VETERANS MEMORIAL MEDICAL CENTER

DEPARTMENT OF PSYCHIATRY
DAILY CENSUS
December 9-10, 2023
Category Male Female Total
Resident-on-Duty Neoffer Jelas DG Macatangay, MD
0 0 0
RG
Admission 0
AFP 1 0 1
RPV
KV 0 0 0

U 0 0 0 Boarder/Co-Managed 1
SENIOR INTERNS
AM DUTY: RG 0 0 0
Ragasa, Jacob R.
AFP 0 1 1
Vito, Jonathan A
RPVD
KV 0 0 0 Discharged 1
PM DUTY:
Tapang, Keana Rae B. U 0 0 0
Occidental, Jed Celso V. III
ER Call 0
JUNIOR INTERNS: VMMCP-D 1 0 1
Senior Interns
AM DUTY: Ward Referral 0
And
Pitong, Carmirose
Clinical Clerks
Rafal, Ronalyn Mae VMMCP 0 0 0
On-duty
Mehta, Ishant
Maniego, Mary
CP 3 2 5 “E” Ward Referral 0
PM DUTY: 0 0 0
Pedrozo, Hannah Jezreel CP with docs THOC/HAMA 0
Puatu, Sahlee Ann
Rafanan, Clarisse Trans In 0
Manahan, Lorielen Mari Unclassified 0 0 0 Trans Out 0
Mahithiphark, Charlene
CP-NBB 0 0 0 Expired 0

5 3 8 Treatment Room 3
Sub-Total In-Patients
Procedure 0

TOTAL PATIENTS 8

RIVAS, MAXIMO #Schizophrenia, multiple >Olanzapine 10mg/tab, ½ tab in AM HEMATOLOGY 12/09/23 HT: 165 cm
AQUINO episodes in acute episode and 1 tab ODHS 09/29/23 CBC: Hgb 126 Hct 0.398 Plt 202 WBC 9.1 RBC 4.7 MCH 27 MCHC 0.33 > No new WT: 66 kg
49/M/CP >Clonazepam 2mg/tab, ½ tab PRN for orders AG: 86 cm
#Assault risk insomnia CHEMISTRY BMI 24.2 (Overweight)
FAS/JNC > Valproic acid 500 mg/ tab 1 tab ODHS 09/29/2023 BUN 4.1 Crea 86, Na 140 K 3.8 Cl 105 ALT 30, AST 30 FBS 5.7 TC 4.6 TG 1.4 HDL 1.4
#Escape Risk LDL 1.4
DOB: 12/9/1973 Discontinued Lithium 12/01/23 10/22/23 FBS 5.9, HBA1C 6.5, BUA 398, CHOLE 4.2, TAG 1.7, HDL 0.8, LDL 2.5

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DOA: 09/28/23 #Hoarding of Medication Risk
CLINICAL MICROSCOPY
SIIC: PGI #Complicated UTI – resolved 09/28/23 UA: yellow, slightly turbid, SG 1.007, pH 6, esterase positive, alb neg, ketones neg,
OCCIDENTAL erythrocytes neg, nitrite positive, glucose neg, urobilinogen neg, rbc 2-5, wbc pus cells 10-20,
JIIC: JI PITONG HD: 73 abundant mucus threads
10/7/2023 UA: yellow, clear, SG 1.008, pH 5.5, esterase negative, alb neg, ketones neg,
erythrocytes neg, nitrite negative, glucose negative, urobilinogen neg, RBC 0-2, WBC pus cells 0-2,
FEW mucus threads, Some Bacteria, Few Mucus threads

ANCILLARIES
09/28/23 ECG: SINUS RHYTHM, LVH BY VOLTAGE, NORMAL AXIS
09/28/2023: Urine MAP/THC: Negative
09/29/23 Chest X-ray: CHEST (AP SIT) No demonstrable active parenchymal infiltrates. Heart is
magnified. Aorta is calcified. Diaphragm and sulci are intact. Osteophytes are seen along the
vertebral body endplates of the thoracic spine. Impression: Magnified Heart; Atheromatous
Aorta; Thoracic Osteophytosis; Remarks: Suggest Clinical Correlation.

IRIGAYEN, ROANNE #Schizophrenia, multiple >Amisulpride 200mg/tab, 1 tab BID
GAEA ANTONIO episodes in acute episode > Quetiapine 25mg/tab 1 tab PRN for
28/F/CP difficulty sleeping
#Assault Risk > Paracetamol 500mg/tab 1 tab Q4
AAA/DDC PRN for fever
#Escape Risk > Haloperidol 5mg/ml + 11/20/23: Hgb 103 / Hct 0.32 / WBC 14.7 / Seg 0.70 / Lymph 0.21 / Mono 0.05 / Eos 0.04 / Baso
DOB: 08/06/1995 Diphenhydramine 50mg/ml injection
DOA: 11/10/2023 #Hoarding of Medication Risk PRN for disruptive behavior
> Risperidone 2mg/tab 1 tab in AM
IIC: PGI VITO #Hospital-acquired Pneumonia- > Biperiden 2mg/tab ½ tab PRN for EPS
JIIC: JI PEDROZO Resolved > Atorvastatin 40mg/tab 1 tab ODHS
> Febuxostat 40mg/tab 1 tab ODHS
# Rectal impaction; Lower GI >Losartan 50 mg/tab 1 tab OD
bleeding, possibly secondary to > Omeprazole 40mg/cap 1 cap ODAC
Internal Hemorrhoids vs. >Lactulose 30 cc ODHS
Stercoral Ulcers >Dulcolax Suppository OD
> Completed Tranexamic acid 1g IV
HD: 30 now then 500mg IV q6 6 more doses
> Discontinued NAC 600mg/tab 1 tab
ODHS
> Discontinued Fleet Enema BID
> Completed: Piperacillin-Tazobactam
4.5g IV Q6 - 11/22/23
HEMATOLOGY IDS- Dr. Lee 12/09/23 HT: 5‘1
11/10/23: Hgb 117 / Hct 0.35 / WBC 15.1 / Seg 0.71 / Lymph 0.20 / Mono 0.07 / Eos 0.02 / Baso GI- Dr. Atienza > No new WT: 55kg
0.00 / RBC 4.9 / MCV 72 / MCH 24 / MCHC 0.33 / RDW 21.2 / PLT 346 orders AG: 85cm
11/15/23: Hgb 129 / Hct 0.40 / WBC 10 / Seg 0.83 / Lymph 0.12 / Mono 0.03 / Eos 0.01 / Baso BMI: 22.9 (Normal)
0.01 / RBC 5.6 / MCV 71 / MCH 23 / MCHC 0.33 / RDW 20.6 / PLT 323
Last BM 12/10/23, 1 in
0.00 / RBC 4.4 / MCV 71 / MCH 23 / MCHC 0.32 / RDW 20.3 / PLT 295 AM
11/22/23: Hgb 87.0 / Hct 0.27 / WBC 11.90 / Seg 0.74 / Lymph 0.18 / Mono 0.04 / Eos 0.03 / Baso
0.01 / RBC 3.7 / MCV 71 / MCH 23 / MCHC 0.33 / RDW 19.9 / PLT 269
11/22/23: Coagulation PT Patient 14.90 / PA 78.00 / Control 11.6 / INR 1.18
11/23/23: Hgb 88.0 / Hct 0.27
11/24/23: Hgb 97.0 / Hct 0.30
11/25/23: Hgb 104.0 / Hct 0.31
CHEMISTRY
11/10/23: BUN 6.7 / Crea 56 / Na 139 / K 4.1 / Cl 103 / Mg 0.9 / ALT 33 / AST 23
11/11/23: FBS 5.3 / BUA / TC 5.7/ TG 1.1/ HDL 1.5 / LDL 3.7
11/15/23: BUN 12.2 / Crea 61 / Uric Acid 559/ TC 7.1 / TG 2.0 / HDL 1.1 / LDL 5.4 / Na 139 / K 4.1 /
Cl 103 / Mg 0.8 / iPhos 1.9 / CPK Total 189 / CPKMB 11 / ALT 24 / AST 27 / Trop I 13 / RBS 7.0
12/01/23: BUN 3.2/ Crea 38 / Na 138/ K 3.4/ Cl 106
12/6/2023: Na 141/ K 3.7/ Cl 103
CLINICAL MICROSCOPY
11/11/23 UA: Dark Yellow / Slightly Turbid / 1.031 / 5.5/ Esterase 2+ / Alb trace / Urobilinogen
1+ / Ketones, Bilirubin, Erythrocyte, Nitrite, Glucose Negative/ RBC 0-2 / WBC 5-10 / Sq Cells Mod
/ Trans Cells Occ / Bact Mod / MT Some
11/27/23 UA: Yellow / Turbid / SpGr 1.018 / pH 8.0 / Esterase 2+ / Albumin 1+ / Ketones
Negative / Bilirubin Negative / Erythrocytes 3+ / Albumins 1+ / Ketones Negative / Bilirubin
Negative / Erythrocytes 3+ / Nitrite Negative / Glucose Negative / Urobilinogen 2+ / RBC >100 /
WBC 3-6 / Bacteria Many / Amorphous Phosphate Many / Others
11/29/23 UA: Dark yellow / Turbid / sp. Gr 1.027 / pH 5.5 / Esterase trace / Albumin +1 / Ketones
Neg / Bilirubin +1 / Erythrocytes +3 / Nitrite Neg / Glucose Neg / Urobilinogen +2 / RBC red cells
35-45 / WBC Pus cells 4-6 / Yeast cells Few / Bacteria Moderate / Mucus threads Few /
Amorphous urate Few / Ca Oxalate Moderate

ANCILLARIES
11/10/23: 12L ECG NSR, Normal axis
11/11/23: Urine MAP, THC Negative

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11/11/23: Pregnancy test Negative
11/13/23: CHEST PA No demonstrable active parenchymal infiltrates. Heart is not enlarged. Aorta
is unremarkable. Costophrenic sulci are intact. Both hemidiaphragm is elevated. Visualized
osseous structures are unremarkable. The rest of the chest structures are unremarkable.
IMPRESSION:
ELEVATED DIAPHRAGM.
11/15/23: AP Follow up study shows interval development of reticular hazy densities in both
lower lobes and right midlung field. Heart is not enlarged. The rest of the chest findings are
essentially the same. Technical differences are being considered.
IMPRESSION:
CONSIDER BILATERAL LOWER LOBE AND RIGHT MIDLUNG FIELD PNEUMONIA
Remarks:
Suggest Clinical Correlation
11/15/23: FPA (Supine & Left Decubitus view)
Examination shows long segments of gas-filled, non-uniformly dilated large bowel loops with
plenty of fecal materials/scybalous stools in the visualized color.
No air-fluid level or subdiaphragmatic air collection noted in the upright view.
Rectal gas is appreciated.
No radiopaque lithiasis seen in the region of the KUB tract and gallbladder.
Liver shadow is not enlarged.
Psoas outlines and flank stripes appear intact.
Incidental note of orthopedic plate and screws transfixing the right ilium.
IMPRESSION:
CONSIDER LARGE BOWEL ILEUS, CANNOT RULE OUT FECAL IMPACTION.
REMARK: SUGGEST CLINICAL CORRELATION.
11/16/23: Urine GS: No Organism Seen
11/16/23: Sputum GS Gram positive cocci in Clusters 2+ / Chains 2+ / Pairs 2+ / Tetrads 2+ / Gram
positive bacilli 2+ / Pus cells 2+ / Epithelial cells 4+
11/17/23: URINE CS: No growth after 2 DAYS of incubation
11/20/23: CHEST PA:
Follow-up study shows regression of reticular and hazy densities in both lower lobes and right
midlung field.
Heart is not enlarged.
The rest of the chest findings are essentially the same.
Technical differences are being considered.
IMPRESSION:
ELEVATED DIAPHRAGM WITH CROWDING OF THE BASAL LUNG MARKINGS.
Remarks: Suggest clinical correlation.
11/20/23 ABG: Ph 7.445, co2 30.5, O2 149,HCO3 21.0, dFiO2 21.7 ; Fully compensated respiratory
alkalosis
11/21/23: Gram Stain Gram Positive Cocci in Pairs 2+, Gram negative bacilli 2+ / Spores/Mycelia
2+ / Pus Cells 2+ / Epithelial Cells 2+
11/22/23 Routine Fecalysis: Color Reddish Brown / Consistency Formed / Pus cells 0-2 / RBC 20-30
11/22/23 Hemoglobin (Occult Blood Test), Feces: Positive
11/24/23: FPA & LAT DECUBITUS:
ABDOMEN (SUPINE & LEFT LATERAL DECUBITUS): 11/24/2023 compared with 11/15/2023 Follow-
up study shows regression in the degree of dilatation of gas-filled large bowel loops with some
fecal materials. Rectal gas is appreciated. Liver shadow is not enlarged. Psoas outlines and flank
stripes appear intact. No radiopaque lithiasis seen in the region of the KUB tract and gallbladder.
Orthopedic plate and screws transfixing the right ilium again noted.
IMPRESSION: SEGMENTAL ILEUS. CONSIDER FECAL IMPACTON. WITH REGRESSION. REMARK:
SUGGEST CLINICAL CORRELATION.
11/24/23: Occult Bld (FIT)Test only: Positive

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DISTAJO, RAMON #Schizophrenia, Multiple > Olanzapine 10mg/tab, ½ tab in AM HEMATOLOGY 12/09/23 HT: 168 cm
PALACIO Episodes In Acute Episode and 1 tab in PM 10/23/2023 CBC PC: Hgb 127 Hct 0.39 WBC 13.8 S 0.89 L 0.05 M 0.05 E 0.01 B 0 RBC 4.5 MCV 87 > No new WT: 63 kg
57/M/CP > Quetiapine 100mg/tab, 1 tab ODHS MCH 29 MCHC 0.33 RDW 15.6 Plt 266 orders AG: 86 cm
#Escape Risk > Clonazepam 2mg/tab1/2 tab PRN for 10/24/2023 CBC PC: Hgb 129 Hct 0.39 WBC 9.2 S 0.70 L 0.19 M 0.07 E 0.03 B 0.01 RBC 4.5 MCV 88 BMI: 22.3 (Normal)
FAS/DDC insomnia MCH 29 MCHC 0.33 RDW 15.4 Plt 269
#Assault Risk > Fluphenazine Decanoate 25mg/1mL, Discharge papers
DOB: 03/02/67 TIM (11/20/23) then q4 weeks with BP CHEMISTRY started. CF4 updated.
DOA: 10/23/23 #Hoarding Of Medication Risk precautions (Next dose: December 18, 10/23/2023 BUN 3.5, Crea 104, Na 138, K 3.6
2023) Fasting Labs 10/24/2023 FBS 5.8 BUA 147 Total Chole 5.1 Triglyceride 1.1 HDL 1.9 LDL 2.8
IIC: PGI POLLOSO HD: 48 > Ferrous sulfate tab, 1 tab once a day 10/24/23: HBA1C 5.7 ALT 22 AST 32
JIIC: JI MANIEGO, JI > Mupirocin ointment, apply 3x a day THYROID FUNCTION TEST
MEHTA on affected site (discontinued 10/24/2023 FT3 4.89 FT4 25.60 TSH 0.922
11/19/23)
CLINICAL MICROSCOPY
10/23/23 URINALYSIS: yellow, clear SG 1.003, pH 5.0, esterase neg, alb neg, ketone neg, bilirubin
neg, erythrocytes neg, nitrite neg, glucose neg, urobilinogen neg, RBC 0-1, WBC 0-1, Bacteria few,
mucus threads few, hyaline
ANCILLARIES
10/23/2023: ECG: Sinus rhythm. Normal axis.
10/23/2023: Urine MAP/THC: Negative
10/24/23 CXR PA: Heart is normal in size. Diaphragm and costophrenic sulci are intact.
Osteophytes are seen along the thoracic vertebral body endplates. IMPRESSION: MILD
OSTEODEGENERATIVE CHANGES OF THORACIC SPINE

SINGAYAN, #Schizophrenia, Multiple > Olanzapine 10mg/tab 1 tab ODHS HEMATOLOGY 12/09/23 HT: 5‘6“
EDUARDO JOSE Episodes In Acute Episode > Clonazepam 2mg/tab ½ tab as 11/26/2023: Hgb 158, Hct 0.44, WBC 14, Seg 0.54, Lymph 0.37, Mono 0.03, Eos 0.05, Baso 0.01, >No new WT: 56
TAÑECA needed for insomnia RBC 4.9, MCV 89, MCH 32, MCHC 0.36, RDW 14, Plt 341 orders AG: 88
39/M/CP #Escape Risk > Haloperidol 5mg/ml + BMI: 19.9 (Normal)
Diphenhydramine 50 mg/ml IM CHEMISTRY
FAS/JNC #Assault Risk injection for disruptive behavior 11/26/2023: HbA1c 5.2, BUN 2.5, Creatinine 61, Na 135, Potassium 4.0, Cl 101, Mg 0.8, SGPT/ALT Refer to GS for
> Vitamin C tablet, 1 tab BID 28, SGOT/AST 29 UA 261 evaluation and
DOB: 12/03/83 #Hoarding Of Medication Risk 12/03/2023: FBS: 5.0, Chol: 8.2 (ELEVATED), TG: 4.7 (ELEVATED), HDL: 0.6, LDL: 3.4 (ELEVATED) management of pea-
DOA: 11/26/23 sized bulging mass on
#T/C Methamphetamine IMMUNOLOGY the right foot on
IIC: PGI QUEBEC Intoxication 12/3/2023: Free T3 6.84, Free T4 11.60, Thyroid Stimulating Hormone 2.800 Monday (12/11/23)
JIIC: JI PABILON, JI 12/4/2023: Free T3 5.82, Free T4 10.70, Thyroid Stimulating Hormone 2.007
ACTTANASIRI #Pneumonia, unlikely
URINALYSIS
#COVID-19 negative 11/26/23: Color Yellow, Transparency Clear, SpGr 1.007, pH 7.0, Esterase Negative, Albumin
Negative, Ketones Negative, Bilirubin Negative, Erythrocytes Negative, Nitrite Negative, Glucose
HD: 14 Negative, Urobilinogen Negative, RBC 0-2, WBC 0-2, Bacteria few, Mucus threads few

ANCILLARIES
11/26/2023 CXR: No previous radiograph available for comparison.
Fibroreticular densities in the left mid to upper lung zones.
Nodulocalcific density at the left paracardiac area.
Heart is not enlarged.
Rest of the chest structures are unremarkable.
IMPRESSION:
CONSIDER AN INFECTIOUS PROCESS (SUCH PT OR PNEUMONIA), LEFT MID TO UPPER LUNG
ZONES. KINDLY CORRELATE WITH CLINICAL AND PREVIOUS CHEST XRAY FINDINGS
CONSIDER NODULOCALCIFIC DENSITY LEFT PARACARDIAC AREA, MAY BE A VESSEL TAKEN EN
FACE OR CALCIFIED GRANULOMA.

12/06/2023 CXR: CHEST (UPRIGHT): 12/06/2023 compared to 11/26/2023

4
 Present study shows regression of the previously noted reticular and hazy densities in the left
upper lobe.
Heart is not enlarged.
The rest of the chest findings are essentially the same.
Technical differences are being considered.
IMPRESSION:
PNEUMONIC PROCESS, LEFT UPPER LOBE, WITH REGRESSION.

REMARKS: SUGGEST CLINICAL CORRELATION.

11/26/23: Urine MAP/THC: Positive for Methamphetamine

12/16/23: 12-L ECG: Sinus Rhythm
12/26/23: COVID-19 RAT: Negative

ZAFRA, JULIAN #Bipolar Type I Disorder, > Aripiprazole 400 mg/2mL IM injection HEMATOLOGY Endo – Dr. 12/09/23 Ht: 5‘4“
EYMARD LABITAG Current Episode Manic now then after 4 weeks 11/30/23: Hgb 166.0 / Hct 0.48 / WBC 8.30 / Seg 0.69 / Lymph 0.27 / Mono 0.03 / Eos 0.01 / Baso Florendo >No new Wt: 69kg
24/M/RPV > Divalproate Na 250 mg/tab 2 tabs in 0.00 / RBC 5.4 / MCV 90 / MCH 31 /MCHC 0.34 / RDW 13.1 / PLT 308 orders AG: 90cm
#Hoarding of Medications Risk AM, 2 tabs in PM BMI: 26.1 (Overweight)
AAA/JBR > Alprazolam 500 mcg/tab ½ tab prn CHEMISTRY
HD: 9 for difficulty sleeping 11/30/23: BUN 4.3 / Na 77 / Na 139 / K 4.1 / Cl 104 / Mg 0.8 / SGPT(ALT) 29 / SGOT (AST) 26 Endo Notes
DOB: 01/23/99 > Haloperidol 5 mg/mL + A> Non-Thyroidal
DOA: 11/30/23 Diphenhydramine 50 mg/mL IM 12/01/23: FBS 4.8/BUA 430/ Chol 4.5/ TGs 2.1/ HDL 1.0/ LDL 2.5 Illness
injection prn for disruptive behavior P > Repeat FT3, TSH,
IIC: PGI RAGASA IMMUNOLOGY FT4 after 1 month
JIIC: JI RAFAL 11/30/23: FT3 9.02 (H) / FT4 12.00 / TSH 1.987

MICROSCOPY
11/30/23: UA Yellow / Clear/ SpGr 1.013 / pH 6.5 / Esterase Negative / Albumin Negative /
Ketones Negative / Bilirubin Negative / Erythrocytes Negative / Nitrite Negative/ Glucose Negative
/ Urobilinogen 1+ / RBC 0-1 / WBC 0-1 / Bacteria Few / Mucus Threads Few

TREATMENT ROOM

MAYO, KATHLEEN #Bipolar I Disorder, Current > Lithium Carbonate 450 mg/tab 1 ½ HEMATOLOGY 12/09/23 HT: 157.48
KAYE UGADDAN Episode Manic tab in AM, 1 tab in PM 11/18/2023: Hgb 121, Hct 0.35, WBC 6.6, Seg 0.67, Lymph 0.26, Mono 0.03, Eos 0.04, Baso 0.00, > No new WT: 66 kg
32/F/CP >Olanzapine 10 mg/tab 1 tab ODHS RBC 3.8, MCV 92, MCH 32, MCHC 0.35, RDW 13.8, Plt 262 orders AG:
# Suicide Risk >Clonazepam 2mg/tab ½ tab BID X 3 CHEMISTRY BMI: 26.61 (Obese I)
FZAS/DDC days then PRN for insomnia; extend 11/18/2023: HbA1c 4.9, BUN 3.5, Creatinine 52, UA 403, Na 138, Potassium 3.8, Cl 109, Mg 0.9,
#Escape Risk Clonazepam 2 mg/tab ½ tab BID for 2 SGPT/ALT 33, SGOT/AST 29 Still For Lithium Assay
DOB: 4/26/91 more days (5 days in total - 11/19/23: FBS 5.2, Total Cholesterol 4.1, Triglycerides: 1.5, HDL 1.1, LDL 2.3
DOA: 11/18/23 #Hoarding Of Medications Risk COMPLETED) 11/20/23: FT3 6.37, FT4 10.60, TSH 1.946 Remind Doc Danine on
>Haloperidol 5 mg/mL + Monday to edit date on
IIC: PGI HD: 22 Diphenhydramine 50 mg/mL IM URINALYSIS Doctor’s Orders (says
OCCIDENTAL TR: 22 injection for disruptive behavior as 11/18/23: Color Straw, Transparency Clear, SpGr 1.008, pH 8.0, Esterase 2+, Albumin Negative, November not
JIIC: JI RAFANAN needed Ketones Negative, Bilirubin Negative, Erythrocytes Negative, Nitrite Negative, Glucose Negative, December)
Urobilinogen Negative, RBC 0-2, WBC 5-10, Squamous cells few, Bacteria few, Mucus threads
Occasional

ANCILLARIES
11/18/2023 CXR: COMPARED WITH 11/02/2021; Re-examination shows elevated diaphragm with
crowding of basal lung markings; Heart is not enlarged; The rest of the chest findings are
essentially the same; Technical differences are being considered; IMPRESSION: ELEVATED
DIAPHRAGM WITH CROWDING OF BASAL LUNG MARKINGS. CONCOMITANT PNEUMONIA IN THE

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 LOWER LOBES NOT RULED OUT. THORACIC DEXTROSCOLIOSIS
11/18/23: Urine PT: negative
11/18/23: Urine MAP/THC: Negative
11/19/23: Pregnancy Test: Negative
11/18/23: 12L-ECG: NSR

CRUZ, RENATO #Bipolar I Disorder, Current >Divalproex Na 250mg/tab 3 tabs AM, HEMATOLOGY 12/09/23 HT: 5‘8“
FLOR Episode Manic, Rapid Cycler 3 tabs PM 12/3/23: Hgb 141.0 / Hct 0.41 / WBC 6.82 / Seg 0.53 / Lymph 0.29 / Mono 0.16 / Eos 0.02 / Baso > No new WT: 76kg
75/M/VMMCCP-D >Olanzapine 10mg/tab 1 tab ODHS 0.00 / RBC 4.34 / MCV 95.4 / MCH 32.5 /MCHC 0.34 / RDW 14.6 / PLT 174 orders AG: 99cm
#Assault Risk >Clonazepam 2mg/tab ½ tab BID x 3 BMI: 26.9
FZAS/DDC days CHEMISTRY
#Fall Risk >Amlodipine 10mg/tab 1 tab OD 12/3/23: BUN 9.4 / Crea 91 / Uric Acid 470 / Na 141 / K 4.2 / Cl 104 / SGPT(ALT) 28 / SGOT (AST)
DOB: 4/01/48 >Losartan 50mg/tab 2 tabs OD 51 / RBS 8.1 / HbA1c 5.7
DOA: 12/03/23 #Hoarding Of Medications Risk >Clopidogrel 75mg/tab 1 tab ODPC 12/5/23 FBS 5.2/ BUA 477/ TC 3.1/TG 1.4/HDL 1.3/ LDL 1.2
>Atorvastatin 20mg/tab 1 tab ODHS
IIC: PGI QUEBEC #Hypertension, Controlled >ISMN 30mg/tab 1 tab OD URINALYSIS
JIIC: JI PEREZ, JI >Carvedilol 6.25mg/tab 1 tab BID 12/5/23: Color Yellow, Transparency Slightly Turbid, SpGr 1.016, pH 6.0, Esterase Negative,
RAMOS #Benign Prostatic Hyperplasia >Clonidine 75mcg/tab 1 tab SL BP > Albumin Negative, Ketones Negative, Bilirubin Negative, Erythrocytes Negative, Nitrite Negative,
160/90 Glucose Negative, Urobilinogen 1+, RBC 0-1, WBC 1-3, Squamous cells few, Bacteria some, Mucus
#Chronic Venous Insufficiency >Tamsulosin 400mcg/tab 1 tab OD threads Few, Calcium Oxalate Occasional
>Finastride 5mg/tab 1 tab OD
#Chronic Obstructive >Sulodexide 250mg/tab 1 tab BID ANCILLARIES
Pulmonary Disease, Gold B >Indacaterol + Glycopyrronium
110/50mcg/cap 1 cap DHS CHEST X-RAY 12/3/23: CHEST (PA VIEW): 12/03/2023 compared with 09/21/2023. Re-examination
HD: 7 >Ipratropium + Salbutamol (Duavent) shows no demonstrable active parenchymal infiltrates. Heart is not enlarged. The rest of the chest
TR: 7 q8 for dyspnea findings are essentially the same. Technical differences are being considered.

IMPRESSION: ATHEROMATOUS AORTA. DEGENERATIVE OSSEOUS CHANGES OF THE THORACIC

SPINE. OLD FRACTURE DEFORMITIES, 3RD-5TH RIGHT POSTEROLATERAL RIBS. Remarks: Clinical
correlation is suggested

12-L ECG 12/3/23: Sinus Rhythm, Normal Axis, Left Bundle Branch Block

Urine Drug Test 12/5/23: Negative

DUMLAO, #Schizophrenia, continuous >Risperidone 2mg/tab 1 tab TID HEMATOLOGY 12/09/23 HT: 5‘2“
FEREHLYN YANA >Lithium Carbonate 450mg/tab 1 tab 12/3/23: Hgb 122.0 / Hct 0.36 / WBC 15.1 (HIGH) / Seg 0.70 / Lymph 0.20 / Mono 0.08 / Eos 0.02 / > No new WT: 76kg
41/F/RPVD-A #Escape Risk AM Baso 0.00 / RBC 4.2 / MCV 85 / MCH 29 /MCHC 0.34 / RDW 13.8 / PLT 353 orders AG: 110cm
>Biperiden 2mg/tab 1 tab OD BMI: 30 (Obese 1)
GGO/JNC/GTF #Hoarding of Medications Risk >Quetiapine 200mg/tab ½ tab ODHS CHEMISTRY
>Losartan 50mg/tab 1 tab OD 12/3/23: BUN 4.7 / Crea 55 / Uric Acid 207 / Na 133 / K 3.7 / Cl 97 / Total Ca 2.3 / Inorganic P 1.4 /
DOB: 3/4/82 #HASCVD ACC/AHA Stage B >Rosuvastatin 20mg/tab 1 tab ODHS SGPT(ALT) 42 / SGOT (AST) 27 / RBS 19.6 / HbA1c 10
DOA: 12/03/23 >Insulin Glargine 20u SQ ODHS 12/3/23: PT 11.30 (patient) vs 30.3 (control), Percent Activity 123, INR 0.88
#Dyslipidemia >Gemigliptin 50mg/tab 1 tab OD 12/3/23 ABG: pH 7.417 / pCO2 23.8 / pO2 164 / Na 163 / K 2.4 / Cl 118 / Glu 4.2 / Hct 62 / Hb 20.2
IIC: PGI RAGASA >Insulin HR 6u IV CBG > 180mg/dL / tCO2 28.1 / HCO3 15.3 / FO2 783
JIIC: JI PABILON, JI #Type 2 Diabetes Mellitus, >1 vial D5050 for CBG < 80mg/dL 12/5/2023 FBS 13.2(H)/ BUA 222/ TC 2.5/ TG 0.8/ HDL 1.0/ LDL 1.2
ACTTANASIRI poorly controlled >Vildagliptin + Metformin
50/500mg/tab 1 tab BID – HOLD IMMUNOLOGY
HD:7 >Clonazepam 2mg/tab ½ tab as needed 12/4/23: Free T3 7.98 / Free T4 13.40 / Thyroid Stimulating Hormone 2.711
TR:7 for agitation started (12/723)
URINALYSIS
12/4/23: Yellow / Slightly Turbid / SG 1.028 / pH 5.5 / Est (-) / Alb (+2) / Ket (-) / Bil (-) / Ery (-) / Nit
(-) / Glu (+3) / Uro (-) / RBC 0-1 / WBC 1-3 / Sq some / Bac mod / Muc few

6
 ANCILLARIES

CHEST (AP SIT): 12/03/2023 compared with 07/10/2023 Re-examination shows elevated
diaphragm with crowding of the basal lung markings; concomitant pneumonia in the bases not
ruled out. Heart is magnified. Aorta is unremarkable. Visualized osseous structures are
unremarkable. No other remarkable interval findings. Please correlate clinically.
POSTEROLATERAL RIBS. Remarks: Clinical correlation is suggested

12L ECG 12/3/23: Sinus Rhythm, Normal Axis

ABG 12/4/23: Respiratory alkalosis, fully oxygenated
Urine Drug Test 12/4/23: Negative
Pregnancy Test 12/4/23: Negative
RAT 12/4/23: Negative

CBG
12/3/23 930pm 338 (given Insulin HR 10u SQ), 10:15pm 359 (given Insulin HR 10u IV), 11:30pm
117
12/4/23 5AM 117 / 11AM 105 / 5PM Eaten

BORDER/WARD 15

TABERDO, GERRITO #BIPOLAR I DISORDER, >Clozapine 100mg/tab; ½ tab AM, 1 HEMATOLOGY 12/09/23 HT: 5‘9“
TUSCANO CURRENT EPISODE MANIC tabs PM 12/1/23: Hgb 116.0 / Hct 0.35 / WBC 11.10 / Seg 0.66 / Lymph 0.29 / Mono 0.02 / Eos 0.03 / Baso --Pulmo-- WT: 75kg
64/M/RPVD >Divalproex Na 250 mg/tab 2 tabs AM, 0.00 / RBC 2.9 / MCV 89 / MCH 30 /MCHC 0.34 / RDW 15.3 / PLT 495 Dx: AG: 96cm
#HOARDING OF MEDICATIONS 2 tabs noon, 2 tabs in PM 12/4/23: Hgb 140 / Hct 0.42 / WBC 12.4 (H) / Seg 0.82 (H) / Lymph 0.08 / Mono 0.08 / Eos 0.02 / > Awaiting BMI: 24.4 (overweight)
JPR/NJM RISK >Risperidone 2mg/tab ½ tab ODHS – Baso 0.00 / RBC 4.7 / MCV 90 / MCH 30 /MCHC 0.34 / RDW 16.6 (h) / PLT 499 (H) Blood CS x 2
discontinued 12/07/23 sites Refer to Endo on
DOA: 12/1/2023 #ESCAPE RISK >Aripiprazole 400 mg/2mL, 2mL IM CHEMISTRY > Awaiting Monday
DOB: 4/14/59 injection now then every 28 days (Next 12/1/23: BUN 1.8 / Na 135 / K 3.9 / Cl 103 / Ca 2.2 / P 1.0 / Mg 0.8 / SGPT(ALT) 54 / SGOT (AST) 73 sputum CS
#ASSAULT RISK dose Dec/19/2023) / RBS 8.1 / HbA1c 5.7 results
IIC: POLLOSO > Bipireden 2mg/tab, 1 tab OD 12/2/23: FBS 5.8 Chol: 5.3 (SLIGHTLY ABOVE UPPER LIMIT) TG: 1.2 HDL:1.6 LDL: 3.1 (ELEVATED) > For CBC, CXR
JIIC: JI MANAHAN, JI #HASCVD ACC/AHA STAGE B >Clonazepam 2mg/tab ½ tab 2x a day 12/4/23: BUN 7.2 / Crea 84 / Na 138 / K 4.6 / Cl 104 / Ca 2.3 / P 1.5 (H) / Mg 0.8 / SGPT(ALT) 44 today
MAHITHPMARK for 5 days; then decrease ½ tab ODHS H / SGOT (AST) 83 H / Uric Acid 4.38 Tx:
#TYPE 2 DIABETES MELLITUS for 4 days then ½ PRN for agitation and 12/4/23: LDH 252 / Total Bilirubin 12 / Direct Bilirubin 3 / Indirect Bilirubin 9 / C-Reactive Protein 1. Piperacillin –
insomnia 3.40 (H) Tazobactam
#PRIMARY HYPERTHYROIDISM >Losartan 50mg/tab, 1 tab OD 4.5g IV q6h
>Amlodipine 10mg/tab, 1 tab ODHS IMMUNOLOGY (Day 5)
#ANEMIA PROBABLY >Fenofibrate 160mg/tablet 1 tab ODHS 12/4/23: Free T3 4.29 / Free T4 11.10 / Thyroid Stimulating Hormone 1.536 2. Continue
NUTRITIONAL >Carvedilol 6.25mg/tablet ½ tab BID other meds
>Metformin 500mg/tablet 1 tab OD URINALYSIS >Refer
#ELEVATED LIVER after meal 12/1/23: Yellow / Slightly turbid / SpGr 1.014 / pH 6.5 / Esterase Negative / Albumin 2+ / Ketones
TRANSAMINASES, ETIOLOGY TO >Vitamin B Complex tablet, 1 tab, OD 1+ (diabetic) / Bilirubin Negative / Erythrocytes Negative / Nitrite Negative/ Glucose Negative / --Psychiatry--
BE DETERMINED >Multivitamins capsule, 1 cap, OD Urobilinogen 1+ / RBC 0-2 / WBC 0-2 / Bacteria some / Mucus Threads many >Continue
>Paracetamol 500mg/tablet, 1 tab Q6 present
HD: 9 PRN ANCILLARIES management
W15: 7 >Methimazole 5mg/tablet, 1 tab, OD DRUG TEST 12/1/23: Negative for THC and MET > Continue
>Lactulose 30cc PRN for no BM >/= 3 CHEST X-RAY 12/1/23: CHEST (SUPINE): 12/01/2023: IMPRESSION: RIGHT LOWER LOBE 1. Clozapine
days; Hold if BM >3x a day PNEUMONIA. TORTUOUS AND ATHEROMATOUS AORTA. CONSIDER PLEURAL THICKENING, LEFT 100mg/tab ½
>Folic Acid 5mg/tab, 1 tab OD after COSTOPHRENIC SULCUS. DEGENERATIVE OSSEOUS CHANGES OF THE THORACIC SPINE. tab AM, 1 tab
meals SUSPICIOUS LEFT PARATRACHEAL SOFT TISSUE DENSITY, PROBABLY THYROID IN ORIGIN. PM
>Diphenhydramine 50mg/ml 1ml/IM 1 CHEST X – RAY 12/4/23: CHEST (SUPINE): Progression of Initial (as in Chart) 2. Biperiden
dose (12/02/23) 12-L ECG 12/1/23: Sinus Tachycardia 2mg/tab, 1 tab
12 – L ECG 12/4/23: Sinus Tachycardia, Normal Axis OD
RAPID ANTIGEN TEST 12/1/23: Negative 3. D ivalproex
RAPID ANTIGEN TEST 12/4/23: Negative Na 250mg/tab

7
ABG 12/4/23: pH 7.41/ pCO2 50.7/ pO2 61.3/ HCO3 19.2: Respiratory alkalosis with metabolic 2 tabs AM, 2
acidosis with less than corrected hypoxemia. tabs noon and
GRAM STAIN 12/4/23: Pus 2+/ Epithelial cells 4+ 2 tabs PM.
D.DIMER 12/4/23: 0.948 (H) 4. Haloperidol
THYROID FUNCTION TEST 12/4/23: FT3 3.82 (L)/ FT4 9.52 (L)/ TSH 1.069 5mg +
FERRITIN: 182 Diphenhydrami
HEPA PROFILE: HBsAg 0.08 NR/ Anti-HBS 0.4 NEG/ Anti-HCV 0.01 NR/ Anti HBC Total 3.63 NEG ne 50mg, 1 mL
each in 1
syringe IM PRN
x agitation
> Will update
Psych CIC
>Refer
>Maintain a 2
pt restraints
>Still had
responsible
watcher 24/7
>Refer