1. Course in the Wards

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 OR
Atenolol 50mg/tab
Midazolam 15mg/tab, 1/2 tab
Fleet enema and abdominal prep
reserve 1 unit PRBC for possible OR use
scheduled 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 & spleen
Patient tolerated the procedure well
Vital signs were stable
EBL: 2000cc, UO: 100cc
Post-op orders:
NPO and IVF: D5NR, D5NM, D5W
Cefazolin 500mg/IV q6, Metronidazole 500mg/IV q8, Ketorolac 30mg/IV q8, Paracetamol 300mg/IV q6 x 4 doses, Dolcet 1 tab TID, epidural morphine
Tight abdominal binder
Transfuse another unit if PRBC then CBC post BT

4. 2nd Hospital Day
S> (-) 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 Day
S> multiple flatus, voiding freely, (+) epigastric pain
O> stable VS
A> s/p ELAP + TAHBSO
P> Continue post-op care
May have soft diet for breakfast then low salt & low fat diet once soft diet tolerated
Remove foley catheter
Esomeprazole 40mg/tab
Shift Metronidazole to 500mg/tab q8
Increase OFI

6. 4th Hospital Day
S> 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 Day
S> 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