DATE Sept.

24, 2010 1:20 pm

PROBLEM

MANAGEMENT -For possible transfer to the female neurology ward. -Shift Omeprazole N to omeprazole 40mg I tab OD. -Start head and neck feeding as follows: 1000kcal in same volume, divided into 6 equal feedings. -If fever persists until tomorrow, repeat CXR in A.M. -Will follow plan -Increase Nicardipine drip to 17gtts/min. -IVF to ff:PNSS 1L + 20 meqs KCL ->150cc per hour. -Nicardipine drip to ff: Nicardipine 20mg/amp,1 amps +D5W 250 CC to regulate at 15 gtts/min. -Fast drip 200cc of IVF now then regulate back to 150 cc/hr. -IVF to ff. PNSS 1L +20 meqs KCL ->150 cc/hr. -Increase Nicardipine drip to 18 gtts/min. Nicardipine drip to ff. Nicardipine 10mg/amp. 1 amp in 250 cc N-> 180gtts/min.

Fever

HTN, uncontrolled

4 pm BP=180/80

Sept. 24, 2010 6:55 pm

Sept. 25, 2010 9:00am

HTN

-Increase Nicardipine drip to20gtts/min. To maintain SBP below 150 mmhg. -Nicardipine drip as ordered. -Run remaining 600cc of IVF to ff:PNSS + 20 meqs KCL->150 cc/hr. -Start amlodipine 10mg 1 tab now then OD. -Start captopril 25mg 1 tab now then q6. -Start turning schedule q2.

SAH secondary to ruptured aneurysm

10:20 am

Episodes of chest heaviness -For 12-1 ECG and ES. Sept. -D/C RBS monitoring. -Inform MROD of OR plans. -May give celecoxib 400mg 1cap -OD PRN for headache. 2010 9am . 26. 2010 6:15 am 8 pm Sept. 27. -Please do trial of administering meds per orem. General order: -Remove NGT -May have soft diet per orem. strict aspiration precaution please. -Transderm patch 10mg OALW. -IV to ff:PNSS 1L -> 125cc/hr. -Start olmesartan + hctz 20/12. low fat diet.5mg 1 tablet now then OD. BUN and RBS on Monday. -D/C Dipenhydramine IV. -Facilitate troponin I determination. IVF to ff: PNSS 1L-> 125cc/hr. urinalysis today. 3:40 pm -May have trial of soft diet once tolerated may shift h/n feeding to low salt. -Mannitol to 150cc q6.Medicine: 11:30 am -May hold repeat CXR. CBG-209 Give HR 4 u SQnow. -Give paracetamol K+C -IVF to follow PNSS 1L + 20 meq KCL-> 150cc/hr. K. -Repeat serum Na. -IVF to ff:PNSS 1L-> 125cc/hr. Febrile episodes -Repeat CBCP. 2010 7:30 pm 9:00 pm Sept. 25. -Decrease nicardipine drip to 8gtts/min. -For tryonin I.

Chua -Decrease mannitol to 150cc IV q8. -Give dulcolax 1tab now (on top of lactulose) . -Consume nicardipine drip. on PRN basis. Awaiting relatives consent. -Plan is to do a 4-vessel angiogram. -May have 02 via nasal cannula.-Decrease nicardipine drip to 6gtts/min. 12:40pm -Rounds with Dr.