DOCTORS ORDER

DATE/TIME

6/26/148:25PM

DOCTORS ORDER

> pls admit to ROD under the service of J. BAYANA

> Secure consent

>TPR q 4

>DAT to watcher Labs:

CBC,

U/A,

SE,

Crea,

BLOOD TYPING

Cranial CT Scan—plain

IVF started @ talakag Hospital D5 0.3NaCl 500cc- 30cc/hr

Meds:- PHENOBARBITAL 13mg + 9ml PNSS give slow IV now in 20mins

RATIONALE

-For proper monitoring, management and evaluation

- Patient has the right to be consented in all procedures to be done

-Monitoring vital signs provides baseline information for comparison of changes.-Provide screening as part of a generalphysical examination, especiallyon admission to a health carefacility-Evaluate known or suspectedanemia and related treatment-Determine the presence of agenitourinary infection or abnormality-Look for the cause of an infection, such as bacteria, a fungus, or a virus.-Evaluate known or suspectedimpairment of renal function-Identify maternal and infantABO and Rh blood types topredict risk of hemolytic disease of the newborn.

-CT remains the investigation

for the diagnosis and

management of many central

nervous system diseases.

-To maintain fluid and electrolytes balance

- used as a sedative hypnotic and also as an anticonvulsant+ To prevent formation of crystals or precipitate

10pm

ABW 6.5kgDAY 5 fever

DAT 4 irritability and ↑sleeping

time(+) seizure x1day

A- Acute Meningitis

>Seizure PrecO2 @ 2-1L/minSuction PRN

> start Rocephin 1gm drip now no testing the after 12hrs maintain @300mg q 12hrs IV

>maintain PHENOBARBITAL @15mg IV Q 12

>change IVF to PNSS 500cc @30cc/hr (3 bottles)

>give paracetamol 60mg q 4hr pm for fever 37.8c

>insert NGT F8

>monitor Neurovital signs q 2

>monitor I and O 4hrs

>for possible LUMBAR TAP

>for blood CSF

>CXR-APL

- to correct alveolar and/or tissue hypoxia to increase oxygen saturation in tissues where the saturation levels are too low

- To reduce the development of drug-resistant bacteria and maintain the effectiveness of ceftriaxone and other antibacterial drugs, ceftriaxone should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.

- used as a sedative hypnotic and also as an anticonvulsant

- To maintain fluid and electrolytes balance

-To relieve fever

- To provide a route for feeding or administration of medications

- To perform an initial baseline assessment for comparison of changes.

- helps evaluate client's fluid and electrolyte balance

- To help diagnose serious infections, such as meningitis

- to measure pressure in the spinal fluid

- to evaluate organs and structures within the chest for symptoms of disease.

6/27/141:35AM

(+)SEIZURE(+) BLACK STOOL

>give diazepam 2.5mg IV now

>give additional dose of phenobarbital 65mg slow IV now for 10mins>for LUMBAR TAP tomorrow @8AM

- To adjunct for seizure disorders-To sedate and to increase seizure threshold- To help diagnose serious infections, such as meningitis

10AM

>secure consent for procedure

>prepare the ff needs:-sterile eye towel #1, sterile vials #4, sterile gloves sixe 7#1, free needle G23 #3, free needle G26 #1 tuberculin syringe #1, 3cc syringe #1 lidocaine 2 % vespule #1, diazepam 10mg/ampule #1, OS, cotton balls, alcohol, betadine

>start FM feeding c 2oz q 6hr/NGT

>NPO starting 5AM tomorrow

>IVF to follow: PNSS 500ml @20cc/hr>↓IVF rate to 20cc/hr once feeding started

> give mannitol 30ml IV bulos now the q 6hrs defer for SBP less than 70mmHg

-for legal purposes

-to have a smooth flow of the procedure, also it can save time and effort

-to maintain nutritional balance-to prevent vomiting during and after the procedure-to maintain fluid and electrolytes balance

- inhibits reabsorption of water and electrolytes and increases urinary output

6/28/1411:20AM

5PM

>S/P LUMBAR TAP>CSF obtained @L3-L4: clear, colorless & free –flowing>submit CSF for examBOTTLE #1 – CSF cell count, differential count, sugar, proteinBOTTLE #2 – CSF GS/CS, AFB,KOHBOTTLE #3 – DOH surveillanceBOTTLE #4- save in REF

>for HGT now

>flat on bed x 6hrs

>NPO temp x 6hrs

>monitor neurovital signs q 1hr x 4 taking q 3hr

>start CITICOLINE 75MG IV q 8hrs No testing>IVF to follow:PNSS 500ml @30cc/hr

>to consume CITICOLINE IV then shift to CITICOLINE syrup 100mg/ml 1.0ml BID, PO

-To check for abnormalities and to report the case to DOH

-to check blood glucose result

-to provide adequate rest

-to prevent vomiting during and after the procedure

- To perform an initial baseline assessment for comparison of changes.

-accelerates the recovery of consciousness and overcoming motor deficit

-to maintain fluid and electrolytes balance

-to accelerate the recovery of consciousness and overcoming motor deficit

6/ 29/141PM

A-Viral meningoencephali

tis

>↓ PHENOBARBITAL IV to 10mg q 12hrs IV

>discontinue O2 support

>pls give milk feeding per NGT>IVF to followD5NSS 500ccml @30cc/hr

-To sedate and to increase seizure threshold-To stop Oxygenation support

-to maintain nutritional status

-To maintain fluid and electrolytes balance and used as a mixing solution (diluent) for other IV medications.

6/30/1412:30PM

12:40PM

>↓ PHENOBARBITAL to 7.5 mg IV q 12hrs then consume present open IV stock and shift to PHENOBARBITAL Gr ¼ tab (15mg) ½ tab q 12hrs PO>↑feeding to 4oz q 6hrs>↓IVF rate to 20cc/hr

>hold mannitol>remove NGT>give oral meds PO

-Change IV to PO for maintenance

-To maintain nutritional status-To decrease rate of administration

-To stop administration of drug-To start giving feeding per orem-To administer drug orally

7/1/1412nn

>↑feeding to 4oz q 4hrs>↓present IVF rate to 15cc/hr>IVF to follow D5IMB 500cc/hr

-To maintain nutritional status-To decrease rate of administration

7/2/149:30PM

>to consume open IV stock of CITICOLINE IV per 100mg/ml, 1.0ml BID,PO>to consume open IV stock of CEFTRIAXONE per shift to CEFIXIME 100mg/5ml, 2.5ml BID PO>terminate present IVF once consumed>for home tomorrow

-To continue giving the drug

-To continue giving the drug until consumed and start CEFIXIME as antibiotic-To remove when consume-Ok for discharge after billing

7/3/1410AM

3PM

> MGH today c meds

1. CEFIXIME 100mg/s/ml 2.5ml BID x 1wk

2. 2. CITICOLINE100mg/ml 1ml BID, x month

3. 3. PHENOBARBITAL Gr ¼ (15mg) ½ tablet BID as maintenance

>AP will still come back for final instructions prior to discharge

>defer discharge today>continue oral meds>will make rounds tomorrow

- Ok for discharge c medication compliance prescribed- Broad-spectrum antibiotic to prevent bacterial synthesis- to accelerate the recovery of consciousness and overcoming motor deficit-To sedate and to increase seizure threshold

-to instruct for further management

-defer for further instructions-to maintain physical well being-to have further instructions