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Pre-operative prescribing


Setting: You are a junior doctor based on a surgical firm.

Patient: Kane White (DOB 22/03/1972, Hospital number 723111, Address: 12 Smith Street, Wareham, WR22 2HD) has come in this afternoon for admission prior to his Whipple’s procedure tomorrow.

He has a history of pancreatic cancer, hypertension and peripheral vascular disease.

He does not have any allergies and weighs 81kg.

He brought a list of his medications (click to enlarge):

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The patient says he stopped aspirin 6 days ago as advised by an anaesthetist he saw in clinic.

Blood results: Hb 103 g/L (130-180), WCC 4.5 x10^9/L (4-11), Plt 266 x10^9/L (150-500), Na+ 137 mmol/L (133-146), K+ 4.5 mmol/L (3.5-5.4), Ur 4.5 mmol/L (2.5-7.8), Cr 92 mmol/L (59-104), Mg 0.4 mmol/L (0.8-1.0), INR 1.0 (0.8-1.2)

Task: Please complete the patients drug and fluid prescription charts. You have clarified with your consultant and she has specified:

  1. The patient should have venous thromboembolism prophylaxis this evening but not on the day of the operation
  2. The patient should have maintenance intravenous fluids overnight as he will be nil by mouth from midnight (please prescribe 2L initially in case of delay in list)
  3. Aspirin can be resumed on day 5 post-op
  4. Any antihypertensives should not be given today or on the day of the operation
  5. Any electrolyte abnormalities must be corrected intravenously

Please also write up an antiemetic and paracetamol in case the patient needs them post-op.

You have 8 minutes and there will be no questions. Your national formulary (e.g. BNF in UK) is available if needed.

Drug chart can be printed here. Fluid chart can be printed here.

There is no patient present in this station.

An example of a correctly completed drug chart can be viewed here.

An example of a correctly completed fluid chart can be viewed here.

Category Question
Done
Excellent
Patient Patient details completed correctly on both charts
Full name
Hospital number
DOB
Address (drug chart only)


Allergies Allergy box completed on both charts
None known
Signed and dated


Other Other details completed on both charts
Date chart started
Chart number
Weight entered


Fluids Fluid chart 1
Prescribed IV magnesium replacement
Fluid = 0.9% saline
Additive = 2-5g magensium sulfate
Volume = 200-500ml (depending on magnesium content)
Duration = 100ml/h (or total duration equivalent)
Dated and signed


Fluids Fluid chart 2
Maintenance fluid prescribed
Fluid choice = 2x dextrose-saline (preferred); or 1x dextrose, 1x normal saline
1L volume bags x2
Additive 20mmol KCl in one or both bags
Rate = approximately 1.5ml/kg/h
Dated and signed


PRN 1 As required medication 1
Paracetamol 1g
Route = IV or PO or IV/PO
Indication for nurses given (e.g. pyrexia/pain)
Frequency 4-6 hourly
Max dose 4g
Signed and dated


PRN 2 As required medication 2
Anti-emetic e.g. Cyclizine 50mg or Ondansetron 4mg
Route = IV or PO or IV/PO
Indication for nurses given (e.g. nausea/vomiting)
Frequency Cyclizine 6-8 hourly, Ondansetron 4-6 hourly
Max dose Cyclizine 150mg, Ondansetron 16mg
Signed and dated


Regular Regular medications
Enoxaparin 40mg S/C or Dalteparin 5000units S/C or local hospital alternative
Anti-embolism stockings should not be given in PVD (IPCs may be considered instead)
Aspirin 75mg PO
Ramipril 5mg ON
Times correct
Indications completed
Special instructions completed
Aspirin suspended correctly until day 5 post-op
Enoxaparin/Dalteparin suspended on day of operation
Ramipril suspended today and on day of operation
Signed and dated


Other Other points
Considers (or says they would check) drug interactions



Submit your answers to get your score.

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