COURSE IN THE WARD

February 27, 2016

On the 27th day of February, 1:30 PM, a 46 years old., G4P2 (2-0-2-2) was
admitted at Quezon Medical Center. She was admitted with complaint of hypogastric
pain. Prior to admission, Dra. Escondo, her admitting physician ordered to secure consent
for admission and management, intravenous fluid of D5LR 1L for 8 hours, CBC and
Ultrasound. She also ordered to have the client for pregnancy test and to refer to Dra.
Lajara for further evaluation.

At 11:45 PM, patient was ordered to have CA125, CEA C19-9, Transvaginal
Sonography, ECG, Chest X-ray and Ultrasound. Dra. Lajara also ordered to secure 2
units of whole blood for OR use and to refer to Dra. Macapagal.

February 28, 2017

At 12:30NN, patient was ordered to follow up pregnancy test and to have a blood
chemistry, TPAG, Na and K

March 1, 2017

Patient was ordered on DAT diet by Dra. Lajara and was prescribed Ampicillin 1
ampule IV ANST q6 x 4 doses and to follow up official result of pregnancy test.

At 5:30PM, patient was referred to Dra. Dela Pena and planned the patient for
TAHBSO. The patient was ordered for Elective OR after CP clearance. Also, Dra. Dela
Pena ordered to secure 2 units of fresh whole blood for OR use and to coordinate with
Dra. Veloso for OR scheduling
March 2, 2017

On the 2nd day of March, Dra. Agbayani ordered to follow up blood donors and
availability of 2 units of fresh whole blood and the patient was still for CP clearance.

At 3:30 PM, the patient was complaining of pain. She was referred to Dra. Lajara
and was given Mefenamic Acid 500mg 1 tab PRN

March 3, 2017

At 12:40AM, patient was already CP cleared by Dr. Alcantara. Clients CP

Clearance shows Minimal to moderate risk and was given medications such as
Combivent neb 30 mins. Prior to OR, Hydrocortisone 100g IV q6 x 2 doses and Co-
amoxiclav 625 mg. The patient also has 2 units of available blood therefore was ordered
by Dra. Macapagal for OR scheduling care of Dra. Veloso.

March 4, 2017

At 11:55AM, patient was still for OR scheduling care of Dra. Veloso.

March 5, 2017

Patient was still for OR scheduling

At 11:24AM, Dra. Veloso made a text order of to start bowel prep and scheduled
patient for TAHBSO on Tuesday.

March 6, 2017

Dra. Lajara made an order of to facilitate bowel prep and cefuroxime 1.5g IV
ANST prior to OR
 At 4:00PM, Dr. Guarin made an orders to secure consent for anesthesia and
procedure, NPO post midnight, to start IVF of D5LR1L x 8 hours once on NPO, full oral
and body hygiene prior to OR, to secure 2 units of Fresh whole blood for possible OR
use. To facilitate prothrombin time, %ACT, INR APTT. He also ordered to administer
hydrocortisone 100 mg IV q6 x 2 doses prior to OR, to nebulize with combivent 1 neb 30
minutes prior to OR, omeprazole 40mg IV once a day while in NPO, VS q4 and to refer
accordingly.

March 7, 2017

At 12PM Dra. Lajara ordered to defer OR since prothrombin time and APTT
result is prolonged. She ordered for correction of bleeding parameters and to secure 4
units of Fresh Frozen Plasma (FFP) for possible OR use. She also ordered to refer to
Internal Medicine for co-management of bleeding parameters. Her ordered medication is
Vit. K now then 1amp IV q8 x 6 doses then repeat PT, aPTT

At 7PM, Dra. Veloso ordered the patient for OR tomorrow and may have light
meals now then clear liquid diet then NPO post midnight. Also an IVF of D5LR1L x 8
hours once on NPO and medication of cefuroxime 1.5g IV ANST prior to OR. She
ordered to secure blood for OR use.

At 7:30PM, Dr. Guarin ordered for repeat PT, PTT/INR then refer results once
available. He also ordered to correct coagulopathy parameters prior to OR and to
continue Vit K as ordered

March 8, 2017

Dra. Lajara ordered to follow up PT and PTT result