COURSE IN THE WARD

July 21, 2012 DOCTORS ORDER RATIONALE NURSING RESPONSIBILITIES To maintain patients nutritional status Admitted the patient as ordered Prepared and filled out necessary documents Obtainedinitial vital signs and recorded Assisted the patient to room of choice Informed and explainedto the patient and significant others about the ordered diet Informed the dietary department regarding the diet of the patient Monitored V/S q shift, recorded and reported immediately any deviations Verified doctors order Informed the patient about the diagnostic exams Filled out necessary request forms Informed the laboratory department about the exams Followed up results and attached it to the patients chart.

Please admit to ROC under the service of Dr. Mark Guzman

For further monitoring, management, and evaluation of patients condition

DAT

V/S q Shift

To monitor deviation from normal values

Diagnostics: CBC with APC UA ASO Titer; ESR X-ray both feet AP/O BUA

To evaluate alterations in blood components To determine alterations in urine components To rule out presence of Group A Beta-hemolytic Streptococcus To assess presence of inflammation To assess if there is any degree of kidney damage To visualize the underlying organ within the feet To assess presence of uric acid level in the blood

Therapeutics: IVF: PNSS 1L x 12 hours

For hydration and to facilitate fluid and electrolyte replacement and serve as an access for IV

Verified doctors order Regulated at 20-21 gtts/ minute and put on IV tag.

medication. Medications: Co- Amoxiclav 1.2 g/ IV q 12 hrs. (-) ANST Ketorolac 1 amp/ IV now then q 8 hrs. Ranitidine 1 amp/iv q 8 hrs. Paracetamol 500mg/tab q 4 for fever To treat inflammation and infection For pain relief To prevent gastric irritation Antipyretic Verified doctors order Performed skin testing Observed 10 Rs of drug administration >Right Drug >Right Dosage >Right Client >Right Route > Right Time > Right Documentation >Right Education > Right assessment > Right Refuse > Right Evaluation Monitored vital signs Monitored patients I & O q shift, recorded and reported any deviations Informed the physician about the admission Referred and endorsed accordingly Verified doctors order Informed the patient about the diagnostic exam Filled out necessary request forms Informed the laboratory department about the exam Followed up results and attached it to the patients chart. Referred and endorsed accordingly

I & O q shift and record

For monitoring of fluid status For further assessment and treatment For further assessment and treatment To rule out Rheumatoid Arthritis

Pls. inform AP regarding the admission Refer 6:35 PM For CRP, Rheumatoid factor

Refer

For further assessment and treatment

July 22, 2012 Gouty arthritis vs. Rheumatoid Arthritis Start Pen-G 2.5 U IV q 8 - Prednisone 20mg 1tab TID - Ranitidine 50mg IV q 8 Continue Ketorolac IV Vaitril S 1 tab BID

To prevent infection For inflammation To prevent gastric irritation For pain relief For pain relief

Verified doctors order Observed 10 Rs of drug administration >Right Drug >Right Dosage >Right Client >Right Route > Right Time > Right Documentation >Right Education > Right assessment > Right Refuse

Low Purine Diet

To prevent increase of uric acid level

Elevate both legs with 1 pillow Flat on bed with bathroom privileges

To decrease swelling and improve venous return To improve venous return and provide independent mobility

Allopurinol 300mg/ tab or at HS

Inhibits the enzyme responsible for the conversion of purines to uric acid thus reducing the production of uric acid

> Right Evaluation Monitored vital signs Informed and explained to the patient and significant others about the ordered diet Informed the dietary department regarding the diet of the patient Instructed and assisted the patient to elevate both legs with 1 pillow Instructed the patient about the order and provided bathroom privileges Verified doctors order Observed 10 Rs of drug administration >Right Drug >Right Dosage >Right Client >Right Route > Right Time > Right Documentation >Right Education > Right assessment > Right Refuse > Right Evaluation Monitored vital signs

July 23, 2012 Decrease Pen-G 1U IV q 6 Bactericidal: Inhibits cell wall synthesis of sensitive organisms, causing cell death. Verified doctors order Administered as order Observed 10Rs of safe drug administration Informed and explained to the patient and significant others about the order Verified doctors order Discontinued Ketorolac and started cello 200mg BID Observed 10Rs of safe drug administration Verified doctors order Regulated at KVO and put on IV tag.

Gargle with Bactidol TID (PC)

Use as oral antiseptic

Discontinue Ketorolac IV, start Celecoxib 200mg BID

To avoid over dosage

Continue: - PNSS IVF at KVO

For hydration and to facilitate fluid and electrolyte replacement and serve as an access for IV medication

NPO for midnight refer Uric Acid ESR tomorrow AM

To gather accurate result for tomorrows diagnostic examination

Refer accordingly

For further assessment and treatment.

Verified doctors order Informed the patient about the diagnostic exam Filled out necessary request forms Informed the laboratory department about the exam Followed up results and attached it to the patients chart Referred accordingly Referred and endorsed accordingly

July 24, 2012 MGH Signs and symptoms are manageable; not causing so much trouble to the patient To prevent infection To prevent gastric irritation For pain relief Anti-inflammatory The patient must do follow up check-up to continue post care Instructed patient to visit OPD for scheduled check-ups Advised patient to report recurrences of signs and symptoms Verified doctors order Informed the patient about the diagnostic exam Filled out necessary request forms Informed the laboratory department about the exam Followed up results and attached it to the patients chart Verified doctors order Instructed patient to take prescribed medications with the right time, right route and right dosage

Home meds: Co-Amoxiclav 625mg/tab BID x 2 weeks Omeprazole 20mg 1 tab OD x 2 weeks Viartryl S 1 tab BID x weeks Prednisone 20mg 1 tab TID x 2 weeks PC Follow up check-up

Repeat ESR, CBC, and BUA

To note changes that may affect the pathological process