Condition:  Critical Guarded Fair Stable

Diagnosis:  Morbid Obesity, HTN,  IDDM,  CAD, Hyperlipidemia, Sleep Apnea, Asthma

Disposition: Admit to MED/SURG Admit to MED/SURG TELEMETRY To OPS D/C if cleared by anesthesia Admit to Observation Admit to PCU Admit to CV-TELEMETRY Admit to ICU

Vital Signs: Q 15 MIN Q 30 MIN Q 1 HOUR Q 2 HOUR Q 4 HOUR Q 6 HOUR

Diet: NPO ICE CHIPS SIPS OF CLEAR LIQUIDS Ice chips tonite  Gastric Bypass Clear liquid diet 30 ml medicine cup q 15 minutes start in am. CLEAR LIQUIDS FULL LIQUIDS REGULAR DIET

Activity: BED REST OOB TO CHAIR OOB AS SOON AS TOLERATED OOB WITH ASSISTANCE

I&O: Q SHIFT Q 1 HOUR Q 2 HOURS Q 4 HOURS

IV: L/R D5LR NSS D5NSS D5 1/2NSS D5  RATE: 20 40 60 70 80 90 100 120 150 milliliters per hour

Additives: NONE KCL 10 MILLIEQUIVALENTS PER LITER KCL 20 MILLIEQUIVALENTS PER LITER KCL 30 MILLIEQUIVALENT KCL 40 MILLIEQUIVALENTS PER LITER NONE MVI once daily

Pain: DEMEROL 25 MG IV Q 3 HOURS PRN DEMEROL 50 MG IV Q 3 HOURS MORPHINE 4 MG IV Q 2 HOURS MORPHINE 6 MG IV Q 2 HOURS DILAUDID 2 MG IV Q 4 HOURS

Nausea: Phenergan 12.5 mg IV q 3 hours prn Phenergan 25 mg IV q 3 hours Zofran 4 mg IV q 8 hours prn

Sleep: Ambien 5 mg po q hs prn,  Ativan 1 mg IV q hs prn.            

Constipation:  MOM 30 ml po prn

Headache:  Acetaminophen HCL liquid 650 mg po q 4-6hrs prn

Itching:  Benadryl 25-50 mg IM q 4-6 hrs prn

Indigestion:  Maalox 30 ml q 2hrs prn

 SCD hose while in bed,  Lovenox 40 mg subcut. daily.

 cath if needed    insert foley if > than 500 ml residual or if still unable to void.

 Incentive Spirometry q 2hrs

 Reinforce or change dressing as needed

Catheters: None PICC line to be inserted by Radiology Foley NGT to low continuous suction irrigate and adjust prn NGT to low continuous suction don't irrigate or adjust JP drain q 2hrs prn Chest Tube to Close suction drainage 20 cm

O2 : None Nasal Cannula Mask None rebreather to maintain 02 sats greater than 90%

Labs: H&H none q 1 hour q 2 hours q 4 hours q 8 hours q 12 hours daily  Blood Sugar none q 1 hour q 2 hours q 4 hours q 8 hours q 12 hours daily

  __CBC, __BMP, __CMP, __UA, __PT&PTT,

Xrays:

Sliding scale: None Standard Low Dose Standard Medium Dose Standard High Dose

Medications:   Altace 5 mg 1 tablet po daily Altace 10 mg 1 tablet po daily Alupent 2 puffs four times daily none Neuronting 500 mg po four times daily

                             

Consults: Bariatric Coordinator, Dietician.

                None Carolina Cardiology Pulmonary Adalakha Pulmonary Creagha Pulmonary Allyene Pulmonary Denneberg Sanger Clinic Digestive Disease Associates

Kamran Borhanian, MD   Pager 328-4078 Alex R. Espinal, MD    Pager 328-4035

 office: 324-5858