Professional Documents
Culture Documents
ASMAD
ASMAD
ASMAD
1 Admission
st
A.H.
54 years old
Female
Muslim
Housewife
Diego Silang, Taguig City
o Chief Complain RIGHT LOWER
QUADRANT
ABDOMINAL PAIN
Epigastric Area
Burning in character
Pain scale 5/10
Radiating to the RLQ
o Vomiting x3
ingested food
o Anorexia
previously
Hct
0.42
WBC
9.0
D.
yellow
Cloudy
Acidic
1.020
Seg
0.75
Lym
0.25
Plt 274
Trace
Negativ
e
Abunda
nt
2-4
o Referred to AFPMC
o ADMISSION
PMH
+
Hypertensio
n
maintained
with
Amlodipine
5mg
+
Dyslipidemia
maintained
with
Simvastatin
10mg
No DM
FMH
No
Hypertension
No Diabetes
No Asthma
No Thyroid
disease
No PTB
PSH
Non Smoker
Non Alcoholic
Beverage
Drinker
Physical Examination
GENERA
L
VITAL
SIGNS
HEENT
Conscious Coherent,
Appears weak and in pain
BP: 130/90 PR: 90 RR: 18
T:36.9
Wt: 70kg Ht:
54
Pink palpebral conjunctiva,
anicteric sclerae, no CLAD
CHEST
CARDIO
ABD
EXT
ADMITTI
NG
DIAGNOS
IS
T/C ACUTE
APPENDICITIS
INITIAL PLAN
NPO Temporarily
DIET
IV FLUIDS D5 LRS 1L to run for 8 hours
PT with INR
Urinalysis
Ultrasound of the Lower Abdomen