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2 MAIN B - HRPU February 22, 2023
2 MAIN B - HRPU February 22, 2023
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:
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
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:
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
CHEST ULTRASOUND
KUB 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
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
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.
HEIGHT:
WEIGHT:
BMI:
Classification:
IBW:
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)
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
VASCULAR
OTHERS
41 =49