HANI GUDA Staff asked 4 years ago
Patient AS is admitted to your surgical floor following a hip replacement surgery.
She is 75 years old.
Allergies: Penicillin (severe)
Medical conditions: High blood pressure, Hypothyroidism, Anemia, GI reflux, Osteoporosis.
Weight 65kg, CrCl 25 mL/min, other blood work: within normal limits.
Her home medications are the following:
- Synthroid 100mcg po daily
- Ferrous sulfate 300mg po BID
- Fosavance (Alendronate 70mg + Vit D 5600 unit) once weekly
- Ramipril 5mg po BID
- Esomeprazole (Nexium) 40mg po daily
- Docusate sodium 200mg po BID
After surgery, all home medications were continued, along with the following additional post-op orders:
- Cephalexin 500mg po q6h for 5 days
- Rivaroxaban 10mg po daily for 4 weeks
- Acetaminophen 650mg po q6h PRN
- Hydromorphone 2mg po q4h PRN
- Ranitidine 150mg po BID
You are verifying the patient’s orders post-op, and you realize that Rivaroxaban is contraindicated in patients with CrCl less than 30mL/min, and know that hospital policy is to give Enoxaparin 30mg subcut daily instead. You also recognize her penicillin allergy and note that pre-operatively she received Clindamycin 900mg IV instead of the usual cefazolin. You’re also debating whether ranitidine is appropriate for this patient or not.
You call for the surgeon, but he is in the OR and his nurse tells you that you can leave him all your recommendations in the chart, he will have a look when he is done in the OR.
Please document below your recommendation as you would chart it for the surgeon to review.
