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COURSE IN THE WARD Doctors Progress Notes Date: August 16, 2013 Admission Complaint : Left Sided hemiparesis

joint pains Bp: 180/120 160/80 130/70 Temp: 38.4 PR: 108 RR: 23

History: AM prior to admission with fever, with numbness on left hand then multiple Physical Assessment History of Present Illness Am prior to admission (+) fever (+) sudden numbness and weakness of left arm Serology Report 08/19/13- 8:38 pm Dr. C. Carag Examination: Dengue NS1 Result: Negative Electrocardiographic Report- 8-16-13- 3:04 pm Dr. C. Carag Atrial rate: 112 Ventricular rate: 112 Impression: Sinus Tachycardia

joint pain

1:15 pm

2:00 pm

BP 180/70 >please admit to ROV under the service of Dr. Carag HR 108 >please obtain consent of admission and management RR 23 > NPO temporarily VS Q2 and record Temp. 38.4 > Diagnostics: CBC/PC, UA, Na, K, Crea, BUN, Cranial CT Scan, X-ray HPN > IVF PNSS 1L X KVO T/C CVA > nicardipine drip 90 cc PNSS + 1 cup pediderine at 20gtts/min to maintain a BPof 140/90 T/C DFS >continue norvasc 50 mg/tab 1 tab OD cholerene 1gm/IV q8 hours > Manitol 100cc/IV now then q6 hours IV with BP precaution >INO q shift >refer accordingly > paracetamol 500mg/IV q 4 hours for fever BP 160/90 >hold Manitol PR 94 >hold Nicardipine +fever >VS q1 +joint pain >low salt low cholesterol diet +cough and colds >INO q shift +weakness L arm >paracetamol for fever >celebrex 200mg 1tab OD

4:30pm 8pm August 17, 13 9:00 am BP 130/70 +fever Left shoulder pain

>amlodipine 1tab OD >defer paracetamol IV >lipid profile in AM

12:15pm

> for uric acid >viatril 500mg 1tad OD >for X-ray Left shoulder Left knee >refer to DR. Manuela while I am away >for sputum AFB x 3 determination >refer to Dr. H. Ramos while I am away

August 18, 2013 9:25 am 12:15 pm 2:45 pm 2:48 pm 4:00 pm 5:00 pm 8:00 pm 9:45 pm >purinase 300mg/1 tab OD >MGH >defer discharge > CBC with PC new > IVF to consume >refer to Dr. H. Ramos to take over with my absence >Paracetamol 500 mg 1tab q4 for fever and joint pain >give dyphenhydramine 500 mg IV now >repeat CBC/PC now

+erythroderma

August 19, 2013 6:00 pm +fever August 20, 2013

>CBC for dengue NS1 test >increase fluid intake >MGH > additional med 25mg Iterax OD > centrum Silver 1tab OD