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    Pearls

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    patriciaatan1497
    This clinical pathway provides guidelines for the treatment of patients presenting with blunt abdominal trauma and signs of peritonitis at Negros Oriental Provincial Hospital. It outlines orders for vital sign monitoring, diagnostic tests, IV fluids, antibiotics, and a diet of nothing by mouth. It also specifies a plan for exploratory laparotomy surgery, pre-op evaluation, informed consent, post-op care, and discharge instructions once the patient has normal GI function. The pathway is to be activated upon signing by the surgical resident on duty and nurse in charge, and discontinued if the patient's condition changes or fails to meet outcomes within 24-48 hours.

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    Pearls

    Uploaded by

    patriciaatan1497
    17 views2 pages
    This clinical pathway provides guidelines for the treatment of patients presenting with blunt abdominal trauma and signs of peritonitis at Negros Oriental Provincial Hospital. It outlines orders for vital sign monitoring, diagnostic tests, IV fluids, antibiotics, and a diet of nothing by mouth. It also specifies a plan for exploratory laparotomy surgery, pre-op evaluation, informed consent, post-op care, and discharge instructions once the patient has normal GI function. The pathway is to be activated upon signing by the surgical resident on duty and nurse in charge, and discontinued if the patient's condition changes or fails to meet outcomes within 24-48 hours.

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    This clinical pathway provides guidelines for the treatment of patients presenting with blunt abdominal trauma and signs of peritonitis at Negros Oriental Provincial Hospital. It outlines orders for vital sign monitoring, diagnostic tests, IV fluids, antibiotics, and a diet of nothing by mouth. It also specifies a plan for exploratory laparotomy surgery, pre-op evaluation, informed consent, post-op care, and discharge instructions once the patient has normal GI function. The pathway is to be activated upon signing by the surgical resident on duty and nurse in charge, and discontinued if the patient's condition changes or fails to meet outcomes within 24-48 hours.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    17 views2 pages

    Pearls

    Uploaded by

    patriciaatan1497
    This clinical pathway provides guidelines for the treatment of patients presenting with blunt abdominal trauma and signs of peritonitis at Negros Oriental Provincial Hospital. It outlines orders for vital sign monitoring, diagnostic tests, IV fluids, antibiotics, and a diet of nothing by mouth. It also specifies a plan for exploratory laparotomy surgery, pre-op evaluation, informed consent, post-op care, and discharge instructions once the patient has normal GI function. The pathway is to be activated upon signing by the surgical resident on duty and nurse in charge, and discontinued if the patient's condition changes or fails to meet outcomes within 24-48 hours.

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    ccDEPARTMENT OF SURGERY

    Negros Oriental Provincial Hospital

    CLINICAL PATHWAY FOR


    BLUNT ABDOMINAL TRAUMA

    PHYSICIAN’S ADMITTING ORDER SHEET

    Inclusion criteria: All patients presenting with blunt abdominal trauma WITH CLINICAL SIGNS OF PERITONITIS
    Expected LOS: _____ Days
    Exclusion criteria: no signs of peritonitis, significant comorbidities
    Date : : Day ______

    Patient’s Name Age : Weight: Hospital #:


    Height:
    BMI:
    Last Name First name Middle Name
    ORDERS
    PHYSICIAN’S NOTES: Admit to _______ under the service of Variance Sign
    S: Subjective Complaints/ Symptoms Dr. __________________________

    Vital Signs Monitoring q

    Diagnostics/ Procedures:
    ▪ Bloodtyping
    ● HBsAg
    € ABG
    O: Objective, Physical/ Lab Findings € PROTIME
    VS: € CBC
    BP: HR: RR: T:
    IVF with double line using PLR @ 30 gtts/min
    Pain Score: each

    C/L: Start meds:


    ▪ Cefuroxime 750mg IVTT q 8h
    Abd: ▪ Metronidazole 500 mg IV drip q 8h
    € Ranitidine 50 mg IVTT q 8h
    € Tramadol 50 mg IVTT q 6h
    Rectal:
    € Insert NGT Fr16 open to drain
    € Insert FBC Fr16 attach to urobag

    A: Assessment/ Working Impression/ Diet: NPO


    Clinical Diagnosis Activity: Complete bed rest without toilet
    privileges
    Acute Abdomen sec to Blunt abdominal trauma
    Consults/ Co-management orders:
    € Refer to Anesthesia for pre-op evaluation
    P: Plan of Care
    Procedures:
    Diagnostics/ Imaging: Direct to OR for Exploratory Laparotomy
    Blood typing, HBsAg Secure consent for procedure and
    photodocumentation

    Therapeutics: Provide for psychosocial needs


    ● Patient appraised of the clinical
    Surgery situation and the need for emergency
    Exploratory laparotomy surgery and also appraised of the
    Antibiotic therapy risk, benefit and possible
    complications

    Provide patient/Family education


    Patient’s family appraised of current situation

    Discharge Plan:
    Discharge if without complications once with
    normal GI function
    Take home medications, wound care and follow
    up instructions to be given

    Activated by: Acknowledged by:


    ______________________ _________________________
    Surgical Resident on Duty Nurse in charge

    NOTE: THIS PATHWAY WILL BE ACTIVATED ONCE SIGNED BY THE SURGICAL RESIDENT ON DUTY AND NURSE IN
    CHARGE AND SHOULD BE STOPPED WHEN AN ADVERSE REACTION IS NOTED.

    ● Both AP and NIC must sign at the bottom of the pathway form to activate it
    ● The pathway will be discontinued by anyone whenever:
    1. The patient’s primary diagnosis changes
    2. The patient’s condition significantly worsens
    3. The patient fails to meet clinical outcomes for 24-48 hours
    ● Variance codes:

    A. PATIENT/FAMILY B. CLINICAL C. SYSTEM D. COMMUNITY


    a.1 Non-adherence to b.1 Development of a c.1 Lack of available d.1 Unable to contact
    plan of care new medical Equipment / Community Health
    a.2 Patient or family /surgical problem Medicines Service
    refuses discharge b.2 Exacerbation of c.2 Failure to perform a d.2 Delay in availability
    a.3 Financial constraints underlying condition recommended of recommended
    a.4 Home per b.3 Delay in response to procedure support
    request/against medical treatment c.3 Delay in response to
    medical advice interdepartmental
    a.5 Absconded referral (co-
    management,
    consult, or transfer
    of service)

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