DOCTOR’S ORDER

DATE/TIME DOCTOR’S ORDER RATIONALE

December 5, 2015 12:15 PM Please admit patient to To be able to provide the
surgical ward patient with the specific care
needed.
Secure consent to care To have ethical
considerations and also to
protect their freedom to make
healthcare decisions
TPR q 4hrs To have baseline data and to
assess the stability of the
client’s health status.
Low-salt and Low Fat Diet This is also known as a heart-
healthy diet. Its purpose it
decrease and control the
levels of cholesterol in the
blood and also to decrease
blood pressure and/or fluid
retention
Start venoclysis PNSS1L For fluid and electrolyte
regulate @ 20gtts/min replacement therapy in
conditions where water and
sodium losses are in isotonic
proportion.
IVFTF PNSS @ SR For fluid and electrolyte
replacement therapy in
conditions where water and
sodium losses are in isotonic
proportion.
Labs: To evaluate blood
CBC with PC components and clotting
factor. Abnormal increases or
decreases in cell counts as
revealed in a complete blood
count may indicate that you
have an underlying medical
condition that calls for further
evaluation.
U/A This test is used to detect and
assess a wide range of
disorders such as UTI, kidney
disease and diabetes.
HBsAg Hepatitis B surface antigen; a
a positive test indicates acute
 or chronic infection of HBV
SE Stool cultures are important
tools for understanding and
treating intestinal illness.
Examination of stool (fecal)
samples helps identify
organisms that may cause
disease.
SGPT An alanine aminotransferase
(ALT) or SGPT (serum
glutamic-pyruvic transaminase)
test is often part of an initial
screening for liver disease.
This is usually done if an
individual is experiencing
symptoms of liver disease,
including jaundice (yellowish
skin or eyes), dark urine,
nausea, vomiting, or
abdominal pain.
Blood Typing Blood typing is a test used to
find out what specific blood
type you have.
FBS Blood glucose test measures
the amount of glucose, or
sugar, in your bloodstream. It
is most often used to screen
for diabetes.
Blood glucose tests can be
fasting or random. Fasting
tests provide the most
accurate results and are easier
to interpret than random tests.
Lipid Profile The lipid profile is used as
part of a cardiac risk
assessment to help determine
an individual's risk of heart
disease and to help make
decisions about what
treatment may be best if there
is borderline or high risk.
Lipids are a group of fats and
fat-like substances that are
important constituents of cells
and sources of energy.
Monitoring and maintaining
 healthy levels of these lipids
is important in staying
healthy.

Abdominal ultrasounds are

UTZ whole abd used to check ailments of the
major organs in the
abdominal cavity. These
organs include your
gallbladder, kidneys, liver,
pancreas, and spleen.
Sodium Potassium To evaluate serum electrolyte
levels and monitor for any
abnormal deviations that may
indicate underlying condition
Crea To examine kidney function

Medications: Anticholelithic—Although
1.Ursodeoxycholic Acid 1 tab the exact mechanism of
TID PO ursodiol's anticholelithic
action is not completely
understood, it is known that
when administered orally
ursodiol is concentrated in
bile and decreases biliary
cholesterol saturation by
suppressing hepatic synthesis
and secretion of cholesterol,
and by inhibiting its intestinal
absorption. The reduced
cholesterol saturation permits
the gradual solubilization of
cholesterol from gallstones,
resulting in their eventual
dissolution.
2. Ranitidine 50mg IVTT Ranitidine blocks histamine
q8hours H2-receptors in the stomach
and prevents histamine-
mediated gastric acid
secretion. It does not affect
pepsin secretion,
pentagastrin-stimulated factor
secretion or serum gastrin.
3.Essentiale Forte TID PO Nutritional support in the
management of damaged

I&O q shift
Refer accordingly
December 6, 2015 @ Ciprofloxacin 200mg IVTT
10:30AM q8hours
For UTZ whole abd
IVFTF PNSS iiL @SR
December 7, 2015 Hydralazine 5mg IVTT now
Paracetamol 500mg/tab 1 tab
q 4hrs
liver (due to chronic liver
disease, liver cirrhosis, fatty
liver and intoxication by
hepatotoxic substances). It
was also seen to inhibit
steatosis and fibrosis in
chronic liver damage models
(induced by ethanol,
thioacetamide and organic
solvents). Its suggested
principal actions have been
through accelerated
membrane regeneration and
stabilization, inhibited lipid
peroxidation and inhibited
collagen synthesis.
To assess fluid balance and
recognize significant losses
To monitor for any
unusualities
Inhibits the enzymes
topoisomerase II (DNA
gyrase) and topoisomerase IV
(both Type II
topoisomerases), which are
required for bacterial DNA
replication, transcription,
repair, and recombination.
Abdominal ultrasounds are
used to check ailments of the
major organs in the
abdominal cavity. These
organs include your
gallbladder, kidneys, liver,
pancreas, and spleen.
For fluid and electrolyte
replacement therapy in
conditions where water and
sodium losses are in isotonic
proportion.
A direct-acting peripheral
vasodilator that relaxes
arteriolar smooth muscle.
Thought to produce analgesia
by inhibiting prostaglandin
and other substances that

December 8,2015 Continue other medications
Vitamin K 1 amp IV q 8hrs
Secure 2 units of whole blood
of prescribed blood type and
transfuse as settled RBC after
proper screening
To run for 4hours, 6 hours
apart
Furosemide 40mg IVTT
Post-BT each unit
Potassium citrate 1 tab TID
x3 days
Multivitamins + amino acids
1 cap TID
sensitize pain receptors. Drug
may relieve fever through
central action in the
hypothalamic heat-regulating
center.
For proper effectivity of the
drug and to promote and
continue healing process
Vitamin K promotes the
hepatic formation of active
prothrombin (factor II),
proconvertin (factor VII),
plasma thromboplastin
component or Christmas
factor (factor IX), and Stuart
factor (factor X), which are
required for normal blood
clotting.
A red blood cell transfusion is
to treat anaemia. Anaemia
occurs when the body doesn't
have enough red, oxygen-
carrying blood cells, which
means the body’s tissues and
cells aren't getting enough
oxygen.
Inhibits sodium and chloride
reabsorption at the proximal
and distal tubules and the
ascending loop of Henle.
Crystallizes stone-forming
salts such as calcium oxalate,
calcium phosphate, and uric
acid within the urinary
bladder by increasing the
urinary pH and urine citrate
levels.
Amino acids plus
multivitamins is composed of
8 essential amino acids, a
supply source of proteins.
The 8 essential amino acids
are combined in well-
proportional contents, so that
they can be assimilated into
protein in a perfect manner.

Rpt CBC every 6 hours post
BT
IVFTF with PNSS 1L @ SR
2 cycles
December 9, 2015 Still for ultrasound
Still for repeat CBC
Please administer Iron sulfate
Continue meds
IVFTF PNSS1L @
The vitamins are selected up
to 11 kinds as contained
based on recent research ie,
each amino acids with the
vitamins so that they can be
formulated into a living
nutrient.
To evaluate if the hematocrit
and hemoglobin levels
increased after Blood
Transfusion
For fluid and electrolyte
replacement therapy in
conditions where water and
sodium losses are in isotonic
proportion; for proper
hydration and cell
supplementation
Abdominal ultrasounds are
used to check ailments of the
major organs in the
abdominal cavity. These
organs include your
gallbladder, kidneys, liver,
pancreas, and spleen.
To evaluate blood
components and clotting
factor. Abnormal increases or
decreases in cell counts as
revealed in a complete blood
count may indicate that you
have an underlying medical
condition that calls for further
evaluation.
Elevates the serum iron
concentration which then
helps to form high levels of
iron or trapped in the
reticuloendothelial ells for
storage and eventual
conversion to a usable form
of iron
For proper effectivity of the
drug and to promote and
continue healing process
For fluid and electrolyte
 20gtts/min
Amlodipine 10mg/tab 1 tab
OD PO
December 10, 2015 For serum alkaline phosphate
SGPT
IVFTF with PNSS 1L at SR
Medically cleared for surgery
Metoclopramide 1mg IVTT
now then q 8hrs
December 11, 2015 Continue IVTT medications
IVFTF PNSS iiL @ SR
For serum albumin
replacement therapy in
conditions where water and
sodium losses are in isotonic
proportion; for proper
hydration and cell
supplementation
Inhibits calcium ion influx
across cardiac and smooth-
muscle cells, dilates coronary
arteries and arterioles, and
decreases blood pressure and
myocardial oxygen demand.
An alanine aminotransferase
(ALT) or SGPT (serum
glutamic-pyruvic
transaminase) test is often
part of an initial screening for
liver disease. This is usually
done if an individual is
experiencing symptoms of
liver disease, including
jaundice (yellowish skin or
eyes), dark urine, nausea,
vomiting, or abdominal pain.
For fluid and electrolyte
replacement therapy in
conditions where water and
sodium losses are in isotonic
proportion; for proper
hydration and cell
supplementation
If medically cleared, patient
can now undergo surgery on a
scheduled date and time.
Stimulates motility of upper
GI tract, increases lower
esophageal sphincter tone,
and blocks dopamine
receptors at the
chemoreceptor trigger zone.
For proper effectivity of the
drug and to promote and
continue healing process
For fluid and electrolyte
replacement therapy
An albumin test may be
 ordered as part of a liver
panel to evaluate liver
function, along with a
creatinine and blood urea
nitrogen (BUN) to evaluate
kidney function, or to
evaluate a person's nutritional
status.
For pro time Prothrombin time (PT) is a
blood test that measures how
long it takes blood to clot. A
prothrombin time test can be
used to screen for bleeding
abnormalities.
Refer accordingly To monitor for any
unusualities