2 MAIN B

February 22, 2023

CHUA CHING/TANTUCO/ MATIAS/NOBLEZA
Microbiology 4139 Blood bank 4110 Histopathology 4113 Chem-Serology 4137 Hematology 4138 Medical Records 4183

—----— 2MAINB / HRPU —-----

3025 CUALES, Jenifer Idea 3 F 2/22 DOT DOD AMD: Dr. IM: Dr. Aleta (Immuno) 2203 191 785 MROD: CHUA CHING
3 Madamba NONIM:

PROBLEM LIST ENDORSEMENT O2/MV, PBW: RA

COVID Status:
HPI: DIET: DAT
PENDING LABS
Patient is a 33/F non HTN, non DM G2P0 pregnancy uterine, 38 2/7 weeks G2P0 pregnancy uterine, 38 2/7 weeks AOG, APAS, Reproductive FLUSHING:
AOG known APAS coming in for induction of labor. Disorder category II PENDING OFFICIAL
IVF:
Baseline: Independent on all ADLs PROCEDURE
CBG:
Patient had her check up done last week with no abnormal results. Patient TRANSFUSION
advised to be admitted for induction of labor due to her APAS. DRIPS:

ROS HEIGHT:
no fever, cough, cold WEIGHT:
no headache, dizziness BMI:
no chest pain, dyspnea, nausea/vomiting Classification:
IBW:
PMHx
(-)HPN, DM, BA, PTB, CA, kidney thyroid, liver, MI, TIA, stroke
RADIOGRAPHY LABORATORIES MEDICATIONS
(+)APAS (June 2022) CHEST IMAGING CBC ANTIBIOTICS
march 2022 miscarriage - had work up done 10/27/22 11.5/33/1/3.66/13480/ n72 l13 e3 m6 s5 m1/252k/ 90-31-35/13.7
tinzaparin 0.35ml sq (2/10/23) ABDOMEN/SCOUT FILM 4/1/22 14/42.3/ 4.94/13220/N77 L17 M6/346K/ 86-28-33/13.2 NEURO MEDS
aspirin 100mg od (2/6/23)
OTHERS PULMO MEDS
UTI, 2 weeks ago - unrecalled antibiotics ELECTROLYTES/RENAL
yeast infection- unrecalled medication ULTRASOUND CARDIAC MEDS
ABG
(+) aspirin and tinzaparin TRANSVAGINAL ULTRASOUND GI MEDS
(+) unrecalled antibiotics GASTRO (TPAG, SGPT/ALT, SGOT/AST, BILIRUBINS, FIT/FOBT)
no chronic nsaid use CHEST ULTRASOUND ENDO MEDS
no known allergies FECALYSIS
no hospitalization KUB ULTRASOUND NEPHRO MEDS
s/p dilation and curretage (2022) ENDO (FBS, TSH, FT3, FT4, HBa1c, Vit D, Lipid profile, etc)
no blood transfusions WHOLE ABDOMINAL ULTRASOUND RHEUMA MEDS
no herbal medications HEMA (Blood type, PT/PTT, INR, BT/CT, Fibrinogen, FDP, response
OTHERS monitoring assay, serum electrophoresis, BMA) HEMA MEDS
Fhx 2/22 PT10.9 INR0.9 PTT26.2
(+) HPN - paternal grandparents CT-SCAN VTE RISK/PROPHYLAXIS
(-) DM, thyroid, kidney, liver disease, CA CRANIAL CT-SCAN INFLAMMATORY MARKERS (ESR, CRP, LDH, FERRITIN, D-DIMER)
OTHER MEDS
PSHx CHEST CT-SCAN ID (PROCALCITONIN, VANCO TROUGH, C-difficile,etc) propess at 1210H
non smoker
occasional alcoholic beverage drinker ABDOMINAL CT-SCAN URINALYSIS PROCEDURE DATE & FINDINGS
10/27/22 Y/SH/GBKPNB-/1.017/6.5/UN L trace/R1 W5 E2 C0 B85 MT
Seen comfortable, not in distress OTHERS FEW
No headache, dizziness MICROBIO (GS/CS, KOH, AFB, MTB-PCR, etc)
No chest pain, dyspnea MRI 2/10/22 GBS Negative for group 'B' Strep
No abdominal pain, nausea/vomiting CRANIAL MRI 4/5/22 Histopath Products of conception - IMMATURE PLACENTAL
TISSUES AND DECIDUA
BP 110/80 HR 124 RR 22 T 36.6 ABDOMINAL MRI
Pink palpebral conjunctiva, anicteric
Moist lips and oral mucosa LUMBOSACRAL SPINE HISTOPATHOLOGY
Flat neck veins
Clear breath sounds OTHERS OTHER LABORATORIES (AUTOANTIBODIES, etc)
Tachycardic, regular rhythm 7/29/22 LAC1.29 (+ Lupus coagulant)
Abdomen gravid, nontender CARDIO WORKUPS 7/27/22 Anticardiolipin Anti-IgM 0.70 (Neg) Anti-IgG1.5 (Neg)
No bipedal edema 2D-ECHO

12ECG or 24Holter

OTHER CARDIO LABS (NTproBNP, D-dimer for VTE, etc)

DAILY EVENTS
VASCULAR

OTHERS

HRPU 5 MGH LEE, Danica Eunice Lu 3 F 02/20 DOT DOD AMD:Dr. IM: Dr. Velez (Immuno), Dr. Lim-Uy (Endo) 2111 164 359 MROD: CHUA CHING
2 Madamba NONIM:

PROBLEM LIST ENDORSEMENT O2/MV, PBW: RA

COVID Status: HOLD tinzaparin 48hrs prior if with plans to deliver
DIET: DM diet 2000kcal/day 40% CHON 30% CHO 30%
Patient is a 32/F, G1P0 pregnancy uterine 35 2/7 weeks AOG cephalic not in fats (MUFA and PUFA) with at least 28g fiber, divided
labor, Gestational HPN r/o preeclampsia, GDM insulin requiring, APAS, known G1P0 pregnancy uterine 35 2/7 weeks AOG cephalic not in labor, PENDING LABS into 3 meals and 2 snacks. Brown rice instead of white
case of hypothyroidism coming in for steroid administration. Gestational HPN r/o preeclampsia, GDM insulin requiring, rice
Hypothyroidism, Non criteria APAS (abnormal doppler, high DRVVT) PENDING OFFICIAL
Baseline: Independent on all ADLs FLUSHING:
PROCEDURE
3 days prior, patient had an ultrasound done which showed calcification on the IVF: D5NM 100cc/hr
placenta and small size of the baby. Patient has no headache, dizziness, TRANSFUSION
nasuea/vomiting, chest pain, dyspnea, abdominal pain, or bleeding. Patient CBG: 6pt
was advised to be admitted hence admission.
DRIPS:
PMHx:
(+) Gestational hypertension HEIGHT:
No records done at home due to device malfunctioning. WEIGHT:
BMI:
(+) APAS (2022) Classification:
on heparin 0.35ml tinzaparin IBW:
aspirin last taken on thursday

(+) GDM - insulin requiring RADIOGRAPHY LABORATORIES MEDICATIONS

CBGs premeals 85-90 CBG 1-hr post meal - 107-160s CHEST IMAGING CBC ANTIBIOTICS
was on Hemalog lispro 18 units pre-lunhch 01/19 CBC 11.6/35/3.87/13230/N81 L12 M4 E1/314K/90-30-33/14.5
given 16 units pre-dinner ABDOMEN/SCOUT FILM ELECTROLYTES/RENAL NEURO MEDS
01/22 Mg 1.8 Na 137 K 3.6 Cl 107 iCa 1.17
(+) Hypothyroidism (2021) OTHERS 01/19 Crea 0.42 ALT 25 AST 18.22 LDH 144.46 PULMO MEDS
skip heart beat, palpitate ABG
levothyroxine start 50mcg M-Sat 100 mcg Sun ULTRASOUND CARDIAC MEDS
2/15 TSH 1.43 FT3 4.12 FT4 11.5 GASTRO (TPAG, SGPT/ALT, SGOT/AST, BILIRUBINS, FIT/FOBT) Methyldopa 250mg 1 tab every 6hrs
TRANSVAGINAL ULTRASOUND GI MEDS
no kidney, liver, stroke, mi BA PTB 2/22 BPS FECALYSIS
PREGNANCY UTERINE, 34 WEEKS 3 DAYS AOG BY FETAL ENDO MEDS

1
 2 MAIN B
February 22, 2023
CHUA CHING/TANTUCO/ MATIAS/NOBLEZA
Microbiology 4139 Blood bank 4110 Histopathology 4113 Chem-Serology 4137 Hematology 4138 Medical Records 4183

no herbal medications BIOMETRY ENDO (FBS, TSH, FT3, FT4, HBa1c, Vit D, Lipid profile, etc) Levothyroxine 50mcg/tab 1 tab OD 30mins prebreakfast
no chronic nsaid use CEPHALIC PRESENTATION, LIVE, SINGLETON Mon-Sat, 100mcg/tab 1 tab OD 30mins prebreakfast
no previous surgery ESTIMATED FETAL WEIGHT: 2350 grams, +/- 343 grams (5 lbs 3 HEMA (Blood type, PT/PTT, INR, BT/CT, Fibrinogen, FDP, response every Sun
Admitted last Jan 22-23 for palpitations oz) monitoring assay, serum electrophoresis, BMA) Humalog 16units subcutaneously 3x/day -> 22u
no blood transfusions GOOD CARDIAC ACTIVITY (FHB = 140 BPM) 1/19 PT 11.2 INR 0.99 PTT 25.7 Levemir 10units subcutaneously once daily at 10pm ->
no allergies ACTIVE FETAL BREATHING AND MOVEMENTS INFLAMMATORY MARKERS (ESR, CRP, LDH, FERRITIN, D-DIMER) 14u
Covid nov 2022 mild home quarantine ADEQUATE AMNIOTIC FLUID VOLUME (AFI = 8.73cm; DVP = NEPHRO MEDS
Vaccines: astrazeneca 2x, no booster 2.82cm) ID (PROCALCITONIN, VANCO TROUGH, C-difficile,etc)
PLACENTA ANTERIOR, GRADE III, NO PREVIA RHEUMA MEDS
FMHx BIOPHYSICAL PROFILE SCORE: 8/8 URINALYSIS
(+)HPN - both EDD: APRIL 2, 2023 01/19 UA Y/H/1.010/7.00/PGBKNB-/Leu +++/R0 W3-5 Emoderate HEMA MEDS
(+) Thyroid- mom hypo, dad hyper MYOMA UTERI Bmoderate
(-) DM, kidney, liver, CA, BA MICROBIO (GS/CS, KOH, AFB, MTB-PCR, etc) VTE RISK/PROPHYLAXIS

PSHx 2/17 Biophysical Profile HISTOPATHOLOGY OTHER MEDS

non smoker IMPRESSION:PREGNANCY UTERINE, 34 WEEKS AOG BY Betamethasone 12mg IM now then q24 for 2 doses in
non alcohol beverage drinker FETAL BIOMETRY. CEPHALIC PRESENTATION, LIVE, OTHER LABORATORIES (AUTOANTIBODIES, etc) total
not exposed to 2nd hand smoking SINGLETON. ESTIMATED FETAL WEIGHT: 2141 grams, +/- 313 Innohep (Tinzaparin) 10,000iu/ml
interior designer gms. (4 lbs 12 oz). GOOD CARDIAC ACTIVITY (FHB = 143 BPM).
ACTIVE FETAL BREATHING AND MOVEMENTS. ADEQUATE PROCEDURE DATE & FINDINGS
Seen awake, comfortable, not in distress AMNIOTIC FLUID VOLUME (AFI = 8.98cm; DVP =
no headache, dizziness, nausea/vomiting 3.13cm)PLACENTA ANTERIOR, GRADE II - III, NO PREVIA.
no chest pain, dyspnea, abdominal pain, or bleeding BIOPHYSICAL PROFILE SCORE: 8/8
2/3 Biophysical Profile
BP 140/80 HR 86 RR 18 T 36 IMPRESSION: PREGNANCY UTERINE, 32 WEEKS 5 DAYS AOG
Pink palpebral conjunctiva BY FETAL BIOMETRY. CEPHALIC PRESENTATION, LIVE,
Moist lips and oral mucosa SINGLETON. ESTIMATED FETAL WEIGHT: 1863 grams, +/- 272
Flat neck veins gms. (4 lbs 2 oz) GOOD CARDIAC ACTIVITY (FHB = 136
Clear breath sounds BPM)ACTIVE FETAL BREATHING AND MOVEMENTS.
Normal rate, regular rhythm ADEQUATE AMNIOTIC FLUID VOLUME (AFI = 12.78cm; DVP =
Abdomen gravid nontender 4.59cm) PLACENTA ANTERIOR, GRADE II, NO PREVIA.
no edema BIOPHYSICAL PROFILE SCORE: 8/8. MYOMA AS DESCRIBED
1/20 Biophysical Profile
PREGNANCY UTERINE, 30 WEEKS 3 DAYS AOG BY FETAL
BIOMETRY. CEPHALIC PRESENTATION, LIVE, SINGLETON,
ESTIMATED FETAL WEIGHT: 1548 grams, +/- 226 grams (3 lbs 7
oz)GOOD CARDIAC ACTIVITY (FHB = 137 BPM)ACTIVE FETAL
BREATHING AND MOVEMENTS. ADEQUATE AMNIOTIC FLUID
VOLUME (AFI = 9.94cm; DVP = 5.88cm)PLACENTA ANTERIOR,
DAILY EVENTS GRADE II, NO PREVIA.BIOPHYSICAL PROFILE SCORE: 8/8EDD:
MARCH 28, 2023
1/06 Doppler Velocimetry
Other Findings:CPR 1.7304Doppler velocimetry studies showed
normal indices (PI) in all maternal and fetal vessels but with bilateral
uterine artery diastolic notching, more on the left, indicative of
adequate uteroplacental and fetal perfusion at the time of
examination. Presence of notching in the uterine arteries suggest
failure of spiral artery remodeling predictive of possible onset of
hypertension and/or fetal growth restriction later in the course of
pregnancy.

IMPRESSION:PREGNANCY UTERINE, 28 WEEKS 5 DAYS AOG

BY FETAL BIOMETRY CEPHALIC PRESENTATION, LIVE,
SINGLETON ESTIMATED FETAL WEIGHT: 1146 grams, +/- 167
grams (2 lbs 8 oz)GOOD CARDIAC ACTIVITY (FHB = 148
BPM)ACTIVE FETAL MOVEMENTS. ADEQUATE AMNIOTIC
FLUID VOLUME (AFI = 14.90cm; DVP = 5.64cm)PLACENTA
ANTERIOR, GRADE II, NO PREVIA. DOPPLER VELOCIMETRY
STUDIES AS DESCRIBED ABOVE

CHEST ULTRASOUND

KUB ULTRASOUND

WHOLE ABDOMINAL ULTRASOUND

OTHERS

CT-SCAN
CRANIAL CT-SCAN

CHEST CT-SCAN

ABDOMINAL CT-SCAN

OTHERS

MRI
CRANIAL MRI

ABDOMINAL MRI

LUMBOSACRAL SPINE

OTHERS

CARDIO WORKUPS
2D-ECHO
01/22 2D ECHO
Study was done in sinus tachycardia.
Technically poor echo window. Interpretation based on suboptimal
views.
Normal left ventricular diameter, left ventricular mass index and
relative wall thickness.
Adequate wall motion and contractility.
Calculated ejection fraction of 66 % by Simpson's method.
Normal diastolic function.
Normal right ventricular size.
Adequate wall motion and contractility.
Normal left atrial diameter and left atrial volume index.
Normal right atrial diameter.
Normal mitral valve.
Mild regurgitation.
Normal aortic valve.
Normal tricuspid valve.
Mild regurgitation.
Normal pulmonic valve.
Normal aortic root and proximal ascending aorta.
Normal main pulmonary artery.
Normal pulmonary arterial systolic pressure

12ECG or 24Holter
01/23 24HR Holter
1. Basic rhythm is sinus with heart rate ranging from 63 bpm to 134
bpm and an average of 96 bpm.

2
 2 MAIN B
February 22, 2023
CHUA CHING/TANTUCO/ MATIAS/NOBLEZA
Microbiology 4139 Blood bank 4110 Histopathology 4113 Chem-Serology 4137 Hematology 4138 Medical Records 4183

2. No atrioventricular conduction defect. No intraventricular

conduction defect.
3. No premature atrial complexes.
4. No premature ventricular complexes.
5. No significant ST-segment shifts.
6. No reported symptoms.

OTHER CARDIO LABS (NTproBNP, D-dimer for VTE, etc)

VASCULAR

OTHERS

OBRR -> IDIESCA, Crissa Sarah Juson 29 F 2/14 2/21 DO AMD: Dr. Lim -> t/c Dr. Tan (OB) IM: Dr. Fernando (Endo) Dr. Magsombol (Cardio); Dr. Balmores 2302163737 MROD: Nobleza
ICU 11 D (Nephro)
(PC NONIM: Dr. Laxamana (Neuro)
overflow)
-> 2236

COVID Status: PROBLEM LIST ENDORSEMENT O2/MV, PBW: RA

HPI Maintain SBP 110-140
BFC: Independent in all ADLs Hypertensive emergency, resolved DIET: DM Heart's delight diet 1700 kcal/ day 50% CHO,
G1P1 (0101) S/P primary CS Order Levemir 20u as home meds for dr. fernando 25% CHON, 25% fats. <7% saturated fat, rest from
Patient is a 29 year old G1P0 32 2/7 weeks AOG cephalic not in labor, Chronic hypertension with superimposed pre-eclampsia MUFA and PUFA, 3 g Na, 20 g fiber to be divided in 3
chronic hypertension with superimposed pre-eclampsia, Overt DM s/p Overt T2DM PENDING LABS meals, 2 snacks. No source of simple sugars.-> NPO
Hemorrhagic Infarct, MRS 0 (2020) coming in for epigastric pain. Chronic Hemorrhagic Infarct, MRS 0 (2020) 2/24 Na, K, Mg tom 0500H 2/19 General liquids → Soft diet-> full dm diet limit K
AKI at risk on top of possible CKD secondary to HTNSS/DKD sources
Few hours PTA, noted epigastric pain characterized as “parang humihilab
and naninigas” graded 7/10 with no radiation with associated contractions PENDING OFFICIAL FLUSHING:
every 3-5 mins which spontaneously resolves. No fever, no vomiting,
headache, diaphoresis, chest pain, vaginal bleeding or watery discharge. PROCEDURE IVF: PLRS x 10 ml/hr -> D5NSS TFR 125ml/hr +
Patient sought consult and was noted to have high BP at 180/100. No Magnesium sulfate 2g/hr + Oxytocin 40ml/hr → NSS TFR
headache, blurring of vision, dizziness, chest pains, palpitations, changes TRANSFUSION 40ml/hr
in sensorium,and nausea/vomiting. Patient was subsequently admitted
and was given Hydralazine 5 mg with no decrease in BP. Another dose of CBG: TIDHS
Hydralazine 10 mg was given and BP decreased to 150/90.
140(12) - 104 - 136
ROS
no fever, headache, blurring of vision, loss of consciousness, seizures DRIPS: Nicardipine drip 40mg in 60ml currently at 7mg/hr
no dyspnea → 2mg/hr → 2/20 to consume
no orthopnea, no PND, no palpitations
no diarrhea, constipation HEIGHT:
no joint pains WEIGHT:
no hx of gross bleeding BMI:
Classification:
IBW:
PMHx
1. Type 2 DM (2020) - diagnosed while admitted at PGH for the
management of Hemorrhagic stroke, SMBGs premeals 120-130 post RADIOGRAPHY LABORATORIES MEDICATIONS
meals- uncompliant to monitoring, latest HbA1C: 6.7% , on Metformin 500 CHEST IMAGING CBC ANTIBIOTICS
mg tab OD (stopped during pregnancy), currently on Insuget 70/30 26 02/22 CBC 13.5 (14.7)/40.7 (42.2)/4.70/14040 (17840)/N80 L12 E4 2/18 Cefazolin 2g IV - Done
units before breakfast, 16 units before dinner ABDOMEN/SCOUT FILM M4/304K/(285k)87-29-33/13.3
2/19 CBC 14.7/42.2)/5.05/17840/N86 L9 M5/285K/84-29-35/13.2 NEURO MEDS
2. Hypertension (2020) - UBP 140-150/80 HBP 160s, maintained on OTHERS 2/14 13.9/40.3/4.78/15560/ N73 L18 E3 M6/274K/84–29-35/13.7
Amlodipine 10 mg tab OD, Atorvastatin 10 mg OD (stopped during 2/03 12.9/41/4.4/13300/N71 L21 M1/92-29-316/13.5 PULMO MEDS
pregnancy), ASA 80 mg OD (stopped last 2mos), Nifedipine 30 mg 1 tab ULTRASOUND
BID ELECTROLYTES/RENAL CARDIAC MEDS
TRANSVAGINAL ULTRASOUND 02/22 Crea 0.86 (0.84) BUN 30 (27) Mg 1.7 (2.7) HCO3 25 (20) Na Hydralazine 5 mg IV now
3. Hemorrhagic infarct midpontine ASPECTS 2 NIHSS 7 MRS 0 (2020) - 138 (138) K 5.1 (4.8) Cl 102 (104) iCa 1.17 (1.07) Betamethasone 12 mg IM now then 12 mg after 24 hours
presenting as headache and right arm numbness, BP was 200/140, not CHEST ULTRASOUND 2/21 Microalbumin 7.6 Crea 127.7 A/C 6.0 Magnesium sulfate 4 grams IV push x 30 minutes
on any maintenance medications 2/20 Crea 0.84 ECC 96 BUN 33 Na 138 K 4.8 Mg 2.7 HCO3 23 Cl Famotidinee 1 amp now
KUB ULTRASOUND 104 iCa 1.07 Phos 5.4 Aldomet 250mg/tab, 3 tab every 6 hours
No BA, PTB, thyroid or kidney disease,MI 02/17 KUB UTZ 2/19 Crea 1.00 ECC 65.6 BUN 27 Na 135 K 4.8 Mg 6.2 iCa 1.09 Nifedipine 10mg/tab, 3 tabs every 6 hours
No history of blood transfusion Consider Bilateral Renal Parenchymal Changes /Disease, With Non-Specific HCO3 20 Cl 103 Amvasc 5mg 1 tab BID → 2/19 resumed
No antibiotic use in the past 3 months Parenchymal Calcification, Left Urinary Sediments And/Or Cellular Debris 23% Or 149 2/14 Crea 0.76 iCa 1.19 Mg 3.5 Na 137 K4.2 Carvid 25mg 1 tab BID → 2/19 resumed
Previous hospitalization at PGH 2020 due to Hemorrhagic infarct Cc Moderate Urinary Retention 2/14 Crea 0.76 ECC 109 Methyldopa 250mcg q6h → 750mg tab TID
No herbal medication use Unremarkable Study Of The Right Kidney 2/03/23 UPCR 17.96 Urine Protein 172 Urine Crea 9.6 Aldactone 25mg tab OD
COVID Vaccine: Astra x 2 08/22 13.9/43/5.22/11100/N74 L21 M4 E1/284k/82-26-32/15.4 Clonidine 75mcg q6
(+) COVID infection (2020) hospitalized at PGH, O2-requiring WHOLE ABDOMINAL ULTRASOUND
ABG GI MEDS
FamHx OTHERS Omeprazole 40mg IV once a day while on NPO → oral
HTN - mother side 2/23 Renal duplex scan (Initial) GASTRO (TPAG, SGPT/ALT, SGOT/AST, BILIRUBINS, FIT/FOBT)
DM - father side No evidence of renal artery stenosis, bilateral. 2/14 AST 16 ALT 10 LDH 189 ENDO MEDS
CKD - father side No evidence of renal parenchymal disease, bilateral. 2/03 ALT 27.4 AST 17.2 Insuget 70/30 26 units before breakfast, 16 units before
No hx of asthma, cancer, stroke, kidney disease, blood dyscrasia Normal kidney size, bilateral. Patent renal veins, bilateral. dinner - HOLD
FECALYSIS Caltrate plus 1 tab BID
PSHx Levemir to 28 units at 9am -> 20 units
Non-smoker, occasional alcoholic drinker CT-SCAN ENDO (FBS, TSH, FT3, FT4, HBa1c, Vit D, Lipid profile, etc) novorapid IV rescue dose
Marketing secretary in QC CRANIAL CT-SCAN 2/20 Vit D 24 >180 give 2 units
02/15 TSH 0.69 >220 4 units
O CHEST CT-SCAN 02/14 FT3 3.63 ft4 1.03 >260 6 units
awake 12/22 FBS 96.4 >300 8 units and refer
BP 160/100 PR 127 RR 20 T 36.5 O2 98% RA ABDOMINAL CT-SCAN 11/22 FBS 120.3
Wt 82 Ht 154 BMI 32.59 (Obese II) 11/22 HBA1C 6.7% NEPHRO MEDS
anicteric sclera, pink palpebral conjunctiva OTHERS OGTT 120.3
non-distended neck veins, no bruit 1st 207.9 RHEUMA MEDS
clear breath sounds MRI 2nd 166.7
tachycardic, regular rhythm CRANIAL MRI HEMA MEDS
gravid, soft, non-tender abdomen 02/17 Cranial MRI HEMA (Blood type, PT/PTT, INR, BT/CT, Fibrinogen, FDP,
no edema, full pulses IMPRESSION:No restricted diffusion to suggest an acute infarct, acute hemorrhage response monitoring assay, serum electrophoresis, BMA) VTE RISK/PROPHYLAXIS
and discrete mass lesionHemosiderin deposits, right frontal lobe and pons. 02/18 PTT 26.3 PT 10.1 INR 0.83
Neuro PE Microvascular ischemic white matter changes (Modified Fazekas II) and/or areas of OTHER MEDS
GCS 15, oriented to time, place, person demyelination, bilateralfrontal and parietal lobes as well as the periventricular regions INFLAMMATORY MARKERS (ESR, CRP, LDH, FERRITIN, Heragest 20mg/cap 1 cap every 12 hours
Pupils 3 mm EBRTL, no visual field cuts Unremarkable MR angiography of the brain Mucosal sinus disease, sphenoid sinus D-DIMER) Ketorolac 30mg IV q6 for 4 doses then shift to (LD 10am
Full EOMS 2/15 ESR 74 (H) CRP 6 2/19)
Intact V1-V3 ABDOMINAL MRI Naproxen 550mg/tab BID for 7 days
No facial asymmetry ID (PROCALCITONIN, VANCO TROUGH, C-difficile,etc) Paracetamol 1g IV q8 for 4 doses then shift to (LD 4pm
Tongue midline LUMBOSACRAL SPINE 2/19 HBsAg Nonreactive 2/19)
Sensory 100% all extremities Paracetamol + Tramadol 325mg/37.5mg/tab 1 tab per
Motor 5/5 all extremities OTHERS URINALYSIS orem every 8 hours for 5 days
DTRs 2+ all extremities 02/14 Y/SH/G 1+/ BPN-/Ketone 1+/1.012/6.0/Blood 1+/Leu trace/R10 Epidural morphine 0.02% 10ml every 12hrs for 2 doses
No babinski CARDIO WORKUPS W8 E1 C2 B5 then may remove epidural morphine (1st dose 1600h)
2D-ECHO
DAILY EVENTS 02/14 PROCEDURE DATE & FINDINGS
12ECG or 24Holter Random Urine Protein 25.4 02/18
02-14-2023: Patient admitted under the service of dr. Tan. Noted blood 02/14 Sinus rhythmAbnormal R wave progression Random Urine Creatinine 55.01 s/p Primary LTCS due to deteriorating maternal status

3
 2 MAIN B
February 22, 2023
CHUA CHING/TANTUCO/ MATIAS/NOBLEZA
Microbiology 4139 Blood bank 4110 Histopathology 4113 Chem-Serology 4137 Hematology 4138 Medical Records 4183

pressure of 180/100. Patient given methyldopa, hydralazine, magnesium random Urine protein and Creatinine ratio 0.46 Total OR time: 1 hour
sulfate, and betamethasone. Patient assessed as chronic hypertension OTHER CARDIO LABS (NTproBNP, D-dimer for VTE, etc) EBL: 300ml
with superimposed preeclampsia; overt DM, and pregnancy uterine 32 1/7 MICROBIO (GS/CS, KOH, AFB, MTB-PCR, etc) BP range: 110s-170s/60s-100s
week AOG cephalic in threatened preterm labor. Patient was referred to VASCULAR 02/14 Negative for group 'B' Strep HR range: 100s-120s
endo service for her diabetes mellitus and cardio service for her 02/16 Carotid/Vascular Artery Duplex 02/14 Vaginal discharge No episodes of hypotension, desaturation, dysrhythmia
hypertension. Carotid artery disease with less than 50% stenosis (approximately 1 to 15%) in the Enterococcus faecalis (few growth) Tolerated procedure well
02-15-2023: Patient referred to neuro service due to history of right internal carotid artery.Normal left carotid duplex scan.Normal antegrade flow in Ampicillin sensitive
hermorrhagic stroke. Patient's blood sugar remained high hence started the bilateral vertebral arteries.Hypoplastic left vertebral artery Benzylpenicillin sensitive IOF: Live boy APGAR score 8,9 , 32 6/7 AOG
on levemir. Noted blood pressure to be persistently at 150s/100s. Linezolid sensitive
Medications were continued and was scheduled for bps with doppler. OTHERS Vancomycin sensitive
02-16-2023: patient's tracings showed minimal variabilities, with 2/15 Doppler Velocimetry 02/14 Vaginal discharge
accelerations, and episodic decelerations. Close monitoring was done for Doppler studies of the uterine arteries show normal waveform pattern and indices Gram positive bacilli occuring singly = Few
recurrent decelerations. Duplex scan done. Current management as indicative of normal vascular resistance in the maternal compartment. Umbilical artery Squamous epithelial cells = 10-15/lpf
follows: methyldopa (aldomet) 250mg/tab 3 tab every 6 hours; nifedipine Doppler indices are increased which indicate the presence of obstructive vasculopathy Leucocytes = 0-5/lpf
10mg/tab 3 tab every 6 hours; levemir 24 units subcutaneously once a in the placenta suggestive of decreased fetoplacental perfusion. Middle cerebral artery possible organisms include Lactobacillus spp.
day; novorapid 8 units 3 times a day with dose adjustments >100 +2, indices are normal indicative of absence of fetal arterial compensatory redistribution.
>120 +4. Nifedipine increased to 3 tabs every 6 hours. Started on Cerebroplacental ratio > 1, no brain sparing blood flow redistribution. HISTOPATHOLOGY
heragest 200mg q12. Levemir increased to 26units due to high CBGs
02-17-2023: Patient still with high BP reaching 160s. Neurology ordered 2/15 Biophysical Profile OTHER LABORATORIES (AUTOANTIBODIES, etc)
for plain cranial mri/mra and kub utz. Still with high CBGs so Levemir Pregnancy Uterine, 32 Weeks 1 Day Aog By Fetal Biometry 2/23 Anti-dsdna 2.4 (Neg), C3 112 (N), ANA neg, ASO <200 (N)
increased to 28units. novorapid fixed dose increased to 10units 3 times a Cephalic Presentation, Live, Singleton 02/15 ANA negative
day with dose adjustments: >120 +2 units, >160 +4units, >200 +6units Estimated Fetal Weight: 1938 Grams, +/- 283 Gms. (4 Lbs 4 Oz)
Good Cardiac Activity (Fhb = 130 Bpm)
02-18-2023: Patient with high BP reaching 170/120 given hydralazine Active Fetal Breathing And Movements
which brought down BP to 160/120 given another dose of hydralazine. BP Polyhydramnios, Mild (Dvp = 9.85cm)
ranges were still high. Fetal tracing minimal variability with accelerations, Placenta Posterior, Grade Ii, No Previa
no decelerations and mild contractions. BP still high at 150s-160s given Biophysical Profile Score: 8/8
nifedipine with no improvement. Patient had perceived contractions with Edd: April 11, 2023
watery/bloody vaginal discharge, good fetal movement. Patient underwent
emergency CS, given magnesium sulfate, cefazolin, hydralazine. Live
baby boy delivered. Patient referred due to high BP reaching 180s, given
oral BP meds of amlodipine and carvedilol but still at 180s. Patient given
1mg nicardipine IV push but no improvement. Patient had no headache,
dizziness, blurring of vision, no neurological deficits. Patient assessed to
be in Hypertensive urgency. Hooked to nicardipine drip and for transfer to
progressive care.

2/19 Soft diet. FC removed. Oral HTN resumed. Nicardipine drip titrated.
Referred to Nephro service for workup of possible CKD.

2/20 CBG to TIDACHS; Nicardipine drip consumed → for transfer to reg

room

ROOM TEMPLATE A Se DOA DOT DOD AMD: IM: PIN MROD:

g x NONIM:
e

PROBLEM LIST ENDORSEMENT O2/MV, PBW: RA

COVID Status:
DIET:
PENDING LABS
DAILY EVENTS FLUSHING:
PENDING OFFICIAL
IVF:
PROCEDURE
CBG:
TRANSFUSION
DRIPS:

HEIGHT:
WEIGHT:
BMI:
Classification:
IBW:

RADIOGRAPHY LABORATORIES MEDICATIONS

CHEST IMAGING CBC ANTIBIOTICS

ABDOMEN/SCOUT FILM ELECTROLYTES/RENAL NEURO MEDS

OTHERS ABG PULMO MEDS

ULTRASOUND GASTRO (TPAG, SGPT/ALT, SGOT/AST, BILIRUBINS, FIT/FOBT) CARDIAC MEDS

TRANSVAGINAL ULTRASOUND FECALYSIS GI MEDS

CHEST ULTRASOUND ENDO (FBS, TSH, FT3, FT4, HBa1c, Vit D, Lipid profile, etc) ENDO MEDS

KUB ULTRASOUND HEMA (Blood type, PT/PTT, INR, BT/CT, Fibrinogen, FDP, response NEPHRO MEDS
monitoring assay, serum electrophoresis, BMA)
WHOLE ABDOMINAL ULTRASOUND RHEUMA MEDS
INFLAMMATORY MARKERS (ESR, CRP, LDH, FERRITIN, D-DIMER)
OTHERS HEMA MEDS
ID (PROCALCITONIN, VANCO TROUGH, C-difficile,etc)
CT-SCAN VTE RISK/PROPHYLAXIS
CRANIAL CT-SCAN URINALYSIS
OTHER MEDS
CHEST CT-SCAN MICROBIO (GS/CS, KOH, AFB, MTB-PCR, etc)

ABDOMINAL CT-SCAN HISTOPATHOLOGY PROCEDURE DATE & FINDINGS

OTHERS OTHER LABORATORIES (AUTOANTIBODIES, etc)

MRI
CRANIAL MRI

ABDOMINAL MRI

LUMBOSACRAL SPINE

OTHERS

CARDIO WORKUPS
2D-ECHO

12ECG or 24Holter

4
 2 MAIN B
February 22, 2023
CHUA CHING/TANTUCO/ MATIAS/NOBLEZA
Microbiology 4139 Blood bank 4110 Histopathology 4113 Chem-Serology 4137 Hematology 4138 Medical Records 4183

OTHER CARDIO LABS (NTproBNP, D-dimer for VTE, etc)

VASCULAR

OTHERS

41 =49