2 On Admission DAT then NPO past midnight IVF: D5NR 1L x 8h once on NPO Meds:Cefazolin (Stancef) 1g/IV ANST 1h prior to ORAtenolol 50mg/tabMidazolam 15mg/tab, 1/2 tabFleet enema and abdominal prepreserve 1 unit PRBC for possible OR usescheduled for e-lap + TAHBSO at 8am
3 1st Hospital Day Transfused 1 unit PRBC with repeat CBC post BT Underwent ELAP + TAHBSO + PFC + partial omentectomy + adhesiolysis + palpation of liver & spleenPatient tolerated the procedure wellVital signs were stableEBL: 2000cc, UO: 100ccPost-op orders:NPO and IVF: D5NR, D5NM, D5WCefazolin 500mg/IV q6, Metronidazole 500mg/IV q8, Ketorolac 30mg/IV q8, Paracetamol 300mg/IV q6 x 4 doses, Dolcet 1 tab TID, epidural morphineTight abdominal binderTransfuse another unit if PRBC then CBC post BT
4 2nd Hospital DayS> (-) flatus, awake & comfortable (+) chest pain relieved by passing out of gas O> stable VS, clear & adequate urine output A> s/p ELAP + TAHBSO P> Continue post-op care SBE, crackers & gelatin for lunch, maintain on clear liquids, soft diet once flatus >3x or (+) BM 2 glycerine suppository per rectum at night Epidural morphine 2mg/IV given then epidural catheter pulled out completely Esomeprazole 40mg/tab once
5 3rd Hospital DayS> multiple flatus, voiding freely, (+) epigastric painO> stable VSA> s/p ELAP + TAHBSOP> Continue post-op careMay have soft diet for breakfast then low salt & low fat diet once soft diet toleratedRemove foley catheterEsomeprazole 40mg/tabShift Metronidazole to 500mg/tab q8Increase OFI
6 4th Hospital DayS> Px comfortable w/ slight headache, (-) BM O> Stable VS A> s/p ELAP + TAHBSO P> Continue post op care Possible d/c tom COD w/ tegaderm: wound dry & well coaptated
7 5th Hospital DayS> Px slightly tense & was unable to sleep last night, voiding freely, multiple flatus , (-) BM O> Stable VS A> s/p ELAP + TAHBSO P> MGH THM: - Neurobion (Vit. B complex) 1 tab OD - Paracetamol + Tramadol (Dolcet) 1 tab 3x/day as needed for pain
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