New Intern Guide

 

INTERNAL MEDICINE ADMISSION Please   admit to room of choice/near nurses/ Please nurses/ ICU ICU un under der the service of Dr._____ Monitor VS Monitor  VS Q4H/QHourly and record Diet: NPO/DAT/Low Diet:  NPO/DAT/Low Salt and Low fat Venoclysis:: PNSS 1L x __cc/H Venoclysis LABS:   CBC, APC, U/A, S. Na, K, Ca, FBS, Crea, SGPT, Lipid Profile, Uric LABS: Acid, ECG 12 Leads, Chest Xray, CBG now(routine) Meds: S/O: MIO Qshift and record S/O: MIO Stool and vomitus count sheet (diarrhea and vomit) Replace GIonce losses Relay labs invol/vol w/PLR Will inform Dr.___ of this admission Watch out for any untowards S/Sx Refer accordingly Thank you. Resident/Intern

PEDIATRICS (ER) ADMISSION Please admit Please  admit to room of choice/ PICU under the service of Dr._____ Monitor VS Monitor  VS Q4H/QHourly and record Diet: NPO/DAT/No Diet:  NPO/DAT/No Dark colored foods Venoclysis:: Venoclysis LABS: CBC, LABS:  CBC, APC, S. Na, K, U/A, F/A, Chest Xray APL

PEDIATRICS (NICU) ADMISSION TOB: BW: BL T: HC: CC: AC: AS: OBAOG: PAOG:

Please admit to NICU under the service of Dr._____ Please admit TPR QHourly and record Diet: May Diet:  May have breast feeding Venoclysis:: Venoclysis LABS:   CBC, APC, Blood typing, Blood CS(PROM), New LABS: born screening within 24 hours Meds: Erythromycin eye ointment OU Phytomenadione 1mg IM Hep B vaccine 0.5ml IM BCG 0.05ml prior to discharge S/O: Routine S/O:  Routine newborn care Thermoregulate between 36.5-37.5

Maternal BT: HBsAg;NR RPR:NR (NR=non Reactive)

Reweigh px every other day Suction secretion prn Daily Cord Care Will inform Dr.___ of this admission Watch out for any untowards S/Sx Refer accordingly

Resident/Intern

SKIN TEST ORDER (-)erythema (-) induration

*Negative Skin Test(NST) CEFUROXIME(Zegen)

Meds:

to

*NST to Generic(Brand)

S/O: MIO Qshift and record S/O: MIO Stool and vomitus count sheet (diarrhea and vomit) Replace GI losses vol/vol w/PLR Relay labs once in Will inform Dr.___ of this admission Watch out for any untowards S/Sx Refer accordingly Thank you. Resident/Intern

IV FOLLOW UP (-/+)dry lips (-/+)dry tonque

*IVF to ff: D5LR 1Lx 100cc/H Resident/Intern (Refer to the latest IV patient/or ask the nurse)

of the

TRANSOUT ORDERS SURGERY ADMISSION Please admit Please  admit to room of choice/ SICU under the service service of Dr._____ Monitor VS Monitor  VS Q4H/QHourly and record Diet: NPO/DAT Diet:  NPO/DAT Venoclysis:: D5LR/PLR 1L x__cc/H Venoclysis LABS: CBC, LABS:  CBC, Protime, APTT, CT, BT, Blood typing S. Na. K, U/A Meds: S/O: MIO Qshift and record S/O: MIO Will inform Operating Room Will inform Dr.___ of this admission Dr. ___ for anesthesia Watch out for any untowards S/Sx Refer accordingly Thank you.

Resident/Intern

T: P: R: BP: (-)headache (-) vomiting (+)able to flex knees=for spinal anesthesia

*May Transfer Patient Back to Room *D/C O2 and Pulse Oximeter *Monitor VS Qhourly and record *MIO QHourly and record, *Refer for UO38.5C(10mg/kg/dose) *Ranitidine __mg Q8H SIVTT(NPO)(1mg/kg/dose) *Metronidazole __mg/ml; S/O: Fast Drip __CC of PLR __ml now  Q8H IVTT(30-50mg/kg/day) now  MIO Qshift and record Stool and vomitus count sheet Replace GI losses vol/vol w/PLR Relay labs once in Will inform Dr.___ of this admission Watch out for any untowards S/Sx Refer accordingly Thank you.

CP(Cardiopulmonary)

ASSESSMENT(PEDIATRICS)

T: P: R: Bmkko0gP: SCE, CBS, RCRR, (-)dyspnea

*CP Status Assessed *May transfuse ___cc of PRBC/FWD/Modified PRBC/ Platelet Conc of patient’s blood type after proper crossmatching Monitor VS Q15min for the 1 st hour then Qhourly therafter *Mainline to KVO(Keep vein Open) while on BT *Watch out for any untowards S/Sx like fever tachypnea, rashes *Refer Accordingly *Thank You Resident/intern

CO-MANAGEMENT *Surg/IM/Pedia/Gyne Notes *Thank You for this referral *Patient seen and Examined *History and PE reviewed *Will inform Dr.____ of this referral *Watch out for any untowards S/Sx *Refer accordingly Resident/Intern

PATIENTS WITH CARRIED WRITTEN ORDER(C.W.O) (Copy the written order of consultant every word every letter) C.W.O Dr(consultant)/Resident/Intern

ACUTE TONSILLOPHARYNGITIS EXUDATIVE/NON-EXUDATIVE Please  admit to room of Please

choice under the service of Dr._____

Monitor VS Q4H and record Monitor VS Diet: NPO/DAT Diet:  NPO/DAT Venoclysis:: Venoclysis LABS: CBC, LABS:  CBC, APC, S. Na, K, U/A, F/A, Chest Xray APL Meds:   Meds: *Cefuroxime 20-40mg/kg/day(ORAL) or 50-100mg/kg/day(IV) TID *or Co-amoxiclav 30-50mg/kg/day TID *Paracetamol __mg/__ml;__ml Q4H prn for fever 37.838.5C(10mg/kg/dose) *Paracetamol__mg prn for fever >38.5C(10mg/kg/dose) *Ranitidine __mg Q8H SIVTT(NPO)(1mg/kg/dose) S/O: MIO S/O:  MIO Qshift and record Replace GI losses vol/vol w/PLR Relay labs once in Will inform Dr.___ of this admission Watch out for any untowards S/Sx Refer accordingly Thank you.

 

PEDIATRIC COMMUNITY ACQUIRED PNEUMONIA C or D

BENIGN FEBRILE CONVULSION

Please admit to room of choice under the service of Dr._____ Please  Monitor VS Monitor  VS Q4H and record Diet: NPO/DAT Diet:  NPO/DAT Venoclysis:: Venoclysis LABS: CBC, LABS:  CBC, APC, S. Na, K, U/A, F/A, Chest Xray APL Meds:   Meds: *Antibiotic(Refer to table for PCAP) *Paracetamol __mg/__ml;__ml Q4H prn for fever 37.838.5C(10mg/kg/dose) *Paracetamol__mg prn for fever >38.5C(10mg/kg/dose) *Salbutamol ½ nebule +2cc of PNSS; PAI 1 nebule x 3 doses every

Please admit to room of choice/PICU under the service of Dr._____ Please admit Monitor VS Monitor  VS Q4H and record Diet: NPO Diet:  NPO temp Venoclysis:: Venoclysis LABS: CBC, LABS:  CBC, APC, S. Na, K, U/A, F/A, Chest Xray APL Meds:   Meds: *Diazepam(0.2mg/kg/dose) *Paracetamol __mg/__ml;__ml Q4H prn for fever 37.838.5C(15mg/kg/dose) *Paracetamol__mg prn for fever >38.5C(15mg/kg/dose) S/O: MIO S/O:  MIO Qshift and record

15mins(DOB) *Ranitidine __mg Q8H S/O: MIO S/O:  MIO Qshift and record Relay labs once in Will inform Dr.___ of this admission Watch out for any untowards S/Sx Refer accordingly Thank you.

Seizure precautions at bedside Stand by O2 at bedside Relay labs once in Will inform Dr.___ of this admission Watch out for any untowards S/Sx Refer accordingly Thank you.

SIVTT(NPO)(1mg/kg/dose)

BRONCHIAL ASTHMA IN ACUTE EXCACERBATION Please admit to room of choice under the service of Dr._____ Please  Monitor VS Monitor  VS Q4H and record Diet: DAT/ Diet:  DAT/ NPO(tachypneic) Venoclysis:: Venoclysis LABS: CBC, LABS:  CBC, APC, S. Na, K, U/A, F/A, Chest Xray APL Meds:   Meds: *Salbutamol ½ nebule +2cc of PNSS; PAI 1 nebule x 3 doses every 15mins(DOB) *Salbutamol ½ nebule+2cc PNSS Q8H prn for DOB *Hydrocortisone(5mg/kg/dose)Q4H S/O: 02 S/O:  02 at _LPM/standby O2 at bedside MIO Qshift and record Relay labs once in Will inform Dr.___ of this admission Watch out for any untowards S/Sx Refer accordingly Thank you.

NEONATAL SEPSIS Please admit to NICU/PICU the service of Dr._____ Please admit Monitor VS Monitor  VS Q4H and record Diet: Cont.Breastfeeding Diet: Cont.Breastfeeding Venoclysis:: Venoclysis LABS: CBC, LABS:  CBC, APC, S. Na, K, U/A, F/A, Chest Xray APL Meds:   Meds: *Amicillin 50-100mg/kg/day TID *Cefotaxime or Ceftazidime(30-50mg/kg/day)BID S/O: Daily S/O:  Daily cord care Phototherapy MIO Qshift and record Relay labs once in Will inform Dr.___ of this admission Watch out for any untowards S/Sx Refer accordingly Thank you.

or

TID

DENGUE FEVER W/ OR W/o WARNING SIGNS or SYSTEMIC VIRAL INFECTION HYPERSENSITIVITY REACTION

Please admit to room of choice under the service of Dr._____ Please  Monitor VS Monitor  VS Q4H and record Diet: NPO/DAT Diet:  NPO/DAT Venoclysis:: Venoclysis LABS:   CBC, APC, S. Na, K, U/A, F/A, Chest Xray APL, Dengue NS1Ag, LABS: Blood and Rh Typing Meds:   Meds: *Paracetamol __mg/__ml;__ml Q4H prn for fever 37.838.5C(10mg/kg/dose) *Paracetamol__mg prn for fever >38.5C(10mg/kg/dose) *Ranitidine __mg Q8H SIVTT(NPO)(1mg/kg/dose S/O: MIO S/O:  MIO Qshift and record Relay labs once in Will inform Dr.___ of this admission Watch out for any untowards S/Sx

Please admit Please  admit to room of choice/ PICU under the service of Dr._____ Monitor VS Q4H/QHourly and record Monitor VS Diet: Hypoallergenic Diet:  Hypoallergenic Diet Venoclysis:: Venoclysis LABS: CBC, LABS:  CBC, APC, S. Na, K, U/A, F/A, Chest Xray APL Meds: *Epinephrine 0.3cc IM now *Diphenhydramine(1 mg/kg/dose)IV now *Hydrocortisone (5mg/kg/dose) Q8H *PAI Salbutamol 1 nebule +2cc NSS Q15 mins x 3 doses S/O: MIO Qshift and record Relay labs once in Will inform Dr.___ of this admission Watch out for any untowards S/Sx

Refer accordingly Thank you.

Refer accordingly Thank you. Resident/Intern

 

FLUID CHOICE

NEWBORN FLUID and FEEDING Common fluid choice is D5IMB

SURGERY Admitted on Diet as Tolerated(DAT) *Plain Lactated Ringer(PLR) Admitted on Nil per Orem(NPO) *Dextrose5%Lactated Ringer(D5LR) (need to provide sugar(dextrose) as source of energy) Example order: *Venoclyis:PLR 1Liter X125cc/H INTERNAL MEDICINE Admitted *Plain on anyNormal diet Saline Solution(PNSS) To Hydrate Acute gastroenteritis Patient’s  Patient’s   *Use Plain Lactated Ringers Example order: *Venoclyis:PNSS 1Liter X125cc/H OB-GYNE Admitted(OB case) on labor *D5LR Admitted(Gyne case) *PLR, once on NPO shift to D5LR Example order: *Venoclyis:D5LR 1Liter X125cc/H **maximum fluid to give is 125cc/H

PEDIATRICS  >15kg

0-1day old 80cc/kg/D 2days old 90cc/kg/D 3days old 100cc/kg/D 4days old 110cc/kg/D 5days old 120cc/kg/D 6days old 130cc/kg/D 7days old 140cc/kg/D 8days old 150cc/kg/D(maximum) Example case: 3days old newborn weighs 2kgs with some complications. Newborn is on daily feeding with 10cc/3H *Ffeeding is usually given every 3 hours. So 10cc/3H=3.33cc/H IVF: 100 X 2/24=8.33cc/H Since patient is fed and not on NPO: 8.33-3.33=5cc/H Sample Order: Diet: Continue feeding at 10cc/H IVF:D5IMB 500cc X 5cc/H

COMMONLY USED FORMULA Mean Arterial Pressure MAP=Systole+2Diastole 3

*D5LR 90%- normal 70-80%- moderate 80-90%- mild 95%- normal 80-90%- moderate 90-95%- mild