INTERNAL MEDICINE PEDIATRICS (NICU)

ADMISSION ADMISSION
Please admit to room of choice/near nurses/ ICU under the service of TOB: Please admit to NICU under the service of Dr._____
Dr._____ BW: TPR QHourly and record
Monitor VS Q4H/QHourly and record BL Diet: May have breast feeding
Venoclysis:
Diet: NPO/DAT/Low Salt and Low fat T:
LABS: CBC, APC, Blood typing, Blood CS(PROM), New
Venoclysis: PNSS 1L x __cc/H HC: born screening within 24 hours
LABS: CBC, APC, U/A, S. Na, K, Ca, FBS, Crea, SGPT, Lipid Profile, Uric CC: Meds:
Acid, ECG 12 Leads, Chest Xray, CBG now(routine) AC: Erythromycin eye ointment OU
Meds: AS: Phytomenadione 1mg IM
OBAOG: Hep B vaccine 0.5ml IM
S/O: MIO Qshift and record PAOG: BCG 0.05ml prior to discharge
Stool and vomitus count sheet (diarrhea and vomit) S/O: Routine newborn care
Thermoregulate between 36.5-37.5
Replace GI losses vol/vol w/PLR Maternal
Reweigh px every other day
Relay labs once in BT: Suction secretion prn
Will inform Dr.___ of this admission HBsAg;NR Daily Cord Care
Watch out for any untowards S/Sx RPR:NR Will inform Dr.___ of this admission
Refer accordingly (NR=non Watch out for any untowards S/Sx
Thank you. Reactive) Refer accordingly
Resident/Intern Resident/Intern

PEDIATRICS (ER)
ADMISSION
Please admit to room of choice/ PICU under the service of Dr._____
SKIN TEST ORDER
Monitor VS Q4H/QHourly and record
Diet: NPO/DAT/No Dark colored foods
Venoclysis: (-)erythema *Negative Skin Test(NST) to
LABS: CBC, APC, S. Na, K, U/A, F/A, Chest Xray APL (-) induration CEFUROXIME(Zegen)
Meds:
*NST to Generic(Brand)
S/O: MIO Qshift and record
Stool and vomitus count sheet (diarrhea and vomit)
Replace GI losses vol/vol w/PLR IV FOLLOW UP
Relay labs once in
Will inform Dr.___ of this admission (-/+)dry lips *IVF to ff: D5LR 1Lx 100cc/H
Watch out for any untowards S/Sx (-/+)dry tonque Resident/Intern
Refer accordingly
Thank you. (Refer to the latest IV of the
Resident/Intern patient/or ask the nurse)

TRANSOUT ORDERS
T: P: R: BP: *May Transfer Patient Back to Room
SURGERY (-)headache *D/C O2 and Pulse Oximeter
ADMISSION *Monitor VS Qhourly and record
Please admit to room of choice/ SICU under the service of Dr._____ (-) vomiting *MIO QHourly and record, *Refer for
Monitor VS Q4H/QHourly and record UO<30cc/H
Diet: NPO/DAT (+)able to flex *Watch out for any untowards S/Sx
Venoclysis: D5LR/PLR 1L x__cc/H knees=for spinal *Refer Accordingly
LABS: CBC, Protime, APTT, CT, BT, Blood typing S. Na. K, U/A anesthesia *Thank You
Meds:
Resident/Intern
S/O: MIO Qshift and record
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
BLOOD TRANSFUSION ORDER/ CP(Cardiopulmonary) Acute Gastroenteritis with Mild/Mod/Severe DHN
ASSESSMENT(IM/SURG/GYNE)
Please admit to room of choice under the service of Dr._____
*CP Status Assessed Monitor VS Q4H and record
T: P: R: BP: *May transfuse available unit of Diet: NPO/DAT
SCE, CBS, RCRR, PRBC/FWD/Modified PRBC/ Platelet Conc of Venoclysis:
(-)DOB patient’s blood type after proper LABS: CBC, APC, S. Na, K, U/A, F/A, Chest Xray APL
crossmatching Meds:
Monitor VS Q15min for the 1st hour then *B.Clausii(Erceflora) 1-2 vial TID
Qhourly therafter *Paracetamol __mg/__ml;__ml Q4H prn for fever 37.8-
*Mainline to KVO(Keep vein Open) while on 38.5C(10mg/kg/dose)
BT *Paracetamol__mg prn for fever >38.5C(10mg/kg/dose)
*Watch out for any untowards S/Sx like fever *Ranitidine __mg Q8H SIVTT(NPO)(1mg/kg/dose)
tachypnea, rashes *Metronidazole __mg/ml; __ml Q8H IVTT(30-50mg/kg/day)
*Refer Accordingly S/O: Fast Drip __CC of PLR now
*Thank You MIO Qshift and record
Resident/intern 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.
BLOOD TRANSFUSION ORDER/ CP(Cardiopulmonary)
ASSESSMENT(PEDIATRICS)
ACUTE TONSILLOPHARYNGITIS EXUDATIVE/NON-EXUDATIVE
*CP Status Assessed
T: P: R: *May transfuse ___cc of PRBC/FWD/Modified Please admit to room of choice under the service of Dr._____
Bmkko0gP: PRBC/ Platelet Conc of patient’s blood type after Monitor VS Q4H and record
SCE, CBS, RCRR, proper crossmatching Diet: NPO/DAT
(-)dyspnea Monitor VS Q15min for the 1st hour then Qhourly Venoclysis:
therafter LABS: CBC, APC, S. Na, K, U/A, F/A, Chest Xray APL
*Mainline to KVO(Keep vein Open) while on BT Meds:
*Watch out for any untowards S/Sx like fever *Cefuroxime 20-40mg/kg/day(ORAL) or 50-100mg/kg/day(IV) TID
tachypnea, rashes *or Co-amoxiclav 30-50mg/kg/day TID
*Refer Accordingly *Paracetamol __mg/__ml;__ml Q4H prn for fever 37.8-
*Thank You 38.5C(10mg/kg/dose)
Resident/intern *Paracetamol__mg prn for fever >38.5C(10mg/kg/dose)
*Ranitidine __mg Q8H SIVTT(NPO)(1mg/kg/dose)
S/O: MIO Qshift and record
Replace GI losses vol/vol w/PLR
Relay labs once in
Will inform Dr.___ of this admission
CO-MANAGEMENT Watch out for any untowards S/Sx
Refer accordingly
*Surg/IM/Pedia/Gyne Notes Thank you.
*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
 PEDIATRIC COMMUNITY ACQUIRED PNEUMONIA C or D BENIGN FEBRILE CONVULSION
Please admit to room of choice under the service of Dr._____ Please admit to room of choice/PICU under the service of Dr._____
Monitor VS Q4H and record Monitor VS Q4H and record
Diet: NPO/DAT Diet: NPO temp
Venoclysis: Venoclysis:
LABS: CBC, APC, S. Na, K, U/A, F/A, Chest Xray APL LABS: CBC, APC, S. Na, K, U/A, F/A, Chest Xray APL
Meds: Meds:
*Antibiotic(Refer to table for PCAP) *Diazepam(0.2mg/kg/dose)
*Paracetamol __mg/__ml;__ml Q4H prn for fever 37.8- *Paracetamol __mg/__ml;__ml Q4H prn for fever 37.8-
38.5C(10mg/kg/dose) 38.5C(15mg/kg/dose)
*Paracetamol__mg prn for fever >38.5C(10mg/kg/dose) *Paracetamol__mg prn for fever >38.5C(15mg/kg/dose)
*Salbutamol ½ nebule +2cc of PNSS; PAI 1 nebule x 3 doses every S/O: MIO Qshift and record
15mins(DOB) Seizure precautions at bedside
*Ranitidine __mg Q8H SIVTT(NPO)(1mg/kg/dose) Stand by O2 at bedside
S/O: MIO Qshift and record Relay labs once in
Relay labs once in Will inform Dr.___ of this admission
Will inform Dr.___ of this admission Watch out for any untowards S/Sx
Watch out for any untowards S/Sx Refer accordingly
Refer accordingly Thank you.
Thank you.

BRONCHIAL ASTHMA IN ACUTE EXCACERBATION

Please admit to room of choice under the service of Dr._____
Monitor VS Q4H and record NEONATAL SEPSIS
Diet: DAT/ NPO(tachypneic)
Venoclysis: Please admit to NICU/PICU the service of Dr._____
LABS: CBC, APC, S. Na, K, U/A, F/A, Chest Xray APL Monitor VS Q4H and record
Meds: Diet: Cont.Breastfeeding
*Salbutamol ½ nebule +2cc of PNSS; PAI 1 nebule x 3 doses every Venoclysis:
15mins(DOB) LABS: CBC, APC, S. Na, K, U/A, F/A, Chest Xray APL
*Salbutamol ½ nebule+2cc PNSS Q8H prn for DOB Meds:
*Hydrocortisone(5mg/kg/dose)Q4H *Amicillin 50-100mg/kg/day TID
S/O: 02 at _LPM/standby O2 at bedside *Cefotaxime or Ceftazidime(30-50mg/kg/day)BID or TID
MIO Qshift and record S/O: Daily cord care
Relay labs once in Phototherapy
Will inform Dr.___ of this admission MIO Qshift and record
Watch out for any untowards S/Sx Relay labs once in
Refer accordingly Will inform Dr.___ of this admission
Thank you. Watch out for any untowards S/Sx
Refer accordingly
Thank you.
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._____
Monitor VS Q4H and record Please admit to room of choice/ PICU under the service of Dr._____
Diet: NPO/DAT Monitor VS Q4H/QHourly and record
Venoclysis: Diet: Hypoallergenic Diet
LABS: CBC, APC, S. Na, K, U/A, F/A, Chest Xray APL, Dengue NS1Ag, Venoclysis:
Blood and Rh Typing LABS: CBC, APC, S. Na, K, U/A, F/A, Chest Xray APL
Meds: Meds:
*Paracetamol __mg/__ml;__ml Q4H prn for fever 37.8- *Epinephrine 0.3cc IM now
38.5C(10mg/kg/dose) *Diphenhydramine(1 mg/kg/dose)IV now
*Paracetamol__mg prn for fever >38.5C(10mg/kg/dose) *Hydrocortisone (5mg/kg/dose) Q8H
*Ranitidine __mg Q8H SIVTT(NPO)(1mg/kg/dose *PAI Salbutamol 1 nebule +2cc NSS Q15 mins x 3 doses
S/O: MIO Qshift and record S/O: MIO Qshift and record
Relay labs once in Relay labs once in
Will inform Dr.___ of this admission Will inform Dr.___ of this admission
Watch out for any untowards S/Sx Watch out for any untowards S/Sx
Refer accordingly Refer accordingly
Thank you. Thank you.
Resident/Intern
 FLUID CHOICE NEWBORN FLUID and FEEDING
Common fluid choice is D5IMB
SURGERY
0-1day old 80cc/kg/D
Admitted on Diet as Tolerated(DAT) 2days old 90cc/kg/D
*Plain Lactated Ringer(PLR) 3days old 100cc/kg/D
Admitted on Nil per Orem(NPO) 4days old 110cc/kg/D
*Dextrose5%Lactated Ringer(D5LR) 5days old 120cc/kg/D
(need to provide sugar(dextrose) as source of energy) 6days old 130cc/kg/D
Example order: 7days old 140cc/kg/D
*Venoclyis:PLR 1Liter X125cc/H 8days old 150cc/kg/D(maximum)
Example case:
INTERNAL MEDICINE 3days old newborn weighs 2kgs with some complications. Newborn is on
Admitted on any diet
daily feeding with 10cc/3H
*Plain Normal Saline Solution(PNSS)
To Hydrate Acute gastroenteritis Patient’s
*Ffeeding is usually given every 3 hours. So 10cc/3H=3.33cc/H
*Use Plain Lactated Ringers
Example order:
IVF:
*Venoclyis:PNSS 1Liter X125cc/H 100 X 2/24=8.33cc/H
Since patient is fed and not on NPO:
OB-GYNE
8.33-3.33=5cc/H
Admitted(OB case) on labor Sample Order:
*D5LR
Diet: Continue feeding at 10cc/H
Admitted(Gyne case) IVF:D5IMB 500cc X 5cc/H
*PLR, once on NPO shift to D5LR
Example order:
*Venoclyis:D5LR 1Liter X125cc/H

**maximum fluid to give is 125cc/H

COMMONLY USED FORMULA

Mean Arterial Pressure

PEDIATRICS
>15kg MAP=Systole+2Diastole
*D5LR 3
<15kg
*D50.3NaCl BMI=kg/m2
*D5IMB(used in neonates) <18.5 Underweight
18.5-24.9 Normal
IVF RATE 25-29.9 Overweight
DEHYDRATION <10KG >10KG 30-34.9 Obese
Mild 50 30 35-39.9 Moderately obese
Moderate 100 60 >50 Super morbid obese
Severe 150 90
BSA= wt x kg
Formula:
3600
*Weight X Deficit/8

Example: 6 years old 17kg with dry lips(mild DHN)

Creatinine Clearance:
CrCl= (140-age) X BW
17kg=fluid is D5LR, and use the constant 30.
0.72Xcrea(mg/dl)
*for females use 0.85 instead of 0.72
17x30/8 = 63.75 or 64
Wasting= actual weight X 100
Example Order:
Ideal wt for age
Venoclysis: D5LR 1Lx 64cc/H
>90%- normal 70-80%- moderate
80-90%- mild <70%- severe

Stunting= actual height X 100

Ideal height for age
>95%- normal 80-90%- moderate
90-95%- mild <80%- severe
 Glasgow Coma Scale Ph PCO2 HCO3 BE
ADULT PEDIATRIC
Spontaneously 4 Spontaneously 4 Metabolic Acidosis (Change in HCO3 is greater than change in pCO2) (HCO3 is
To verbal stimuli 3 To verbal stimuli 3 decreased)
To pain 2 Eye To pain 2 Uncompensated  N   (-)
No eye opening 1 Response No eye opening 1
Oriented 5 Appropriate coo 5 Partially Compensated     (-)
and cry
Confused 4 Verbal Irritable cry 4 Complete Compensated N    (-)
Inappropriate words 3 response Inconsolable cry 3 Metabolic Alkalosis (Change in HCO3 is greater than change in pCO2) (HCO3 is
Incomprehensible 2 Grunts 2 increased)
No verbal response 1 No verbal response 1
Obeys command 6 Normal 6 Uncompensated  N   (+)
spontaneous
Best
Partially Compensated    (+)
Localizes pain 5 Withdraws to touch 5
Withdraws to pain 4 motor Withdraws to pain 4 Completely Compensated N    (+)
Flexion to pain 3 response Flexion to pain 3
Respiratory Acidosis (Change in pCO2 is greater than change in HCO3) (pCO2 is
Extension to pain 2 Extension to pain 2
increased)
No motor response 1 No motor response 1
Uncompensated   N N

Partially Compensated    
VACCINATION
Vaccine Age of # of Dose Route SIte Completely Compensated N   
1st doses
dose Respiratory Alkalosis (Change in pCO2 is greater than change in HCO3) (pCO2 is
BCG Birth 1 0.05ml ID R deltoid decreased)
R buttocks Uncompensated   N N
DPT 6 3(6th, 0.5ml IM Upper thigh
weeks 10th,14th Vastus Partially Compensated    
month) lateralis
OPV 6 3(6th, 2- Oral Mouth Completely Compensated N   
weeks 10th, 14th 3drops
month)
COMON MEDICATIONS THAT ARE USED
Hepa B Birth 3(0,4th, 0.5ml IM Vastus
8th week) lateralis Anti-emetic/Anti-vomiting
Measles 9 1 0.5ml SQ R deltoid *Metoclopramide-dopamine receptor blocker
month Recommended Dose:
MMR 12-15th 2 (12th - 0.5ml SQ R deltoid 0.5mg/kg/dose- ORAL
month 15th R buttock 0.2mg/kg/dose- IV
month, Preparation:
4-6Y.O) Ampule:10mg/2ml Syrup: 5mg/ml
5mg/2ml Tab: 10mg
Anto-Spasmodic
*Dicycloverine-anticholinergic activity
Recommended Dose:
2.5-5mg/kg/day-TID
Preparation:
Drops: 5mg/ml Syrup:2mg/ml
15mg/ml Tab: 10mg
*Hyoscine-N-Butyl Bromide(HNBB)-anticholinergic activity
Recommended Dose:
0.15mg/kg/dose-TID
Preparation:
Ampule: 20mg/ml Tab:10mg
Promotility(For Dyspepsia)
*Domperidone
Recommended Dose:
0.3mg/kg/dose
MULTIVITAMINS: ANTIHISTAMINE(H1-receptor blocker)
Preparation: 1st generation
Drops: 100mg/ml Syrup: 100mg/ml *Hydroxyzine HCl(Iterax)-1mg/kg/day, Q12H
Syrup: 2mg/ml
Dosage: <3 months=0.3ml. Increase dosage proportionately to Tab: 10mg, 25mg
the patient’s age base on months *Chlorphenamine maleate-0.2mg/kg/dose, Q8H
6months 0.6ml Ampule:10mg/ml
1y.o 1ml Syrup: 2mg/5ml
1y 6mos 1.5ml *DIphenhydramine- 3-5mg/kg/dose-oral
2y 2ml 1mg/kg/dose-IV
IRON: Syrup: 12.5mg/5ml
Prophylactic dose: 1mg/kg/day OD Cap:25mg/50mg
Therapeutic dose: 3-6mg/kg/day BID IV:50mg/ml
Vitamin A: 2nd generation
6-11mos:100,000 IU-1 dose *Cetirizine-0.25-0.27mg/kg/dose(OD-BID)
12-71mos:200,00 IU Drops: 10mg/ml, 2.5mg/ml
Zinc: Sol’n: 1mg/ml
10mg:infants Syrup:5mg/5ml
20mg:2y.o+ Tab:10mg
*Desloratidine:
6-11mo-2ml
1-5yo-2.5ml
6-11y.o-5ml
ANTIPYRETIC/ANALGESIC >12y.o- 10ml
*Paracetamol-COX inhibitor Syrup: 2.5mg/5ml
Recommended Dose:
10-15mg/kg/dose(Q4H) MUCOLYTIC
Preparation:
Drops: 100mg/ml Tab: 250mg, 325mg,
Syrup:125mg/5ml 500mg
250mg/5ml
Ampule:300mg/ml
*Ibuprofen-prostaglandin synthesis inhibitor
Recommended Dose:
5-10mg/kg/dose(Q6-8H)
Preparation:
Suspension: 100mg/5ml
Capsule:200mg/cap

*Mefenamic Acid-prostaglandin synthesis inhibitor

Recommended Dose:
5-8mg/kg/dose(Q6-8H)
Preparation:
Suspension: 125mg/5ml
Capsule:250mg/cap, 500mg/cap
*Aspirin-
Recommended Dose:
10-15mg/kg/dose
60-100mg/kg/24H(Kawasaki Dse)
ANTACIDS
*Ranitidine-H2 Blocker
Recommended Dose(Q8-12H)
0.75mg/kg//dose-oral
0.8-1mg/kg/dose-IV
Preparation
Ampule: 25mg/ml
50mg/5ml
Tab:150mg, 300mg
Other H2 blockers:
*Cemetidine(10-15mg/kg/dose, Q4-6H)
*Famotidine(0.2mg/kg/dose, Q8H)

*Aluminum/Magnesium Hydroxide
(Q6H)
*Omeprazole 40mg/OD(Proton pump inhibitor)
*Pantoprazole 40mg/OD(Proton-pump inhibitor)
*Esomeprazole 40mg/OD(Proton-Pump inhibitor)
 History and PE reviewed
Laboratory Tests requested
Medications given
Patient managed well

Complete Blood Count:

Segs Hemoglobin Stabs
WBC PLT
Lymphs hematocrit Eosi
Mono
Baso

Urinalysis:
Sugar RBC
Albumin Pus

Squamous Spec.gravity

SURGERY COMMON OUTPATIENT CASES

*Lacerated Wound
Plans:
*For Suturing of Wound
*Secure Consent
*For Xray of ___, ___ view
*TT 0.5ml/amp via deep IM now
*HTIG 250IU/Amp via deep IM now
*Cefalexin (dosage) TID x7 days
*FF. Up Official Xray result after 3 days
*To comeback after __ days for suture removal
*Watch out for any untowards S/Sx
*Advised
*Thank You

Suture Choice:
Nylon 4.0 and 5.0- Face or less muscular area
Nylon 3.0-Extremeties
Suture Removal:
COMMONLY USED TERMS/ PHRASES/ SYMBOLS IN INTERNSHIP Face: 3-5 days
*Physical Examination Extremeties 7-10 days
AS-Anicteric Sclerae
PC-Pinkish Conjunctiva
CLADS-Cervical Lymphadenopathy
SCE-Symmetrical Chest Expansion
CBS-Clear Breath Sounds
AP-Adynamic Precordium *Animal Bite(only dogs and cats- if rodents NO HRIG or verorab
RCRR-Regular Cardiac Rate and Rhythm required)
NVE-Neck vein Engorgement Plans:
*For Xray of ___, ___ view
*Internal Examination *TT 0.5ml/amp via deep IM now
I-Introitus (Admits 2 fingers) *HTIG 250IU/Amp via deep IM now
C-Cervix (Smooth, soft) *HRIG 300IU/amp (dosage), ½ to be infiltrated
U-Uterus (level of umbilicus/symphysis pubis) surrounding the bite site; ½ via deep IM
A-Adnexa (No adnexal mass nor tenderness) *Verorab 0.5ml/amp via deep IM now, then on Day 3, 7, 14, 28
D-Discharges (Minimal bloody discharge) *Patient opted for HRIG injection at WVMC(very expensive)
E-Episiotomy( well-coaptated episiotomy site *Sultamicillin tosylate (dosage) BID x7 days
*FF. Up Official Xray result after 3 days
*Digital Rectal Exam *Watch out for any untowards S/Sx
No external mass *Advised
No internal masses/haemorrhoids *Thank You
No tenderness
No discharges Rabies Immunoglobulin dosage:
No blood/Minimal fecal material HRIG: 20IU/kg
ERIG: 40IU/kg

COMMONLY USED TERMS/ PHRASES/ SYMBOLS IN INTERNSHIP

*Course in the Wards
Patient seen and Examined
 MURMUR GRADING
*Burns
I So faint
Plans:
*TT 0.5ml/amp via deep IM now II Quiet but can be heard by stethoscope
*HTIG 250IU/Amp via deep IM now III Loud
*Silver Sulfadiazine ointment apply thinly/thickly to affected IV Moderately loud with thrill
area V Very loud, audible with stet partly off
*Cefalexin(dosage) TID x7days
the chest
*Daily dresseing
*Daily Wound Care VI Very loud, audible with stet removed
*Watch out for any untowards S/sx from the chest
*Advised

*Cellulitis
Plans:
*TT 0.5ml/amp via deep IM now(situational)
*HTIG 250IU/Amp via deep IM now(situational)
*Sultamicillin (dosage) BID x7 days
*Daily wound care
*Watch out for any untowards S/Sx
*Advised

Muscular Pain/Spasms with History of Fall

Plans:
*Omphenadrine+Paracetamol(Norgesic Forte) TID x3 days
*Mefenamic Acid 500mg/tab TID x3days
OR
*Celecoxib 200mg/cap BID x5days
OR
*Pregabalin 75mg/cap(neuropathic)
*Xray___ view, (with hx of fall)
FF up official Xray result after 3 days
TCB with untowards S/Sx
Advised

GRADING OF MURMURS

1 – Faint
2 – Audible
3 – Moderately Loud
4 – Loud with palpable thrill
5 – Loud with thrill, stet partially off
6 – Loud with thrill, w/o stet

MUSCLE STRENGTH

O – No muscular contraction
1 – Trace contraction
2 – Active movement with gravity eliminated
3 – Active movement against gravity
4 – Active movement against gravity & slight resistance
5 – Against full resistance