Plan of Care - Nurse Jayla W - 12/19/2025 9:09 AM CSTFormatting of this note might be different from the original.Goals: Clinical Goals for the Shift: ambulation, vital signsSummary: Problem: ActivityGoal: Patient’s tolerance of increased activity will improveOutcome: ProgressingGoal: Patient will maintain or regain ADL functionOutcome: ProgressingProblem: NutritionGoal: Patient’s nutritional status will improveOutcome: ProgressingGoal: Patient’s ability to achieve adequate nutrition will improveOutcome: ProgressingElectronically signed by Nurse Jayla W at 12/19/2025 9:09 AM CSTPlan of Care - Nurse Danee C - 12/19/2025 6:11 AM CSTFormatting of this note might be different from the original.Shift Summary: Pain controlled with current regimen. Patient ambulated independently in hallway. Problem: NutritionGoal: Patient’s nutritional status will improveOutcome: OngoingFlowsheets (Taken 12/19/2025 0610)Patient’s nutritional status will improve: Provide postoperative nutritional progressionProblem: Physical RegulationGoal: Gastrointestinal status for postoperative course will improveOutcome: OngoingFlowsheets (Taken 12/19/2025 0610)Gastrointestinal status for postoperative course will improve: Monitor gastrointestinal status Perform actions to prevent or reduce the incidence of constipationProblem: ActivityGoal: Patient’s tolerance of increased activity will improveOutcome: ProgressingFlowsheets (Taken 12/19/2025 0610)Patient’s tolerance of increased activity will improve: Implement and manage activity progression plan Encourage out of bed for meals Encourage energy conservation techniquesProblem: Lack of KnowledgeGoal: Ability to develop a pain control plan will improveOutcome: ProgressingFlowsheets (Taken 12/19/2025 0609)Ability to develop a pain control plan will improve: Explain causes of pain and how long pain can be expected to last Teach information regarding pain management Educate pain scale for assessing level of painProblem: MedicationGoal: Satisfaction with pain management medication regimen will improveOutcome: ProgressingFlowsheets (Taken 12/19/2025 0609)Satisfaction with pain management medication regimen will improve: Assess satisfaction with pain management regimenElectronically signed by Nurse Danee C at 12/19/2025 6:12 AM CSTBrief Op Note - William Chapman, MD - 12/18/2025 2:05 PM CSTFormatting of this note is different from the original.Operative Progress NoteSurgical Team: * Chapman, William Cavanaugh - Primary * Godfrey, Caroline Marie - FellowAnesthesiologist: King, Christopher R., MD PhDCRNA: Maxey, Lucas Aaron, CRNACirculator: Boehmer, Natalie Nicole, RNScrub: Sullivan, Ryan W., STSurgical Assistant: Matson, Sarah Christine, PAOrientee Circulator: Thomason, Andy Keith, RNDATE OF SURGERY :12/18/2025Preoperative

Diagnosis: Pre-op Diagnosis * Metastatic colon cancer to liver [C18.9, C78.7]Postoperative

Diagnosis: Post-op Diagnosis * Metastatic colon cancer to liver [C18.9, C78.7]Procedure(s):Procedure(s) (LRB):XI LIVER RESECTION - LAPAROSCOPIC ROBOTIC ASSISTED SEGMENT 5 8 and 4B, INTRAOPERATIVE ULTRASOUND and TAP BLOCK (N/A)Operative Findings:Superficial tumor in seg 5/8 and 4BEstimated Blood Loss:minimalIntraoperative Fluids:14000 mlsSpecimens:ID Type Source Tests Collected by Time A : Sement 5/8 Liver Resection Tissue Liver, Partial Resection SURGICAL PATHOLOGY Chapman, William Cavanaugh, MD 12/18/2025 1452 B : Segment 4B Liver Resection Tissue Liver, Partial Resection SURGICAL PATHOLOGY Chapman, William Cavanaugh, MD 12/18/2025 1453 Implants:Nothing was implanted during the procedureBlood/Blood Products Transfused:1400 mls crystalloidComplications:NoneCondition on Discharge from the operating room was stableWilliam Cavanaugh Chapman, MDDate: 12/18/2025 Time: 3:20 PMElectronically signed by William Chapman, MD at 12/18/2025 3:21 PM CSTOp Note - William Chapman, MD - 12/18/2025 12:00 AM CSTFormatting of this note might be different from the original.SURGEONWilliam Chapman, MD.FIRST ASSISTANTAaron Delman, MDI was present during the operative procedure from after the time of incision until the time of closure and immediately available for all remaining portions of the procedure. Dr. Delman acted as 1st assistant since no suitable resident was available. He was present for the entire procedure including the initial exploration, intraoperative ultrasonography, and liver resection.PREOPERATIVE DIAGNOSISMetastatic colorectal cancer to 2 sites in the liver.POSTOP DIAGNOSISMetastatic colorectal cancer to 2 sites in the liver.PROCEDUREResection of 2 sites of hepatic metastasis from colorectal cancer prior, intraoperative ultrasonography, tap block.OPERATIVE FINDINGSThe patient had a normal-appearing background liver. Two surface-based tumors were easily identified and as anticipated with 1 in segment 4B and a second tumor site in segments 5 and 8. Nonanatomic excisional resection was performed of both tumor sites. There was no evidence of bile leakage and no significant bleeding at the time of the resection.OPERATIVE PROCEDUREAfter placing the patient on the operating table supine position, general endotracheal anesthesia was induced. The abdomen was prepped and draped in the usual sterile fashion. Using a knife, a 1.5 cm incision was made on the supraumbilical location incorporating the patient’s previous incision. This was extended through the subcutaneous tissue and fascia with electrocautery. Peritoneum was carefully entered to avoid injury to the underlying bowel. Following entry in the peritoneal cavity, a fixed table Hassan check cannula was placed and laparoscopy and robotic imaging were both examined. So the was no evidence of bowel adhesion to the anterior abdominal wall. The liver was normal in appearance. Overall, this appeared to be suitable for resection. A 1.5 cm tumor site was noted in segment 4B and an approximately 1 cm tumor site noted in segments 5 and 8. These were resected with wedge excision with no difficulty and no significant blood loss at the time of the procedure. Final sponge and instrument counts correct x2.ESTIMATED BLOOD LOSSMinimal.IV FLUIDS800 mL crystalloidJob ID/Internal Job ID: 259270/1079574445Electronically signed by William Chapman, MD at 12/19/2025 4:00 PM CSTdocumented in this encounter