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COURSE IN THE WARD Day 1 A 72 year old female was admitted at exactly 10:04pm at medical center Muntinlupa last

August, 27, 2012, accompanied by her son with a chief complaint of generalized body weakness however while at the emergency room she also complained of having leg cramps with involuntary twitching and tachypnea. She was admitted under the service of Dr. Macadagdag and following orders were given. The patient underwent laboratory test and examinations to diagnose her disease. The results revealed elevated blood sugar , cholesterol, serum creatinine , BUN , BUA and potassium levels and decreased calcium level. Upon release of laboratory results the patient underwent Intrajugular catheter insertion for easy access dialysis, IJ catheter was checked through X-ray with its tip at the level of T9, X-ray also reveled atheromatous aorta and thickening of intralobular septa. The physician ordered 5% Dextrose in Lactated Ringers solution to be regulated at 20gtts/minute. She was hooked to oxygen via nasal cannula with a flow rate of 2-3 L per minute. An indwelling catheter was inserted as well as nasogastric tube. The physician advised to be admitted at the ICU, but due to lack of financial resources, she was only admitted at the private room of a ward. Day2 The patient was brought to room 306. Continuous monitoring of patient physical status after undergoing dialysis treatment for evidence of physiologic imbalance and change. Vital signs q1 were ordered. At 8am patient seen lying on bed, conscious and awake and oxygen maintained at 2-3 L per minute via nasal cannula. Repeated Laboratory exams were requested. Blood chemistry revealed normal creatinine and Potassium levels and decreased Sodium levels. Hematology reports revealed decreased in hemoglobin, hematocrit, ESR, and lymphocyte levels. Arterial Blood Gas analysis showed metabolic Acidosis partially compensated. Seen and assessed by Dr. Macadagdag at 10am. The attending physician ordered calcium Gluconate 10ml/BID/ IV. Sodium Chloride 1tab/TID/PO, Azithromycin 500mg/BID/PO, Sodium Bicarb. 300mg/QID/PO, Omeprazole 400mg/PO, Trimetazidine 1tanb/BID/PO, allopurinol 200mg/ OD/ PO,

Enoxaparin 40mg/ BID/ SQ, Rosuvastatin 20mg/OD/PO, Insulin glargine 10Units/ SQ. Furosemide 20mg/q12/IV. Day3 Vital Signs had taken for 8:00am, Blood Pressure-180/100, Pulse rate-106bpm/min., Temperature- 36 Celsius, Respiratory rate of 21breaths/minute. Seen and examined by Dr. Macadagdag at 7:00am. Attending physician ordered Nicardipine 40mg/ BID/ PO. To follow Intravenous fluid D5NSS 1L regulated at the same rate. On low salt, low fat Diet. Due meds were given via NGT. Day4 Seen and examined by Dr. Macadagdag. Vital Signs taken and recorded Temperature, pulse rate, and Respiratory rate are within normal range, Blood pressure is 130/90. To follow IVF D5NSS x KVO. Due meds were given. Nasogastric tube was removed. Health teachings were made patient was able to identify risk factor that contributes to the disease process. Day5 Nursing care done. Vital Signs for 8am were monitored and recorded as follows, Blood Pressure-130/90, respiratory rate- 19 breaths per minute, Pulse rate- 90bpm and temperature of 36 C. The patient is sitting on bed, awake, conscious and coherent. She verbalized that she wanted to go home because of big hospital expenses. At 3pm IVF and foley catheter were removed. The patient sign consent indicating not to continue dialysis treatment because of financial problems. Attending physician prescribed home medications. Health teachings were given before discharge.