CHIONG

11/22/19
11 am

S- Patient is a 52/M/CP seen and examined with the ff subjective complaints:

No febrile episodes No seizure No hypotensive episodes No tachycardic episodes
No chest pain No dyspnea No desaturation
Patient was for Tpiece trial for 8hrs as tolerated.

O- GCS 9: E4VTM4
BP: 130/70 HR: 82 RR: A T: 36.6 O2: 98
Anicteric sclera, pink palpebral conjunctiva, no nasoaural discharge
Hyperextended neck, no neck vein engorgement, no palpable cervical lymphadenopathy
Pulmo: Symmetrical chest expansion, no retractions, (+) rhonchi, bilateral
Cardio: Adynamic precordium, normal rate, regular rhythm, no murmurs
GI: Flabby, normoactive bowel sounds, soft, non-tender, no palpable mass
Ext: full and equal pulses, (+) edema, (+) grade 4 sacral ulcer, (+) blister and ulcerations, both UE

A- #Sacral ulcer gr IV S/P necrosectomy, partial coccygectomy

#Chronic Vegetative State
#Chronic ventilator dependence sec to central apnea
# Anemia of Chronic disease
#Pressure ulcer grade II s/p debridement Right leg
#DKD G5D
#T2DM

P- IVF: none
Diet: as ordered
Diagnostics: none for now
Therapeutics: Continue present meds
For PEG insertion
For daily RSBI
MV setting: SIMV F8 PEEP 5 VT 500 PS 10 FiO2 30%
Refer
NARSOLIS
11/22/19
11am

S- Patient is a 75/M/CP seen and examined with the ff subjective complaints:

No febrile episodes (+) nausea No tachycardic episodes
No chest pain No dyspnea No desaturation
(+) abdominal pain, vague and diffuse
Seen by Nephro Service. Patient was classified as very high risk to go into renal failure and is
advised Renal Replacement Therapy prior OR however relatives remain undecided.

O- GCS 15 conscious, coherent not in cardiorespiratory distress

BP: 120/80 HR: 90 RR: 19 T: 36.6 O2: 96
Icteric sclera, pink palpebral conjunctiva, no nasoaural discharge
No neck vein engorgement, no palpable cervical lymphadenopathy
Pulmo: Symmetrical chest expansion, no retractions, decreased breath sounds, bases
Cardio: Adynamic precordium, normal rate, regular rhythm, no murmurs
GI: Distended, hypoactive bowel sounds, soft, (+) tender, no palpable mass,
(+) bilious output per NGT (+) output per colostomy
Ext: pulses full and equal, (+) edema, BUE

A- #Partial Bowel Obstruction – extraluminal

#Rectal Adenocarcinoma Stage IV (liver, pancreas)
#HASCVD Anterolateral Wall Ischemia ACC/AHA Stage 3
#GUTB
#Chronic hyponatremia
#AKI on top of probably CKD
#Complicated UTI

P- IVF: PNSS drip to 70c/hr

Diet: NPO
Diagnostics: Awaiting:
ABG
H&H
Na,K,Ca,
Therapeutics: Piperacillin Tazobactam 2.25g IV infusion over 4 hrs q6 D5; Continue TPN

Patient was seen by GS and current plan is to do “E” Exploratory Laparotomy

Medical Risk Assessment:
Cardio - High Risk
Pulmo - Class IV for Post op pneumonia and Class V for respiratory failure
Nephro - High (Explained the risk and benefits to the patient and his wife)
Patient is also advised Renal Replacement Therapy prior OR however relatives remain undecided.
Refer
REYES
11/22/19
11am

S- Patient is a 57/F/CP seen and examined with the ff subjective complaints:

Patient is for hemodialysis today,
No febrile episodes No seizure No hypertensive episodes (+) tachycardic
episodes
No chest pain (+) shortness of breath No desaturation

No abdominal pain No melena/hematochezia

O- GCS 15
BP: 110/80 HR: 88 RR: 17 T: 36.7 O2: 97
Anicteric sclera, pink palpebral conjunctiva, no nasoaural discharge
No neck vein engorgement, no palpable cervical lymphadenopathy
Pulmo: Symmetrical chest expansion, no retractions, decreased breath sounds, bases
Cardio: Adynamic precordium, normal rate with tachycardic episodes, regular rhythm, no murmurs
GI: Flabby, normoactive bowel sounds, soft non-tender, no palpable mass
Ext: Full and equal pulses, (+) bipedal, edema

A- #HASCVD, Acute Decompensated Heart Failure NYHA III

#CAP-MR, resolving
#Pleural Effusion, Bilateral probably secondary to volume overload
#T2DM
#DM Foot Right
#Cardiorenal syndrome type 2
#DKDG5D
#Anemia probably secondary to 1. CKD 2. Inflammation
#S/p IJ Catheter insertion, right (11/19/19)

P- IVF: Heplock
Diet: as ordered
Diagnostics: Repeat CXR post HD (11/22/19)
For CBC PC, Na,K,Ca, PT,TA Post-HD
Awaiting:
2D echo with DS (11/14/19)
ABI (11/14/19)
AV Duplex scan (11/14/19)
ETA GS/CS, Blood CS
Awaiting hepa profile
Therapeutics: Continue present meds
Refer
VILLARINO
11/22/19
11 AM

S- Patient is a 65/F/RPV seen and examined with the ff subjective complaints:

No febrile episodes No seizure No hypotensive episodes No tachycardic episodes
No chest pain No dyspnea No desaturation No abdominal
pain

O- GCS 7 E2-3VTM4, obtunded with minimal reaction to stimuli; preferential movement

BP: 130/80 HR: 83 RR: A T: 36.9 O2: 98
Anicteric sclera, pink palpebral conjunctiva, no nasoaural discharge
No neck vein engorgement, no palpable cervical lymphadenopathy
Symmetrical chest expansion, (-) retractions, (+) rhonchi, bilateral, decreased breath sounds,
bilateral
Adynamic precordium, normal rate, regular rhythm, no murmurs
Flabby, normoactive bowel sounds, soft non-tender, no palpable mass
Full and equal pulses, (+) flank edema

A- #Chronic Respiratory Failure sec to VAP

#Septic Encephalopathy
#Vascular Dementia
#DKD G5D
#HASCVD Heart Failure ACC/AHA ST B
#T2DM
#Anemia, multifactorial
#Sacral Decubitus ulcer grade 2
#Chronic Hyponatremia

P- IVF: PNSS 1L 10cc/hr to maintain cutdown

Diet: as ordered
Diagnostics: For chest mapping with possible thoracentesis 11/25/19
For cranial MRI once extubated (scheduling)
For repeat CBC PC,PTPA, INR and CXR on Day 14 of Ampi- Sul11/24/19

Therapeutics: Ampicillin–sulbactam 3g IV infusion over 1hr post HD then q24 Day 12/14
HOLD Clopidogrel 75mg/tab OD
Continue other meds
MV settings: AC mode F18 PEEP 5 FI02 30% TV 400
Refer
TRIBUNSAY
11/21/19
4PM

S- Patient is a 42/F/RPVD seen and examined with the ff subjective complaints:

No febrile episodes No seizure No hypertensive episodes No tachycardic episodes
No chest heaviness No dyspnea No desaturation No
abdominal pain No melena/hematochezia

O- GCS 15
BP: 100/70 HR: 64 RR: 18 T: 36.5 O2: 97
Anicteric sclera, pink palpebral conjunctiva, no nasoaural discharge
No neck vein engorgement, no palpable cervical lymphadenopathy
Pulmo: Symmetrical chest expansion, no retractions, clear breath sounds
Cardio: Adynamic precordium, normal rate, regular rhythm, no murmurs
GI: Flabby, normoactive bowel sounds, soft non-tender, no palpable mass
Ext: full and equal pulses, (-) edema

A- #ACS STEMI - inferior wall D5

#HASCVD CAD IVD-RCA NYHA II in SR
#Chronic CVD infarct MRS 0
#T2DM, poor control

P- IVF: Heplock
Diet: as ordered
Diagnostics: none for now
Therapeutics:
1. Isoket drip 10mg in 100cc PNSS to run at 6cc/hr (10mcg/min) + 3cc/hr to attain chest
pain free
2. Insulin glargine 10 units sc ODHS – Hold once with Linagliptin
3. Start Linagliptin 5mg/tab 1 tab OD
IFC removal
Refer
ESPERA
11/22/19

S- Patient is an 85/F/RPV seen and examined with the ff subjective complaints:

No febrile episodes No seizure No hypotensive episodes No tachycardic episodes
No chest pain No dyspnea No desaturation No abdominal pain
No melena/hematochezia

O- GCS 9 E4VTM4
BP: 100/70 HR: 67 RR: A T: 36.7 O2: 97
Anicteric sclera, pink palpebral conjunctiva, no nasoaural discharge
No neck vein engorgement, no palpable cervical lymphadenopathy
Pulmo: Symmetrical chest expansion, no retractions, (+) rhonchi, bilateral
Cardio: Adynamic precordium, normal rate, regular rhythm, no murmurs
GI: Flabby, normoactive bowel sounds, soft non-tender, no palpable mass
Ext: No edema, full and equal pulses

A- #Chronic Ventilator Dependence with Central Apnea s/p change of tracheostomy 9/9/19
#HASCVD ACC/AHA Stage B
#Chronic CVD Infarct (2010, 2018) MRS 5
#S/P PEG change June 2019

P- Diet: as ordered
Diagnostics: none for now
Therapeutics: Cutasept spray to stoma BID
Clopidogrel 75mg/tab ODPC
Duavent nebule q8 prn
Omeprazole to 20 mg/cap ODAC
Atorvastatin 40 mg/tab ODHS
Levetiracetam 500mg/tab 1 tab BID
Lactulose 30cc ODHS.Hold if BM >2x/day
Peptamen 6 scoops in 1 glass of waterTID
Bactidol mouthwash TID
Salbutamol + Ipratropium neb
MV Setting: SIMV TV 360 PS10 FiO2 30% PEEP 5
Refer
DE LEON
11/22/19
11am

S- Patient is an 57/M/RPV seen and examined with the ff subjective complaints:

As of 11/22/19 at 11am, there was no recurrence of chest heaviness or chest pain.
No febrile episodes No seizure No hypotensive episodes No palpitations
No chest heaviness No dyspnea No desaturation No abdominal pain
No melena/hematochezia

O- GCS 15
BP: 120/80 HR: 60 RR: 18 T: 36.5 O2: 98
Anicteric sclera, pink palpebral conjunctiva, no nasoaural discharge
No neck vein engorgement, no palpable cervical lymphadenopathy
Pulmo: Symmetrical chest expansion, no retractions, clear breath sounds
Cardio: Adynamic precordium, normal rate with episodes of bradycardia, regular rhythm, no
murmurs
GI: Flabby, normoactive bowel sounds, soft non-tender, no palpable mass
Ext: full and equal pulses, (-) edema

A- #ACS, STEMI Inferior wall T1M1 D4

#HASCVD CAD 3VD NYHA I in SR
#PTB treatment completed
#Asymptomatic hyperuricemia

P- IVF: Heplock
Diet: NPO 4 hours prior procedure
Diagnostics: For coronary angioplasty tmrw 11/22/19 6am
Therapeutics: Dopamine drip 200mg/amp 2 amps in 100cc pnss to run at 1cc/hr
Clopidogrel (Plavix) 3 tabs at 10pm and 3 tabs at 4 am
Continue other meds
Refer
PEREZ
11/22/19
11pm

S- Patient is an 24/F/RPV seen and examined with the ff subjective complaints:

As of 11/22/19 at 11am, there was no recurrence of Seizures.
No febrile episodes No Chest Pain No hypotensive episodes No palpitations
No chest heaviness No dyspnea No desaturation No abdominal pain
No melena/hematochezia

O- GCS 15
BP: 120/80 HR: 60 RR: 18 T: 36.5 O2: 98
Anicteric sclera, pink palpebral conjunctiva, no nasoaural discharge
No neck vein engorgement, no palpable cervical lymphadenopathy
Pulmo: Symmetrical chest expansion, no retractions, clear breath sounds
Cardio: Adynamic precordium, normal rate with episodes of bradycardia, regular rhythm, no
murmurs
GI: Flabby, normoactive bowel sounds, soft non-tender, no palpable mass
Ext: full and equal pulses, (-) edema

A- #Psychosis secondary to general medical condition TB Meningitis Vs. Bacterial Meningitis

P- IVF: Heplock
Diet: As tolerated
Diagnostics:
Therapeutics: Ceftriaxone 2g IV now then TIV Q12
Valproic Acid 500mg TIV Q12
Midazolam drip 10mg in 100cc PNSS x 3cc/hr +- 2 until no agitation
Refer