Course in the Wards

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

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

2nd Hospital DayS> (-) flatus, awake & comfortable

(+) chest pain relieved by passing out of gasO> stable VS, clear & adequate urine output A> s/p ELAP + TAHBSOP> 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 nightEpidural morphine 2mg/IV given then epidural

catheter pulled out completelyEsomeprazole 40mg/tab once

3rd Hospital Day

S> multiple flatus, voiding freely, (+) epigastric painO> stable VSA> s/p ELAP + TAHBSOP> Continue post-op care

May have soft diet for breakfast then low salt & low fat diet once soft diet tolerated

Remove foley catheterEsomeprazole 40mg/tabShift Metronidazole to 500mg/tab q8Increase OFI

4th Hospital Day

S> Px comfortable w/ slight headache, (-) BM

O> Stable VSA> s/p ELAP + TAHBSOP> Continue post op care Possible d/c tom COD w/ tegaderm: wound dry & well

coaptated

5th Hospital Day

S> Px slightly tense & was unable to sleep last night, voiding freely, multiple flatus , (-) BM

O> Stable VSA> s/p ELAP + TAHBSOP> MGH THM: - Neurobion (Vit. B complex) 1 tab OD - Paracetamol + Tramadol (Dolcet) 1 tab

3x/day as needed for pain