower as instructed by your healthcare provider.
● Promote proper hygiene.
● Take medications accordingly by the doctor’s order.

Health Teaching
● Review medications that will be taken at home. Its name, dosage, frequency and
possible side effects.
● Educate about the importance of taking and continuing the medicines.
● Instruct the patient to avoid heavy activities
● Notify the physician if undesired feeling was experienced such as difficulty breathing or
chest pain.
● Rest as directed
● Refrain from alcohol, smoking, and other vices
● Daily perennial care and proper hygiene

Out-Patient (Follow up check up)

● Patient is advised to follow up with a check-up 1 month after discharge.
● Instruct her family to seek immediate medical care in case of any emergency with the
patient.

Diet
● Limit fluid intake to 1 liter per day
● Low salt
● Low fat diet

Spiritual
● Advise to seek guidance and pray regularly together with her family.
● Pray for the fast recovery of the patient.
● Advise their family to support in uplifting the patient’s mental, and spiritual being. Be
someone that they can talk to.
● Always maintain a positive outlook in life.