Physicians order sheet 2/23 assessment: fonatnels soft,unbukging hyperactive bowelsounds,(+) BM, soft abdomen, pupils isocopic 2-3

m ERTL. Fixatesobjects , spontaneous movement of all extremities, decreased spartiety Pedia neurology: Decreased salbutamol q8hrs Citirizine 5mg/ 5ml,give 2.5mldaioy now then q2 x 5 days Neurosurgery (nsx ) COD done Discontinue ketorolac Continue paracetamol

2:50 pm Give clear liquids After 3 tolerated doses, may resume milk feeding Observevstrict aspiration precaution May not reinsert indwelling catheter Do diaper count

2/22. 5:05 Estimared blood loss - 40 ml S/p cystoperitoneal shunting Patient seen and examined with stable vital signs CR: 112 ; RR: 27 ; T: 36.6; O2 saturation: 98 Neurosurgery

Please prepare the following: @ bedside 4 4 OS #5 Cutasept #1 Keep FOB 9:45 (+) COARSE CRACKLES Salbutamol nebulizatiom, 1 nebule, 1 nebule every 6 hours x 4 doses 8:15 am Anesthesiologist notes: Diagnosis seen and examined; VS note Preoperative orders: Maintaij on NPO IVf to run at present rate

follow up pediatrics Refer accordingly 9:35 am preoperative risk assesment, PS2, mild to moderate disturbances that do not interfere with daily activities Please give salbutamol nebulization, 1 nebuole at 11am

2/21/13 Flat fontanels AC 46.8 cm (+) fontanel 6.5 x7.5 2-3mm ERTL, can still track objects past midline and fixates upward (+) corneals, OU (both eyes) ; no facial asymmetry; can lateralize to bell; turns headside to side, spontaneous movement of all extremities (+) spastic all extremities DTRs OH on all 4s; (+) babinski, bilaterally intercartjal 3cms (+) frontal bossing & occipital protrusion, spine straight (-) tuffs of hair; laughs loud Mental age: 3-4 months

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(+) grasp reflex Had lag Inconsistently lateralized to bell Lateralized to bell

thank you for this referra. Patient seem and examined.history reviewed Once on NPO start IVF D5 0.3% NaCl 500ml to run @ 25 m/ hour (100 %) Start ampicillin-sulbactam (unasyn) 150 mg/ IV soluset for 39 mins every 6 hrs based on ampicillin content (100mg/kg/day) after negative skin test please Ff. Up official chest x-ray results

Addendum: Salbutamol nebulization 1 nebule 1 hr prior to OR 9:15 PM May have milk formula until 7am them NPO No pre-op meals