The patient was admitted for complaints of lethargy, headache, pruritus, lower extremity edema, nausea, and emesis. Diagnostic tests ordered include blood tests, a urinalysis, EKG, and chest x-ray. Medications ordered include IV fluids, insulin, diuretics, antiemetics, and medications for fluid and electrolyte imbalance. Nursing notes document the patient's admission information, diagnostic tests, and medications.
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Endorsement Notes
The patient was admitted for complaints of lethargy, headache, pruritus, lower extremity edema, nausea, and emesis. Diagnostic tests ordered include blood tests, a urinalysis, EKG, and chest x-ray. Medications ordered include IV fluids, insulin, diuretics, antiemetics, and medications for fluid and electrolyte imbalance. Nursing notes document the patient's admission information, diagnostic tests, and medications.
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ENDORSEMENT NOTES
Student’s Name: MIGUEL KELLY D. CATANE IVF’S Diagnostic Tests Medications
Patient’s Name: ARTURO L. MENDOZA IVF infusion 0.9% Sodium STAT Blood Draws: CBC D50 25 g IV for IV injection Room/Bed: Admission Date: 7/29/2020 chloride at KVO rate (30 with auto differential count, Sodium bicarbonate 50 Age: 52 Religion: Roman Catholic Gender: Male Diet: mL/hr using an IV tubing Comprehensive Metabolic mEq for IV Inj CC: complaints of S/P: with a drop factor of 15 Panel, BUN, Creatinine level, Sodium Polystyrene lethargy, banding gtt/mL fingerstick blood sugar (Kayexalate) for Oral headache, pruritus on Calcium gluconate 2 g IV check, and ABGs administration both legs, lower bag for infusion Urinalysis Regular Insulin (Humulin extremity edema, STAT 12-lead EKG, Chest X- R) vial and 100 unit Insulin nausea, and emesis ray APL syringe Admitting Dx: AP: Furosemide (Lasix) 20 mg Fluid and electrolyte IV vial for injection imbalance Remarks: Ondansetron (Zofran) 4
Previous Nursing Diagnosis/es: mg vial
Hydralazine 20 mg IV vial
Activity Restriction/s: for inj
Calcium gluconate 2 g IV bag for infusion Albuterol 1.5 mg/3mL Nebule for Inhalation 0.9% Sodium Chloride and tubing with corresponding drop factor