November 24, 2009

 Please to medical 1
 NPO temporarily, except meds
 CBC, creatinine, BUN, Na, K
 Urinalysis, midstream do c/s if WBC> 15 hpf
 Stool exam
 D5LRS 1L x 8 hrs
 Measure I & O
 Ceftuzidine (Zeptrigen) 1 gm IV q 8 hrs ANST
 Omepron 40 grams IV OD
 Appetite plus, 1 cap OD
 Nephrosteril 500cc x 24 hrs
 Plasil 1 amp q 8 hrs
 Fortifier FA 1 cap OD
 Inform ROD/ IOD
 May have 02 @ 2 LPM

November 25, 2009

12:00 am
 Transfer 4 “u” of PRBC properly typed and crossmatched to run for 4 hrs with 2 hrs
interval
 Give Diphenhydramine 50 mg IV prior to BT
 Give furosemide 40 g IV after 2nd unit of PRBC with BP precaution
 WOF hypotension, dysuria
 For ABG now
 For 12 lead ECG
 Give Calcium gluconate 1 amp SIVP now
 MW with duavent q 8 hrs x 3 doses
 D5050 1 vial + HR 10 IV q 8 hrs x 3 doses
 Repeat K am
 CBG now then 4 hrs while on NPO
 Shift IVF to D5NSS 1L x 12 hrs
 Refer accordingly
 Quantify platelet count
2:10 am
 ABG noted
 Give Sodium Bicarb. 50 meqs SIVP now
 Start Sodium Bicarb. Drip D5 water 250cc + 50 meqs for 2 hours
5:30 am
 IVF to follow D5NSS 1L x 12 hrs
10:40 am
 Rounds with Dr. Alcoriza
 Refer to Dr. Samonte labs: increase creatinine
 May have soft diet as tolerated 1400 kcal/day divide into 3 meals and 3 snacks
 Please shift IVF to PNSS 1L x 12 hrs
11:30 am
  Please give Catapres 75 mg 1 tab. tid
 Rpt BP after 1 hr
 Decrease CBC to BID premeals
1:00 pm
 For PT, PTT
 For stat dialysis
3:25 pm
 Nephro notes:
 Thank you ver much for this referral, continue accurate
I & O monitoring, diet : CHON 0.8 gms/ KBW 60%. Rpt creatinine today include
serum, sodium, albumin facilitate blood transfusion.
 Increase IVF to 120 cc/hr, suggest to decrease
Ceftazidine 1gram/IV suggest rpt ultrasound of the whole abdomen of the whole
abdomen.
 Relay serum creatinine please
 Make sure that bed is available ASAP
 Carry out suggestion of Nephro service
6:10 pm
 Hold Dialysis for the moment
 Facilitate transfusion
 Continue hydration
 ABG now
 Crea= 930, K= 4.3, vomiting noted
6:15 pm
 Give HR 4 “u” now
 CBG= 237
 Repeat crea, potassium, sodium in am
 Watch out for recurrence of vomiting and Refer asap
 Include HBAIC to blood extraction
9:30 pm
 For stat dialysis
 Secure consent
 While awaiting for the consent may continue BT
 May hold nephrosteril and NAHCO3 while BT is going on
 Rpt ABG
 Ph= 7.36, DO2= 138, O2 sat= 99, PCO2=17, HCO3= 9.6, note acidosis with consistant
respiratory alkalosis
9:45 pm
 Refer to Dr. Samonte for IJ insertion
 Dr. Alcoriza aware of the above plans & orders
10:30 pm
 Endorse to hemodialysis unit for hemodialysis
 Secure consent: Dr. Alcoriza to close IJ insertion
 Hemodialysis prescription
Duration: 2 ½ hrs
Dialysis: F6
No Heparin
 U F BT + .5L + NSS fluid
HCO3 bath
BF 150cc/min
Dialysate flow 500 cc
Pre HD HBS Ag & Anti HBS, Anti HCV
Give D5050 in the 2nd hemodialysis
10:50 pm
 May delay dialysis till tomorrow
 Correct bleeding parameters
 Konakion 1 amp Iv q 8 hrs x 3 doses, give first dose now
 Rpt PT with INR after the 2nd dose of konakion
 Base line ECG 12 lead now

November 26, 2009

7:00 am
 Strict I & O monitoring
11:00 am
 Thank you very much for this referral
 Catheter inserted into the right subclavian vein without difficulty of good venous
backflow on all three parts.
 For CXR now for localization
 Refer accordingly
11:10 am
 CXR noted
 Dialysis catheter in place, catheter tip inserted through the heart
 Thank you very much for this referral
 Catheter is now ready for use
 Please inform dialysis
 Refer accordingly
 Hold
2:30 pm
 Scheduled for HD tomorrow
Duration: 4 hr
UF: flushing
Dialyzer: F6
Heparin: None
BFR: 150 cc/min
DF: 500 cc/min
 Give D5050 1 vial at 2nd hemodialysis
 Repeat Hgb, Hct, 8 pm
 Suggest CT scan of the whole abdomen: possible cause of obstruction for further
delineation
 Suggest referral to urology service
 Pre HD creatinine, K
 Carry out suggestion of nephro service
 Refer to Dr. Macaya for neurology examination
  D/C CBG monitoring
4:20 pm
 For abdominal CT scan, with triple contrast
5:30 pm
 Thank you very much for this referral
 Patient seen, history received
 Will inform Dr. Macaya
 Will follow-up
 Please refer as needed
6:20 pm
 Catapres 75 mg SL now
 Report BP after 1 hour & relay to MROD
10:50 pm
 IVF: D5NSS 1L x 12 hrs

November 27, 2009

2:45 pm
 Rounds with Dr. Alcoriza
 Nephro notes
 Please follcow up referral to urology
 Follow up CT scan results & relay
 Relay labs pending
 Repeat CBC, Crea, Na, K, Tommorow am
 Give nephrosteril during dialysis
 D/C NaHCO3 drip
 Repeat urine C/S please

3:00 pm
 Suggest start Clindamycin 300mg IV q6
- (Possible anaerobic average)
8:40 pm
 Carry Out suggestion of Dr. Samonte to staff
 Clindamycin (Dalacin C) 300mg IV q 6 hrs
9:15 pm
 Burinex 1 tab in am
 Furosemide 40 mg IV now
10:00 pm
 Neurontin 100mg 1 cap BID
 IVF TF: D5NSS 1l x 12 hrs

November 28, 2009

9:45 am
 Please include Piperacillin (tazobactam) to sensitivity studies to previously ordered urine
CS
 Rounds with Dr. Alcoriza
 Continue meds.
5:00 pm
 Amlodipine 5mg/tab OD
BP: 170-160/90
6:00 pm
 Neprho Notes
- Suggest to start Tazobactam Piperacillin 2.25 gram IV q 8 hrs ANST
- Hold Ceftazidime, Clindamycin once carried out above suggestion.
- In latest urine C&S request, include sensitivity to Tazobactan
- Repeat crea, Na, K tomorrow AM
- Include BUN to lab test
- Carry out suggestion of nephro notes
-
November 29, 2009

10:40 am
 For hemodialysis today

5:50 pm
 Rounds with Dr. Samonte
 For PT with INR and PTT Now
 Include platelet count to lab exam now
 Decrease IVF rate to 40cc/hr
 For repeat crea and serum K tomorrow AM
 For H&H tomorrow AM
9:00 pm
 Paracetamol 30mg IV now then q4 PRN for
T: 38.2 C
9:15 PM
 For BT 4 “u” FFP properly typed and crossmatched
 Refer back to Dr. Macaya
 Dr. Alcoriza informed and ordered as well as Dr. Samonte
 PTT increased 4x
 (+) gross hematuria

November 30, 2009

12:30 am
 Please provide bedside turning schedule
 Mefanamic acid 500mg IV AM
10:30 am
 Nephro Notes
 Repeat urea, Na, K tomorrow AM
 Accurate I&O pls.
10:40 AM
 Rounds with Dr. Samonte
(+) note of focal tumor
Of the upper extremities
to consider seizure like
HGT: 147
 Suggest referral to Neuro Service
 Apply cold compress to Left arm
 Include Na to blood work-ups today
 For cranial CT scan (plain)
3:00 pm
 Refer to Dr. Dela Cruz for neuro evaluation
 CR-150/min
(+) Fever
BP:180/80- 100/90
T: 39C
 Please do 12 leads ECG
 Paracetamol 300mg IV
 Please insert IV now IV PNSS 1Lx KVO
 May give Isoptin 2.5mg IV now
 Dr. Alcoriza aware of above orders
 Increase V/S monitoring to q 15 until stable
 Start citicoline (zynapse) 1gm 10q 8
 Inform MROD of latest VS
 Rounds with Dr. ALcoriza
 For PTT
 Please follow up referral to Uro service
Urology Suggestions
 Change Foley catheter to 3 way- Foley catheter now and do cystoclysis
5:00 pm
 Around with Dr. Dela Cruz
 See consultation notes
 Copied suggestion/plans of Dr. Dela Cruz
 NGT insertion
 Dilantin 100mg BID/NGT
 Citicholine (Tycol) 500mg IV q6
7:10 pm
 Carry out suggestions/plans of Dr. Dela Cruz

December 1, 2009

5:30 am
 Rounds with Dr. Macaya
11:00 am
 Endorse to dialysis
 For HD today
  Duration 4 hours
UF: 2L + PNSS flushing
BFR: 150-200 cc/hr
No heparin
Give D5050 on the 2nd hour
12:45 PM
 Rounds with Dr. Alcoriza
 Hold HGT temporarily
 For CBC with platelet count to next blood extraction
1:45 PM
 Nephro Notes
 Repeat serum creatinine, K tomorrow AM
 Rounds with Dr. Samonte
 Give D5050 1 vial on the 2nd hour after HD
 IVF to 1L instead of 2L
 Start CBG monitoring every 6 hour
2:05 pm
 Nephro Notes
 Next IVF D5 NM 1Lx 60cc/hr
 Repeat creatinine, K, tomorrow AM
 For possible HD tomorrow
2:45 pm
 IVF to follow #8 PNSS 1Lx KVO
 Repeat HD and Hct in AM
5:30 pm
 Start TPN (nutriplex) 1300 kcal to run for 30 hrs
6:30 pm
 Insert another line : PNSS 1lx KVO for TPN

December 3, 2009

9: 00 am
 Please transfuse 3 units PRBC properly typed and crossmatched each unit to run for 4 hours
with 2 hours interval
 Repeat CBC with platelet count 6 hours post BT
11:00 am
 Nephro Notes
 For hemodialysis today
UF: 1L x PNSS
Duration : 4 hours
Dialyzer: f6
DF: 500cc
Heparin: None
BFR: 200-250
 Please transfuse blood products during HD
 Please repeat serum K, creatinine tomorrow AM
5:30 pm
  T: 38.3C
 While on 3rd unit of BT
 Give paracetamol 50g PRN Now
 Give hydrocortisone IV now, if Ok with Dr. Alcoriza
 Refer accordingly
 Dr. Samonte update with Alcoriza
 AP updates
 May give hydrocortisone 2mg 1 amp IV now
 Rounds with Dr. Macaya

December 4, 2009

12: 00 am
 BP:200/110 -Give catapres 75mg 1 tab now
1:00 pm
 Rounds with Dr. Alcoriza
 Hemostan 500mg IV q8,give 1st dose now
1:55 pm
 Rounds with Dr. Samonte
 Kalium Durule 1tab TID
 Repeat serum creatinine, K, tomorrow AM
 Accurate I&O please without fail
8:30 pm
 For steam inhalation
(+) sticky phlegm as claimed
11:45 pm
 IVF TF: D5nm 1Lx 60cc/hr

December 5, 2009

12:05 pm
 Rounds with Dr. Alcoriza
 Seizure precaution @ bedside
 Refer if with recurrence of seizure
7:15 pm
 Nephro Notes ( paayos nlng nito bro ehe)
 Schedule for HD tomorrow
 Inform dialysis unit
 Duration: 4 hours
 UF: 16 x NSS
 Heparin: NONE
 BFR: 200-300cc
 DF: 500cc
 Pre HD creatinine, H&H, K tomorrow

 Rounds with Dr. Alcoriza

 Give nephrosteril during dialysis
December 6, 2009

1:10 pm
 Epoctin 4000 “u” subcutaneously
5:00 pm
 Ok to give epoctin 4000 “u” subcutaneous once only until further orders
 Please d/c kalium durule
 Catapres 100 mg tab Sublingual now for bp- 210/100
7:00 pm
 Hold catapres previously ordered
 May give nicardipine 1 mg IV push now
 Please recheck bp prior to giving nicardipine push
8:00 pm
 Nephro notes
 Rpt crea, k tomorrow
8:20 pm
 For blood c/s in am
 Please give 1 mg nicardipine IV now for bp- 180/90
 Relay repeat bp after 30 minutes
 Increase amlodipine 5mg/ tab, 1 tab TID
