Fill out the document based on the information provided. When evaluated, report

Fill out the document based on the information provided.
When evaluated, reported still having crampy intermittent abdominal pain, but was not currently in pain. Reports still having some mildly bloody stools.
History of Present Illness:
15yo male with history of HR ALL, currently in day 22 of consolidation per
(last chemotherapy on the 9th, given vincristine, PEG-Asparaginase, and steroids) who presented to ED due to fever found at lab/infusion center. Per mother at bedside, one temperature of 100.4 before bed, that resolved spontaneously prior to going to bed on the 14th. However, this morning (09/15), he developed crampy abdominal pain (RLQ localized), with watery diarrhea ×2 where he appreciated bright red blood per rectum. He endorses no sick contacts, URI symptoms, urinary symptoms, dizziness, weakness, fatigue, loss of consciousness prior to presentation. Additionally, he has no history during treatment or prior to treatment of BRBPR, melanous stool, or G
came to the floor in stable condition. When evaluated, reported still havign crampy intermittent abdominal pain, but was not He denies feeling chills until presentation at the infusion center. Per mom, throughout day, he has appeared more pale, and has been far more tired than his baseline. He is still able to PO appropriately, and has been taking fluids to stay hydrated.
Of note, mother states that he took her medications (flagy and cetirizine) yesterday instead of his own.
Infusion Center course 9/15:
PE: Pale, tired appearing, with slight icterus noted in eyes. TTP in RLQ
Labs: 0.13>6.9/24<18 | Na 128, CI 96, CO2 16, Ca 8.2 Diagnostics: None Tylenol PO x 1 NS 1000ml x 2 Meropenem 2000mg IV x 1 Pain Ease Medium Stream, 1 Application, Topical, Q5MIN, PRN, Start Date: 09/15/2023 Comments: PRN Needlesticks polyethylene glycol 3350 oral powder for reconstitution, 17 g, PO, BID, Start Date: 09/15/2023 Protonix, 40 mg= 10 mL, IV, QDay, Start Date: 09/16/2023 sulfamethoxazole-trimethoprim 800 mg-160 mg oral tablet, 160 mg= 1 Tablet, PO, BIDSaSu, Start Date: 09/16/2023 Comments:Dose expressed in trimethoprim component Transderm-Scop, 1 mg/72hr= 1 Each, Transdermal, Q3Day, PRN, Start Date: 09/15/2023 vancomycin, 500 mg= 10 mL, PO, QID, Start Date: 09/16/2023 Comments:fulminant Problem List May exclude sensitive diagnoses Abdominal pain (R10.9) Acid reflux (K21.9) Acute lymphoblastic leukemia (ALL) Acute lymphoblastic leukemia (ALL) in pediatric patient (C91.00) Anemia (D64.9) B-cell acute lymphoblastic leukemia Bloody stool (K92.1) Chemotherapy induced nausea and vomiting (R11.2) Constipation (K59.00) Febrile neutropenia (D70.9) Septic shock (R65.21) Chronic May exclude sensitive problems Perceived hearing loss Congestion of upper airway Adenotonsillar hypertrophy Obesity Need for pneumocystis prophylaxis Acute lymphoblastic lukemia (ALL) in pediatric patient H/O hypercalcemia ALL (acute lymphoid leukemia) in remission Medications Inpatient acetaminophen IV, 1000 mg= 100 mL, IV, Q6H, Start Date: 09/15/2023 Comments: Do not give within 4 hours another acetaminophen-containing product. Do not exceed max recommended daily dose. famotidine, 20 mg= 1 Tablet, PO, BID, Start Date: 09/15/2023 granisetron, 1 mg= 1 Tablet, PO, Q12H, PRN, Start Date: 09/15/2023 heparin flush, 30 Unit= 3 mL, Central Line, Q12H, PRN, Start Date: 09/15/2023 Comments:30 Units/ 3 mL heparin flush, 30 Unit= 3 mL, Central Line, Q12H, PRN, Start Date: 09/16/2023 Comments:30 Units/ 3 mL hydrocortisone, 80 mg= 1.6 mL, IV, Q6H, Start Date: 09/16/2023 Comments: Target Dose: hydrocortisone 1 mg/kg 09/15/2023 22:30:15 lidocaine 4% topical cream, 1 Application, Topical, Q1H, PRN, Start Date: 09/15/2023 Comments:PRN needle sticks LORazepam, 0.5 mg= 1 Tablet, PO, Q6H, PRN, Start Date: 09/15/2023 meropenem, 2000 mg= 100 mL, 20 mg/kg, IV, Q8H, Start Date: 09/15/2023 Comments: If multiple antibiotics, administer meropenem first. Daily maximum dose = 6g/Day Target Dose: meropenem 20 mg/kg 09/15/2023 22:39:04*Standardized* morphine < REMS ETASU>, 2 mg, IV, Q4H, PRN, Start Date: 09/15/2023
Comments: Target Dose: morphine
0.05 mg/kg
09/15/2023 22:28:39
normal saline lock, 2 mL, Peripheral Line, Q4H, PRN, Start Date: 09/15/2023
normal saline lock, 10 mL, Central Line, Q4H, PRN, Start Date: 09/15/2023
NS 1,000 mL, 1000 mL, IV,
General Appearance: alert, interactive, laying in bed HEENT: PERRL, EOMI, MMM, OP clear
Neck: supple
Respiratory: BSCTA, no wheezes, crackles
Chest: symmetric rise, no retractions. port accessed, c/d/i Cardiovascular: nl S12, RRR, CR<2s, no murmurs Abdomen: soft, flat, +BS, +TTP diffusely, soft Extremities: MAEW, WWP Neurological: no focal deficits Skin: no rash, no lesions Musculoskeletal: normal bulk and tone 15 year old male with HR B-ALL CNS 2b diagnosed 07/2023, MRD negative on Ind Day 29, who is currently on Consolidation per CHLA HR protocol, today is Day 23, who is admitted to PICU for uncompensated septic shock while neutropenic and found to have c diff colitis. Blood cultures pending. Due for Consol Day 22 VCR but will hold in setting of acute illness. Remains admitted for acute management of septic shock and hydration given NPO status. Plan: Neuro: Acetaminophen 1000mg IV q6hr Morphine 2mg IV q4hr prn pain No NSAIDs Resp: RA Sp02 > 94%
VBG+ prn
CV:
MAP > 65
Trend mixed venous saturations + Lactates
Access: Rt chest SL port, PIV x2
FEN/GI:
NPO
NS @ 100ml/hr
Granisetron 1 mg PO q12hr prn nausea
Lorazepam 0.5mg PO q6hr prn nausea
Home Famotidine 20mg PO BID
Home Miralax 17g PO BID