Case 1 Iccu Chart

BLOOD GLUCOSE LOG SHEET
Name: DELA CRUZ, MARIO___________ Age: _69___________________________________ Attending Physician: DR. ESPAñOL_______________________
Sex: _MALE______________Civil Status: MARRIED_______________ Room No. /Bed No. _ICCU 1__________ Hospital No. 123894_________________
DATE TIME TYPE OF TEST RESULT MED/INSULIN TAKEN PHYSICIAN NOD
4/15/2020 5:55 PM HGT NOW 147 mg/dl None Dr. A.U B.Y.N, RN
DOH-SWUMed-NSD-F-008 Rev.1
INTRAVENOUS FLUID MONITORING SHEET
Date IV Amount Flow Time IV Infusion Time Amount The Amount Date
Shift Left
Ordered Rate Started Site Finished Absorbed Bottle Terminated/
Consumed
4/15/2020 1L 10 7:40 Left PNSS 10 1L 1 0 4/16/2020
gtts/min Arm
4/16/2020 1L 120 cc/hr 10:00 Right PNSS 7:30 1L 2 0 4/16/2020
Arm
Arm
4/16/2020 100 10 cc/hr 9:30 Right Nicardipine 10 mg + 90 11:00 100 1 0 4/19/2020
Arm ml PNSS
4/17/2020 1L 180 cc/hr 2:00 Right PNSS 8 :00 1L 3 0 4/17/2020
Arm
Arm
Arm

Arm
4/18/20 1L 100 cc/hr 2:30 Left PNSS 11:10 1L 7 0 4/18/2020
Arm
4/18/2020 1L 140 cc/hr 11:10 Left PNSS 7:00 1L 8 0 4/18/2020
Arm
Arm
4/19/2020 1L 100 cc/hr 5:35 Left PNSS 1:30 1L 10 0 4/20/2020
Arm
4/19/2020 100 5 cc/hr 11:00 Left Nicardipine 10 mg + 90 2:00 100 2 0 4/21/2020
Arm cc PNSS
4/20/2020 1L 100 cc/hr 10:00 Left PNSS 11:30 1L 11 0 4/20/2020
Arm
4/20/2020 1L 160 cc/hr 11:30 Left PNSS 4:50 1L 12 0 4/20/2020
Arm
4/20/2020 1L 200 cc/hr 4:50 Left PNSS 9:30 1L 13 0 4/20/2020
Arm
4/20/2020 1L 240 cc/hr 9:30 Left PNSS 1:30 1L 14 0 4/21/2020
Arm
4/21/2020 1L 240 cc/hr 1:30 Left PNSS 5:40 1L 15 0 4/21/2020
Arm
4/21/2020 1L 15 cc/hr 2:00 Left Nicardipine 10 mg + 90 8:40 100 3 0 4/21/2020
Arm cc PNSS
4/21/2020 1L 280 cc/hr 5:40 Left PNSS 9:10 1L 16 0 4/21/2020
Arm
4/21/2020 1L 320 cc/hr 9:10 Left PNSS 12:50 1L 17 0 4/21/2020
Arm
4/21/2020 1L 300 cc/hr 12:50 Left PNSS 4:00 1L 18 0 4/21/2020
Arm
4/21/2020 1L 280 cc/hr 4:00 Left PNSS 8:28 1L 19 0 4/21/2020
Arm
4/21/2020 1L 240 cc/hr 8:28 Left PNSS 1:30 1L 20 0 4/22/2020
Arm
4/22/2020 1L 200 cc/hr 1:30 Left PNSS 5:30 1L 21 0 4/22/2020
Arm
4/22/2020 1L 200 cc/hr 5:30 Left PNSS 12:00 1L 22 0 4/22/2020
Arm
Shift Left
Consumed
4/22/2020 1L 160 cc/hr 12:00 Left PNSS 6:00 PM 1L 23 0 4/22/2020
Arm
4/22/2020 1L 180 cc/hr 6:00 Left PNSS 11:00 1L 24 0 4/22/2020
Arm
Arm
4/23/2020 100 30 cc/hr 8:45 Left KCl 10 meqs + 90 cc PNSS 12:00 100 1 0 4/23/2020
Arm
4/23/2020 1L 160 cc/hr 9:00 Left PNSS 2:40 1L 27 0 4/23/2020
Arm
Arm
Arm
4/23/2020 1L 180 cc/hr 2:40 Left PNSS 9:00 1L 28 0 4/23/2020

Arm
Arm
4/23/2020 1L 180 cc/hr 9:00 Left PNSS 3:00 1L 29 0 4/23/2020
Arm
Arm
Arm
4/24/2020 1L 180 cc/hr 3:00 Left PNSS 10:00 1L 30 0 4/24/2020
Arm
4/24/2020 1L 180 cc/hr 10:00 Left PNSS 4:00 1L 31 0 4/24/2020
Arm
4/24/2020 1L 180 cc/hr 4:00 Left PNSS 12:00 1L 32 0 4/25/2020
Arm
4/25/2020 1L 180 cc/hr 12:00 Left PNSS 6:30 1L 33 0 4/25/2020
Arm
4/25/2020 1L 180 cc/hr 6:30 Left PNSS 1:30 1L 34 0 4/25/2020
Arm
4/25/2020 1L 140 cc/hr 1:30 Left PNSS 8:35 1L 35 0 4/25/2020
Arm
4/25/2020 1L 140 cc/hr 8:35 Left PNSS 3:30 1L 36 0 4/26/2020
Arm
4/26/2020 1L 160 cc/hr 3:30 Left PNSS 11:00 1L 37 0 4/26/2020
Arm
4/26/2020 1L 120 cc/hr 11:00 Left PNSS 4:30 1L 38 0 4/27/2020
Arm
Arm
Arm
Arm
Arm
Shift Left
Consumed
Arm
Arm
Arm
Arm
4/30/2020 1L 100 cc/hr 1:05 Right PNSS 8:00 540 47 460 4/30/2020
Arm
4/30/2020 460 80 cc/hr 8:00 Right PNSS 12:00 320 47 140 4/30/2020
Arm
4/30/2020 140 60 cc/hr 12:00 Right PNSS 2:00 140 47 0 4/30/2020
Arm

Arm
5/01/2020 1L 60 cc/hr 5:30 Right PNSS 9:00 210 49 790 5/01/2020
Arm
5/01/2020 790 40 cc/hr 9:00 Right PNSS 4:30 1L 49 0 5/02/2020
Arm
5/02/2020 1L 40 cc/hr 4:30 Right PNSS 10:40 900 49 100 5/02/2020
Arm
5/02/2020 100 60 cc/hr 10:40 Right PNSS 2:00 100 49 0 5/03/2020
Arm
Arm
Arm
Arm
5/05/2020 1L 60 cc/hr 12:15 Right PNSS 11:30 700 52 300 5/05/2020
Arm
Arm
5/05/2020 1L 40 cc/hr 8:00 Right PNSS 10:00 80 52 920 5/05/2020
Arm
FLUID INTAKE & OUTPUT MONITORING RECORD
Name: DELA CRUZ, MARIO___________ Age: _69___________________________________ Attending Physician: DR. ESPAñOL________________
Sex: _MALE______________Civil Status: MARRIED_______________ Room No. /Bed No. _ICCU 1__________ Hospital No. 123894_________
DATE TIME INTAKE TOTAL OUTPUT TOTAL

PARENTERAL ORAL OTHERS URINE DRAINAGE OTHERS
4/15/20 5-10 80 0 - 80 550 - - 550
10-11 20 0 20 300 300
11-12 100 100 100 100
12-1 100 100 110 110
1-2 100 280 380 110 110
2-3 100 100 120 120
3-4 100 160 260 90 90
4-5 100 100 50 50
5-6 100 100 90 90
1164 970
7-3 = 7-3 =
3-11 = 3-11 =
11-7_ __=______________ 11-7 =_________________
24H Total = 24H Total =
Fluid Balance = _____________________________

4/16/20 6-7 ML Nicardipine 120 100 100
120
7-8 120 120 150 150
8-9 120 NGT:300 370 100 100
9-10 120 120 100 100
10-11 120 50 200 200
11-12 120 NGT:300 370 150 150
12-1 120 170 150 150
1-2 120 120 200 200
1440 1150
4/16/20 2-3 ML Nicardipine 100 250 250
100
3-4 100 NGT:240 340 250 250
4-5 100 100 150 150
5-6 100 100 150 150
6-7 140 140 100 100
7-8 140 140 200 200
8-9 140 NGT:240 Piptaz: 70 450 200 200
9-10 140 5 145 400 400
1515 1700
4/16/20 10-11 ML Nicardipine 150 300 300
140 10
11-12 180 5 185 150 150
12-1 180 NGT:250 430 400 400
1-2 180 180 200 200
2-3 180 180 180 180
3-4 180 180 180 180
4-5 180 NGT:250 430 110 110
5-6 180 180 150 150
1915 1670
7-3 = 1440 7-3 = 1150

3-11 = 1515 3-11 = 1700
11-7_ __=_1915____________ 11-7 =_1670__________
Fluid Balance = + 350

4/17/20 6-7 ML Nicardipine 180 220 100
180
7-8 180 180 250 150
8-9 180 NGT:250 430 100 100
9-10 180 180 120 100
10-11 140 NGT:30 170 380 200
11-12 140 5 145 330 150
12-1 140 5 NGT:250 Piptaz: 70 415 130 150
1-2 140 5 163 120 200
1863 1150
4/17/20 2-3 ML Nicardipine 143 400 250
140 3
3-4 140 3 NGT:250 393 150 250
4-5 120 3 123 120 150
5-6 120 3 NGT:30 153 100 150
6-7 120 3 123 290 100
7-8 120 2 122 50 200
8-9 120 1 NGT:280 Piptaz: 70 441 50 200
9-10 120 1 121 60 400
1649 1700
4/17/20 10-11 ML Nicardipine 80 190 190
80
11-12 80 NGT:240 820 180 180
12-1 80 80 70 70
1-2 80 80 50 50
2-3 80 80 50 50
3-4 80 NGT:240 320 70 70
4-5 80 Piptaz: 70 150 160 160
5-6 80 5 NGT:50 135 180 180
1245 950
7-3 = 1863 7-3 = 1550

3-11 = 1649 3-11 = 1220
11-7_ __=_1245____________ 11-7 =_950__________
24H Total = 4757 24H Total =

4/18/20 6-7 ML Nicardipine 120 400 400
60
7-8 60 120 150 150
8-9 60 NGT:260 370 80 80
9-10 60 120 170 170
10-11 80 50 130 130
11-12 80 370 170 170
12-1 80 NGT:260 Piptaz: 60 170 60 60
1-2 80 5 120 60 60
1145 1220
4/18/20 2-3 ML Nicardipine 100 100 100
100
3-4 100 5 NGT:230 335 90 90
4-5 100 10 110 350 350
5-6 100 10 110 200 200
6-7 140 140 140 140
7-8 140 NGT:230 430 140 140
8-9 140 Piptaz: 70 140 120 120
9-10 140 140 120 120
1405 1260
4/18/20 10-11 140 140 130 130
11-12 180 5 NGT:260 400 90 90
12-1 180 140 20 20
1-2 180 140 30 30
2-3 180 140 260 260
3-4 180 140 120 120
4-5 180 NGT:260 Piptaz: 60 460 130 130
5-6 180 NGT:30 170 25 25
1730 805
7-3 = 1145 7-3 = 1220

3-11 = 1405 3-11 = 1260
11-7_ __=_1730____________ 11-7 =_805__________
24H Total = 4280 24H Total = 3285

4/19/20 6-7 ML Nicardipine 80 270 270
80
7-8 80 80 60 60
8-9 80 NGT:270 350 80 80
9-10 80 80 30 30
10-11 100 100 210 210
11-12 100 100 240 240
12-1 100 NGT:270 Piptaz: 50 420 40 40
1-2 100 100 40 40
1210 970
4/19/20 2-3 ML Nicardipine 100 110 110
100
3-4 100 NGT:240 340 150 150
4-5 100 100 110 110
5-6 100 NGT:60 160 210 210
6-7 140 140 120 120
7-8 140 NGT:250 390 90 90
8-9 140 Piptaz: 40 180 70 70
9-10 140 5 145 130 130
1515 990
4/19/20 10-11 ML Nicardipine 105 450 450
100 5
11-12 100 5 105 260 260
12-1 100 5 NGT:250 355 220 220
1-2 100 5 105 220 220
2-3 100 3 103 350 350
3-4 100 3 NGT:250 Piptaz: 40 393 220 220
4-5 100 3 103 200 200
5-6 100 3 NGT:30 133 350 350
1402 2270
7-3 = 1210 7-3 = 970

3-11 = 1550 3-11 = 990
11-7_ __=_1402____________ 11-7 =_2270__________
24H Total = 4126 24H Total = 4230
Fluid Balance = - 68

4/20/20 6-7 120 120 240 240
7-8 120 120 200 200
8-9 120 NGT:260 380 170 170
9-10 120 NGT:50 Meropenem 230 430 430
60
10-11 160 160 440 440
11-12 160 160 170 170
12-1 160 NGT:250 410 130 130
1-2 160 160 240 240
1750 2020
4/20/20 2-3 ML Nicardipine 200 540 540
200
3-4 200 200 100 100
4-5 200 NGT:270 Meropenem 530 300 300
60
5-6 200 200 400 400
6-7 240 NGT:50 290 250 250
7-8 240 NGT:270 510 250 250
8-9 240 50 245 250 250
9-10 240 10 250 190 190
2425 160 160
4/20/20 10-11 ML Nicardipine 255 550 550
240 5
11-12 240 15 Meropenem 315 430 430
60
12-1 240 15 NGT:250 505 500 500
1-2 240 15 NGT:60 345 350 350
2-3 280 20 300 650 650
3-4 280 20 NGT:230 530 180 180
4-5 280 20 300 430 430
5-6 280 20 NGT:60 360 450 450
2880 3540
7-3 = 1750 7-3 = 2020

3-11 = 2425 3-11 = 2100
11-7_ __=_2880____________ 11-7 =_3540__________
24H Total = 7055 24H Total = 7660

4/21/20 6-7 ML Nicardipine 335 500 500
320 15
7-8 320 10 330 400 400
8-9 320 5 NGT:250 Meropenem 615 410 410
40
9-10 300 300 230 230
10-11 300 300 400 400
11-12 300 NGT:250 300 400 400
12-1 300 NGT:60 550 500 500
1-2 300 360 250 250
3090 3090
4/21/20 2-3 ML Nicardipine 300 300 300
300
3-4 280 280 450 450
4-5 NGT:260 Meropenem 600 220 220
280 60
5-6 280 NGT:50 300 450 450
6-7 280 280 350 350
7-8 240 240 250 250
8-9 240 NGT:260 500 250 250
9-10 240 240 190 190
2770 2260
4/21/20 10-11 ML Nicardipine 200 400 400
200
11-12 200 NGT:300 500 2820 280
12-1 200 Meropenem 200 200 200
60
1-2 200 NGT:60 260 150 150
2-3 200 200 250 250
3-4 200 200 400 400
4-5 200 NGT:250 450 300 300
5-6 200 NGT:60 260 350 350
2330 2330
7-3 = 3090 7-3 = 3090

3-11 = 2770 3-11 = 2260
11-7_ __=_2330____________ 11-7 =_2330__________
24H Total = 8190 24H Total = 7680

4/22/20 6-7 ML Nicardipine NGT:60 240 250 250
180
7-8 160 160 350 350
8-9 160 NGT:250 Meropenem 450 110 110
40
9-10 160 160 290 290
10-11 160 160 510 510
11-12 160 160 300 300
12-1 160 NGT:250 410 220 220
1-2 160 NGT:80 240 340 340
1980 2370
4/22/20 2-3 180 600 600
3-4 180 NGT:250 500 500
4-5 180 Meropenem 160 160
50
5-6 180 NGT:90 140 140
6-7 200 50 50
7-8 200 NGT:50 50 50
8-9 200 NGT:250 150 150
9-10 200 150 150
2700
4/22/20 10-11 200 200 200 200
11-12 200 200 250 250
12-1 200 NGT:270 Meropenem 450 300 300
50
1-2 200 200 200 200
2-3 200 200 400 400
3-4 200 NGT:270 470 300 300
4-5 200 200 150 150
5-6 200 NGT:50 250 400 400
2220 2200
7-3 = 1980 7-3 = 2370

3-11 = 2210 3-11 = 2700
11-7_ __=_2220____________ 11-7 =_3200__________
24H Total = 6410 24H Total = 7270

4/23/20 6-7 ML KCl 220 700 700
220
7-8 200 200 350 350
8-9 200 15 NGT:270 Meropenem 525 180 180
40
9-10 180 30 NGT:30 240 140 140
10-11 180 30 210 560 560
11-12 180 30 NGT:300 510 160 160
12-1 180 30 NGT:30 240 300 300
1-2 180 30 NGT:30 240 300 300
2385 2690
4/23/20 2-3 ML KCl 210 180 180
180 30
3-4 180 30 210 200 200
4-5 180 30 NGT:300 Meropenem 250 320 320
40
5-6 180 30 NGT:30 240 320 320
6-7 180 30 210 230 230
7-8 180 30 210 310 310
8-9 180 30 NGT:280 490 100 100
9-10 180 40 220 150 150
2340 1810
4/23/20 10-11 ML KCl NGT:50 270 350 350
180 40
11-12 180 40 245 210 210
12-1 180 40 NGT:270 Meropenem 540 200 200
50
1-2 180 40 NGT:50 270 280 280
2-3 180 40 220 250 250
3-4 180 180 220 220
4-5 180 NGT:270 450 \ 200
5-6 180 NGT:50 230 200 200
2328 1910
7-3 = 2385 7-3 = 2690

3-11 = 2340 3-11 = 1810
11-7_ __=_2380____________ 11-7 =_1910__________
24H Total = 7105 24H Total = 6410

4/24/20 6-7 160 160 400 400
7-8 140 140 470 470
8-9 140 NGT:240 380 160 160
9-10 160 160 240 240
10-11 180 Meropenem 230 210 210
40
11-12 180 180 150 150
12-1 180 NGT:260 440 220 220
1-2 180 180 640 640
1870 2490
4/24/20 2-3 180 180 50 50
3-4 180 280 50 50
4-5 180 NGT:280 460 500 500
5-6 180 NGT:50 230 500 500
6-7 140 Meropenem 200 210 210
60
7-8 140 NGT:300 440 200 200
8-9 140 140 320 320
9-10 140 140 250 250
2070 2080
4/24/20 10-11 180 180 160 160
11-12 180 NGT:250 460 60 60
12-1 180 180 120 120
1-2 180 180 180 180
2-3 180 NGT:30 210 260 260
3-4 180 180 210 210
4-5 180 NGT:250 460 150 150
5-6 180 NGT:100 280 100 100
2130 1470
7-3 = 1870 7-3 = 2490

3-11 = 2070 3-11 = 2080
11-7_ __=_2130____________ 11-7 =_1770__________
24H Total = 6070 24H Total = 6040

4/25/20 6-7 180 180 170 170
7-8 180 NGT:240 420 80 80
8-9 180 Meropenem 105 150 150
50
9-10 140 165 180 180
10-11 140 140 470 470
11-12 140 NGT:240 380 120 120
12-1 140 140 210 210
1-2 140 NGT:50 140 100 100
1670 1480
4/25/20 2-3 140 140 230 230
3-4 140 140 150 150
4-5 140 NGT:260 Meropenem 450 150 150
50
5-6 140 NGT:60 200 210 210
6-7 140 NGT:260 400 340 340
7-8 140 140 160 160
8-9 140 NGT:30 170 100 100
9-10 140 140 130 130
1780 1470
4/25/20 10-11 140 140 300 300
11-12 140 140 120 120
12-1 140 NGT:280 Meropenem 480 200 200
60
1-2 140 140 250 250
2-3 160 160 190 190
3-4 160 160 210 210
4-5 160 NGT:270 430 120 120
5-6 160 NGT:50 210 100 100
1490
7-3 = 1670 7-3 = 1480

3-11 = 1780 3-11 = 1470
11-7_ __=_1860____________ 11-7 =_1490__________
24H Total = 5310 24H Total = 4440

4/26/20 6-7 120 120 300 300
7-8 120 NGT:260 Meropenem 430 150 150
50
8-9 120 120 90 90
9-10 120 120 170 170
10-11 120 NGT:60 180 380 380
11-12 120 NGT:260 380 180 180
12-1 120 NGT:60 180 150 150
1-2 120 NGT:60 180 250 250
1710 1670
4/26/20 2-3 120 120 450 450
3-4 120 120 130 130
4-5 120 NGT:300 Meropenem 420 350 350
40
5-6 120 120 150 150
6-7 120 NGT:30 150 330 330
7-8 120 120 130 130
8-9 120 NGT:280 400 150 150
9-10 120 120 130 130
1610 1820
4/26/20 10-11 140 140 210 210
11-12 140 NGT:250 390 170 170
12-1 140 NGT:50 Meropenem 240 190 190
50
1-2 140 140 120 120
2-3 140 NGT:250 190 270 270
3-4 140 140 200 200
4-5 140 NGT:250 390 130 130
5-6 140 NGT:50 190 130 130
1820 1420
7-3 = 1710 7-3 = 1670

3-11 = 1610 3-11 = 1820
11-7_ __=_1820____________ 11-7 =_1420__________
24H Total = 5140 24H Total = 4910

4/27/20 6-7 140 140 380 380
7-8 120 120 180 180
8-9 120 NGT:260 Meropenem 440 150 150
60
9-10 120 120 700 700
10-11 120 120 320 320
11-12 120 120 240 240
12-1 120 NGT:270 390 150 150
1-2 120 NGT:50 170 120 120
1620 1740
4/27/20 2-3 140 140 300 300
3-4 140 NGT:270 Meropenem 470 350 350
60
4-5 140 140 200 200
5-6 140 140 300 300
6-7 140 NGT:50 190 210 210
7-8 140 NGT:320 460 220 220
8-9 140 140 150 150
9-10 140 140 200 200
1820 1930
4/27/20 10-11 140 NGT:60 200 150 150
11-12 140 NGT:250 390 130 130
12-1 140 Meropenem 200 90 90
60
1-2 140 NGT:50 190 50 50
2-3 140 140 40 40
3-4 140 140 70 70
4-5 140 NGT:270 410 110 110
5-6 140 NGT:50 190 150 150
1840 790
7-3 = 1620 7-3 = 1740

3-11 = 1820 3-11 = 1930
11-7_ __=_1840____________ 11-7 =_790__________
24H Total = 5280 24H Total = 4910

4/28/20 6-7 140 140 400 400
7-8 140 140 100 100
8-9 140 NGT:280 Meropenem 470 140 140
50
9-10 120 120 170 170
10-11 120 120 350 350
11-12 120 NGT:280 400 100 100
12-1 120 120 200 200
1-2 120 120 200 200
1630 1660
4/28/20 2-3 120 120 100 100
3-4 120 120 120 120
4-5 120 NGT:280 400 50 50
5-6 120 120 230 230
6-7 120 120 200 200
7-8 120 NGT:250 370 300 300
8-9 100 100 120 120
9-10 100 100 160 160
1450 1280
4/28/20 10-11 120 120 150 150
11-12 120 NGT:270 Meropenem 420 130 130
30
12-1 120 120 90 90
1-2 120 120 50 50
2-3 100 100 40 40
3-4 100 NGT:270 370 70 70
4-5 100 100 110 110
5-6 100 NGT:20 120 150 150
1470 790
7-3 = 1630 7-3 = 1660

3-11 = 1450 3-11 = 1280
11-7_ __=_1470____________ 11-7 =_790__________
24H Total = 4550 24H Total = 3730

4/29/20 6-7 80 80 40 40
7-8 80 80 70 70
8-9 80 NGT:230 310 90 90
9-10 80 80 70 70
10-11 80 80 100 100
11-12 80 80 130 130
12-1 80 NGT:230 310 100 100
1-2 80 80 80 80
1100 680
4/16/20 2-3 80 80 100 100
3-4 80 80 200 200
4-5 80 NGT:270 Meropenem 380 150 150
30
5-6 80 80 180 180
6-7 100 100 220 220
7-8 100 100 200 200
8-9 100 NGT:305 405 250 250
9-10 100 100 200 200
1345 1500
4/16/20 10-11 100 100 90 90
11-12 100 100 90 90
12-1 100 NGT:210 310 96 96
1-2 100 100 100 100
2-3 100 100 120 120
3-4 100 NGT:295 395 100 100
4-5 100 100 210 210
5-6 100 100 200 200
1305 1006
7-3 = 1100 7-3 = 680

3-11 = 1345 3-11 = 1500
11-7_ __=_1305____________ 11-7 =_1006__________
24H Total = 3750 24H Total = 3186

4/30/20 6-7 100 100 100 100
7-8 100 100 120 120
8-9 80 NGT:230 Meropenem 340 200 200
30
9-10 60 60 150 150
10-11 60 60 110 110
11-12 60 60 90 90
12-1 60 NGT:250 310 64 64
1-2 60 NGT:30 90 115 115
1120 949
4/16/20 2-3 60 60 40 40
3-4 60 60 40 40
4-5 60 NGT:280 Meropenem 390 30 30
50
5-6 60 60 140 140
6-7 60 60 120 120
7-8 60 60 300 300
8-9 60 NGT:390 450 100 100
9-10 60 60 100 100
1200 870
4/16/20 10-11 60 60 65 65
11-12 60 60 60 60
12-1 60 NGT:270 330 120 120
1-2 60 60 84 84
2-3 60 60 100 100
3-4 60 60 120 120
4-5 60 NGT:330 390 100 100
5-6 60 60 150 150
1060 799
7-3 = 1120 7-3 = 949

3-11 = 1200 3-11 = 870
11-7_ __=_1060____________ 11-7 =_799__________
24H Total = 3360 24H Total = 2618

5/1/20 6-7 60 60 180 180
7-8 60 60 120 120
8-9 60 NGT:250 Meropenem 340 100 100
30
9-10 40 40 82 82
10-11 40 40 91 91
11-12 40 40 100 100
12-1 40 NGT:300 340 150 150
1-2 40 40 200 200
960 1023
5/1/20 2-3 40 40 80 80
3-4 40 40 40 40
4-5 40 NGT:250 Meropenem 330 100 100
40
5-6 40 NGT:30 70 270 270
6-7 40 40 100 100
7-8 40 40 200 200
8-9 40 NGT:300 340 100 100
9-10 40 40 70 70
940 960
5/1/20 10-11 40 40 50 50
11-12 40 40 70 70
12-1 40 NGT:250 Meropenem 330 80 80
40
1-2 40 40 150 150
2-3 40 40 200 200
3-4 40 NGT:320 360 100 100
4-5 40 40 150 150
5-6 40 NGT:20 60 150 150
950 950
7-3 = 960 7-3 = 1023

3-11 = 940 3-11 = 960
11-7_ __=_950____________ 11-7 =_950__________
24H Total = 2650 24H Total = 2933

5/2/20 6-7 60 60 120 120
7-8 60 60 100 100
8-9 60 NGT:290 Meropenem 380 112 112
30
9-10 40 40 115 115
10-11 40 40 154 154
11-12 40 NGT:320 360 0 0
12-1 40 40 10 10
1-2 40 40 300 300
1020 911
5/2/20 2-3 40 40 175 175
3-4 40 40 175 175
4-5 40 NGT:230 270 175 175
5-6 40 40 175 175
6-7 40 40 175 175
7-8 40 40 175 175
8-9 40 NGT:230 270 175 175
9-10 40 40 175 175
780 1400
5/2/20 10-11 40 40 35 35
11-12 60 60 40 40
12-1 60 NGT:250 Meropenem 310 50 50
40
1-2 60 60 60 60
2-3 60 60 60 60
3-4 60 80 180 180
4-5 60 NGT:300 360 90 90
5-6 60 60 200 200
1030 710
7-3 = 1020 7-3 = 911

3-11 = 780 3-11 = 1400
11-7_ __= 1030________ 11-7 =_710_________
24H Total = 2830 24H Total = 3021

5/3/20 6-7 60 60 100 100
7-8 60 60 150 150
8-9 60 NGT:250 310 100 100
9-10 60 60 100 100
10-2 240 NGT:250 490 0 0
980 450
5/3/20 2-5 180 NGT:250 430 850 850
5-6 60 60 140 140
490 990
5/3/20 6-7 60 60 200 200
7-8 60 60 100 100
8-9 60 NGT:250 310 90 90
9-10 60 60 190 190
490 1570
5/3/20 10-11 60 60 100 100
11-12 60 60 60 60
12-1 60 NGT:280 340 70 70
1-2 60 60 100 100
2-3 60 60 70 70
3-4 60 60 60 60
4-5 60 NGT:250 310 50 50
5-6 60 60 60 60
1010 670
2570 2650
7-3 = 7-3 =
3-11 = 3-11 =
11-7_ __=_____________ 11-7 =___________
Fluid Balance =

5/4/20 6-7 60 60 100 100
7-8 60 60 55 55
8-9 60 NGT:250 310 70 70
9-10 60 60 50 50
10-11 60 60 115 115
11-12 60 60 72 72
12-1 60 NGT:250 310 100 100
1-2 60 60 54 54
980 616
5/4/20 2-3 60 60 70 70
3-4 60 60 180 180
4-5 60 NGT:250 290 100 100
5-6 60 60 75 75
6-7 60 60 60 60
7-8 60 NGT:250 310 55 55
8-9 60 60 80 80
9-10 60 60 170 170
960 730
5/4/20 10-11 60 60 120 120
11-12 60 60 80 80
12-1 60 NGT:250 310 80 80
1-2 60 NGT:30 90 100 100
2-3 60 60 100 100
3-4 60 60 150 150
4-5 60 NGT:230 290 100 100
5-6 60 NGT:20 80 180 180
1010 830
7-3 = 980 7-3 = 616

3-11 = 960 3-11 = 730
11-7_ __=_1010____________ 11-7 =_830__________
24H Total = 2950 24H Total = 2176

5/5/20 6-7 60 60 70 70
7-8 60 60 85 85
8-9 60 NGT:310 370 90 90
9-10 60 60 60 60
10-11 60 60 150 150
11-12 40 NGT:310 350 150 150
12-1 40 40 100 100
1-2 40 40 50 50
1040 755
5/5/20 2-3 40 40 200 200
3-4 40 40 200 200
4-5 40 NGT:290 330 200 200
5-6 40 60 200 200
6-7 40 40 150 150
7-8 40 NGT:310 350 150 150
8-9 40 40 75 75
9-10 40 40 75 75
920 1150
5/5/20 10-11 40 40 100 100
11-12 40 40 100 100
12-1 40 NGT:240 280 50 50
1-2 40 40 50 50
2-3 40 NGT:40 80 100 100
3-4 40 40 150 150
4-5 40 NGT:250 290 50 50
5-6 40 40 50 50
850 2555
7-3 = 1040 7-3 = 755

3-11 = 920 3-11 = 1150
11-7_ __=_850____________ 11-7 =_650__________
24H Total = 2810 24H Total = 2555

5/6/20 6-7 40 40 75 75
7-8 40 40 100 100
8-9 40 NGT:280 320 50 50
9-10 20 20 75 75
10-11 20 20 150 150
11-12 20 20 80 80
12-1 20 NGT:280 300 75 75
1-2 20 20 55 55
780 660
5/6/20 2-3 20 NGT:30 50 51 51
3-4 20 20 70 70
4-5 20 NGT:280 300 130 130
5-6 20 20 100 100
6-7 20 20 50 50
7-8 20 20 50 50
8-9 20 NGT:250 270 100 100
9-10 20 20 50 50
860 351
5/6/20 10-11 60 20 50 50
11-12 60 20 40 40
12-1 60 NGT:380 400 70 70
1-2 60 20 60 60
2-3 60 20 90 90
3-4 60 20 70 70
4-5 60 NGT:380 400 60 60
5-6 60 20 75 75
920 515
7-3 = 780 7-3 = 660

3-11 = 860 3-11 = 351
11-7_ __=_920____________ 11-7 =_515__________
24H Total = 2560 24H Total = 1776

5/7/20 6-2 NGT:760 760 550 550
2-6 NGT:380 380 250 250
6-10 NGT:380 380 550 550
760 800
5/7/20 10-2 NGT:390 390 570 570
2-6 NGT:380 380 220 220
2290 2140
5/8/20 6-10 NGT:350 350 200 200
10-2 NGT:350 350 200 200
700 450
5/8/20 2-6 NGT:360 360 200 200
6-10 NGT:360 360 200 200
720 400
5/8/20 10-2 NGT:350 350 500 500
2-6 NGT:350 350 380 380
700 880
2120 1730
5/9/20 6-10 NGT:370 370 200 200
10-2 NGT:370 370 125 125
740 325
7-3 = 7-3 =
3-11 = 3-11 =
11-7_ __=_____________ 11-7 =___________
Fluid Balance =
MEDICATION ADMINISTRATION RECORD (MAR)
MEDICATION: Dosage, Date: 5/7/2020 Date: 5/8/2020 Date: 5/9/2020 Date: 5/10/2020
Route, Frequency Time NOD NOD Time NOD NOD Time NOD NOD Time NOD NOD
1 2 1 2 1 2 1 2
CITICOLINE 1 GRAM/TAB; 1 8 signed 8 Signed 8 Signed
TAB TID / NGT 4 signed 4 signed 4 signed
8 signed 8 signed 8 signed
MUPIROCIN OINTMENT 2 signed 6 signed 6 signed

APPLY TO PUNCTURE SITES 10 signed 2 signed 2 signed
10 signed 10 signed
CLONIDINE 75 MCG/TAB q 6
H, PRN FOR BP ≥ 160 mmHg
Signature Specimens:
(Provide signature beside full name in print)
DOH-SWUMed-NSD-F-013 Rev. 1
1 2 1 2 1 2 1 2
MUPIROCIN OINTMENT 6 signed 6 signed 6 signed 6 signed
APPLY TO PUNCTURE SITES 2 signed 2 signed 2 signed 2 signed
10 signed 10 signed 10 signed 10 signed
CITICOLINE 1 GRAM/TAB; 1 2 signed 2 signed 2 signed 2 signed

TAB q 6 H/ NGT 8 signed 8 signed 8 signed 8 signed
MEROPENEM (MEROMAX) 1 12 signed

GM q 8 H IV DRIP
(-)ANST
VALSARTAN 160 MG/TAB; 1 12 signed 12 signed 12 signed 12 signed

TAB OD / NGT
SALBUTAMOL PLAIN 1 NEB q 2 signed 6 signed 6 signed 6 signed

8H 10 signed 2 signed 2 signed 2 signed
10 signed 10 signed
CLONIDINE 75 MCG/TAB q 6
1 2 1 2 1 2 1 2
VITAMIN B COMPLEX; 1 CAP 8 signed
OD / NGT
PANTOPRAZOLE 40 MG/CAP; 6 signed

1 CAP OD / NGT ACBF
ASPIRIN 80 MG/TAB 1 TAB 2 signed

OD / NGT
CLOPIDOGREL 75 MG/TAB; 1 12 signed

TAB OD / NGT
ATORVASTATIN 80 MG/TAB; 8 signed

1 TAB OD / NGT q HS
1 2 1 2 1 2 1 2
VITAMIN B COMPLEX; 1 CAP 8 signed 8 signed 8 signed 8 signed
OD / NGT
PANTOPRAZOLE 40 MG/CAP; 6 signed 6 signed 6 signed 6 signed

1 CAP OD / NGT ACBF
ASPIRIN 80 MG/TAB 1 TAB 2 signed 2 signed 2 signed 2 signed

OD / NGT
CLOPIDOGREL 75 MG/TAB; 1 12 signed 12 signed 12 signed 12 signed

TAB OD / NGT
ATORVASTATIN 80 MG/TAB; 8 Rx 8 signed 8 signed 8 signed

1 TAB OD / NGT q HS
1 2 1 2 1 2 1 2
AMLODIPINE 10MG/TAB; 1 8 signed 8 signed 8 signed 8 signed
TAB BID / NGT 8 signed 8 signed 8 signed 8 signed
(HOLD FOR SBP <110 mmHg)
LACTULOSE 30 ML OD q HS 8 signed 8 signed 8 signed 8 signed

(HOLD FOR BM ≥ 2X/DAY
METOCLOPRAMIDE 10 MG
IVTT q 8 PRN FOR HICCUPS
PARACETAMOL 500 MG/TAB;

1 TAB q 4 H PRN FOR T≥
38.0 °C
MEDICATION: Dosage, Date: 5/9/2020 Date Date: Date:

1 2 1 2 1 2 1 2
AMLODIPINE 10MG/TAB; 1 8 signed
TAB BID / NGT 8 signed
LACTULOSE 30 ML OD q HS 8 signed
DESLORATIDINE 5MG/TAB; 1 8 signed

TAB / NGT OD q HS
1 2 1 2 1 2 1 2
DESLORATIDINE 5MG/TAB; 1 8 Rx 8 signed
TAB / NGT OD q HS
LORATADINE + 8 signed 8 signed

DEXAMETHASONE 8 signed
(CLARICORT) 5/ 250 MG; 1
TAB / NGT BID
D/C
1 2 1 2 1 2 1 2
LEVOFLOXACIN 500 MG/TAB 8 signed 8 signed 8 signed
OD / NGT
LORATADINE + 8 signed 8 signed 8 signed

DEXAMETHASONE 8 signed 8 signed 8 signed
TAB / NGT BID
SALBUTAMOL + 10 signed 6 signed 6 signed

IPRATROPIUM; 1 NEB q 8 H 2 signed
10 signed SHIFTED
1 2 1 2 1 2 1 2
TAB BID / NGT 8 signed 8 signed 8 signed 8 signed

DESLORATIDINE 5MG/TAB; 1 4 signed 1 signed

TAB / NGT OD PC LUNCH
METOCLOPRAMIDE 10 MG 1 signed 2 signed

IVTT q 8 PRN FOR HICCUPS 4 signed

38.0 °C
1 2 1 2 1 2 1 2
OD / NGT

1 CAP OD / NGT ACBF
ASPIRIN 80 MG/TAB 1 TAB 2 signed 2 signed 2 signed 2 signed

OD / NGT

TAB OD / NGT
ATORVASTATIN 80 MG/TAB; 8 Rx 8 signed 8 signed 8 signed

1 TAB OD / NGT q HS
NaCl 1 TAB TID FOR 4 DOSES 4 signed 8 signed

1 signed
6 signed
COMPLETED
1 2 1 2 1 2 1 2
LEVOFLOXACIN 500 MG/TAB 8 Rx 8 signed 8 signed 8 signed
OD / NGT 4 signed
SALBUTAMOL PLAIN 1 NEB q 10 signed 6 signed 6 signed 6 signed

8H 2 signed 2 Signed 2 Signed
10 signed 10 signed
SHIFTED
LORATADINE + 8 Rx 8 signed 8 signed

DEXAMETHASONE 8 signed 8 signed 8 signed
TAB / NGT BID
MANNITOL 50 CC IV q 8 H 12 signed 4 signed 4 signed
8 signed 12 signed
8 signed
DECREASED
MANNITOL 50 CC IV q 12 H 4 signed
SALBUTAMOL NEB; 1 NEB 10 Rx

FIRST DOSE NOW 2 signed
1 2 1 2 1 2 1 2
CLINDAMYCIN 300/CAP; 1 12 Signed 12 Signed 12 Signed 12 Signed

CAP q 6H / NGT 6 Signed 6 Signed 6 Signed 6 Signed
12 Signed 12 Signed 12 Signed 12 Signed
CITICOLINE 1 G/TAB; 1 TAB q 2 signed 2 signed 2 signed 2 signed

6 H / NGT 8 signed 8 signed 8 signed 8 signed
MEROPENEM (MEROMAX) 1 12 signed 12 signed 12 signed 12 signed

GRAM q 8 H IV DRIP 8 signed 8 signed 8 signed 8 signed
(-) ANST
VALSARTAN 160 MG/TAB; 1 12 signed 12 Rx 12 signed 12 signed
TAB PO 2 signed
CLONIDINE 75 MCG/TAB q 6 12 signed

1 2 1 2 1 2 1 2
TAB BID / NGT 8 signed 8 signed 8 signed
MANNITOL 75 CC IV q 6 H 10 signed 4 signed 4 signed
4 signed 10 signed
10 signed 4 signed DECREASED
10 signed
LACTULOSE 30 ML OD q HS 8 signed 8 signed 8 signed

MANNITOL 75 CC IV q 8 H 12 signed 4 signed

8 signed
DECREASED
METOCLOPRAMIDE 10 MG 1:30 signed 4:20 signed 1:10 signed
IVTT q 8 PRN FOR HICCUPS 5 signed 7:10 signed

38.0 °C
1 2 1 2 1 2 1 2
KCl TABLET; GIVE 2 TABS 8 signed 8 signed 8 signed
TID/NGT 12 signed 12 signed
8 signed 8 signed
DISCONTINUE

OD/NGT

1 CAP OD / NGT ACBF
ASPIRIN 80 MG/TAB; 1 TAB 1 signed 1 signed 1 signed 1 signed

OD/NGT

TAB OD/NGT
ATORVASTATIV 80MG/TAB; 8 signed 8 signed 8 signed 8 signed

1 TAB OD/NGT
MEDICATION: Dosage, Date 4/26/2020 Date: 4/27/2020 Date: 4/28/2020 Date: 4/29/2020
1 2 1 2 1 2 1 2
CLINDAMYCIN 300/CAP; 1 12 Signed 12 Signed 12 Signed 12 Signed

CAP q 6H / NGT 6 Signed 6 Signed 6 Signed 6 Signed


(-) ANST
VALSARTAN 160 MG/TAB; 1 12 signed 12 signed 12 signed
TAB PO
CLONIDINE 75 MCG/TAB q 6 5 signed 1:30 signed 10 signed

H, PRN FOR BP ≥ 160 mmHg 11 signed 2 signed
5:30 signed 9:44 signed
1 2 1 2 1 2 1 2

TAB BID / NGT 8 signed 8 signed 8 signed
MANNITOL 100 CC IV BOLUS 2 signed 2 signed

q 4H 6 signed 6 signed
10 signed
2 signed
6 signed DISCONTINUE
10 signed
MANNITOL 75 CC IV BOLUS q 10 signed 2 signed 2 signed
4 HOURS 2 signed 6 signed 6 signed
10 signed 2 signed
6 signed
10 signed
METOCLOPRAMIDE 10 MG 9:20 signed 2:30 signed 12 signed 3:30 signed
IVTT q 8 PRN FOR HICCUPS 9:30 signed 11 signed 8 signed

38.0 °C
1 2 1 2 1 2 1 2
OD/NGT

1 CAP OD / NGT ACBF

OD/NGT

TAB OD/NGT

1 TAB OD/NGT
KCl TABLET; GIVE 2 TABS 8 signed 8 signed

TID/NGT 12 signed
8 signed
DECREASED
1 2 1 2 1 2 1 2
VALSARTAN 160 MG/TAB; 1 12 signed 12 signed 12 signed 12 signed
TAB PO

8 signed
INCREASED
12 signed
8 signed
MEDICATION: Dosage, Date: 4/22/2020 Date: 4/23/2020 Date: 4/24/2020 Date:4/25/2020

1 2 1 2 1 2 1 2
APPLY TO PUNCTURE SITES q 2 signed 2 signed 2 signed 2 signed
SHIFT 10 signed 10 signed 10 signed 10 signed
CLINDAMYCIN 300/CAP; 1 12 signed 12 signed 12 signed 12 signed

CAP q 6H / NGT 6 signed 6 signed 6 signed 6 signed

(-)ANST

VALSARTAN 160 MG/TAB; 10 Rx

1/2 TAB NOW THEN OD 12 signed
(HOLD FOR SBP< 110 mmHg)
INCREASED
CLONIDINE 75 MCG/TAB q 6 2 signed 2:30 signed 6 signed 6 signed

H, PRN FOR BP ≥ 160 mmHg 8 signed 9 signed 2 signed 1:25 signed
1 2 1 2 1 2 1 2
AMLODIPINE 10MG/TAB; 1 8 signed 8 signed 8 signed

TAB BID / NGT 8 signed 8 signed

8 signed
INCREASED
MANNITOL 100 CC IV BOLUS 2 signed

q 4H 6 signed
10 signed
2 signed
6 signed
10 signed
METOCLOPRAMIDE 10 MG 9:30 signed 2 signed 7 signed
IVTT q 8 PRN FOR HICCUPS 8:40 signed 8 signed 3 signed

38.0 °C
1 2 1 2 1 2 1 2
C ITICOLINE 1 G IVTT q 6 H 2 signed 2 signed
8 signed 8 signed
2 signed REVISED
8 signed

1 CAP OD / NGT ACBF

OD/NGT

TAB OD/NGT

1 TAB OD/NGT
LACTULOSE 30 ML NOW 8 signed
1 2 1 2 1 2 1 2
MANNITOL 100 CC IV BOLUS 2 signed 2 signed 2 signed 2 signed
q4H 6 signed 6 signed 6 signed 6 signed


BETAHISTINE (SERC) 16 8 signed
MG/TAB; 1 TAB TID / NGT 12 signed
8 signed
DISCONTINU
E
VITAMIN B COMPLEX; 1 CAP 8 signed

OD / NGT
PIPERACILLIN + 4 signed 4 signed

TAZOBACTAM 4.5 GMS IV 12 signed SHIFTED
DRIPq 8 H 8 signed
CLONIDINE 75 MCG/TAB; 4 signed 10 signed 2:30 signed 12 signed

PRN FOR BP ≥ 180/100 5:30 signed 8 signed 5 signed 6 signed
mmHg
REVISED
KCl 2 TABS; TID X 6 DOSES 8 signed 8 signed
ONLY 12 signed 12 signed
8 signed 8 signed
1 2 1 2 1 2 1 2
APPLY TO PUNCTURE SITES q 2 signed 2 signed 2 signed
SHIFT 10 signed 10 signed 10 signed
CLINDAMYCIN 300/CAP; 1 12 signed 12 signed 12 signed

CAP q 6H / NGT 6 signed 6 signed 6 signed
12 signed 12 signed
6 signed 6 signed
MEROPENEM (MEROMAX) 1 9 signed 12 signed

GRAM q 8 H IV DRIP 4 signed 8 signed
4 signed
(-)ANST
AMLODIPINE 5 MG/TAB; 1 8 signed 8 Signed

TAB OD
INCREASED
CITICOLINE 1 GM/TAB; 1 2 Signed 2 Signed
TAB q 6 H/NGT 8 Signed 8 Signed
2 Signed
8 Signed
CARVEDILOL 6.25 NOW 6:30 signed
1 2 1 2 1 2 1 2
LACTULOSE 30 ML OD q HS 8 HOLD BM>2
LACTULOSE 30 ML NOW 12:05 signed
CLOPIDOGREL 75 MG/TAB; 3 12 signed

TABS NOW
CLONIDINE 75 MCG/TAB; 1 6:05 Signed

TAB SL NOW
PARACETAMOL 500 MG/TAB; 6 Signed

38.0 °C
1 2 1 2 1 2 1 2
C ITICOLINE 1 G IVTT q 6 H 7:50 signed 2 Signed 2 Signed 2 Signed
8 Signed 8 Signed 8 Signed
PANTOPRAZOLE 40 MG/CAP; 6 signed 6 signed 6 Signed

1 CAP OD / NGT ACBF
ASPIRIN 80 MG/TAB; 1 TAB 8 Signed 1 signed 1 Signed 1 signed

OD/NGT
CLOPIDOGREL 75 MG/TAB; 1 1:30 signed 1 signed 1 Signed

TAB OD/NGT
ATORVASTATIV 80MG/TAB; 1:30 Signed 8 signed 8 Signed

1 TAB OD/NGT 8 Signed
PANTOPLRAZOLE 40 MG 7:50 signed

IVTT NOW
1 2 1 2 1 2 1 2
MANNITOL 100 CC IV BOLUS 9:30 signed 2 signed 2 signed 2 signed
q4H 6 signed 6 signed 6 signed

BETAHISTINE (SERC) 16 w/o signed signed signed
9:30 1:30 8 8
MG/TAB; 1 TAB TID / NGT NGT
KCl TAB; 1 TAB TID/NGT FOR w/o signed signed signed

9:30 1:30 8 8
6 DOSES NGT
VITAMIN B COMPLEX; 1 CAP w/o

9:30 1:30 signed 8 signed 8 signed
OD/NGT NGT
PIPERACILLIN + 12 signed 4 signed 4 signed

TAZOBACTAM 4.5 GM IV 8 signed 12 signed 12 signed
DRIP q 8 H 8 signed 8 signed
(-) ANST
CLONIDINE 75 MCG/TAB; 1 10 signed 4 signed 4:30 signed

TAB q 6 H / NGT PRN FOR 4 signed 10:30 signed 12:10 signed
BP ≥ 180/100 mmHg 7:50 signed
(Provide signature beside full name in pri
NEUROLOGIC MONITORING SHEET
Hospital No. ___123894_____________________
Patient Name: __DELA CRUZ, MARIO__________________________ Age: 69___ Sex: _M______ Civil Status: ___MARRIED_______ Room No. _ICCU 1_______ Attending Physician: DR. ESPAñOL_________
DATE: 4/15/2020 AM NN PM MN AM
GLASGOW COME SCLARE (ADULT) TIME 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6
I.EYE OPENING SCORE
A. NEVER 1
B. To PAIN 2
C. VERBAL STIMULUS 3
D. SPONTANEOUS 4 / / / / / / /
II.VERBAL
A. NO RESPONSE 1
B. INCOMPREHENSIBLE SOUND 2 / / / / / / /
C. INAPPROPRIATE WORDS 3
D. DISORIENTED AND CONVERSE 4
E. ORIENTED AND CONVERSE 5
III.MOTOR
A. NONE (FLACCID) 1
B. ABNORMAL EXTENSION (DECEREBRATE) 2
C. ABNORMAL FLEXION (DECORTICATE) 3
D. FLEXION WITHDRAWAL 4
E. LOCALIZES PAIN 5
F. OBEYS COMMANDS 6 / / / / / / /
TOTAL 15 12 12 12 12 12 12 12
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 173
/90
164
/100
159
/77
120
/70
163
/74
166
/80
155
/56
HEART RATE 58 67 63 64 64 63 60
RESPIRATORY RATE 22 18 22 22 19 23 22
02 SATURATION (%) 99 99 99 99 98 98 99
BODY TEMPERATURE 36.5 35.8 36.

0
36.
1
35.
9
35.
9
36.
0
Hospital No. ___123894_____________________
I.EYE OPENING SCORE
A. NEVER 1
B. To PAIN 2
D. SPONTANEOUS 4 / / / / / / / / / / / / / / / / / / / / / / / /
II.VERBAL
A. NO RESPONSE 1 / / / / / / / / / / / / / / / / / / / / / / / /
B. INCOMPREHENSIBLE SOUND 2
III.MOTOR
A. NONE (FLACCID) 1
E. LOCALIZES PAIN 5
F. OBEYS COMMANDS 6 / / / / / / / / / / / / / / / / / / / / / / / /
TOTAL 15 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / / / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 169 168/9 159/ 180/80 153/ 159/ 180 153 200 171/ 181 196/ 220/1 200 200 180/ 196/ 160/ 180/ 180 179 180 182 171
/78 /65 /10 81 /78 86 10 / /93 80 80 80 86 /88 /89 /91 /81 /86
/78 2 75 69 73
`10
0
HEART RATE 63 75 55 63 65 63 66 68 67 60 65 69 67 67 61 72 70 66 72 76 88 69 59 62
RESPIRATORY RATE 22 23 25 21 24 23 21 22 22 22 22 21 21 26 21 21 20 20 20 21 20 21 21 20
02 SATURATION (%)
100
97 97 98 98 99 100 99 99 98 98 99 95 97 97 98 97 90 98 97 98 97 97 97
BODY TEMPERATURE 36.

6
36.5 36.5 36.2 36.4 36.2 36.
1
36.
1
35.
9
36.0 36.
0
36.
0
36.0 35.
4
36.
0
36.
4
36.5 35.8 35.8 36.
4
36.
4
36.
7
36.
6
36.
4
Hospital No. ___123894_____________________
I.EYE OPENING SCORE
A. NEVER 1
B. To PAIN 2
D. SPONTANEOUS 4 / / / / / / / / / / / / / / / / / / / / / / / /
II.VERBAL
A. NO RESPONSE 1 / / / / / / / / / / / / / / / / / / / / / / / /
III.MOTOR
A. NONE (FLACCID) 1
E. LOCALIZES PAIN 5
F. OBEYS COMMANDS 6 / / / / / / / / / / / / / / / / / / / / / / / /
TOTAL 15 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / / / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 169 168/ 159/ 180/80 153 159/ 180 153 200 171/ 181 196/ 220/1 200 200 180/ 196/ 160/ 180/ 180 179 180 182 171
/78 /65 /10 81 /78 86 10 / /93 80 80 80 86 /88 /89 /91 /81 /86
/78 92 75 /69 73
100
HEART RATE 63 75 55 63 65 63 66 68 67 60 65 69 67 67 61 72 70 66 72 76 88 69 59 62
02 SATURATION (%)
100
97 97 98 98 99 100 99 99 98 98 99 95 97 97 98 97 90 98 97 98 97 97 97

6
36.5 36.5 36.2 36.4 36.2 36.
1
36.
1
35.
9
36.0 36.
0
36.
0
36.0 35.
4
36.
0
36.
4
36.5 35.8 35.8 36.
4
36.
4
36.
7
36.
6
36.
4
Patient Name: __DELA CRUZ, MARIO_______ Age: 69___ Sex: _M______ Civil Status: ___MARRIED_______ Room No. _ICCU 1_______ Attending Physician: DR. ESPAñOL_ Hospital No. ___123894__________
I.EYE OPENING SCORE
A. NEVER 1
B. To PAIN 2
D. SPONTANEOUS 4 / / / / / / / / / / / / / / / / / / / / / / / /
II.VERBAL
A. NO RESPONSE 1 / / / / / / / / / / / / / / / / / / / / / / / /
III.MOTOR
A. NONE (FLACCID) 1
E. LOCALIZES PAIN 5 / /
F. OBEYS COMMANDS 6 / / / / / / / / / / / / / / / / / / / / / /
TOTAL 15 10 10 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / / / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 180 172/ 175/ 173/ 192/ 200/ 190 165 200 197/ 210 160/ 174/ 170 187 174/ 182/ 180/83 177 176 176 182 185 182
/ / /10 97 / 90 71 / / 81
/83 86 77 74 84 90 84 /80 / / / / /
90 68 0 100 70 800
80 77 82 89 82
HEART RATE 66 74 71 73 75 87 88 74 76 95 10 98 94 85 72 78 78 91 69 67 65 65 62 62
9
02 SATURATION (%) 99 99 98 97 97 98 97 96 99 96 97 98 98 98 97 99 97 98 97 98 98 99 97 99

1
36.2 36.6 36.6 36.4 36.7 36.
4
36.
7
36.
7
36.3 36.
4
38.
1
37.8 37.
8
36.
7
36.
9
37.1 36. 35.8 36.
2
36.
1
35.
5
35.
1
36.
2
I.EYE OPENING SCORE
A. NEVER 1
B. To PAIN 2
C. VERBAL STIMULUS 3 /
D. SPONTANEOUS 4 / / / / / / / / / / / / / / / / / / / / / / /
II.VERBAL
A. NO RESPONSE 1 / / / / / / / / / / / / / / / / / / / / / / / /
III.MOTOR
A. NONE (FLACCID) 1
E. LOCALIZES PAIN 5
F. OBEYS COMMANDS 6 / / / / / / / / / / / / / / / / / / / / / / / /
TOTAL 15 10 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / / / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 172 170 160 170 160 170 160 160 160 150 160 170 180 180 190 190 190 160 170 180 180 180 170 180
/ / / / / / / / / /
/ / / / / / / / / / / / / /
100 100 100 90 100 100 110 90 90 100
72 100 90 90 100 100 100 100 100 90 110 100 90 90
HEART RATE 65 66 63 67 72 84 64 69 64 66 69 69 67 68 69 70 74 77 80 85 80 78 70 68
19
02 SATURATION (%) 99 99 98 97 97 96 98 99 99 98 97 98 97 98 99 98 98 98 97 98 98 98 99 97

2
36.5 36.5 36.2 36.4 36.2 36.
2
36.
0
35.
8
36.0 36.
2
36.
3
36.0 35.
4
36.
0
36.
2
36.5 35.8 35.8 36.
4
36.
1
36.
4
36.
5
36.
1
I.EYE OPENING SCORE
A. NEVER 1
B. To PAIN 2
D. SPONTANEOUS 4 / / / / / / / / / / / / / / / / / / / / / / / /
II.VERBAL
A. NO RESPONSE 1 / / / / / / / / / / / / / / / / / / / / / / / /
III.MOTOR
A. NONE (FLACCID) 1
E. LOCALIZES PAIN 5
F. OBEYS COMMANDS 6 / / / / / / / / / / / / / / / / / / / / / / / /
TOTAL 15 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / / / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 180 150 150 170 180 180 780 170 150 180 200 181 192 196 177 175 189 190 170 176 188 168 200 200
/ / / / / / / / / /
/ / / / / / / / / / / / / /
80 80 80 86 80 100 84 90 90 98
93 80 80 90 80 80 90 100 89 80 101 99 100 79
HEART RATE 93 80 85 80 81 71 85 69 69 72 71 78 97 67 91 90 81 84 75 75 81 77 79 76
02 SATURATION (%) 98 97 95 98 97 99 99 99 97 97 97 95 96 99 98 98 99 99 99 99 98 98 98 98

2
36.3 36.6 36.3 36.0 36.1 36.
4
36.
1
35.
1
36.0 36.
4
36.
4
36.1 35.
1
36.
2
36.
1
36.2 35.4 35.2 36.
1
36.
3
36.
4
36.
4
36.
1
I.EYE OPENING SCORE
E. NEVER 1
F. To PAIN 2
G. VERBAL STIMULUS 3
H. SPONTANEOUS 4 / / / / / / / / / / / / / / / / / / / / / / / /
II.VERBAL
F. NO RESPONSE 1 / / / / / / / / / / / / / / / / / / / / / / / /
G. INCOMPREHENSIBLE SOUND 2
H. INAPPROPRIATE WORDS 3
I. DISORIENTED AND CONVERSE 4
J. ORIENTED AND CONVERSE 5
III.MOTOR
G. NONE (FLACCID) 1
H. ABNORMAL EXTENSION (DECEREBRATE) 2
I. ABNORMAL FLEXION (DECORTICATE) 3
J. FLEXION WITHDRAWAL 4
K. LOCALIZES PAIN 5
L. OBEYS COMMANDS 6 / / / / / / / / / / / / / / / / / / / / / / / /
TOTAL 15 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / / / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 180 150 150 170 182 180 180 170 183 180 200 181 192 180 177 175 189 194 178 176 188 168 200 200
/ / / / / / / / / /
/ / / / / / / / / / / / / /
80 80 86 80 100 84 90 90 84 88
90 84 80 90 80 80 95 100 87 80 101 99 100 91
HEART RATE 93 80 85 80 81 71 85 69 69 72 71 78 97 67 91 90 81 94 75 75 80 77 79 76
02 SATURATION (%) 98 97 100 98 99 99 99 99 98 97 97 99 99 98 98 98 99 99 98 98 97 98 98 98

2
36.
0
36.1 36.4 36.0 36.3 36.
5
36.
8
36.
1
36.2 36.
3
36.
5
36.1 36.
4
36.
2
36.
0
36.4 35.2 35.8 36.
1
36.
3
36.
4
36.
4
36.
1
I.EYE OPENING SCORE
I. NEVER 1
J. To PAIN 2
K. VERBAL STIMULUS 3
L. SPONTANEOUS 4 / / / / / / / / / / / / / / / / / / / / / / / /
II.VERBAL
K. NO RESPONSE 1 / / / / / / / / / / / / / / / / / / / / / / / /
L. INCOMPREHENSIBLE SOUND 2
M. INAPPROPRIATE WORDS 3
N. DISORIENTED AND CONVERSE 4
O. ORIENTED AND CONVERSE 5
III.MOTOR
M. NONE (FLACCID) 1
N. ABNORMAL EXTENSION (DECEREBRATE) 2
O. ABNORMAL FLEXION (DECORTICATE) 3
P. FLEXION WITHDRAWAL 4
Q. LOCALIZES PAIN 5
R. OBEYS COMMANDS 6 / / / / / / / / / / / / / / / / / / / / / / / /
TOTAL 15 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / / / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 160 170 180 170 180 140 160 160 180 160 160 200 200 190 180 180 171 164 167 170 180 184 179 174
/ / / / / / / / / /
/ / / / / / / / / / / / / /
100 80 90 80 90 100 100 100 84 100
80 100 90 90 90 70 89 75 74 80 90 95 86 79
HEART RATE 80 81 79 83 88 93 91 85 97 96 85 83 95 88 95 90 93 92 92 88 95 88 81 84
02 SATURATION (%) 98 98 98 98 98 98 98 96 97 97 98 97 97 98 96 97 96 97 97 97 96 97 98 98

5
36.
3
36.3 36.5 36.2 36.2 36.
2
36.
1
36.
2
36.3 36.
4
36.
1
36.2 36.
2
36.
7
37.
0
36.8 35.3 35.8 36.
6
36.
4
36.
6
36.
4
36.
5
I.EYE OPENING SCORE
M. NEVER 1
N. To PAIN 2
O. VERBAL STIMULUS 3
P. SPONTANEOUS 4 / / / / / / / / / / / / / / / / / / / / / / / /
II.VERBAL
P. NO RESPONSE 1 / / / / / / / / / / / / / / / / / / / / / / / /
Q. INCOMPREHENSIBLE SOUND 2
R. INAPPROPRIATE WORDS 3
S. DISORIENTED AND CONVERSE 4
T. ORIENTED AND CONVERSE 5
III.MOTOR
S. NONE (FLACCID) 1
T. ABNORMAL EXTENSION (DECEREBRATE) 2
U. ABNORMAL FLEXION (DECORTICATE) 3
V. FLEXION WITHDRAWAL 4
W. LOCALIZES PAIN 5
X. OBEYS COMMANDS 6 / / / / / / / / / / / / / / / / / / / / / / / /
TOTAL 15 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / / / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 170 170 170 150 160 160 160 160 150 160 160 200 200 190 180 180 130 160 167 190 180 161 170 180
/ / / / / / / / / /
/ / / / / / / / / / / / / /
100 80 70 90 90 100 100 90 72 100
90 80 80 70 90 100 90 100 90 100 100 100 95 100
HEART RATE 82 98 96 86 95 82 91 79 88 97 98 98 95 90 98 97 94 92 95 96 92 90 95 99
02 SATURATION (%) 98 98 98 97 98 98 99 99 99 99 99 99 98 97 97 97 97 97 98 97 98 98 98 98

0
36.
6
36.4 36.8 36.5 36.4 36.
3
36.
3
36.
3
36.4 36.
5
36.
15
36.8 37.
4
36.
1
37.
4
37.1 36.8 36.8 36.
6
36.
5
36.
5
36.
9
37.
2
I.EYE OPENING SCORE
Q. NEVER 1
R. To PAIN 2
S. VERBAL STIMULUS 3
T. SPONTANEOUS 4 / / / / / / / / / / / / / / / / / / / / / / / /
II.VERBAL
U. NO RESPONSE 1 / / / / / / / / / / / / / / / / / / / / / / / /
V. INCOMPREHENSIBLE SOUND 2
W. INAPPROPRIATE WORDS 3
X. DISORIENTED AND CONVERSE 4
Y. ORIENTED AND CONVERSE 5
III.MOTOR
Y. NONE (FLACCID) 1
Z. ABNORMAL EXTENSION (DECEREBRATE) 2
AA.ABNORMAL FLEXION (DECORTICATE) 3
BB.FLEXION WITHDRAWAL 4
CC.LOCALIZES PAIN 5 / / / / / / / / / / / / / / /
DD.OBEYS COMMANDS 6 / / / / / / / / /
TOTAL 15 11 11 11 11 11 11 11 11 11 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / / / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 170 160 140 140 150 200 160 180 180 160 200 160 180 180 180 160 160 160 160 170 170 160 160 170
/ / / / / / / / / /
/ / / / / / / / / / / / / /
90 90 100 90 100 90 100 100 90 100
100 100 90 90 80 100 90 100 100 100 100 90 100 90
HEART RATE 71 72 89 97 89 102 105 100 95 109 97 100 103 101 99 110 109 94 102 96 98 100 97 110
02 SATURATION (%) 98 97 96 93 94 96 98 97 97 97 98 98 97 96 98 98 98 98 98 98 97 97 97 97

1
36.
5
36.9 36.6 36.6 36.8 36.
3
36.
3
36.
3
36.4 36.
5
36.
15
36.8 37.
4
36.
1
37.
4
37.1 36.8 36.8 36.
6
36.
5
36.
5
36.
9
37.
2
I.EYE OPENING SCORE
A. NEVER 1
B. To PAIN 2 /
C. VERBAL STIMULUS 3 / / / / / /
D. SPONTANEOUS 4 / / / / / / / / / / / / / / / / /
II.VERBAL
A. NO RESPONSE 1 / / / / / / / / / / / / / / / / / / / / / /
B. INCOMPREHENSIBLE SOUND 2 / /
III.MOTOR
A. NONE (FLACCID) 1
E. LOCALIZES PAIN 5 / / / / / / / / / / / / / / / / / / / /
F. OBEYS COMMANDS 6 / / / /
TOTAL 15 9 11 10 10 10 9 9 9 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / / / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 140 150 150 140 150 150 180 180 190 180 180 170 150 160 160 140 150 140 150 150 150 150 160 140
/ / / / / / / / / /
/ / / / / / / / / / / / / /
100 100 100 100 90 90 80 80 90 80
90 90 90 90 90 90 90 90 90 70 90 90 80 90
HEART RATE 85 95 90 103 92 87 93 100 103 101 91 102 104 100 112 96 93 97 92 101 103 92 92 94
02 SATURATION (%) 97 97 96 94 96 96 98 98 97 96 97 98 97 97 99 99 97 99 97 99 98 98 99 98

5
36.
4
36.4 36.6 36.3 36.4 36.
3
36.
4
36.
7
36.7 36.
7
36.
5
36.3 36.
2
36.
9
36.
6
37.1 36.6 36.8 37.
1
36.
5
36.
7
36.
7
36.
3
I.EYE OPENING SCORE
A. NEVER 1
B. To PAIN 2
D. SPONTANEOUS 4 / / / / / / / / / / / / / / / / / / / / / / / /
II.VERBAL
A. NO RESPONSE 1 / / / / / / / / / / / / / / / / / / / / / / / /
III.MOTOR
A. NONE (FLACCID) 1
E. LOCALIZES PAIN 5
F. OBEYS COMMANDS 6 / / / / / / / / / / / / / / / / / / / / / / / /
TOTAL 15 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / / / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 140 150 150 140 150 150 180 180 190 180 180 170 150 160 160 140 150 140 150 150 150 150 160 140
/ / / / / / / / / /
/ / / / / / / / / / / / / /
100 100 100 100 90 90 80 80 90 80
90 90 90 90 90 90 90 90 90 70 90 90 80 90
HEART RATE 97 92 93 96 107 85 101 103 101 100 10 104 107 105 102 109 108 102 101 99 105 102 92 95
6
9
02 SATURATION (%) 98 97 98 96 96 98 98 97 98 96 97 96 97 96 98 96 96 96 97 96 95 97 98 96

0
36.
2
36.4 36.4 36.5 36.3 36.
2
36.
5
36.
6
36.5 36.
6
36.
4
36.4 36.
3
36.
7
36.
5
37.1 36.3 36.5 36.
3
36.
5
36.
7
36.
8
37.
0
I.EYE OPENING SCORE
A. NEVER 1
B. To PAIN 2
C. VERBAL STIMULUS 3 / / / / / / / / / / / / / / / /
D. SPONTANEOUS 4 / / / / / / / /
II.VERBAL
A. NO RESPONSE 1 / / / / / / / / / / / / / / / / / / / / / / / /
III.MOTOR
A. NONE (FLACCID) 1
E. LOCALIZES PAIN 5
F. OBEYS COMMANDS 6 / / / / / / / / / / / / / / / / / / / / / / / /
TOTAL 15 11 11 10 10 10 11 10 11 10 10 10 10 10 10 10 10 11 11 10 10 10 11 10 10
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / / / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 140 160 160 150 160 160 150 160 160 150 180 160 150 140 180 170 150 170 150 150 150 150 150 145
/ / / / / / / / / /
/ / / / / / / / / / / / / /
100 100 100 100 90 90 80 80 90 80
90 90 90 90 90 90 90 90 90 70 90 90 80 90
HEART RATE 110 104 100 102 106 105 107 101 91 98 102 97 97 101 107 104 98 97 97 100 101 100 103 98
02 SATURATION (%) 97 97 96 97 97 96 96 97 97 98 97 97 98 97 99 98 98 99 98 96 97 97 98 98

2
36.
3
36.5 36.1 36.2 36.3 36.
4
36.
6
36.
4
36.4 36.
4
36.
5
36.5 36.
4
36.
6
36.
2
37.1 36.9 36.5 36.
2
36.
4
36.
3
36.
4
36.
6
I.EYE OPENING SCORE
A. NEVER 1
B. To PAIN 2
D. SPONTANEOUS 4 / / / / / / / / / / / / / / / /
II.VERBAL
A. NO RESPONSE 1 / / / / / / / / / / / / / / / /
III.MOTOR
A. NONE (FLACCID) 1
E. LOCALIZES PAIN 5
F. OBEYS COMMANDS 6 / / / / / / / / / / / / / / / /
TOTAL 15 11 11 10 10 10 11 10 11 10 10 10 10 10 10 10 10
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 150 150 150 140 140 140 130 160 160 140 160 140 140 140 140 150
/ / / 70 / /
/ / / / / / / / / /
90 100 90 90 80
80 70 90 70 80 80 90 80 70 80
HEART RATE 80 70 90 70 80 80 81 81 105 106 102 102 102 109 108 107
RESPIRATORY RATE 21 19 20 17 19 18 19 20 24 22 22 21 21 22 22 20
02 SATURATION (%) 99 96 95 97 96 95 96 97 98 97 95 96 99 98 97 97

9
36.
7
36.4 36.5 36.5 36.5 36.
6
36.
5
37.1 36.
9
36.
8
36.
7
37.5 37.
6
37.
8
37.
5
I.EYE OPENING SCORE
G. NEVER 1
H. To PAIN 2
I. VERBAL STIMULUS 3
J. SPONTANEOUS 4 / / / / / / / / / / / /
II.VERBAL
K. NO RESPONSE 1 / / / / / / / / / / / /
III.MOTOR
P. NONE (FLACCID) 1
Q. ABNORMAL EXTENSION (DECEREBRATE) 2
R. ABNORMAL FLEXION (DECORTICATE) 3
S. FLEXION WITHDRAWAL 4
T. LOCALIZES PAIN 5 / / / / / / / / / / / /
U. OBEYS COMMANDS 6
TOTAL 15 10 10 10 10 10 10 10 10 10 10 10 10
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 150 150 160 150 160 140 140 160 140 140 150 160
/ / 70 / /
/ / / / / / /
80 90 70 90
80 80 90 80 80 80 80
HEART RATE 101 112 108 104 107 108 108 106 97 112 107 106
RESPIRATORY RATE 19 18 20 20 19 22 20 21 21 21 18 20
02 SATURATION (%) 96 97 98 98 98 99 98 98 99 97 98 99
BODY TEMPERATURE 37.5 37.0 36.9 36.

9
37.0 36.
9
37.
1
36.
7
36.5 36.
4
36.
8
36.
9
I.EYE OPENING SCORE
A. NEVER 1
B. To PAIN 2
D. SPONTANEOUS 4 / / / / / / / / / / / /
II.VERBAL
A. NO RESPONSE 1 / / / / / / / / / / / /
III.MOTOR
A. TONE (FLACCID) 1
E. LOCALIZES PAIN 5 / / / / / / / / / / / /
F. OBEYS COMMANDS 6
TOTAL 15 10 10 10 10 10 10 10 10 10 10 10 10
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 150 130 130 150 150 150 140 140 140 140 120 130
/ / 70 / /
/ / / / / / /
70 90 80 90
90 70 80 80 80 80 80
HEART RATE 110 114 110 110 115 108 110 106 112 115 100 107
02 SATURATION (%) 96 97 98 98 98 99 98 98 99 97 98 99

8
36.9 36.
8
36.
5
36.
7
36.9 36.
5
36.
6
36.
5
I.EYE OPENING SCORE
A. NEVER 1
B. To PAIN 2
D. SPONTANEOUS 4 / / / / / / / / / / / /
II.VERBAL
E. NO RESPONSE 1 / / / / / / / / / / / /
F. INCOMPREHENSIBLE SOUND 2
G. INAPPROPRIATE WORDS 3
H. DISORIENTED AND CONVERSE 4
I. ORIENTED AND CONVERSE 5
III.MOTOR
J. NONE (FLACCID) 1
K. ABNORMAL EXTENSION (DECEREBRATE) 2
L. ABNORMAL FLEXION (DECORTICATE) 3
M. FLEXION WITHDRAWAL 4
N. LOCALIZES PAIN 5 / / / / / / / / / / / /
O. OBEYS COMMANDS 6
TOTAL 15 10 10 10 10 10 10 10 10 10 10 10 10
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 150 150 150 150 130 130 140 150 130 140 130 140
/ / / / /
/ / / / / / /
80 70 80 80 90
90 80 90 70 80 70 80
HEART RATE 103 108 110 110 108 100 100 105 116 110 105 107
02 SATURATION (%) 98 98 98 97 97 99 98 99 98 98 99 98

9
36.6 36.
5
36.
5
36.
4
36.9 36.
4
36.
2
36.
5
I.EYE OPENING SCORE
A. NEVER 1
B. To PAIN 2
D. SPONTANEOUS 4 / / / / / / / / / / / /
II.VERBAL
A. NO RESPONSE 1 / / / / / / / / / / / /
III.MOTOR
A. NONE (FLACCID) 1
E. LOCALIZES PAIN 5 / / / / / / / / / / / /
F. OBEYS COMMANDS 6
TOTAL 15 10 10 10 10 10 10 10 10 10 10 10 10
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 150 130 120 130 140 140 150 140 160 130 140 140
/ / / / /
/ / / / / / /
80 70 80 80 90
90 80 90 70 80 70 80
HEART RATE 109 105 110 107 106 106 107 107 114 116 106 104
02 SATURATION (%) 98 98 97 98 99 99 98 97 98 98 98 97

0
36.7 36.
5
36.
5
36.
6
36.7 36.
4
36.
5
36.
7
Patient Name: __DELA CRUZ, MARIO_______ Age: 69___ Sex: _M______ Civil Status: ___MARRIED_______ Room No. _ICCU 1_______ Attending Physician: DR. ESPAñOL_ Hospital No. ___12389____
I.EYE OPENING SCORE
E. NEVER 1
F. To PAIN 2
G. VERBAL STIMULUS 3
H. SPONTANEOUS 4 / / / / / / / / / / / /
II.VERBAL
F. NO RESPONSE 1 / / / / / / / / / / / /
G. INCOMPREHENSIBLE SOUND 2
H. INAPPROPRIATE WORDS 3
I. DISORIENTED AND CONVERSE 4
J. ORIENTED AND CONVERSE 5
III.MOTOR
G. NONE (FLACCID) 1
H. ABNORMAL EXTENSION (DECEREBRATE) 2
I. ABNORMAL FLEXION (DECORTICATE) 3
J. FLEXION WITHDRAWAL 4
K. LOCALIZES PAIN 5 / / / / / / / / / / / /
L. OBEYS COMMANDS 6
TOTAL 15 10 10 10 10 10 10 10 10 10 10 10 10
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 150 140 140 150 140 140 130 140 140 140 120 120
/ / / / /
/ / / / / / /
80 80 80 80 90
80 80 80 80 80 80 80
HEART RATE 109 115 108 107 111 115 117 110 103 115 101 107
02 SATURATION (%) 98 97 99 98 99 98 98 98 100 99 99 98

2
36.4 36.
5
36.
5
36.
7
36.7 36.
3
36.
1
36.
3
I.EYE OPENING SCORE
A. NEVER 1
B. To PAIN 2
D. SPONTANEOUS 4 / / / / / / / / / / / /
II.VERBAL
A. NO RESPONSE 1 / / / / / / / / / / / /
III.MOTOR
A. NONE (FLACCID) 1
E. LOCALIZES PAIN 5 / / / / / / / / / / / /
F. OBEYS COMMANDS 6
TOTAL 15 10 10 10 10 10 10 10 10 10 10 10 10
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 130 120 140 140 130 140 140 140 130 140 140 140
/ / / / /
/ / / / / / /
80 80 70 90 80
90 70 80 80 80 70 80
HEART RATE 109 115 108 107 111 115 117 110 103 115 101 107
02 SATURATION (%) 97 97 99 99 99 99 97 98 99 98 99 97

1
36.6 36.
4
36.
7
36.
6
36.3 36.
1
36.
4
36.
5
I.EYE OPENING SCORE
A. NEVER 1
B. To PAIN 2
D. SPONTANEOUS 4 / / / / / / / / / / / /
II.VERBAL
A. NO RESPONSE 1 / / / / / / / / / / / /
III.MOTOR
A. NONE (FLACCID) 1
E. LOCALIZES PAIN 5 / / / / / / / / / / / /
F. OBEYS COMMANDS 6
TOTAL 15 10 10 10 10 10 10 10 10 10 10 10 10
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 140 140 140 140 140 140 140 140 140 120 120 120
/ / / / /
/ / / / / / /
90 80 80 80 90
80 80 80 70 80 80 80
HEART RATE 108 105 105 100 113 115 114 113 110 103 117 113
02 SATURATION (%) 97 97 99 99 99 99 97 98 99 98 99 97

2
36.4 36.
4
36.
5
36.
7
36.2 36.
3
36.
1
36.
2
I.EYE OPENING SCORE
A. NEVER 1
B. To PAIN 2
D. SPONTANEOUS 4 / / / / / / / / / / / /
II.VERBAL
A. NO RESPONSE 1 / / / / / / / / / / / /
III.MOTOR
A. NONE (FLACCID) 1
E. LOCALIZES PAIN 5 / / / / / / / / / / / /
F. OBEYS COMMANDS 6
TOTAL 15 10 10 10 10 10 10 10 10 10 10 10 10
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 140 130 120 130 120 130 130 140 120 130 130 130
/ / / / /
/ / / / / / /
80 70 70 80 80
70 80 70 80 70 80 70
HEART RATE 107 105 107 102 110 101 100 100 108 106 114 109
02 SATURATION (%) 99 99 97 98 99 97 97 97 98 98 98 97

5
36.6 36.
8
36.
8
36.
9
37.0 36.
3
36.
1
37.
2
I.EYE OPENING SCORE
A. NEVER 1
B. To PAIN 2
D. SPONTANEOUS 4 / / / / / / / / / / / /
II.VERBAL
A. NO RESPONSE 1 / / / / / / / / / / / /
III.MOTOR
A. NONE (FLACCID) 1
E. LOCALIZES PAIN 5 / / / / / / / / / / / /
F. OBEYS COMMANDS 6
TOTAL 15 10 10 10 10 10 10 10 10 10 10 10 10
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 130 130 130 130 130 130 130 120 110 120 140 140
/ / / / /
/ / / / / / /
80 70 70 70 60
80 80 80 70 80 80 70
HEART RATE 102 107 105 105 103 107 101 103 105 104 105 104
02 SATURATION (%) 99 99 97 98 99 97 97 97 98 98 98 97

7
36.6 36.
5
36.
5
36.
4
36.4 36.
3
36.
2
36.
4
I.EYE OPENING SCORE
A. NEVER 1
B. To PAIN 2
D. SPONTANEOUS 4 / / / / / / / / / / / /
II.VERBAL
A. NO RESPONSE 1 / / / / / / / / / / / /
III.MOTOR
A. NONE (FLACCID) 1
E. LOCALIZES PAIN 5 / / / / / / / / / / / /
F. OBEYS COMMANDS 6
TOTAL 15 10 10 10 10 10 10 10 10 10 10 10 10
PUPPILLARY SIZE
Left 2 2 2 2 2 2 2 2 2 2 2 2
Right 2 2 2 2 2 2 2 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / / / / / / / / /
Sluggish
Fixed
BLOOD PRESSURE 160 120 120 120 130 130 130 130 120 130 120 120
/ / / / /
/ / / / / / /
60 80 80 80 80
80 80 60 70 80 70 80
HEART RATE 116 104 96 94 96 97 98 98 94 98 109 105
02 SATURATION (%) 99 99 99 98 99 98 98 99 98 98 98 99

5
36.7 36.
2
36.
3
36.
4
36.2 36.
3
36.
4
36.
5
I.EYE OPENING SCORE
G. NEVER 1
H. To PAIN 2
I. VERBAL STIMULUS 3
J. SPONTANEOUS 4 / / / / /
II.VERBAL
K. NO RESPONSE 1 / / / / /
III.MOTOR
P. NONE (FLACCID) 1
Q. ABNORMAL EXTENSION (DECEREBRATE) 2
R. ABNORMAL FLEXION (DECORTICATE) 3
S. FLEXION WITHDRAWAL 4
T. LOCALIZES PAIN 5 / / / / /
U. OBEYS COMMANDS 6
TOTAL 15 10 10 10 10 10
PUPPILLARY SIZE
Left 2 2 2 2 2
Right 2 2 2 2 2
PUPPILLARY REACTION
Reactive / / / / /
Sluggish
Fixed
BLOOD PRESSURE 120 110 110 110 130
/ /
/ / /
70 70
70 60 70
HEART RATE 116 104 96 94 96
RESPIRATORY RATE 20 19 20 20 19
02 SATURATION (%) 99 99 99 99 99

6
36.6
TEMPERATURE PULSE AND RESPIRATION RATE CHART
Name: DELA CRUZ, MARIO___________ Age: _69___________________________________ Attending Physician: DR. ESPAñOL___________________
Sex: _MALE______________Civil Status: MARRIED_______________ Room No. /Bed No. _ICCU 1_______ Hospital No. 123894_________________
Day of
1 2 3 4 5
Hospitalization
Post-Operative
Day No.
Date 4/15/2020 4/16/2020 4/17/2020 4/18/2020 4/19/2020
RR PR Temp 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12
150 41
140 40
130 41
39
120
38
110
37
100 36
90 35
80
70 70
60 60
50 50
40 40
30 30
20
10
BLOOD PRESSEURE
6-2 0 0 0 2
2-10 0 0 0 0 0
STOOL 10-6
0 0 0 0 0
TOTAL
0 0 0 0 2
6-2 WITH FBC-UB WITH FBC-UB WITH FBC-UB WITH FBC-UB
URINE 2-10 WITH FBC-UB WITH FBC-UB WITH FBC-UB WITH FBC-UB WITH FBC-UB
10-6 WITH FBC-UB WITH FBC-UB WITH FBC-UB WITH FBC-UB WITH FBC-UB
TOTAL WITH FBC-UB WITH FBC-UB WITH FBC-UB WITH FBC-UB WITH FBC-UB
DOH-SWUMeD-NSD-F-007 Rev. 1
Day of
6 7 8 9 10
Hospitalization
Post-Operative
Day No.
Date 4/20/2020 4/21/2020 4/22/2020 4/23/2020 4/24/2020
RR PR Temp 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12
150 41
140 40
130 41
39
120
38
110
37
100 36
90 35
80
70 70
60 60
50 50
40 40
30 30
20
10
BLOOD PRESSEURE
6-2 0 0 0 0 0
2-10 0 0 0 1 0
STOOL 10-6
1 1 1 1 0
TOTAL
1 1 0 2 0
DOH-SWUMeD-NSD-F-007 Rev.
Day of
11 12 13 14 15
Hospitalization
Post-Operative
Day No.
Date 4/25/2020 4/26/2020 4/27/2020 4/28/2020 4/29/2020
RR PR Temp 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12
150 41
140 40
130 41
39
120
38
110
37
100 36
90 35
80
70 70
60 60
50 50
40 40
30 30
20
10
BLOOD PRESSEURE
6-2 0 0 0 0 0
2-10 0 0 0 0 0
STOOL 10-6
1 1 2 0 0
TOTAL
1 1 2 0 0
Day of
16 17 18 19 20
Hospitalization
Post-Operative
Day No.
Date 4/30/2020 5/1/2020 5/2/2020 5/3/2020 5/4/2020
RR PR Temp 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12
150 41
140 40
130 41
39
120
38
110
37
100 36
90 35
80
70 70
60 60
50 50
40 40
30 30
20
10
BLOOD PRESSEURE
6-2 0 0 1 0 0
2-10 0 0 0 0 0
STOOL 10-6
1 0 0 0 0
TOTAL
1 0 1 0 0
Day of
21 22 23 24 25
Hospitalization
Post-Operative
Day No.
Date 5/5/2020 5/6/2020 5/7/2020 5/8/2020 5/9/2020
RR PR Temp 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12
150 41
140 40
130 41
39
120
38
110
37
100 36
90 35
80
70 70
60 60
50 50
40 40
30 30
20
10
BLOOD PRESSEURE
6-2 0 0 0 2 0
2-10 0 1 0 0
STOOL 10-6
0 0 0 0
TOTAL
0 1 0 2
DOH-SWUMeD-NSD-F-0V.1
LABORATORY REPORT SHEET
Name: Dela Cruz, Mario___ Age: 69 years old___ Sex: Male__ Room: ICCU 1___
Date Performed: 04-29-2020
Result Date: 04-30-2020
Examination: CHEST PA OR AP
X-RAY REPORT
Previous x-ray dated 4/24/2020 is noted. Lung fields are cleared. Aorta is tortous
and sclerotic. Heart is not enlarged. The pulmonary vascular markings are within
normal limits. Both hemidiaphragms and costophrenic sulci are sharp and distinct.
Tiny osteophytes are seen in the articulating margins of the thoracic spine. The
visualized osseous structures are unremarkable.
IMPRESSION:
1. CLEAR LUNG FIELD

2. ATHEROSCLEROTIC AORTA
3. SPONDYLOSIS OF THE THORACIC SPINE
Examination: CHEST PA OR AP
X-RAY REPORT
Comparison with the previous study done 4/15/2020 again shows lung fields are
cleared. Heart is not enlarged. Aorta is tortuous and sclerotic. The tracheal air
column is at the midline. Both hemidiaphragms and costophrenic sulci are intact.
Tiny osteophytes are seen arising in the lateral articulating margins of the thoracic
spine. The rest of the osseous structures are unremarkable.
IMPRESSION:
1. CLEAR LUNG FIELD

2. ATHEROSCLEROTIC AORTA
3. SPONDYLOSIS OF THE THORACIC SPINE
Examination: Brain or Cranial Plain
CT-SCAN REPORT
Multiple axial tomographic sections of the head, without contrast, were obtained.
Comparison was made with the previous study dated 4/16/2020.
The previously noted infarct in the right cerebellum now appears more hypodense
and well defined and partly extends to the right cerebellar peduncle. No significant
mass effect appreciated.
No new infarcts nor hemorrhage seen.
The rest of the findings remain stable.
IMPRESSION:
EVOLVING INFARCT IN THE RIGHT CEREBELLUM PARTLY EXTENDING TO THE

RIGHT CEREBELLAR PENDUNCLE, NOW IN THE SUBACUTE TO CHRONIC STAGE.
THE REST OF THE FINDINGS ARE STATIONARY:
= CHRONIC INFARCT IN THE RIGHT PARIETO-OCCIPITAL AREA WITH MILD EX-

VACUO DILATATION OF THE POSTERIOR HORN OF THE RIGHT LATERAL
VENTRICLE.
= CHRONIC LACUNAR INFARCTS IN THE PONS.
= MILD MICROVASCULAR ISCHEMIC CHANGES IN BOTH PERIVENTRICULAR

WHITE MATTER.
= ATHEROSCLEROTIC VESSEL DISEASE OF BOTH INTERNAL CAROTID, BASILAR

AND VERTEBRAL ARTERIES.
= AGE-COMPATIBLE CEREBRO-CEREBELLAR VOLUME LOSS.
= LEFT MAXILLARY SINUSITIS.
= DEHISCENCE OF THE LAMINA PAPYRECEA, BILATERAL.
Examination: Brain or Cranial Plain
CT-SCAN REPORT
Multiple axial tomographic sections of the head, without contrast, were obtained.
The brain parenchyma is intact, with no focal lesion or abnormal calcification seen.
There is no parenchymal hemorrhage seen.
An ill- defined hypodensity is noted in the right cerebellum effacing ther overlying
cortical sulci.
There is also a focal hypodensity with no mass effect in the right parieto-occipital
area associated with widening of the posterior horn of the right lateral ventricle.
Hypodense foci are also noted in the pons.
Low density changes are seen in both periventricular white matter.
There is normal gray-white matter demarcation. The midline structures are

undisplaced.
The rest of the ventricles, sulci, sylvian fissures, and cerebellar folia are widened.
The rest of the brainstem and left cerebellum are unremarkable.
Calcific plaques are seen lining the walls of both internal carotid, basilar and both
vertebral arteries.
The calvarium and basal skull structure are unremarkable.
There is muscosal thickening in the left maxillary sinus, A defect is noted in the
medial wall of both orbits.
IMPRESSION:
ACUTE INFARCT IN THE RIGHT CEREBELLUM.
CHRONIC INFARCT IN THE RIGHT PARIETO-OCCIPITAL AREA WITIH EX-VACUO

DILATATION OF THE POSTERIOR HORN OF THE RIGHT LATERAL VENTRICLE.
CHRONIC LANCULAR INFARCTS IN THE PONS.
MILD MICROVASCULAR ISCHEMIC CHANGES IN BOTH PERIVENTRUICULAR

MATTER.
ATHEROSCLEROTIC VESSEL DISEASE OF BOTH INTERNAL CAROTID, BASILAR AND

VERTEBRAL ARTERIES.
AGE-COMPATIBLE CEREBRO-CEREBELLAR VOLUME LOSS.
LEFT MAXILLARY SINUSITIS.
DEHISCENCE OF THE LAMINA PAPYRECEA, BILATERAL.
Laboratory Result
Clinical Chemistry
Blood Gas Analysis
Date: 4/16/2020
Time: 10:04 AM
Test Result Unit Reference Range

pH 7.568 -- 7.350 – 7.450
pCO2 23.5 mmHg 35.0 – 45.0
pO2 104.2 mmHg 80.0 – 100.00
HCO3- 21.3 mmol/L 22.0 – 26.0
BE(ecf) -0.90 mEq/L +-2.0
O2 Sat 98.4 % >95.0
Temperature: 36.6 C
Remarks: SPECIMEN SENT TO LABORATORY
GRAM STAIN
Date: 4/29/2020
Specimen: Sputum
Examination:
AFB: G/S: INDIA INK: KOH: CULT/SENS:
Result:
POLYMORPHONUCLEAR CELL = RARE
EPITHELIAL CELL = MODERATE
GRAM (+) ; BACILLI = PLENTY ; YEAST CELL = FEW
GRAM (+) ; COCCI IN PAIRS = FEW
GRAM (-) ; BACILLI = FEW
Antibiotic Result Antibiotic Result Antibiotic Result
Amoxiclav Cefoxitin Imipinem

Amikacin Cefoperazone Meropenem
Ampicillin Ceftazidine Netilmicin
Amp/Sulbactam Ceftriaxone Nitrofurantoin
Azithromycin Cefuroxime Norfloxacin
Aztreonam Cephalexin Penicillin G
Cefaclor Cephalotin Pip/Tazobactam
Cefamandole Chloramphenicol Sulbactam/CFP
Cefazolin Ciprofloxacin Tetracycline
Cefipime Clindamycin Tobramycin
Cefoperazone Erythromycin Trim/Sulfa
Cefoxatime Gentamicin Vancomycin
Levofloxacin
S = SENSITIVE I = INTERMEDIATE R = RESISTANT
OTHERS/REMARKS:
CULTURE AND SENSITIVITY
Date: 4/29/2020
Specimen: Sputum
Examination:
Result:
MODERATE GROWTH OF STENOTROPHOMONAS MALTOPHILIA

Levofloxacin
OTHERS/REMARKS:
CULTURE AND SENSITIVITY
Date: 4/16/2020
Specimen: Tracheal Aspirate
Examination:
Result:
LIGHT GROWTH OF E.COLI

Levofloxacin
OTHERS/REMARKS:
COMPLETE BLOOD COUNT RESULT
Date: 5/3/2020
Time: 04:16 AM
Range
WBC 13.7 103/mm3 4.4 – 11.0
% # % #
NEU 67.0 9.20 37.0 – 80.0 1.80 – 7.80
LYM 21.9 3.01 10.0 – 50.0 1.0 – 4.80
MON 8.7 1.19 0.0 – 12.0 0.20 – 1.00
EOS 1.8 0.25 0.0 – 7.0 0.0 – 0.50
BAS 0.6 0.08 0.0 – 2.5 0.0 – 0.20
Range
RBC 3.74 106/mm3 4.50 – 5.90
HGB 12.7 g/dl 14.0 – 17.5
HCT 37.1 % 41.5 – 50.4
MCV 99 μm3 80 – 96
MCH 33.9 pg 27.5 – 33.0
MCHC 34.2 g/dl 32.0 – 36.0
RDW 11.1 % 11.6 – 14.8
PLT 564 103/mm3 150 – 450
MPV 6.7 μm3 6.0 – 11.0
Date: 4/29/20
Time: 05:20 AM
Range
WBC 18.0 103/mm3 4.4 – 11.0
% # % #
NEU 68.8 12.38 37.0 – 80.0 1.80 – 7.80
LYM 21.3 3.83 10.0 – 50.0 1.0 – 4.80
MON 7.6 1.37 0.0 – 12.0 0.20 – 1.00
EOS 1.6 0.29 0.0 – 7.0 0.0 – 0.50
BAS 0.7 0.13 0.0 – 2.5 0.0 – 0.20
Range
RBC 3.78 106/mm3 4.50 – 5.90
HGB 12.9 g/dl 14.0 – 17.5
HCT 37.5 % 41.5 – 50.4
MCV 99 μm3 80 – 96
MCH 34.1 pg 27.5 – 33.0
MCHC 34.3 g/dl 32.0 – 36.0
RDW 11.3 % 11.6 – 14.8
PLT 477 103/mm3 150 – 450
MPV 6.7 μm3 6.0 – 11.0
Date: 4/26/20
Time: 05:12 AM
Range
WBC 17.5 103/mm3 4.4 – 11.0
% # % #
NEU 64.6 11.30 37.0 – 80.0 1.80 – 7.80
LYM 25.0 4.37 10.0 – 50.0 1.0 – 4.80
MON 7.5 1.31 0.0 – 12.0 0.20 – 1.00
EOS 2.1 0.37 0.0 – 7.0 0.0 – 0.50
BAS 0.8 0.14 0.0 – 2.5 0.0 – 0.20
Range
RBC 4.00 106/mm3 4.50 – 5.90
HGB 13.6 g/dl 14.0 – 17.5
HCT 39.9 % 41.5 – 50.4
MCV 100 μm3 80 – 96
MCH 33.9 pg 27.5 – 33.0
MCHC 34.0 g/dl 32.0 – 36.0
RDW 10.9 % 11.6 – 14.8
PLT 440 103/mm3 150 – 450
MPV 6.8 μm3 6.0 – 11.0
Date: 4/23/20
Time: 05:02 AM
Range
WBC 14.9 103/mm3 4.4 – 11.0
% # % #
NEU 65.0 9.71 37.0 – 80.0 1.80 – 7.80
LYM 23.1 3.45 10.0 – 50.0 1.0 – 4.80
MON 9.0 1.34 0.0 – 12.0 0.20 – 1.00
EOS 2.2 0.33 0.0 – 7.0 0.0 – 0.50
BAS 0.7 0.10 0.0 – 2.5 0.0 – 0.20
Range
RBC 3.74 106/mm3 4.50 – 5.90
HGB 12.8 g/dl 14.0 – 17.5
HCT 37.3 % 41.5 – 50.4
MCV 100 μm3 80 – 96
MCH 34.1 Pg 27.5 – 33.0
MCHC 34.2 g/dl 32.0 – 36.0
RDW 11.4 % 11.6 – 14.8
PLT 334 103/mm3 150 – 450
MPV 6.7 μm3 6.0 – 11.0
Date: 4/20/20
Time: 05:12 AM
Range
WBC 17.4 103/mm3 4.4 – 11.0
% # % #
NEU 70.3 11.30 37.0 – 80.0 1.80 – 7.80
LYM 20.3 4.37 10.0 – 50.0 1.0 – 4.80
MON 6.9 1.31 0.0 – 12.0 0.20 – 1.00
EOS 1.9 0.37 0.0 – 7.0 0.0 – 0.50
BAS 0.6 0.14 0.0 – 2.5 0.0 – 0.20
Range
RBC 3.87 106/mm3 4.50 – 5.90
HGB 13.3 g/dl 14.0 – 17.5
HCT 38.7 % 41.5 – 50.4
MCV 100 μm3 80 – 96
MCH 34.5 Pg 27.5 – 33.0
MCHC 34.5 g/dl 32.0 – 36.0
RDW 11.0 % 11.6 – 14.8
PLT 296 103/mm3 150 – 450
MPV 7.4 μm3 6.0 – 11.0
Date: 4/17/20
Time: 05:12 AM
Range
WBC 15.4 103/mm3 4.4 – 11.0
% # % #
NEU 70.4 11.30 37.0 – 80.0 1.80 – 7.80
LYM 19.8 4.37 10.0 – 50.0 1.0 – 4.80
MON 7.0 1.31 0.0 – 12.0 0.20 – 1.00
EOS 2.1 0.37 0.0 – 7.0 0.0 – 0.50
BAS 0.7 0.14 0.0 – 2.5 0.0 – 0.20
Range
RBC 3.88 106/mm3 4.50 – 5.90
HGB 13.3 g/dl 14.0 – 17.5
HCT 39.9 % 41.5 – 50.4
MCV 100 μm3 80 – 96
MCH 34.2 Pg 27.5 – 33.0
MCHC 34.1 g/dl 32.0 – 36.0
RDW 11.4 % 11.6 – 14.8
PLT 231 103/mm3 150 – 450
MPV 7.6 μm3 6.0 – 11.0
Date: 4/14/20
Time: 05:12 AM
Range
WBC 11.20 103/mm3 4.4 – 11.0
% # % #
NEU 77.1 11.30 37.0 – 80.0 1.80 – 7.80
LYM 16.5 4.37 10.0 – 50.0 1.0 – 4.80
MON 5.3 1.31 0.0 – 12.0 0.20 – 1.00
EOS 0.8 0.37 0.0 – 7.0 0.0 – 0.50
BAS 0.3 0.14 0.0 – 2.5 0.0 – 0.20
Range
RBC 3.80 106/mm3 4.50 – 5.90
HGB 13.1 g/dl 14.0 – 17.5
HCT 38.5 % 41.5 – 50.4
MCV 101 μm3 80 – 96
MCH 34.4 Pg 27.5 – 33.0
MCHC 34.0 g/dl 32.0 – 36.0
RDW 10.8 % 11.6 – 14.8
PLT 254 103/mm3 150 – 450
MPV 8.6 μm3 6.0 – 11.0
LABORATORY RESULT
Clinical Microscopy
URINE ANALYSIS
Date: 4/29/20
Time: 4:16 PM
MACROSCOPIC EXAMINATION
Color: YELLOW Transparency: CLOUDY

Volume: 40 ml Specific Gravity: 1.010
CHEMICAL EXAMINATION
Albumin: TRACE Glucose: NEGATIVE

pH: 5.0 Nitrite: NEGATIVE
Ketone: NEGATIVE Bilirubin: NEGATIVE
Blood: 3+ Urobilinogen: NORMAL
MICROSCOPIC EXAMINATION
WBC: 4-8/HPF Epithlial Cells RARE

RBC: TNTC/HPF Mucus Threads RARE
Coarse Granular: Bacteria: FEW
Fine Granular: Hyaline
Amorphous Urates: FEW Waxy
Uric Acid: Amorphous Phosphates
Calcium Oxalates: Triple Phosphates
Ammonium Phosphates
OTHERS:
REMARKS:
LABORATORY RESULT
Clinical Microscopy
URINE ANALYSIS
Date: 4/25/20
Time: 1:10 PM
MACROSCOPIC EXAMINATION
Color: YELLOW Transparency: hazy

Volume: 30 ml Specific Gravity: 1.015
CHEMICAL EXAMINATION
Albumin: TRACE Glucose: NEGATIVE

pH: 6.0 Nitrite: NEGATIVE
Ketone: NEGATIVE Bilirubin: NEGATIVE
Blood: 3+ Urobilinogen: NORMAL
MICROSCOPIC EXAMINATION
WBC: 1-3/HPF Epithlial Cells RARE

RBC: TNTC/HPF Mucus Threads RARE
Coarse Granular: Bacteria: FEW
Fine Granular: Hyaline
Amorphous Urates: FEW Waxy
Uric Acid: Amorphous Phosphates
Calcium Oxalates: Triple Phosphates
Ammonium Phosphates
OTHERS:
REMARKS:
LABORATORY RESULT
Clinical Chemistry
Date: 5/3/ 2020
Time: 4:52 AM
Creatinine 1.25 mg/dl 0.51 – 0.95

------------------------ ------------------- -------------------------- --------------------------
Sodium 128.00 mmol/L 136 – 145
------------------------ ------------------- --------------------------- ---------------------------
Potassium 3.60 mmol/L 3.5 – 5.1
Remarks:
LABORATORY RESULT
Clinical Chemistry
Date: 4/29/ 2020
Time: 5:57 AM

------------------------ ------------------- -------------------------- --------------------------
Sodium 130.00 mmol/L 136 – 145
------------------------ ------------------- --------------------------- ---------------------------
------------------------ ------------------- --------------------------- ---------------------------
ALT (SGPT) 46.11 U/L 0 – 41
Remarks:
LABORATORY RESULT
Clinical Chemistry
Date: 4/26/ 2020
Time: 5:47 AM

------------------------ ------------------- -------------------------- --------------------------
Sodium 133.00 mmol/L 136 – 145
------------------------ ------------------- --------------------------- ---------------------------
Remarks:
Date: 4/24/ 2020
Time: 6:07 AM
Remarks:
Date: 4/24/ 2020
Time: 6:07 AM
Remarks:
LABORATORY RESULT
Clinical Chemistry
Date: 4/20/ 2020
Time: 5:22 AM
Remarks:
Date: 4/23/ 2020
Time: 5:53 AM

------------------------ ------------------- -------------------------- --------------------------
Sodium 136.00 mmol/L 136 – 145
------------------------ ------------------- --------------------------- ---------------------------
Remarks:
Date: 4/18/ 2020
Time: 9:48 AM
Remarks:
LABORATORY RESULT
Clinical Chemistry
Date: 4/17/ 2020
Time: 5:44 AM

------------------------ ------------------- -------------------------- --------------------------
Sodium 139.00 mmol/L 136 – 145
------------------------ ------------------- --------------------------- ---------------------------3.5
Potassium 3.30 mmol/L – 5.1
Remarks:
Date: 4/15/ 2020
Time: 4:14 AM

------------------------ ------------------- -------------------------- --------------------------
Sodium 142.00 mmol/L 136 – 145
------------------------ ------------------- --------------------------- ---------------------------3.5
Potassium 3.3 mmol/L – 5.1
------------------------ ------------------- --------------------------- ---------------------------
ALT (SGPT) 32.23 U/L 0 – 41
Remarks:
DISCHARGE INSTRUCTION SHEET
Patient: DELA CRUZ, MARIO________________ Attending Physician: DR. ESPAñOL______________________ Ward/Rm No. ICCU 1_______
Medication Dose Frequency Duration

HOME MEDS
1. CITICOLINE TO 1 GRAM, 1 TAB 3X A DAY/NGT (8 AM-1 PM -6 PM)
2. VALSARTAN 160/TAB, 1 TAB ONCE A DAY, HOLD FOR SBP < 110 (8 AM)
mmHg
3. CLONIDINE 75 MCG/TAB, 1 TAB EVERY 6 H/NGT AS NEEDED SBP
> 160 mmHg
4. VITAMIN B COMPLEX, 1 CAP ONCE A DAY/NGT (8 AM)
5. PANTOPRAZOLE 40 MG/TAB, 1 TAB ONCE A DAY/NGT BEFORE (6 AM)
BREAKFAST
6. ASPIRIN 80 MG/TAB, 1 TAB/NGT ONCE A DAY (8 AM)
7. CLOPIDOGREL 75 MG/TAB, 1 TAB/ NGT ONCE A DAY (1 PM)
8. ATORVASTATIN 80 MG/TAB, 1 TAB ONCE A DAY EVERY HOURS (8 PM)
OF SLEEP/NGT
9. AMLODIPINE 10 MG/TAB, 1 TAB TWICE A DAY/NGT (8 AM)
10. LACTULOSE 30 CC EVERY HOURS OF SLEEP, HOLD FOR BOWEL (8 PM)
MOVEMENT 2X/DAY
11. MUPIROCIN OINTMENT APPLY TO PREVIOUS SITES
Diet: BLENDERIZED FEEDING TO 1800 CC VOLUME IN 6 DIVIDED FEEDINGS
Remarks: PLEASE FOLLOW-UP AT DR. ESPAñOL\S CLINIC 2 WEEKS AFTER DISCHARGE MAY 23, 2020 WITH CBC,
CREATININE, SGT, Na+2, K+ RESULTS.
________________________________________________________
Attending Physician
I / We understand the importance of the above instruction and would follow these as planned and advised.
_____________________________________________ __________________________________________
Patient/Relative Receiving Instructions Patient’s Relative / Significant Other
taking the patient Home/Transfer
_____________________________________________ ______________________________________________
Nurse Giving the Instruction Charge Nurse

Case 1 Iccu Chart

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Case 1 Iccu Chart

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BLOOD GLUCOSE LOG SHEET

DATE TIME TYPE OF TEST RESULT MED/INSULIN TAKEN PHYSICIAN NOD

4/17/2020 1L 80 cc/hr 11:20 Right PNSS 2:30 1L 6 0 4/18/20

4/23/2020 1L 180 cc/hr 2:40 Left PNSS 9:00 1L 28 0 4/23/2020

4/30/2020 1L 60 cc/hr 2:00 Right PNSS 5:30 1L 48 0 5/01/2020

DATE TIME INTAKE TOTAL OUTPUT TOTAL

DATE TIME INTAKE TOTAL OUTPUT TOTAL

7-3 = 1440 7-3 = 1150

DATE TIME INTAKE TOTAL OUTPUT TOTAL

7-3 = 1863 7-3 = 1550

DATE TIME INTAKE TOTAL OUTPUT TOTAL

7-3 = 1145 7-3 = 1220

DATE TIME INTAKE TOTAL OUTPUT TOTAL

7-3 = 1210 7-3 = 970

DATE TIME INTAKE TOTAL OUTPUT TOTAL

7-3 = 1750 7-3 = 2020

DATE TIME INTAKE TOTAL OUTPUT TOTAL

7-3 = 3090 7-3 = 3090

DATE TIME INTAKE TOTAL OUTPUT TOTAL

7-3 = 1980 7-3 = 2370

DATE TIME INTAKE TOTAL OUTPUT TOTAL

7-3 = 2385 7-3 = 2690

DATE TIME INTAKE TOTAL OUTPUT TOTAL

7-3 = 1870 7-3 = 2490

DATE TIME INTAKE TOTAL OUTPUT TOTAL

7-3 = 1670 7-3 = 1480

DATE TIME INTAKE TOTAL OUTPUT TOTAL

7-3 = 1710 7-3 = 1670

DATE TIME INTAKE TOTAL OUTPUT TOTAL

7-3 = 1620 7-3 = 1740

DATE TIME INTAKE TOTAL OUTPUT TOTAL

7-3 = 1630 7-3 = 1660

DATE TIME INTAKE TOTAL OUTPUT TOTAL

7-3 = 1100 7-3 = 680

DATE TIME INTAKE TOTAL OUTPUT TOTAL

7-3 = 1120 7-3 = 949

DATE TIME INTAKE TOTAL OUTPUT TOTAL

7-3 = 960 7-3 = 1023

DATE TIME INTAKE TOTAL OUTPUT TOTAL

7-3 = 1020 7-3 = 911

DATE TIME INTAKE TOTAL OUTPUT TOTAL

DATE TIME INTAKE TOTAL OUTPUT TOTAL

7-3 = 980 7-3 = 616

DATE TIME INTAKE TOTAL OUTPUT TOTAL

7-3 = 1040 7-3 = 755

DATE TIME INTAKE TOTAL OUTPUT TOTAL

7-3 = 780 7-3 = 660

DATE TIME INTAKE TOTAL OUTPUT TOTAL

MUPIROCIN OINTMENT 2 signed 6 signed 6 signed

10 signed 10 signed 10 signed 10 signed

CITICOLINE 1 GRAM/TAB; 1 2 signed 2 signed 2 signed 2 signed

2 signed 2 signed 2 signed 2 signed

8 signed 8 signed 8 signed

MEROPENEM (MEROMAX) 1 12 signed

VALSARTAN 160 MG/TAB; 1 12 signed 12 signed 12 signed 12 signed

SALBUTAMOL PLAIN 1 NEB q 2 signed 6 signed 6 signed 6 signed

PANTOPRAZOLE 40 MG/CAP; 6 signed

ASPIRIN 80 MG/TAB 1 TAB 2 signed

CLOPIDOGREL 75 MG/TAB; 1 12 signed

ATORVASTATIN 80 MG/TAB; 8 signed

PANTOPRAZOLE 40 MG/CAP; 6 signed 6 signed 6 signed 6 signed

ASPIRIN 80 MG/TAB 1 TAB 2 signed 2 signed 2 signed 2 signed

CLOPIDOGREL 75 MG/TAB; 1 12 signed 12 signed 12 signed 12 signed

ATORVASTATIN 80 MG/TAB; 8 Rx 8 signed 8 signed 8 signed