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 Day
S>
(-) flatus, awake & comfortable
(+) chest pain relieved by passing out of gas
O>
stable VS, clear & adequate urine output
A>
s/p ELAP + TAHBSO
P>
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 night
Epidural morphine 2mg/IV given then epidural
catheter pulled out completely
Esomeprazole 40mg/tab once
3rd Hospital Day
S>
O>
A>
P>
multiple flatus, voiding freely, (+) epigastric pain
stable VS
s/p ELAP + TAHBSO
Continue post-op care
May have soft diet for breakfast then low salt &
low fat diet once soft diet tolerated
Remove foley catheter
Esomeprazole 40mg/tab
Shift Metronidazole to 500mg/tab q8
Increase OFI
4th Hospital Day
S>
O>
A>
P>
Px comfortable w/ slight headache, (-) BM
Stable VS
s/p ELAP + TAHBSO
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 VS
A> s/p ELAP + TAHBSO
P> MGH
THM:
- Neurobion (Vit. B complex) 1 tab OD
- Paracetamol + Tramadol (Dolcet) 1 tab
3x/day as needed for pain