449 CASE SCENARIO. MR W. N. LEFT HAND CELLULITIS / DOG BITE.

KINGDOM OF GOD HOSPITAL LOS ANGELES,CALIFORNIA 900000.

Interdisciplinary Kardex.

Attending doctor: Tumtum,Worry

Primary diagnosis: Left hand Cellulitis due to dog bite. S/P incision and drainage of left 03/04/21.

Secondary diagnosis: Diabetes.

Code Status: Full code.

Age/ Sex : 39years old male.

Status: Inpatient admission.

Date of admission:.03/04/2021.

Acount number : Q000000050.

MR# :Q867000447.

Location: Surgical Department.

Room number:400006.

Weight: 140lbs.

Height: 5ft 4inches.

Isolation status:Standard precautions.

Is patient at risk for falls. NO.

Do patient have advanced Directive: NO.

Copy of advanced Directive on the chart.

02 Saturation on Room Air 97%.

Allergy: NKDA.

Diet : Carb control diet.

Medications.

Vancomycin 1gm IV Q12hours.

Rocephin 1gm IV Q24hours.

Lovenox 40mg SubQ Q24hours.

0.9NS at 75ml/hour right forearm via pump. Norco 10/325mg po Q4hours prn pain. Morphine sulfate 2mg IV Q4hours prn severe pain >6/10

Zofran 4mg IV Q4hours prn nausea/Vomiting.

Left hand swollen and elevated on pillows. Sutures intact.

Published by edochie99

A Registered Nurse with over twenty years of hospital experience, an author with Masters Degree in Nursing,also Bachelor Degree in Nursing,graduated in 1996 from USC,University of Southern California.MSN in 2009 University of Phoenix.

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