DEPARTMENT OF INTERNAL MEDICINE

DAILY CENSUS
AUGUST 28 - AUGUST 29, 2023
COC DR. LU

ER ROD DR. ONG/DR. LIBRE

WARD DR. TAMONDONG/DR. PINSOY

ICU ROD DR. PABLEO/DR. WEE

PGI SARAYAN/IRENEA/ARARAL/INSULAR/PIQUIT/FABIAÑA

DISPOSITION
NUMBER OF VACANCIES PER AREA
ADMISSIONS 4
UNIT VACANT RIGHT LEFT
ER REFERRALS
GEN MED 1 P: 1 1-7 48-52
NEW WARD REFERRALS 1 MW (50): 1 1`
CW (51): 2
HOLDING AREA/ ER ISOLATION
FW (52): 0
TRANSFERRED TO ICU GEN MED 2 3 8-15 38– 47

TRANSFERRED FROM ICU TO WARD GEN MED 3 17-27 28-37

TRANSFERRED TO OTHER HOSPITAL FAMMED P2 217-220 221-225

SP2
DISCHARGED 6 SURGICAL WING 201-208 209-216
MORTALITY EXEC WING 1 231-233 226-230
OB WING 234-248
DISTRIBUTION OF IM IN-PATIENT
DR/LR
GEN MED 1
ICU .
GEN MED 2
ICU EXTENSION
GEN MED 3 PEDIA WING 53-60 61-63

SURGERY WING 9

EXECUTIVE WING 6

FAMMED WING 4

PICU

OB WING 1

DR/LR 1

ICU 4

ICU EXTENSION
 PEDIA WING

TOTAL IM IN-PATIENTS

ADMISSIONS:

DATE RM PATIENT’S AGE/ CHIEF PHYSICIAN REASON FOR REMARKS SERVICES

ADMITTED NAME SEX COMPLAINT ADMITTING DIAGNOSIS REFERRAL

08/28/23 6 DAMALI, 60/M ABDOMINAL ACUTE APPENDICITIS VS UTI DR. RASHID (PC) A PNSS 120CC/HR IM
ROBERTO PAIN D NPO
M VS Q4; I&O QSHIFT
I
U CPK (59KG)
M
1.. HNBB 10 MG IV NOW

L
CBC
WBC 10.5
RBC 5.7
HGB 17.1
HCT 0.51
HCT 196
N 0.72
L 0.18
M 0.07
E 0.02
B 0.01

UA
WBC 3
RBC 26
EPITHELIAL CELLS
CAST 0
BACTERIA 6
DARK YELLOW SLIGHTLY HAZY
SUGAR NEGATIVE
PROTIEN +

U
08/28/23 212 GRAVADOR, 91/F COUGH GASTROESOPHAGEAL REFLUX DISEASE DR. ORACASITAS A PNSS @ KVO IM
PRISCILLA UPPER RESPIRATORY TRACT INFECTION D LOW SALT LOW FAT DIET
HYPERTENSIVE CARDIOVASCULAR DISEASE, VALVULAR M VS Q4; I&O QSHIFT
HEART DISEASE – AORTIC STENOSIS SEVERE
SYSTEMIC LUPUS ERYTHEMATOSUS I
AORTIC ABDOMINAL ANEURSYM
U
M
1. OMEPRAZOLE 40 MG IV NOW THEN 1 CAP OD STARTING
TOMORROW
 2. DOMPERIDONE 10 MG 1 TAB OD
3. MONTELUKAST 10 MG 1 TAB OD HS
4. NEBIVOLOL 5 MG 1 TAB OD
5. TRIMETAZIDINE 35 MG 1 TAB BID
6. IRBESARTAN 300 MG 1 TAB OD
7. HYDROXYCHLOROQUINE 200 MG 1 TAB OD

ER REFERRALS: 1

DATE RM PATIENT’S AGE/ CHIEF PHYSICIAN REASON FOR REMARKS SERVICES

ADMITTED NAME SEX COMPLAINT ADMITTING DIAGNOSIS REFERRAL

08/28/23 214 TADINA, 51/F RUQ PAIN GALLSTONE PANCREATITIS, MILD BY REVISED ATLANTA DR. ARARAL (PC) CM A PLR 1L @ 150 CC/HR SURG/IM
TERESA CHAN SCORING; CHOLEDOCHOLITHIASIS, DISTAL SEGMENT
DR. RASHID (CM & CP D NPO FOR NOW
CP CL) CLEARANC
E M VS Q4; I&O QSHIFT

I CEFTRIAXONE

U CPK (79KG)

1. CEFTRIAXONE 2 GM IV OD

2. TRAMADOL 50 MG IVTT Q8

3. HNBB 1 AMP Q8 PRN FOR ABDOMINAL PAIN

4. OMEPRAZOLE 40 MG IV OD WHILE ON NPO

CREA 63

SUA 281

SGPT 111

FBS 6.23
AMYLASE 1500

WBC 19.62

RBC 4.91

HGB 154

HCT 0.46

PLT 227

N 0.91

L 0.05

M0.04

UA DARK YELLOW

ALBUMIN+

SUAGR (-)

PUS 2-5

RBC 5-10

UTZ OF WHOLE ABDOMEN

IMPRESSION:

- DILATED CD LIKELY SECONDARY TO A SOFT CALCULI IN THE DISTAL

SEGMENT. SUGGEST CT SCAN WITH CONTRAST FOR FURTHER
EVALUATION IF CLINICALLY WARRANTED.

- GB CALCULI.

- REST OF THE STUDY IS UNREMARKABLE.

ECG – SINUS RHYTHM

U
 NEW WARD REFERRALS: 1

DATE RM PATIENT’S AGE/ CHIEF PHYSICIAN REASON FOR REMARKS SERVICES

ADMITTED NAME SEX COMPLAINT ADMITTING DIAGNOSIS REFERRAL

08/27/23 DR RAMENTO, 33/F BLOODY TYPE I DM DR. DAHAB (PC) A PNSS 1L @ KVO OB/IM
GEOVANNIR SHOW
G3P2 (1102) PU 34 5/7 WEEKS AOG DR. GATMIN- D DAT
YUZON (CM)
BREECH IN PRETERM LABOR M VSQ4, I&O QS, CBG TID

U CPK (KG)

1. NIFEDIPINE 30 GIT 1 TAB OD

2. HERAGEST 200 MG SOFT GEL Q6 PER VAGINA

3. MGSO4 4 GM IVTT NOW THEN 1 GM/HR FOR 24

HOURS

4. RI RESCUE DOSES

2 UNITS SQ - 121-140

4 UNITS SQ - 141-160

6 UNITS SQ - MORE THAN 160

L 8/27

WBC 11, RBC 4.7, HGB 13.2, HCT 0.39, PLT 182, N 0.72, L 0.19, M
0.07

CBG 190

U 8/27

HOLDING AREA: 0

DATE RM PATIENT’S AGE/ CHIEF PHYSICIAN REASON FOR REMARKS SERVICES

ADMITTED NAME SEX COMPLAINT REFERRAL
 GEN MED I: 8

DATE RM PATIENT’S NAME AGE/ CHIEF ADMITTING DIAGNOSIS PHYSICIAN REASON FOR REMARKS SERVICES
ADMITTED SEX COMPLAINT REFERRAL

08/23/23 1 CASUMPANG, 61/F LEFT SIDED ACUTE CVA INFARCT RIGHT MCA NIHHS - 4 DR. B. RAMOS (PC) A: PNSS 1L @ 100 CC/HR IM
LORIE WEAKNESS
HCVD DR. TORRES (CM) D: LOW SALT LOW FAT WITH STRICT ASPIRATION
PRECAUTION LIMIT 1L PER DAY
TYPE 2 DM DR. MADAYAG
(REHAB) M: VS Q4; NVS Q4; I&O QSHIFT
S/P CVA 2017 – NO RESIDUAL WEAKNESS
I:

U: 3.25 CPK (65 KG)

M:

1. ATORVASTATIN 80 MG 1 TAB OD HS

2. CITICHOLINE 1G IV Q12

3. CILOSTAZOLE SR (PLETAAL SR) 100MG 1 CAP

OD PC DINNER

4. GLARGINE 12 UNITS SQ OD @ HS (REF)

5. ASPIRIN 80 MG / TAB OD PC BREAKFAST

6. CEREBROLYSIN 10CC SIVP X 3 MINUTES Q8

7. EDARAVONE 30 MG IN 100 CC X IV
INFUSION FOR 1 HOUR Q12 - RX

8. BACTIDOL MOUTHWASH TID AFTER MEALS

@ BS

9. RI 4 UNITS SQ TID PRE MEALS

10. EMPAGLIFLOZIN 10 MG TAB; 1 TAB OD

11. LINAGLIPTIN 5MG 1 TAB OD

 12. AMLODIPINE 5MG 1 TAB OD

13. SENOKOT FORTE 1 TAB OD @ HS

14. LOSARTAN 50 MG 1 TAB OD

15. CLONAZEPAM 2MG TAB ¼ TAB OD HS

PRN MEDICATIONS

1. MAT ADD 2 UNITS SQ FOR CBG > 200

MG/DL

2. CLONAZEPAM 2MG ½ TAB OD @ HS PRN

FOR INSOMNIA

L:

08/28

NO NEW LABS

U:

08/28

REFER TO DIETARY FOR NUTRITION COUNSELING PRIOR

DISCHARGE

CONTINUE REHABILITATION

CONTINUE BP MONITORING

08/24/2023 2 LAVINA, 69/F DYSPNEA COMMUNITY ACQUIRED PNEUMONIA HIGH RISK DR. YAP - ARANIEGO A: PNSS 1L @ 10CC/HR
PURIFICACION (HYPOXEMIA)
DR. FLORESCA (CO- D: LSLF, DD
HYPERTENSIVE CARDIOVASCULAR DISEASE ,ATRIAL MGT)
FIBRILLATION IN MVR-RVR M: VS Q4, NVS Q4, I&O QS

I: PIP TAZO 4.5 G IV Q8

RHEUMATIC HEART DISEASE, MITRAL STENOSIS SEVERE
U: 2.11 CPK (60KG)
TYPE II DIABETES MELLITUS NON INSULIN REQUIRING
M:
BRONCHIAL ASTHMA NOT IN ACUTE EXACERBATION
 1. PIPERACILLIN + TAZOBACTAM 4.5 GM IV Q8

2. METFORMIN (GLUMET XR) 500 MG 1 TAB

OD

3. EMPAGLIFLOZIN + LINAGLIPTIN (GLYXAMBI)

25/5 1 TAB OD

4. VERAPAMIL (ISOPTIN) 40 MG 1 TAB BID

5. BUDESODINE + FORMOTEROL (SYMBICORT)

1 PUFF BID GARGLE AFTER

6. DIGOXIN 0.25 MG ½ TAB OD

7. SPIRONOLACTONE (ALDACTONE) 25 MG 1
TAB OD

8. ROSUVASTATIN (ROSWIN) 10 MG 1 TAB OD

HS

9. TRIMAG 1 TAB BID

10. CITICHOLINE 1G IV Q12

PRN MEDICATIONS

1. CBG 180-220 4 UNITS

CBG 221-260 6 UNITS

CBG 261-300 8 UNITS

CBG >300 10 UNITS

2. PARACETAMOL 500 MG 1 TAB Q4 FOR

FEVER

L:

08/28

U:

08/28

FOR STOOL ANALYSIS

REPEAT C XRAY TOMORROW AM

 FOR REPEAT CBC, S.NA, K,CA, MG

08/20/23 4 TINGCO, ROMEL 51/M BODY SHOCK MULTIFACTORIAL DR. MADAYAG (PC) A
MALAISE
HYPOVOLEMIC SHOCK SECONDARY TO THIRD SPACE LOSS DR. ELORDE 1. MAIN: 1L PNSS AT 35CC/HR;
(PULMO)
ACUTE DECOMPENSATED DISEASE SECONDARY TO LIVER 2. AMINOLEBAN 500ML @ 45 CC/HR
CIRRHOSIS SECONDARY TO ALCOHOLIC LIVER DISEASE DR. KASILAG
(CARDIO)
ANEMIA SECONDARY TO GI BLEED
D MAY HAVE SD AT ROOM TEMP
PLEURAL EFFUSION, RIGHT SECONDARY TO MASSIVE
ASCITES M VSQ4, NVSQ4, I/O Q1

I RIFAXIMIN 200MG 2 TABS Q8 D2

8/27 U: 2.28 CPK(60KG)

SHOCK MULTIFACTORIAL M:

1. SEPSIS PROB SEC TO SBP 8/26

2. THIRD SPACE LOSS 1. RIFAXIMIN 200 MG 2 TABS Q8

ACUTE DECOMPENSATED DISEASE SECONDARY TO LIVER 2. MEROPENEM 1 GM IV Q12 TO RUN FOR 3

CIRRHOSIS SECONDARY TO ALCOHOLIC LIVER DISEASE HOURS

ANEMIA SECONDARY TO GI BLEED 3. MUCOSTA 100MG 1 TAB TID

4. SALBU + IPRA 1 NEB Q6 ℅ RT

5. AMINOLEBAN 500 ML @ 45 CC/HR Q 12

HOURS

6. VITAMIN K 10 MG/AMPULE + 30 CC PNSS

X 30 MINUTE INFUSION

7. BACTROBAN OINTMENT ON IV SITES IN IV

FOREARM

8. ALBUMIN 20% 50 ML Q12 TO RUN IN 4

HRS

9. FUROSEMIDE 20 MG IV Q12 POST

ALBUMIN

10. LACTULOSE 30 CC OD @ HS
 POST BT

1. GIVE FUROSEMIDE 200 MG

IV AFTER BT

PRN MEDICATIONS

1. TRAMADOL 25 MG IV PRN FOR PAIN

L:

08/28

NO NEW LABS

U:

08/28

CONSUME AND DISCONTINUE AMINOLEBAN DRIP,

SHIFT TO ORAL SACHET TID

DNR REVOKED

8/26/23 RM ERMITANIO, 79/F DIZZINESS MULTIPLE ELECTROLYTE IMBALANCES: EUVOLEMIC DR. ARSOLON A: PNSS 1 LITER AT 60CC/HR
5 DIANA HYPONATREMIA AND HYPOCALCEMIA SEC TO POOR INTAKE
GEN D: LOW PROTEIN(0.8G/KG/DAY) DIET DIABETIC DIET
ME CKD SEC TO DKD/HPNSS
D1 M: VS Q4; I&0 QSHIFT
HCVD, LVH
I:
T2DM INSULIN REQUIRING
U: 0.71 CPK (59 KG)

M:

1. SODIUM BICARBONATE 650 2 TAB TID @ BS

2. IRBESARTAN 300 MG 1 TAB OD

 3. EZETIMIBE 10 MG 1 TAB

4. AMLODIPINE 10 MG 1 TAB OD

5. VIT B COMPLEX + FOLIC ACID 1 TAB OD

6. KETOANALOGUE 600 MG 1 TAB TID

7. CLOPIDOGREL 75 MG 1 TAB OD

8. GLARGINE 15 UNITS SQ OD

9. EPAGLIFLOZIN 25 MG ½ TAB OD

10. SODIUM CHLORIDE IGM 1 TAB BID

11. CALVIT TABLET, 1 TAB OD

12. BETAHISTINE 24 MG 1 TAB TID RX

PRN MEDICATIONS

1. RI SLIDING SCALE:

CBG 180-220 6 UNITS

CBG 221-260 8 UNITS

CBG 261-300 10 UNITS

2. METOCLOPROMIDE 1 AMP IV Q8 FOR

VOMITING

L:

08/28

TSH 10.905

FT3 2.52

NA 116.3

U:

08/28
 REFER TO DR.EVORA FOR EVALUATION REGARDING
INCREASED TSH LEVELS

INCREASE NACL TAB 2 TABS TID

CONT DAILY SODIUM MONITORING

IM

8/26/23 RM MAGLACION, 38/F CHILLS UROSEPSIS DR. BAD-ANG A: PLR 1L AT 100C/HE IM

7 JEAN ISABEL
AKI SEC TO INFECTION D: DIABETIC DIET
GEN
ME BA NOT IN AE M: VS Q4; I&0 QSHIFT
D1
I: CIPROFLOXACIN 400 MG IV

U: 0.58 CPK (66.5 KG)

M:

1. CIPROFLOXACIN 4OO MG IV Q12

2. KCL 2TABS TID X 5 DOSES

PRN MEDICATIONS

1. TRAMADOL 50 MG IV 8 HOURS PRN FOR

PAIN
 L:

08/28

K 4.69

U:

O8/28

CONTINUE TSB ONCE C FEVER

FACILITATE UYZ OF WA

AVOID PARACETAMOL, CEFUROXIME AND NSAID

GEN MED II: 12

DATE RM PATIENT’S NAME AGE/ CHIEF ADMITTING DIAGNOSIS PHYSICIAN REASON FOR REMARKS SERVICES
ADMITTED SEX COMPLAINT REFERRAL
08/22/23 9 CAHILO, ERICA 29/F UNRESPONSIVE UREMIC ENCEPHALOPATHY SECONDARY TO AKI SECONDARY DR. FLORESCA (PC) A IM/ SURG
NESS TO INCREASED GI LOSSES
DR. J. RAMOS (CM) IJ CATH WHITE PORT: PNSS 1L @ 10 CC/HR
TO CONSIDER NON CONVULSIVE SEIZURES
DR. GUILLANO (CM) IJ CATH BLUE PORT: PNSS 1L @ 10 CC/HR

DR. VELASCO (CM) IJ CATH RED PORT: PNSS 84 CC + 16 MG NE @ 3 CC/HR

8/27
DR. YARRA (IJ CATH) RIGHT: D5W 1L @ 10 CC/HR
SEPSIS SECONDARY TO SALMONELLA TYPHI INFECTION WITH
ARDS DR. ABDURAHMAN D NPO
(EVAL)
ACUTE LIVER FAILURE SECONDARY TO SALMONELLA TYPHI M VSQ1, I&O Q1
INFECTION DR. VEGA-BUNO
(CM) I MEROPENEM D1+1, CIPROFLOXACIN D2
MIXED ENCEPHALOPATHY (HEPATIC, SEPTIC, UREMIC)
U .08 CPK (52 KG)
T/C TYPHOID ENCEPHALITIS
M
 AKI SECONDARY TO INFECTION AND HYPOPERFUSION TO CONSUME AND DISCONTINUE

1. NO MEDS

L 8/27

NO NRE LABS

U 8/27

DNR

08/27/23 10 DELA CRUZ, 66/F 8/28 A IVF PNSS 1L AT 60cc/hr

EUFEMIA
RIGHT FRONTAL LOBE MASS D low salt low fat diabetic diet

T2 DM M neuro vs q4, i and o q shift

HYPOTHYROIDISM I

1. citicoline 1 gram iv now then q 12

2. rosuvastatin 10 mg tab, 1 tab od

3. methimazole 5 mg tab, 1 tab od

4. calcium+ vit D tab, 1 tab od

5. sitagliptin+metformin 50/500 mg tab, 1 tab od

6. RI Sliding scale

2 units sq for cbg 180-220

4 units sq for cbg 221-260

6 units sq for cg 261-300

8 units sq for cbg > 300

8/28

Na 139

K 3.83
 Mg 0.70

Ca 1.09

Crea 71

8/28

Continue cbg monitoring

Continue meds

8/26/23 RM LIBRE, 60/M DIZZINESS BPPV R/O CVA DR. ABOU ZAKI (PC) A: PNSS 1L @ 60 CC/HR IM
11 MAXIMINO JR.
GEN HCVD, CAD, SR D: LOW FAT LOW SALT DIET
ME
D2 S/P ANGIOPLASTY 2003 M: VS Q4; I&0 QSHIFT

I:

U: 1.10 CPK (55KG)

M:

1. BETAHISTINE 24MG 2TABS TID

2. AMLODIPINE 5MG 1 TAB OD

3. CLOPIDOGREL 75MG 1 TAB OD

4. SIMVASTATIN 10MG 1 TAB OD

5. IMMUNOPRO 1 TAB OD

6. COVERSYL 5MG ½ TAB OD @ HS

7. PANTOPRAZOLE 40MG 1 CAP OD

8. KCL 1 TAB QID X 12 DOSES

L:

08/27
 U:08/27

REPEAT NA, K, CA, MG AND HBA1C

FOLLOW UP PENDING LABS

08/07/23 12 MONGAS, JUNOR 47/M ABDOMINAL TO CONSIDER DIVERTICULITIS, RULE OUT APPENDICITIS DR. HAW (PC) A PNSS 1L @ 90 CC/HR IM/ SURG
PAIN
DR. ORCASITAS (CM) D SOFT DIET, GEN LIQUIDS 8/25

8/24 DR. GONZAGA M VSQ4, I&O QS

(ANES)
ACUTE BOWEL ISCHEMIA SECONDARY TO MESENTERIC I METRONIDAZOLE D8, PIPTAZ D5+2
VEIN THROMBOSIS DR. YARRA (IJ)
U 3.51 CPK (70KG)
SHOCK MULTIFACTORIAL (SEPSIS, CARDIOGENIC, DR. PILAPIL (TSP)
HYPOVOLEMIC) M
DR. ABDURAHMAN
S/P EX LAP (EVAL) 1. AMINOLEBAN 500 MG IV X 12 HOURS OD

DR. VALDEZ (CM) 2. PANTOPRAZOLE 40 MG IV Q24

8/27 DR. LINDO (ANES)

3. HIDRASEC 100 MG 1 CAP, 1 CAP TID
ACUTE BOWEL ISCHEMIA SEC TO MVT
4. ZOLPIDAM (STILL NOX) 5MG/TAB OD @
CAP MR-RESOLVED HS

UGIB SEC TO BPUD VS VARICES-RESOLVED PRE BT MEDS

1. HYDROCORTISONE 100 MG IV 30 MINS

PRIOR BT
8/28
2. DIPHENHYDRAMINE 50 MG IV 30 MINS
ACUTE BOWEL ISCHEMIA SEC TO MVT PRIOR BT

CAP MR RESOLVED 3. FUROSEMIDE 20 MG IVTT W BP

PRECAUTION

PRN MEDICATIONS

1. FENTANYL 50 MCG IV Q4 PRN FOR

SEVERE BTP

2. RI 4 UNITS FOR CBG >180

3. MIDAZOLAM 2.5 MG IVTT FOR

RESTLESSNESS

4. PCM 300MG IV PRN FOR TEMP > 37.8 C

5. TRAMADOL 50 MG IVTT Q8 PRN BTP

MIDAZOLAM ½ AMP TO INJECT IM OD
PRN FOR INSOMNIA
 L

8/28

No new labs

08/27

NO NEW LABS TODAY

8/28

Continue monitoring and management

08/27

08/26/23 RM MARADIA, NORA 31/F COUGH COMMUNITY ACQUIRED PNEUMONIA – MODERATE RISK DR. LACUNA A: PNSS @ 80 CC/HR
15
TYPE 2 DIABETES MELLITUS – POORLY CONTROLLED D: DIABETIC DIET
GEN
ME M: VS Q4; I&0 QSHIFT
D2
I: CEFTRIAXONE 2 GMS IV D2

U: 0.97 CPK (56KG)

M:

1. CEFTRIAXONE 2 GMS IV INFUSION NOW THEN OD

2. GLARGINE 18 UNITS SC OD HS

3.RI 4 U TID PREMEALS

PRN MEDICATIONS

1. DOLCET 1 TAB Q 8 PRN FOR BACK PAIN

 2. RI SLIDING SCALE:

RI 4 U FOR CBG OF 180-220

RI 6 U FOR CBG OF 221-260

RI 8 U FOR CBG OF 261-300

RI 10 U FOR CBG > 300

L:

08/28

NO NEW LABS

U: 08/28

START RI 4 UNITS TID PREMEALS

CONT RI SLIDES

08/22/23 43 ALMONIA, 62/F BODY CAP-MR DR. LACUNA A: PNSS 1L TO 60CC/HR

THELMA WEAKNESS
HYPERTENSIVE URGENCY D LIBERAL SALT DM DIET

T2DM-NIR M VS Q4 IO QS

T/C NEPHROLITHIASIS I CEFIPIME 2G IV Q24

MULTIPLE ELECTROLYTE IMBALANCE (HYPONATREMIA, U: 0.02 CPK (58KG)

HYPOMAGNESEMIA AND HYPOCALCEMUA) SECONDARY TO
POOR ORAL INTAKE M 8/25

1. ATORVASTATIN 20MG/TAB OD HS

2. PREGABALIN + METHYLCOBALAMIN 75/750

TAB OD

3. AMLODIPINE 10MG 1 TAB OD (HOLD)

4. CARVEDILOL 25MG 1 TAB BID (HOLD)

5. NACL 1.2G 1 TAB BID

6. METHIMAZOLE 5MG 1 TAB BID

7. BENEPROTIEN 2 SCOOPS BID

8. NAC 1.2G IV Q12

9. SALBU + IPRA 1 NEB Q6

10. CEFIPIME 2G IV Q24

PRN MEDICATIONS

1. RI SLIDING SCALE

2 UN 180-221

4 U 222-240

6 U 241-260

8U 261-300

10 U >3000

2. TRAMADOL 50 MG IV PRN FOR PAIN

L:

08/27

U:

08/27
 REPEAT UA

8/22/23 44 CALBONERO, 73/F COUGH CAP-HR WITH PLEURAL EFFUSION RIGHT DR. ORCASITAS (PC) A: PNSS 1L AT 80CC/HR IM
GENEROSA
TYPE II DIABETES MELLITUS D: LOW FAT LOW SALT DIABETIC SOFT DIET

HYPERTENSION STAGE 1 M: VS Q HOURLY FOR 4 HOURS THEN Q4

I: PIPTAZO D6

8/28 U: 0.96 CPK (65KG)

PLEURAL EFFUSION RIGHT POSSIBLY SEC TO M:

PARAPNEUMONIC PROCESS
1. PIPTAZO (KENZOLIN) 4.5G IV Q6
CAP HR
2. NAC 600MG 1 TAB + ½ GLASS OF H2O BID
TYPE 2 DM
3. LOSARTAN 50 MG 1 TAB OD

4. GLARGINE 14 UNITS SQ OD @ HS

5. AZITHROMYCIN 500 MG 1 TAB OD

6. ATORVASTATIN 40 MG 1 TAB OD

7. AMLODIPINE 5 MG 1 TAB OD -

8. LEVOFLOXACIN 500MG TAB 1 TAB OD

9. KCL 1 TAB QID X 10 DOSES FIRST DOSE NOW

PRN MEDICATIONS

1. RI SLIDING SCALE

4U SQ FOR CBG 180-220

6U SQ FOR CBG 221-260

8U SQ FOR CBG 261-300

10U SQ FOR CBG >300

2. DOLCET 1 TAB PRN FOR CHEST PAIN

L:

8/28

Pleural fluid culture- no growth

 8/27

POTASSIUM 3.08 (L)

CREA 50

U:

8/28

Start kcl tab 1 tab qid

X 10 doses first dose now

Continue present medication and management

08/27

FOR REPEAT S.K, CREA ON NEXT WARDING

DECREASE O2 TO PRN

08/18/23 45 PEPANIA, 73/F DIZZINESS HYPERTENSIVE URGENCY DR. MAGNO (PC) A: PNSS 1 L AT 60 CC/HR IM
ESTERLITA
TYPE 2 DM NON INSULIN REQUIRING DR. LEGITA (CM) D: LOW SALT, LOW FAT DIABETIC DIET

TO CONSIDER COMPLICATED UTI M: VS Q 4

I&O Q SHIFT

8/24 I: CIPROFLOXACIN D7

ACUTE LACUNAR INFARCT U: 2.70 CPK (54KG)

M:

8/27 1. CIPROFLOXACIN 500 MG 1 TAB BID

ACUTE LACUNAR INFARCT 2. GLARGINE 20 UNITS SQ OD HS

TYPE 2 DM-IR 3. NAC 600MG 1 TAB OD HS

HTN 2 4. DIFFLAM SPRAY OD

 5. RI 6U TID PRE-MEAL;S

6. OMEPRAZOLE 40 MG IV Q12

7. CITICOLINE 1GM 1 TAB BID

8. AMLODIPINE 10MG 1 TABLET OD A 5MG

9. ATORVASTATIN 40MG 1 TAB OD @ HS

10. DIAMICRON 60MG 1TAB OD PRE-BF

11. ASPIRIN 75 MG 1 TAB OD AFTER BF

12. PLETAAL SR 200 MG 1 TAB OD

13. GLYXAMBI 10/5 MG 1 TAB OD

PRN MEDICATIONS

1. RI 4 U FOR CBG > 180 MG/DL

2. CLONIDINE 75MG 1TAB SL PRN SBP > 160

3. NORGESIC 1 TAB Q8 PRN FOR SEVERE PAIN

4. BETAHISTINE 24MG FOR 1 TAB PRN

DIZZINESS

5. CINNARAZINE 75MG 1 TAB OD PRN

L:

8/28

No new labs

08/26

CT SCAN RESULT

Acute lacunar infarct, right internal capsule

Old lacunar infarcts, right caudate nucleus and left

cerebellum

Bilateral periventricular small vessel ischemic disease

 Bilateral internal carotid and vertebral atherosclerosis

U:

8/28

Dec O2 to PRN

INC GLARGINE TO 24u

08/27

REFER TO DR. HERRERA FOR REHAB

8/27/23 RM NACU, EMILDA 57/F HYPOGASTRIC PARKINSON’S DISEASE DR. ANUTA A: PNSS 1L @ 40 CC/HR
46 PAIN
HYPERTENSION STAGE 1 D: LOW SALT LOW FAT DIET
GEN
ME DACRYOCYSTITIS OD M:VS Q 4 , I/O Q SHIFT
D2
I: CIPROFLOXACIN 500 MG 1 TAB

8/28 U: 3.26 CPK (45KG)

PARKINSONS DISEASE M:

DACROCYSTITIS OD 1. METROPOLOL 50MG 1 TAB OD

HPN ST II 2. BIPERIDEN 25MG 1 TAB BID

3. MOXIFLOXACIN EYEDROPS1 DROP 4X A DAY

4. CIPROFLOXACIN 500 MG 1 TAB TID

5. CEFTRIAXONE 2G IV OD

L: 0/27/23

NA 129.8

K 4.33
 CREA 59

U:

8/28

CONTINUE MEDS AND MANAGEMENT

FOR SPUTUM GS CS

CLONAZEPAM 2MG TAB ½ TAB AT 8PM

8/21/23 202- PADON, CUSETTE 34/F FEVER ACUTE PYELONEPHRITIS, RIGHT DR. QUIAMBAO A: PNSS 1L @ 40 CC/HR
1
TO CONSIDER ACUTE CHOLECYSTITIS (PC) D: DIABETIC DIET

TYPE 2 DIABETES MELLITUS INSULIN REQUIRING M:VS Q 4; I&O Q SHIFT

I: PIPTAZ D4

8/25 ACUTE PYELONEPHRITIS U: 0.64 CPK (95KG)

M:

1. PIPTAZ 4.5 G IV Q6

2. PANTOPRAZOLE 40 MG 1 TAB OD PRE BF

3. APIDRA 28 UNITS SQ TID PRE MEALS

4. ATORVASTATIN 40 MG 1 TAB OD @ HS

5. CALMAG 1 TAB BID

6. GLARGINE 25 UNITS SQ AT HS

PRN MEDICATIONS

7. PARACETAMOL 300 MG IV Q4 PRN FOR

FEVER
 L: 08/28

NO NEW LABS

U:

08/28

PLAN FOR ANTIBIOTIC PROPHYLAXIS

08/24/23 GM DIOSO, ELEANOR 61/F LEFT SIDED ACUTE CVA INFARCT RIGHT MCA TERRITORY, NIHSS 3 DR. GUILLERMO (PC) A: PNSS 1L @ 60 CC/HR IM
2 WEAKNESS
RM HYPERTENSION STAGE 2 D: LDLF, DIABETIC DIET
42
TYPE 2 DM NON INSULIN REQUIRING M: VS Q4, I&O QSHIFT

S/P ACUTE CVA INFARCT 2016 WITH NO RESIDUAL I:

WEAKNESS
U: 1.04 CPK (60KG)

M:
8/27
1. CITICOLINE 1 GM ITAB BID
ACUTE CVA RIGHT MCA
2. ATORVASTATIN 40 MG TAB OD
NIHSS 3
3. TEGLIPTIN 20MG 1TAB OD
HTN 2
4. ASPIRIN 80MG TAB OD
T2 DM
5. PANTOPRAZOLE 40 MG TAB OD

6. OVERT 24 MG 1 TAB BID

8/28
7. BISOPROLOL 2.5MG OD GIVE FIRST DOSE
CVA LACUNAR INFARCT NOW

T2 DM

L:

8/28

Chol 6.1

Hdl 1.34

Ldl 3.8
 Tgl 2.04

08/27

NO NEW LABS

U:

8/28

Continue meds and monitoring

Possible discharge on wednesday

08/27

MATUTE, 21/M FEVER DENGUE WITH WARNING SIGNS- FEBRILE PHASE DR. MAGNO (PC) A PNSS 1L @ 80 CC/HR IM
08/25/2 47 EMMANUEL
023 D DAT, AVOID DARK COLORED FOODS

8/28 M VS Q4, I&O QSHIFT

DENGUE FEVER WITH WARNING SIGNS I

U 1.06 CPK (52KG)

M:

PRN MEDICATIONS

1. PARACETAMOL 500 MG TAB Q4 PRN FOR

FEVER

2. TRAMADOL 50 MG IV Q8 PRN FOR PAIN

3. METOCLOPROMIDE 1AMP Q8 IV PRN FOR

N/V

8/28

CBC hgb 16.3, hct 0.47, plt 55, wbc 7.1, s 0.30, l 0.54, m
0.10, e 0.05, b 0.01
 08/27

8/28

D/c cbg q12

For repeat cbc tom am

08/27

CONTINUE CBC MONITORING Q12

DC TRANEXAMIC ACID

INCREASE OFI

GEN MED III: 11

DATE RM PATIENT’S NAME AGE/ CHIEF ADMITTING DIAGNOSIS PHYSICIAN REASON FOR REMARKS SERVICES
ADMITTED SEX COMPLAINT REFERRAL

08/27/23 17 CAÑEDA, 22/M STIFFENING STATUS EPILEPTICUS PROBABLY SECONDARY TO MULTIPLE DR. ANUTA (PC) A: IM
MAROEL ELECTROLYTE IMBALANCE (HYPOKALEMIA, HYPOCALCEMIA,
HYPOMAGNESEMIA) 8/28 CUMMULATIVE IVF RATE AT 160CC/HR

LMCV: PNSS 1L @ 1500 CC/HR

8/28 RMCV: PNSS 1L J10 CC/HR

T/C HYPOKALEMIC PERIODIC PARALYSIS D: DAT

MULTIPLE ELECTROLYTE IMBALANCE M: VS Q4; I&O QSHIFT; NEURO VS Q4

AKI, ETIOLOGY TO BE DETERMINE I:

U: 1.15 CPK (60 KG)

M:

1. LEVETIRACETAM 500MG/TAB Q12

2. CALMAG 1 TAB TID

 3. KCL TAB TID X 7 DAYS 4 5 6 7

4. KCL TABLET 2 TABS TID X 3 DAYS

5. KCL 20MEQS +90CC PNSS TO RUN FOR

10HRS 1 CYCLE

6. NAC 1-2 G IV NOW THEN Q12HRS IF ON NPO

ONCE ON DIET START NAC TAB 2 TABS IN
H2O BID

7. PNSTOPRAZOLE 40MG 1 TAB OD

PRN MEDICATIONS

1. NORGESIC FORTE TAB, 1 TAB Q8 PRN FOR

BACK PAIN

2. METOCLOPROMIDE PRN FOR VOMITING

L:

8/28

PH 7.440, PCO2 36.1, PO2 82, HCO3 24.5, P2 SAT 97%, BE

0

CREA 262

CA 0.95

K 2.81

MG 0.79

08/27/23

NA 139.3

K 3.03 L

MG 0.33 L

CA 0.84 L

CREA 107 EGFR

SGPT 80 (H)

CBC

WBC 20.9

RBC 5.8

HGB 15.5

HCT 0.46

PLT 502

NEUTRO 0.61

LYMPHO 0.33

MONO 0.03

EOSINO 0.02

BASO 0.01

CHEST XRAY PA VIEW

NORMAL CHEST FINDINGS

U:

8/28

RANDOM URINE, K,CA,CL, UACR

TO INCLUDE CHLORIDE, BUN NON FASTING ON PREVIOUS

BLOOD EXTRACTION IF NOT POSSIBLE FOR TOM AM

FOR USD OF WA TOMORROW

NO NSAID, ACEI, ARBS

HOLD CRANIAL CT SCAN FOR NOW

8/26/23 RM ANDALES, 65/M DYSPNEA BILATERAL PLEURAL EFFUSION SECONDARY TO HEART DR. ORCASITAS Z A: NO IVF
20 EDGARDO FAILURE ON TOP OF CHRONIC KIDNEY DISEASE
GEN D: LOW SALT, LOW FAT, DIABETIC DIET
MED HYPERTENSIVE CARDIOVASCULAR DISEASE, ISCHEMIC HEART
3 DISEASE, HEART FAILURE FUNCTIONAL CLASS III-IV M: VS Q 4, I AND O Q4HRS STRICTLY

CHRONIC KIDNEY DISEASE SECONDARY TO HYPERTENSIVE I: INH + RIFAMPICIN 450 MG 1 TAB OD

KIDNEY DISEASE/ DIABETIC KIDNEY DISEASE
U: .08 CPK ( 58 KG)
INTERCRITICAL GOUT
M:
TYPE 2 DIABETES MELLITUS – INSULIN REQUIRING
1. COLCHICINE 0.5MG/TAB, 1 TAB OD
S/P ACS NSTEMI FROM JUNE 9 - 14, 2023
2. FERROUS SULFATE + FOLIC ACID 1 TAB OD

3. ATORVASTATIN 40MG/TAB, 1 TAB OD

FINAL DX
4. KETOANALOGUE 600 MG 1 TAB TID
BILATERAL PLEURAL EFFUSION SECONDARY TO PULMONARY
5. NACHO3 650 MG 1 TAB TID
TUBERCULOSIS VS MALIGNANCY

6. TRIMETAZIDINE 35 MG 1 TAB BID

HYPERTENSIVE CARDIOVASCULAR DISEASE, ISCHEMIC HEART
DISEASE, HEART FAILURE FUNCTIONAL CLASS III-IV
7. EMPAGLIFOZIN 1 TAB OD
CHRONIC KIDNEY DISEASE SECONDARY TO HYPERTENSIVE
8. TERACOZIN 1 MG 1 TAB OD
KIDNEY DISEASE/ DIABETIC KIDNEY DISEASE
9. NORPLAST S 1 TAB OD
INTERCRITICAL GOUT
10. INSULIN GLARGINE 18 U SQ OD
TYPE 2 DIABETES MELLITUS INSULIN REQUIRING
11. ENOX 0.6 CC SQ PRE-GD
S/P ALS - NSTEMI
12. EPOIETIN 4,000 IU SQ 3X A WEEK

13. SILYMARIN 1 CAP OD

14. VIT. B COMPLEX 1 TAB OD

15. INH + REFAMPICIN 450MG 1 TAB OD

PRN MEDICATIONS:

1. RI 2 U 180-220

RI 4 U 221-240

RI 6 U 241-260

RI 8 U 261-300
 RI 10 U > 300

1. DOLCET 1 TAB Q8 PRN FOR PAIN

L: 8/26/23

CBC

8/17/23

WBC 11.9

RBC 3.0

HGB 8.4

HCT 0.29

PLT 0.29

N 0.78

L 0.17

M 0.05

E 0.02

B 0.01

CREATININE 381 H (EGFR 15)

UTZ OF THE CHEST 8/22/23:

BILATERAL PLEURAL EFFUSION WITH COMPRESSIVE

ATELECTASIS, RIGHT > LEFT LOCULATED ON THE RIGHT

RIGHT 1786 CC RIGHT AND LEFT 401 CC

CXR 8/17/23

PLEURAL EFFUSION IN PROGRESS, PRESENTLY MASSIVE

IN THE RIGHT AND MINIMAL IN THE LEFT
 ATHEROSCLEROTIC AORTA

RT PCR – NEGATIVE

APTT 31.9

CONTROL 27.9

PT 13.2

CONTROL 12.1

INR 1.12

% ACTIVITY 79.80

U:

8/28

MGH

08/26

FOR THORACENTESIS TOMORROW

PLS PREPARE THORACENTESIS MATERIALS

SHIFT ASPIRIN AND CLOPIDOGREL TO NORPLAT 75/75MG

1 TAB OD

MAINTAIN O2 AT 4-5 LPM

HOLD VALSARTAN AND CARVEDILOL FOR NOW

08/27/23 21 CASILAC, KAREN 38/F LOOSE WATERY ACUTE GASTROENTERITIS WITH MODERATE DEHYDRATION DR. HO A: PNSS 1L @ 80 CC/HR @ LMCV G18 IM
STOOL
HYPERTHYROIDISM NOT IN STORM D: DIABETIC DIET

TYPE 2 DM - CONTROLLED M:VS Q 4 , I/O Q SHIFT

 I: METRONIDAZOLE 750 MG

08/27 U: 1.21 CPK (57 KG)

AMOEBIASIS WITH MODERATE DEHYDRATION M: 8/28

1. ORS SACHET + 250 CC H20 VOL/VOL

REPLACEMENT
8/28
2. RACEDATORIL 100 MG 1 TAB PO TID (UNTIL
E. HISTOLYTICA INFECTION WITH FORM STOOL)

AGE W/ MODERATE DEHYDRATION 3. GLICLAZIDE (GLUBITOR) 30 MG 1 TAB PO BID

HYPERTHYROIDISM 4. PTU 50 MG 3 TABS PO OD

T2DM NIR 5. TRIMAG 1 TAB PO BID X 3 DAYS

6. METRONIDAZOLE 750 MG OR 1 ½ TAB PO

TID X 10 DAYS A: 500 MG

7. REFLUX DUA 1 TAB PO OD

L:

8/28

MG 0.67

CA 1.14

CREA 49

NA 136.9

K 3.29

FT4 0.90

TSH 0.175

08/27

STOOL EXAM

POSITIVE FOR E. HISTOLYTICA CYSTS AND TROPH

MG 0.67
 CA 1.14

CREA 49

NA 136.9

K 3.29

U:

8/28

CONTINUE METRONIDAZOLE

FF UP FT4 AND TSH

08/27

FOLLOW UP STOOL EXAM

HYDRATION ROUNDS Q4

8/23/23 2222 DINGDING, 94/F COUGH CAP MR DR. ANGEL A PNSS 1L @ 40CC/HR
ESTER
RECURRENT UTI D LIBERAL SALT

MULTIPLE SOFT TISSUE CONTUSSION SEC TO FALL M VSQ4

HCVD LVH I PIPTAZO 4.5GMS IV Q8 D1+2

CKD SEC TO HPNSS U 1.09 CPK (43 KG)

DEMENTIA M

1. PIPTAZO 4.5GMS IV Q8

2. LOSARTAN PLUS AMLODIPINE 50/5/TAB 1

TAB OD
8/27
3. ROSUVASTATIN 10MG/TAB 1 TAB OD
CAP MR
4. MEMANTIN 10MG/TAB 1TAB OD
MULTIPLE SOFT TISSUE CONTUSION SEC TO FALL
5. DONEPEZIL 5MG/TAB 1/2 TAB OD
COMPLICATED UTI
6. KETOANALOGUE 3 TABS TID
 HCVD, LVH 7. IBERET 1 TAB OD

FUNCTIONAL DEMENTIA 8. NAHCO3 650MG/TAB 1 TAB TID

OPTIC NERVE COMPRESSION SEC TO TRAUMATIC BRAIN 9. CA +VIT D1 TAB OD

INJURY
10. CACO3 + VIT D 500MG 1 TAB BID

11. DEXAMETHASONE 4MG 1 TAB TID X 5 DAYS

8/28
12. CLONAZEPAM ¼ TAB OD HS
CAP MR
13. CLONAZEPAM ⅛ TAB AFTER LUNCH TIME
MULTIPLE SOFT TISSUE CONTUSION SEC TO FALL T/C PRN FOR DIFFICULT BEHAVIOR
BILATERAL OPTIC NERVE INJURY AND ORBITAL FRACTURE
BILATERAL 14. MUCOSTA 100MG 1 TAB TID BEFORE MEALS

COMPLICATED UTI

ALZHEIMERS DEMENTIA MODERATE TO SEVERE PRN MEDICATIONS:

1. CLONAZEPAM 2 MG ⅛ TO ¼ PRN IF UNABLE

TO SLEEP OR RESTLESS

8/28

UA-

LIGHT YLLW,CLEAR, 6.5, 1.010, SUGAR NEGATIVE, PROT

NEGATIVE

8/28

HIGH RISK FOR ANOTHER FALL

DEC IVF TO 40CC/HR

8/27

FOR CBC AND LIPID PROFILE

FOR REPEAT UA

FACILITATE URINE AND SPUTUM GSCS

08/20/23 23 AMBIT, NICKY SR 52/M DYSPNEA CAP-MR RULE OUT SEPSIS DR. M. MARCOS A: NO IVF IM

AKI SECONDARY TO INFECTION DR. LUY-OMBAO D: NPO FOR NOW

(CM)
MULTIPLE ELECTROLYTE IMBALANCE (HYPONATREMIA, M: VSQ4, I&O QS
HYPOCALCEMIA, HYPOMAGNESEMIA)
I: CIPROFLOXACIN D4, CEFIXIME D2
T2DM NON INSULIN REQUIRING UNCONTROLLED
U: 0.81 CPK (70 KG)
HYPERTENSION STAGE II
M: 8/26

1. CIPROFLOXACIN 500 MG 1 ½ TAB BID X 7

DAYS

8/27 2. FLUIMUCIL 600MG/TAB 1 TAB BID

DISSOLVED IN ½ GLASS OF H20 X 2 WEEKS
CAP MR
3. CEFIXIME 400MG/TAB 1 TAB OD X 7 DAYS
COPD IN AE
4. MONTELUKAST 10MG/TAB 1 TAB ODHS
T2DM UNCONTROLLED ON TOP OF STEROID INDUCED
HYPERGLYCEMIA 5. MEPRESONE 16MG BID X 3 DAYS THEN OD X
3 DAYS THEN EVERY OTHER DAY X 3 DOSES

6. METFORMIN 1000MG/TAB BID AFTER BFAST

FINAL DX AND DINNER TO START TOMORROW

COMMUNITY ACQUIRED PNEUMONIA MODERATE RISK 7. JARDIANCE 25 MG /TAB OD AFTER BFAST

DM II UNCONTROLLED 8. HEPATEK 1 CAPSULE BID X 2 WEEKS

T/C PTB 9. FUROSEMIDE 20MG/TAB 1 TAB OD

TYPE II DIABETES MELLITUS UNCONTROLLED ON TOP OF 10. PIOGLITAZINE 15MG/TAB OD AFTER LUNCH
STEROID INDUCED HYPERGLYCEMIA
L:

08/28

NO NEW LABS

U:

8/28

MGH
 08/27

MGHSI

08/28/23 24 Damali, Roberto 60/m Abdominal Acute Appendicitis VS UTI Dr. Rashid (PC) A PNSS 120CC/HR IM
pain
D NPO

M VS q4; I&O qshift

U cpk (59kg)

1. Ketocrolac 30 mg iv now then q6

CBC

WBC 10.5

RBC 5.7

Hgb 17.1

Hct 0.51

Hct 196

N 0.72

L 0.18

M 0.07

E 0.02

B 0.01

UA

WBC 3

RBC 26
 epithelial cells

cast 0

Bacteria 6

Dark yellow slightly hazy

Sugar Negative

Protien +

Admit

Diet: NPO for now

IVF: PNSS 1l @ 120 cc/hr

Diagnostic:

CBC, UA – relay results

Save serum

08/23/23 26 SANGO, 59/M DOUBLE VISION ACUTE CVA INFARCT, RIGHT BRAINSTEM AREA NIHSS4 DR. MAGNO (PC) A: PNSS 1L @ 100 CC/HR IM
DARWIN
TYPE 2 DM - NON INSULIN REQUIRING D: DIABETIC DIET

DIABETIC NEUROPATHY M: VS Q4, I&O QSHIFT

I:

U: 0.99 CPK (62 KG)

8/27 M:

ACUTE CVA INFARCT 1. CITICOLINE 1 GRAM IV NOW THEN Q 12

2. ATORVASTATIN 80 MG TAB, 1 TAB OD HS

8/28 3. LUPIMET 2/500 MG TAB 1 TAB OD

ACUTE CVA INFARCT 4. POLYNERV 500 MG TAB OD

T2 DM NON INSULIN REQUIRING 5. ASPIRIN 80MG 1 TAB OD

6. CLOPIDOGREL 75MG 1 TAB OD

 PRN MEDICATIONS

1. RI SLIDING SCALE

4 UNITS SQ FOR CBG 180-220

6 UNITS SQ FOR CBG 221-260

8 UNITS SQ FOR CBG 261-300

10 UNITS SQ FOR CBG > 300

L:

8/28

NO NEW LABS

08/27

NO NEW LABS

U:

8/28

REMOVE IV LINE

MGH TOMORROW

08/27

CONTINUE PRESENT MEDICATION

POSSIBLE DISCHARGE TOMORROW

08/12/23 32 TAJORA, 89/F COUGH COMMUNITY ACQUIRED PNEUMONIA DR. LACUNA (PC) A: PNSS 1L @ 10 CC/HR IM
JACINTA
HYPER REACTIVE AIRWAY DISEASE DR. J. RAMOS (CM) D: SOFT DIET WITH STRICT ASPIRATION PRECAUTION,
LIBERAL SALT DIET
ORAL APHTHOUS ULCERS DR. FAJARDO (CM)
 RULE OUT FRACTURE RIGHT THORAX DR. QUIBO (EVAL) M: VSQ4, I&O QS

HON II I:

U: 1.33 CPK (50)

08/27 M: 8/28

CAP MR 1. CALMAG 1 TAB BID

PLEURAL EFFUSION SEC TO PARAPNEUMONIC PROCESS R/O 2. HYDROCORTISONE 100 MG IV Q12

MALIGNANCY
3. SALBU + IPRA NEB Q8
BA IN AE
4. ZYKAST 1 TAB OD @ HS
HCVD, HFPEF
5. ALBUMIN 20% OR 25% 50CC + FUROSEMIDE
AKI ON TOP OF CKD SEC TO INFECTION 40 MG IV OD

MET (NA,CA,MG)-RESOLVING 6. AMLODIPINE 10 MG 1 TAB OD

7. NACL 1 TAB TID

8/28 8. DOLCET 1 TAB PRN

CAP MR 9. OMEPRAZOLE 40 MG 1 CAP OD

PLEURAL EFFUSION (PARAPNEUMONIC VS MALIGNANCY) 10. CARVEDILOL 25MG 1 TAB BID

BA IN AE 11. SODIUM BICARBONATE 1TAB TID

HCVD, HFPEF

AKI ON TOP OF CKD SEC TO INFECTION L:

MEI (DEC NA, CA, MG)- RESOLVING 08/28

NA 130.8

08/25

CHEST ULTRASOUND

BILATERAL PLEURAL EFFUSION, MODERATE ON THE

RIGHT AND MINIMAL ON THE LEFT. COMPRESSIVE
ATELECTASIS, RIGHT
 U:

8/28

DEC HYDROCORTISONE TO Q12

DEC NEBULIZATION TO Q8

FACILITATE NA,K,CA,MG, CREA

8/27

REFER FOR DYSPNEA

8/23/23 36 BANGCAS, 51/F COUGH PNEUMONIA IN ICH DR. IRISH BATALLA A D5W 500 @ KVO
RECILA
MULTIPLE MYELOMA D LOW SALT, LOW FAT

HPN ST. II M VSQ4

I PIPTAZO D3+1

FINAL DX: U 1.29 CPK (57 KG)

PNEUMONIA IN THE IMMUNOCOMPROMISED HOST M: 8/26

MULTIPLE MYELOMA 1. PIPTAZO 4.5 G IV Q6

HYPERTENSION STAGE II 2. NAC 600 MG TAB PLUS ½ GLASS WATER OD

HS

3. ETORICOXIB 120MG 1 TAB OD

4. SALBUTAMOL + IPRA NEB TID

5. FLUCONAZOLE 200MG 1 TAB OD

L:

8/28

SPUTUM GSCS HEAVY GROWTH OF CANDIDA ALBICANS

 08/27

NO NEW LABS

U:

8/28

MGH TODY

FFUP CULTURE

FF UP ON FRIDAY

08/27

FOLLOW UP COMPARATIVE XRAY TODAY

IM

PICU: 0

DATE RM PATIENT’S AGE/ CHIEF COMPLAINT ADMITTING DIAGNOSIS PHYSICIAN REASON REMARKS SERVICES
ADMITTED NAME SEX FOR
REFERRAL

FAMILY MEDICINE WING: 3

DATE RM PATIENT’S AGE/ CHIEF ADMITTING DIAGNOSIS PHYSICIAN REASON FOR REMARKS SERVICES
ADMITTED NAME SEX COMPLAINT REFERRAL

08/27/23 221 MONDAY, 81/M DYSPNEA ASTHMA-COPD OVERLAP IN ACUTE EXACERBATION DR. ORCASITAS (PC) A PNSS 1L @ 70 CC/HR IM
AGOSTO
CAP-MR D LSLF

HYPERTENSION STAGE II M VSQ4, I&O QS, O2 2-3 LPM/NC

I PIP TAZ D0+2

8/28 U CPK (67 KG)

 ASTHMA-COPD OVERLAP IN ACUTE EXACERBATION M

CAP-MR 1. PIPERACILLIN+TAZOBACTAM (KENZOLIN) 4.5

GRAMS IV LD NOW THEN Q 8
HYPERTENSION STAGE II
2. LOSARTAN 100 MG TAB, 1 TAB OD

3. AMLODIPINE 5 MG TAB, 1 TAB OD

4. HYDROCORTISONE 100 MG IV NOW THEN Q 8

5. SALB+IPRA NEB, 1 NEB Q 8

6. SPIOLTO RESPIMAT, 2 PUFFS OD

7. PARACETAMOL 500 MG TAB, 1 TAB Q 4 PRN

FOR FEVER

8. DUODART TAB, 1 TAB OD

9. NAC 600MG/TAB BID + ¼ GLASS H20

L 8/28

PENDING UA

U 8/28

CONTINUE MONITORING

FF UP PENDING LABS

08/22/23 222 PADILLA, 58/M RESTLESSNESS UREMIC ENCEPHALOPATHY SECONDARY TO ESRD SECONDARY DR. VILLANUEVA A PNSS 1L @ 10 CC/HR IM
ELORDE TO HYPERTENSIVE NEPHROSCLEROSIS (PC)
D LSLF, LOW PURINE DIET
HYPERTENSION STAGE 2 DR. ALCASID (CM)
M VSQ4, I&O QS
GOUTY ARTHRITIS NOT IN FLARE DR. ABOUZAKI
I PIPTAZ D4

U CPK (44 KG)

8/27
M
SEPTIC ENCEPHALOPATHY PROBABLY
1. LOSARTAN 100 MG TAB, 1 TAB OD
SECONDARY TO CRBSI
2. FEBUXOSTAT 40 MG TAB OD
ESRD SECONDARY TO HPNSS
3. CACO3 1 TAB BID
 TRANSAMINITIS SECONDARY TO INFECTION 4. NAHCO3 1 TAB TID (GIVE 2 TABS)

5. SEVELAMER 1 TAB TID 800 MG

6. PIP TAZO 2.25 MG IV Q6

7. RISPERIDONE 1MG TAB 1 TAB OD

8. RISPERIDONE 2MG TAB 1 TAB OD @HS

9. LACTULOSE (LILAC) 30 CC TID (HOLD IF BM

>3X)

L 8/28

PENDING PROCAL RESULT

U 8/28

HD AT RDU TODAY

08/24/23 223 BOISER, 59/M MELENA UGIB PROBABLY SECONDARY TO BPUD DR. RASHID (PC) A D5NSS 1L @ 100 CC/HR IM
REYNALDO
HYPERTENSION STAGE 2 D FULL DIET TOMORROW (08/28/23)

S/P CVA X 4 TIMES WITH LEFT RESIDUAL WEAKNESS M VSQ4, I&O QS

I AMOXICILLIN D1+1, CLARITHROMYCIN D1+1

8/28 U CPK (46 KG)

UGIB PROBABLY SECONDARY TO BPUD M

HYPERTENSION STAGE 2 1. PANTOPRAZOLE 40 MG IVTT Q12

S/P CVA X 4 TIMES WITH LEFT RESIDUAL WEAKNESS 2. AMOXICILLIN 500MG 2 TABS BID

3. CLARITHROMYCIN 500MG 1 TAB BID

4. MUCOSTA 100MG 1 TAB TID

L 8/28

U 8/28
 MGH TOMORROW

SURGICAL WING: 9

DATE RM PATIENT’S AGE/ CHIEF ADMITTING DIAGNOSIS PHYSICIAN REASON REMARKS SERVICES
ADMITTED NAME COMPLAINT FOR
SEX REFERRAL

08/24/23 202-1 PISIAO, 51/F COUGH HYPERTENSIVE URGENCY DR. VALDEZ (PC) A PLR 1L @ 90 CC/HR IM

LILIA DR. ANUTA (CM) D DAT

8/28 DR. M HERRERA M VSQ4, I&O QS

(CM)
ACUTE CVA INFARCT RIGHT I

MVA U CPK (54 KG)

HPN STAGE II M

1. FEBUXOSTAT 40 MG TAB OD

2. ATORVASTATIN 80 MG TAB OD

3. CITICOLINE 1 GM IVTT

4. ASPIRIN 80 MG TAB OD

5. CLOPIDOGREL 75 MG TAB OD

6. PANTOPRAZOLE 40 MG TAB OD

7. EDARAVONE 30 MG Q12

8. DONEPEZIL 10 MG TAB OD

9. NEUROAID II CAP TID

L 8/28

U 8/28

TOS FROM SURGERY

CONT CBG MONITORING

08/25/23 202-3 ABABA, 21/F ABDOMINAL PAIN DENGUE FEVER WITH WARNING SIGNS: FEBRILE PHASE DR. VALDEZ (PC) A PLR 1L @ 100 CC/HR SURG/IM
MARIE CRIS
 DR. ANDURAHMAN D NO DARK COLORED FOOD/DAT
(CM)
8/28 M VSQ4, STRICT I&O MONITORING WITHOUT FAIL

DENGUE FEVER WITH WARNING SIGNS - RECOVERY PHASE I

U CPK (48 KG)

1. OMEPRAZOLE 40 MG IVTT OD

2. CETIRIZINE 10 MG 1 TAB BID

L 8/28

U 8/28

MGH - HEMA WISE

08/17/23 202-6 CAPOL, DAISY 46/F LEFT LOWER RECTOSIGMOID MASS DR. VALDEZ (PC) A: PLR 1L @ 120 CC/HR SURG/IM
QUADRANT
AND SMALL UTERINE MYOMA DR. MAGNO (CP) D: DAT
HYPOGASTRIC
PAIN S/P CS DR. ONG- I:
ABRANTES (TOS)
U: 1.3 CPK (54 KG)
DR. HAW (CM)
FINAL DIAGNOSIS M:
DR. PILAPIL (TSP)
PARTIAL INTESTINAL OBSTRUCTION SECONDARY TO
RECTOSIGMOID MASS TO CONSIDER MALIGNANCY DR. FUENTES (OFF)
PRN MEDS:
DR. LINDO (ANES)
1. DOLCET 1 TAB QID

2. CAPTOPRIL 25MG 1 TAB SL IF BP >140/90

L: 8/28

U: 8/28

MGHSI

08/19/23 203-1 BEBELONI, PIL 37/M DISCHARGE ON COLOCUTANEOUS FISTULA DR. PURACAN (PC) A: D5LR 1L @ 55 CC/HR SURG/IM
ANTHONY RLQ
 S/P APPENDECTOMY DR. BANZON (ANES) D: SOW

POTTS DISEASE DR. TORNO (EVAL) M: VSQ4, I&O QS

I: ERTAPENEM D6

8/28 U: CPK (71 KG)

COLOCUTANEOUS FISTULA WITH INTRA ABDOMINAL M

ABSCESS
1. ERTAPENEM 1 GM IV OD
S/P APPENDECTOMY (2014)
2. CALMOSEPTINE BID ON AFFECTED AREA
S/P DRAINAGE OF ABSCESS (2023)
3. CELECOXIB 200 MG TAB BID
POTT’S DISEASE
4. OMEPRAZOLE 40 MG IVTT OD

L: 8/28

U: 8/28

USE MICRODACYN FOR DRESSING

MAINTAIN JP

08/11/23 203-3 LABADO, 72/M HEMATOCHEZIA HYPOVOLEMIC SHOCK SECONDARY TO ACUTE BLOOD LOSS DR. ORCASITAS (PC) A: PNSS 1L @ 40 CC/HR SURG/IM
BENJAMIN PROBABLY SECONDARY TO TUMOR RECURRENCE WITH
PULMONARY AND BONE METASTASIS DR. HAW (CM) D: NO FOOD RESTRICTIONS

SEVERE ANEMIA SECONDARY TO CHRONIC DISEASE DR. YBIERNAS (CM) M: VSQ4, I&O QS, O2 2 LPM/NC PRN

STATUS POST COLON SURGERY (2010) DR. P I:

BUENAVENTURA
STATUS POST CHEMOTHERAPY X 6 CYCLES (TSP) U: 1.7 CPK (49 KG)

STATUS POST OPEN CHOLECYSTECTOMY (2010) DR. J PILAPIL M:

(ENDOSCOPY)
1. DEXAMETHASONE 4 MG TAB BID X 7 DAYS
DR. MABUNGA
8/28 (ANES) 2. OMEPRAZOLE 40 MG TAB OD X 14 DAYS

MULTIPLE METASTASIS ON LUNGS AND CHEST DR. ORCASITAS 3. CLUSIVOL SYRUP 10 ML OD

(CM)
T/C DOUBLE PRIMARY
DR. AYCO (CM)
T/C DIVERTICULAR BLEED L: 8/28
 U: 8/28

SEEN BY PALLIA TODAY

A: PLR 1 L AT 100 CC/HR SURG/IM

205 ASUNCION, ACUTE OTOMASTOIDITIS WITH EXTENSION INTO THE DR. TORNO (IDS
8/27/23 74/M HEADACHE SURROUNDING SOFT TISSUE OF THE PARAPHARYNGEAL, CM D:NGT FEEDING DIABETIC DIET 1700 KCAL IN 6 DIVIDED
ROMUALDO CM)
MASTICATOR, CAROTID SPACE, RIGHT TO CONSIDER
OSTEOMYELITIS CHRONIC ISCHEMIC INFARCT, PONS; TYPE 2 M: VSQ4
DM NON INSULIN REQUIRING DR. ANUTA (NEURO
CM) I CEFEPIME D1

DR. F. HO (ENDO
8/28 CM)
U

ACUTE OTOMASTOIDITIS M:

1. CEFEPIME 1GM Q8H

T/C OSTEOMYELITIS

2. CALMAG 1 TAB BID

CHRONIC ISCHEMIC INFARCT, PONS; TYPE 2 DM NON INSULIN
REQUIRING

AKI PROB SEC TO INFECTION MAINTENANCE:

1. ATORVASTATIN 40MG 1 TAB OD

2. FEBUXOSTAT 40MG 1 TAB OD

3. CILOSTAZOL 100MG 1 TAB OD

RI SLIDING SCALE:

4U CBG 180-220

6U CBG 221-260

8U CBG 261-300

10U >300

L: 8/28

FBS 9.6H

HBA1C 6.8H
 LIPID PROFILE:

TG 0.99

LDL 1.13L

HCL 1.32H

CHO 2.9L

SUA 246

CREA 179H

U: 8/28

08/10/23 209 FAISAL, 25/M SOFT TISSUE SOFT TISSUE INJURY, LEFT LATERAL DR. YAMBAO-ARAO A: PNSS 1L @ KVO FOR BT IM/SURG
MUHADJER INJURY (PC)
MALLEOLUS, TO CONSIDER MULTIPLE FRACTURES SECONDARY D: DAT + EGG WHITES (STRICT ASPIRATION PRECAUTION)
TO MOTOR VEHICULAR ACCIDENT DR. MABUNGA ISLAM
(ANESTH)
M: VSQ4, I&O QS
DR. K. ROA (CM)
FINAL DIAGNOSIS I: CEFUROXIME D4+2
DR. K LIM (PLASTICS
OPEN ANKLE INJURY WITH AVULSED WOUND LATERAL ASPECT - CO MGT) U: 2.6 PK (56 KG)
LEFT ANKLE CLOSED
DR. LACORDA (TSP) M:

1. CEFUROXIME 750 MG IVTT Q8

FRACTURE MEDIAL MALLEOLUS LEFT ANKLE SECONDARY TO
ROAD TRAFFIC ACCIDENT 2. NORGESIC FORTE 1 TAB Q8

3. ETORICOXIB 120 MG CAP OD HS

4. CALTRATE PLUS 1 TAB BID

5. BISACODYL 10 MG TAB OD X 3 DAYS, D1

L: 8/28

U: 8/28
 MGHSI

08/28/23 214 TADINA, 51/F RUQ PAIN GALLSTONE PANCREATITIS, MILD BY REVISED ATLANTA DR. ARARAL (PC) CM A PLR 1L @ 150 CC/HR SURG/IM
TERESA CHAN SCORING; CHOLEDOCHOLITHIASIS, DISTAL SEGMENT
DR. RASHID (CM & CP D NPO FOR NOW
CP CL) CLEARANCE
M VS Q4; I&O QSHIFT

I CEFTRIAXONE

U CPK (79KG)

1. CEFTRIAXONE 2 GM IV OD

2. TRAMADOL 50 MG IVTT Q8

3. HNBB 1 AMP Q8 PRN FOR ABDOMINAL PAIN

4. OMEPRAZOLE 40 MG IV OD WHILE ON NPO

CREA 63

SUA 281

SGPT 111

FBS 6.23

AMYLASE 1500

WBC 19.62

RBC 4.91

HGB 154

HCT 0.46

PLT 227

N 0.91

L 0.05

M0.04
 UA DARK YELLOW

ALBUMIN+

SUAGR (-)

PUS 2-5

RBC 5-10

UTZ OF WHOLE ABDOMEN

IMPRESSION:

- DILATED CD LIKELY SECONDARY TO A SOFT CALCULI IN

THE DISTAL SEGMENT. SUGGEST CT SCAN WITH
CONTRAST FOR FURTHER EVALUATION IF CLINICALLY
WARRANTED.

- GB CALCULI.

- REST OF THE STUDY IS UNREMARKABLE.

ECG – SINUS RHYTHM

08/26/23 215 CREENCIA, 48/F ANTERIOR NECK MULTINODULAR NONTOXIC GOITER DR. LLAMERA (PC) A D5LR 1L @ 100 CC/HR SURG/IM
RUFINA MASS
DR. VILLAROSA D DAT
(ANES)
8/28 M VSQ4, I&O QS
DR. F HO (CM)
MULTINODULAR NON TOXIC GOITER I CEFUROXIME D2

HYPERTENSION STAGE II U CPK (68 KG)

S/P TOTAL THYROIDECTOMY M

1. CEFUROXIME 750 MG IVTT Q8

2. SILYMARIN + VIT E CAP BID

3. ETORICOXIB 120 MG TAB OD X 5 DAYS

4. LEVOCETIRIZINE 5 MG TAB OD HS

5. PARACETAMOL 1 GM IVTT Q6 X 3 DOSES

 6. LEVOPRONT SYRUP 15 ML BID

7. CALTRATE PLUS 1 TAB BID

8. CALCITRIOL 1 TAB OD

9. AMLODIPINE 5 MG TAB OD

L 8/28

U 8/28

SUGGEST TO DISCHARGE IM WISE

08/14/23 216 MICLAT, 59/M ABDOMINAL TO CONSIDER ACUTE APPENDICITIS VS. ACUTE DR. JAMIANA (PC) A PLR 1L @ 10 CC/HR, PNSS 1L @ 10 CC/HR SURG/IM
ROBERTO PAIN CHOLECYSTITIS
DR. ENOJO (CM) D MAY PROGRESS DIET

DR. BANZON (ANES) I MEROPENEM D4

8/28
DR. J CRUZ (CM) U CPK (67 KG)
HYPOVOLEMIC SHOCK SECONDARY TO ACUTE BLOOD LOSS
SECONDARY TO BLEEDING RENAL MASS LEFT DR. LU (CM) M

AKI SEC TO INFECTION DR. QUIBO 1. PARACETAMOL 1 GM IV Q6

(CM & CP) 2. NAHCO3 650MG/ TAB 1 TAB TID

DR. PUNAY (CM) 3. MEROPENEM 1 GM IV Q12

DR. VEGA-BUNO 4. KETOANALOGUE 1 TAB TID

(EVAL)
5. OMEPRAZOLE 40 MG IVTT OD

THM

1. KETOANALOGUE 1 TAB TID

2. NAHCO3 650MG/TAB 2 TAB TID X 3 DAYS

THEN 1 TAB TID

L 8/28

U 8/28
 FOR POSSIBLE DISCHARGE

EXECUTIVE WING: 6

DATE RM PATIENT’S AGE / CHIEF ADMITTING DIAGNOSIS PHYSICIAN REASON REMARKS SERVICE
ADMITTE NAME SEX COMPLAINT FOR S
D REFERRA
L

08/21/23 226 SOMBILON, 61/M DIFFICULTY LACUNAR INFARCT DR. FADERAN (PC) A: PNSS 1L @ 60 CC/HR IM
REYNALDO AMBULATING
HCVD LVH DR. ANUTA (CM) D: LSLF WITH SAP

DR. ABOUZAKI (TSP) M: VSQ4, I&O QS, CBG TID

FINALS DIAGNOSIS DR. KASILAC (BP- I: PIPTAZ D5+1

CARDIO)
SEPTIC ENCEPHALOPATHY SECONDARY TO ASPIRATION PNEUMONIA; U: 0.9 CPK (110 KG)
HYPERTENSIVE CARDIOVASCULAR DISEASE; CHRONIC ATRIAL DR. MACAPAGAL
FIBRILLATION IN MODERATE VENTRICULR RESPONSE; ACUTE KIDNEY (EVAL) M:
INJURY SECONDARY TO INFECTION;ACUTE GOUTY ARTHRITIS ON TOP
OF OSTEOARTHRITIS 1. OMEPRAZOLE 40MG CAP 1 CAP OD

2. COLCHICINE 0.5 MG TAB BID

3. FEBUXOSTAT 40 MG 1 TAB OD

4. CALTRATE TAB BID

5. TRIMETAZIDINE 35 MG TAB 1 TAB BID

6. APIXABAN 2.5MG TAB 1 TAB BID

7. NAHCO3 650 MG TAB TID

8. PIPTAZ 4.5 GM (KINZOLIN) IV Q8

9. NORGESIC FORTE 1 TAB Q8

10. DUODART 1 TAB OD HS

11. ATORVASTATIN 80 MG TAB 1 TAB OD HS

12. NAC 600 MG IN ½ GLASS OF H2O

13. CLONAZEPAM 2 MG ½ TAB OD HS

14. BISOPROLOL 2.5 MG 1 TAB OD

L: 8/27
 U: 8/28

MGHSI

08/24/23 227 PIZARRO, REX 55/M PALLOR LGIB PROBABLY SECONDARY TO BLEEDING HEMORRHOIDS AND DR. L. AMOGUIS (PC) A D5 NSS 1L @ 80 CC/HR, D5W 250 + OCTREOTIDE 60 MCG @ IM
VARICES 10.4 CC/HR X 24 HRS
DR. PILAPIL (CM)
PANCREATIC HEAD MASS, S/P ERCP WITH STENTING D GEN LIQUID
DR. VALLES (EVAL)
HYPERTENSION STAGE 2 M VSQ4, I&O QS, CBG Q4, O2 2-3 LPM/NRM
DR. MAGBANUA
TYPE 2 DIABETES MELLITUS INSULIN REQUIRING (ANES) I

U CPK (65 KG)

8/28 M

ANEMIA SECONDARY TO BLEEDING VARICES 1. TRANEXAMIC ACID 500 MG IV Q 8 RTC FOR NOW

GRADE II ESOPHAGEAL VARICES 2. PARACETAMOL 500 MG TAB, 1 TAB Q 4 PRN FOR

FEVER
SEVERE PORTAL GASTROPATHY
3. HUMULIN 70/30 26 UNITS SQ IN AM, 10 UNITS SQ
GRADE I INTERNAL HEMORRHOIDS IN AM

PANCREATIC HEAD MASS S/P ERCP 4. HUMULIN 70/30 10 UNITS SQ IN AM, 10 UNITS SQ
IN PM
HPN II
5. RIFAXIMIN TAB BID
T2DM IR
6. EPO 4000 IU SQ ONCE A WEEK
T/C ACUTE SVA INFARCT, LEFT MCA
7. CITICOLINE 1 GM IV Q12

8. EDARAVONE 30 MG + PNSS 80 ML X 30 MINS Q12

9. CITICHOLINE 1 GM IV Q12

10. CARVEDILOL 6.25MG, 1 TAB OD

11. AVARIN 300/60 MG

L 8/28

U 8/28

RESUME CARVEDILOL 6.25 MG, 1 TAB OD

08/14/23 228 MONDAY, 48/F DECREASED SECONDARY HEADACHE PROBABLY SECONDARY TO SPACE DR. YBAÑEZ (PC) A NO IVF IM
PACHITA SENSORIUM OCCUPYING LESION
DR. J. TORRES (CM) D SD, DD, LSLF, NO CHICKEN
T/C CENTRAL VENOUS SINUS THROMBOSIS
DR. ONGKINGCO M VSQ4, I&O QS, CBG TID
HPN STAGE 2 (EVAL)
I
DR. VALLES (TSP)
U 0.9 CPK (72 KG)
FINAL DIAGNOSIS DR. DY. K (EVAL)
M
INTRACRANIAL, EXTRA-AXIAL MASS LESION, PARASAGITTAL DR. LAGAPA (CM)
BIFRONTAL MENINGIOMA WITH POSSIBLE SAGITTAL SIMS 1. OMEPRAZOLE 40 MG 1 TAB OD X 1 WEEK
COMPRESSION; TYPE 2 DIABETES MELLITUS WITH STEROID INDUCED DR. BAGIS (EVAL)
HYPERGLYCEMIA;HYPERTENSION STAGE II 2. LOSARTAN 100 MG 1 TAB OD
DR. MADAYAG (REHAB)
3. HEMARATE FA 1 TAB OD

4. ATORVASTATIN 40MG 1 TAB ODHS

5. SITAGLIPTIN 100 MG 1 TAB OD

6. LEVETIRACETAM 1 GM 1 TAB BID

7. DEXAMETHASONE 4 MG TAB OD X 1 WEEK

8. METFORMIN 500MG 1 TAB BID

9. AMLODIPINE 10 MG 1 TAB OD

10. GLARGINE 24 U SQ OD HS

L 8/27

U 8/27

MGHSI
08/22/23 229 JAMERO, 61/F COUGH CAP-MR DR. MT BERNARDO A: PNSS 1L @ 40 CC/HR IM
JACQUELINE (PC)
BRONCHIECTASIS D: FULL DIET
DR. BRATO (AMS)
BA NOT IN AE M: VSQ4, I&O QS, O2 1 LPM/NC

DOG BITE CATEGORY 2 I: CEFEPIME D5+1, METHYLPREDNISOLONE D1+1,

LEVOFLOXACIN D2

U: CPK 1.5 (59 KG)

8/28
M:
CAP-MR
1. CEFEPIME (AXERA) 2G IV Q8 EACH INFUSION TO
BA NOT IN AE RUN FOR 30 MINUTES

POST TB BRONCHIECTASIS 2. LEVOFLOXACIN 500MG 1 TAB OD

3. DUAVENT 1 NEB Q6

4. METHYLPREDNISOLONE 16 MG 1 TAB BID

5. NAC 600 MG + 1 GLASS H2O BID

6. MONTELUKAST 10 MG 1 TAB ODHS

RABIES VAXX SCHED:

DAY 3 - 8/25/23

DAY 7 - 8/29/23

PVRV X 2 SITES IM

L: 8/28

U: 8/28

FOR TOSS TO DR BRATO

08/25/23 231 ROSIALDA, 30/F SHORTNESS OF MASSIVE PERICARDIAL EFFUSION WITH EARLY SIGNS OF TAMPONADE DR. FORTINEZ (PC) A PNSS 1L @ 120 CC/HR IM/
RHEALYN BREATH PROBABLY SECONDARY TO TB
DR. AGUELO (TCVS) D DAT SURG

DR. PUNAY (CM) M VSQ4, I&O QS, O2 1-2 LPM/NC

DR. VALENCIA (ANES) I

8/28
U CPK (53 KG)
SHOCK MULTIFACTORIAL (SEPTIC, CARDIOGENIC) MASSIVE PLEURAL
EFFUSION TUBERCULOUS PERICARDITIS S/P TUBE PARACENTESIS M

1. DOLCET TAB PO BID X 2 DAYS

2. IBUPROFEN 2 TAB TID

3. COLCHICINE 1 TAB BID

L 8/28

ESR 55

PROCALCITONIN 3.95

U 8/28

CONTINUE HRZE

FOLLOW UP PERICARDIAL FLUID (CYTOLOGY, CELL BLOCK)

MAINTAIN JP

ENCOURAGE AMBULATION

08/27/23 232 BILAOEN, 79/M PALPITATION HCVD, LVH, CAD, PAROXYSMAL AF IN MVR-RVR, FC II DR. MARANIAN (PC) A PNSS 1L @ 40 CC/HR IM
SOLOMON
T2DM NIR D LSLF, DD

M VSQ4, I&O QS, CBG Q12, HOOK TO TELEMETRY

8/28 I

HVCD, CAD LVH U CPK (60 KG)

PAROXYSMAL AF, LNMP TO RVR M

FC II 1. TELMISARTAN 80 MG 1 TAB OD

T2DM 2. CARVEDILOL 25 MG 1/2 TAB BID

 3. TRIMITAZIDINE 35 MG 1 TAB BID

4. METFORMIN (NORMAX) 500 MG 1 TAB OD

5. ATORVASTATIN 40 MG 1 TAB OD

6. IRON + FOLIC ACID + VIT. B COMPLEX (FORTIFER

FA) 1 TAB OD

7. ISOSORBIDE DINITRATE (ISODRIL) PRN

8. IVABRADINE (CORALAN) 5 MG PRN @ >70 HR

9. IMMUNPRO 1 TAB OD

10. ZYKAST TAB, 1 TAB OD HS

11. CALMAG 1 TAB BID

12. ISMN 30 MG TAB, ½ TAB OD

L 8/28

U 8/28

SF 2D ECHO

FOR SREUM K+ 6 HRS AFTER LAST DOSE OF KVL TABS

DELIVERY ROOM/LABOR ROOM: 1

DATE RM PATIENT’S NAME AGE/ CHIEF ADMITTING DIAGNOSIS PHYSICIAN REASON FOR REMARKS SERVICES
ADMITTED SEX COMPLAINT REFERRAL
08/27/23 DR RAMENTO, 33/F BLOODY TYPE I DM DR. DAHAB (PC) A PNSS 1L @ KVO OB/IM
GEOVANNIR SHOW
G3P2 (1102) PU 34 5/7 WEEKS AOG DR. GATMIN- D DAT
YUZON (CM)
BREECH IN PRETERM LABOR M VSQ4, I&O QS, CBG TID

U CPK (KG)

M
 1. NIFEDIPINE 30 GIT 1 TAB OD

2. HERAGEST 200 MG SOFT GEL Q6 PER VAGINA

3. MGSO4 4 GM IVTT NOW THEN 1 GM/HR FOR 24 HOURS

4. RI RESCUE DOSES

2 UNITS SQ - 121-140

4 UNITS SQ - 141-160

6 UNITS SQ - MORE THAN 160

L 8/27

WBC 11, RBC 4.7, HGB 13.2, HCT 0.39, PLT 182, N 0.72, L 0.19, M 0.07

CBG 190

U 8/27

OBGYNE WING: 1

DATE RM PATIENT’S AGE/ CHIEF ADMITTING DIAGNOSIS PHYSICIAN REASON REMARKS SERVICES
ADMITTED NAME SEX COMPLAIN FOR
T REFERRAL

08/26/23 248-2 PICHON, 66/F POST- AUB SECONDARY TO OVARIAN PATHOLOGY PROBABLY DR. RAMOS (PC) A: NO IVF FOR NOW OB/IM
AMELITA MENOPAUSA MALIGNANT
L BLEEDING DR. ALQUIZA D: LOW SALT FAT DIET
G2 P1 (1011) (CM)
M:VSQ4, I&O QS
HYPERTENSION STAGE II
I:
DYSLIPIDEMIA
U: CPK (KG)
ASYMPTOMATIC HYPERURICEMIA
M:

1. LOSARTAN 100 MG 1 TAB OD

8/28
2. SIMVASTATIN 10 MG 1 TAB OD
AUB SECONDARY TO OVARIAN PATHOLOGY PROBABLY
MALIGNANT 3. FEBUXOSTAT 40 MG 1 TAB OD

G2P1 (1011)
 HPN II L: 8/27

DYSLIPIDEMIA FT4 0.58-1.64

ASYMPTOMATIC HYPERURICEMIA

U: 8/28

FACILITATE 2D ECHO TOMORROW

ICU: 4

DATE RM PATIENT’S AGE/ CHIEF ADMITTING DIAGNOSIS PHYSICIAN REASON REMARKS SERVICES
ADMITTED NAME SEX COMPLAINT FOR
REFERRAL

08/22/23 ICU-2 ASERIOS, 67/M DYSPNEA ACS ANTEROSEPTAL WALL STEMI KILLIPS III DR. COCHING A: PNSS 1L @ 20 CC/HR IM
ROMEO (PC)
CAP HR (HYPOXEMIA); RULE OUT METASTATIC PROCESS D: GLUCERNA 1900 KCAL IN 1:5:1 DILUTION IN 6 DIVIDED FEEDINGS
DR. B. CHIEW (210 CC)
AKI PROBABLY SECONDARY TO INFECTION (TSP)
M: VSQ1, I&O Q1
ON TOP OF CKD SECONDARY TO DKD AND HPNSS WITH RENAL DR. ORCASITAS
ANEMIA (CM) I: PIPTAZ D4+1

HCVD, SR, IHD, HF REF (40%) DR. TOM (CM) U: CPK (65 KG)

T2DM NIR M:

MEI (HYPOKALEMIA, HYPOCALCEMIA, HYPONATREMIA ) 1. PIPERACILLIN + TAZOBACTAM 4.5G IV NOW THEN 2.25G Q
6 HOURS

2. ASPIRIN 80 MG 4 TABS NOW THEN 1 TAB OD

8/28
3. CLOPIDOGREL 75MG 4 TABS NOW THEN 1 TAB OD
ACS STEMI ANTEROSEPTAL WALL KILLIPS III
4. ENOXAPARIN 0.4CC SC OD
CAP HR HYPOXEMIA
5. PANTOPRAZOLE 4PMG IV NOW THEN 40MG/CAP OD
AKI SECONDARY TO INFECTION BEFORE HS

ON TOP OF CKD SECONDARY TO DKD/HPNSS WITH RENAL 6. EMPAGLIFLOZIN 25 MG TAB 1/2 TAB OD BEFORE
ANEMIA BREAKFAST

HCVD, IHD, HF REF (49%), ST 7. GLICLAZIDE 60 MG 1 TAB BEFORE BREAKFAST

T2DM 8. FERROUS FUMARATE 1 TAT OD

9. ALLOPURINOL 30PMG 1 TAB OD

10. CARVEDILOL 12.5MG 1/2 TAB BID

 11. NAHCO3 650MG 1 TAB TID

12. ROSUVASTATIN 20 MG 1 TAB OD

13. EPO-ALPHA 4000 UNITS INJECTION

14. CONCORE 2.5MG 1 TAB OD

15. AZITHROMYCIN 500MG 1 TAB OD

16. FUROSEMIDE 40 MG IV OD

17. AMLODIPINE 10 MG TAB

18. KCL TAB X 6 DOSES

19. RACECADOTRIL 100 MG CAP TID TILL WITH 2 FORMED

STOOLS

L: 8/27

WBC 10.6, RBC 3.4, HGB 9.9, HCT 0.30, PLT 226, N 0.84, L 0.08, M 0.04,
E 0.04, B 0.00

BUN 28.1, CREA 511, NA 142.1, K 3.46

U: 8/27

PREPARE FOR EXTUBATION FUROSEMIDE

8/27/23 ICU-3 OLEDAN, 70/F DISORIENTA SEPTIC ENCEPHALOPATHY, SOURCE TO BE DETERMINED DR. RASHID A
VIVIEN TION HYPERTENSIVE CARDIOVASCULAR DISEASE IVF PNSS 1 L, FD 300 CC NOW THEN REGULATE AT 120 CC/HR
TYPE 2 DIABETES MELLITUS NON INSULIN REQUIRING O2 AT 2-4 LPM VIA FM

8/28 D NGT INSERTION: GLUCERNA 1400 KCAL IN 6 DIVIDED FEEDINGS

SEPTIC ENCEPHALOPATHY, SECONDARY TO ASPIRATION
PNEUMONIA M VSQHOURLY, I&OQHOURLY, NVSQHOURLY
I
HYPERTENSIVE CARDIOVASCULAR DISEASE U
M
TYPE 2 DIABETES MELLITUS NON INSULIN REQUIRING 1. PIPERACILLIN+TAZOBACTAM 4.5 GRAMS IV LD NOW THEN 2.25 IV
Q6
2. AMLODIPINE 5 MG TAB, 1 TAB OD
3. LINAGLIPTIN 5 MG TAB, 1 TAB OD
4. ROSUVASTATIN 20 MG TAB, 1 TAB OD
5. CLOPIDOGREL+AMLODIPINE 75/75 MG TAB OD
6. DOLCET TAB Q 8 PRN FOR PAIN
7. PARACETAMOL 600 MG IV Q8 PRN FOR FEVER
L
WBC 18.1
RBC 3.8
HGB 10.6
HCT 0.33
 PLT 163
NEUTRO 0.90
LYMPHO 0.05
MONO 0.05
EOSINO 0
BASO 0
NA 134.2
K 3.40
PROCAL 9.88
CREA 209 EGFR 22
URINALYSIS:
YELLOW, CLEAR
6.0, 1.030
WBC 0, RBC 9, EPITH 3, CAST 0, BACTERIA 1
SUGAR NEGATIVE, PROTEIN +
CXR:
CANNOT RULE OUT LYTIC RIB CHANGES AS DESCRIBED, TBC
SUGGESTED
ALV SUGGESTED FOR FURTHER EVALUATION OF THE LEFT UPPER
LUNG
LEFT VENTRICULAR CARDIOMEGALY
ATHEROMATOUS AORTA

07/25/23 ICU-4 CATADMAN, 71/M DYSPNEA ARF TYPE 1 AND 2 SECONDARY TO CAP HR DR. J. RAMOS A: FEMORAL CATH: PNSS 1L @ 38 CC/HR IM
CONCORCIO (PC)
COPD IN AE T/C BRONCHIECTASIS SD1: PNSS 84 CC + 16 MG NOREPINEPHRINE @ 12 CC/HR
DR. GUILLERMO
(CM) (TITRATE NE TO MAINTAIN SBP >110 MMHG)

8/28 DR. FERRER SD2: PNSS 250 CC + 600 MG AMIODARONE X 24 HOURS @ 10 CC/HR
(ASM)
ARF TYPE 1+2 SECONDARY TO VAP + COPD IN AE FEMORAL CATH RED PORT: PNSS 100 CC + KCL 20 MEQS AT 10 CC/HR
DR. LLANES (IDS) X 2 CYCLES
PNEUMOMEDIASTINUM WITH RUPTURED BLEBS
SECONDARY TO PTB DR. FAJARDO D5W 200 CC + 4 AMPS CALGLUC @ 10 CC/HR
(FEMORAL CATH,
S/P CTT BIBASAL CTT, TRACH) D: OF + 2 SCOOPS BENEPROTEIN PER FEEDING IN 1400 KCAL IN 6
DIVIDED FEEDINGS (230CC) W/ KANGAROO BOTTLE
DR. N. CRUZ
(ANES) M VSQ1; I&O Q1 , NVSQ1

I: IMIPENEM - CILASTATIN D4

U: CPK (40 KG)

M:

1. BERODUAL + 2CC PNSS NEB Q8

2. ORAHEX SOLN ORAL CARE TID

3. HYCLENS 4% WASH USED ONCE A DAY

 4. ALBUMIN 20% OD X 4 HRS

5. FLAMMAZINE CREAM APPLY ON AFFECTED SITES BID

6. CAC03 1 TAB BID

7. SENOKOT FORTE TAB OD HS HOLD IF >X2 BM

8. LANOXIN 250 MCG TAB OD

9. DABIGATRAN 110 MG TAB BID

10. TRIMAG 1 TAB BID

11. PANTOPRAZOLE 40MG TAB 1 TAB OD

12. HYDROCORTISONE 100MG IV 08

13. IMIPENEM - CILASTATIN 1G IV Q8

14. KCL12 TAB TID X 6 DOSES

15. HYDROCORTISONE 100 MG IV Q12

16. KCL TAB TID X 6 DOSES

L 8/28

U: SUGGESTIONS IF OK WITH CARDIO:

1.TSH, FT4

2.BASELINE PT/APTT

3.START ENOX 0.4CC SQ OD(PT HAS PAROXYSMAL AF)

4.SUGGESTING CARDIOSELECTIVE BETA BLOCLER

08/26/23 ICU-5 GUERTA, 52/M LEFT SIDED INTRACEREBRAL HEMORRHAGE RIGHT DR. LAGAPA (PC) A: SURG/
TEODORA WEAKNESS
HYPERTENSIVE CARDIOVASCULAR DISEASE DR. ABOUZAKI LEFT: PNSS 1L @ 100 CC/HR IM
(CM)
SD: PNSS 90 CC + 10 MG NICARDIPINE @ 90 CC/HR

8/28 RIGHT: PNSS 1L @ 10 CC/HR

INTRACEREBRAL HEMORRHAGE RIGHT FRONTOTEMPORAL PNSS 80 CC + OMEPRAZOLE 80 MG 10 CC

AREA
D: NPO FOR NOW
 S/P CRANIOTOMY AND EVACUATION OF BLEED M: VSQ1, NVSQ1, I&O Q1

HYPERTENSIVE CARDIOVASCULAR DISEASE, LVH, SR I: PIP TAZ

U: CPK (98 KG)

M:

1. LEVETIRACETAM 100MG/ML 5ML IVTT BID

2. REBAMIPIDE 100MG/ TAB 1 TAB TID

3. PIPTAZ 4.5 GM IV Q6

4. PARACETAMOL 1GM IVTT Q8 X6 DOSES

5. TRANEXAMIC ACID 500 MG IVTT

6. NALBUPHINE 5MG SLOW IVTT

7. CITICOLINE (CHOLINERVE) 1GM IV 08

8. CHLORHEXIDINE (ORAL CARE) TID

9. MANNITOL 150CC IV 04

10. CEREBROLYSIN 10CC IV BOLUS G8

11. EDARAVONE 30MG IN 30CC PNSS TO RUN FOR 30 MINS

G12

12. OMEPRAZOLE 40MG IV Q12

L: 8/28

U: 8/28

FOLLOW UP ETA GSCS

DO NGT LAVAGE PRIOR TO FEEDING

8/27/23 ICU-8 LAVILLA, 83/F DYSPNEA PULMONARY CONGESTION WITH BILATERAL PLEURAL DR. BANICO MAY A IVF PNSS 10 /hr
GUADALUPE EFFUSION SEC TO ADHF O2 AT 5-7 LPM VIA FM
CAP-MR D LOW SALT, LOW FAT DIET, LIMIT WATER TO 1 L/DAY
AKI ON TOP OF CKD SEC TO HYPERTENSIVE M VS QHOURLY, I&O QHOURLY
NEPHROSCLEROSIS, T/C CARDIORENAL SYNDROME I
HYPONATREMIA, PROBABLY DILUTIONAL U (49KG)
M
8/28 1. NAHCO3 650 MG TID
PULMONARY CONGESTION WITH BILATERAL PLEURAL
EFFUSION SEC TO ADHF 2. KETOANALOGUE TAB BID
 CAP-MR 3. PREGABALIN 50 MG TAB OD @, HS

AKI ON TOP OF CKD SEC TO HYPERTENSIVE 4. FES04 + FA TAB OD

NEPHROSCLEROSIS,
5. ROSUVASTATIN 10 MG TAB OD
BA NOT IN AE
6. CLOPIDOGREL 75 MG TAB OD
COMPRESSION FRACTURE IN LUMBAR AREA
7. SULODEXIDE BID

8. DAFLON 1 GRAM TAB OD

9. FEBUXOSTAT 40MG ½ TAB OD

10. SERETIDE 2 PUFF BID

11. CEFTRIAXONE 2 GRAMS IV OD

12. CACO3 TAB BID

13. HYDROCORTISONE 50MG IV 98

14. EPO 6000 IU SO 3X A WEEK

15. SEVELAMER 800MG/TAB 1 TAB TID

16. TOLVAPTAN 15MG 1 TAB OD

8/28

UTZ OF CHEST : BILATERAL MINIMAL PLEURAL EFFUSION WITH

PASSIVE ATELECTASIS

NA 123.4

K 5.24

8/28

ICU EXTENSION: 0

DATE RM PATIENT’S AGE/ CHIEF ADMITTING DIAGNOSIS PHYSICIAN REASON REMARKS SERVICES
ADMITTED NAME SEX COMPLAINT FOR
REFERRAL
 PEDIA WING: 0

DATE RM PATIENT’S AGE/ CHIEF ADMITTING DIAGNOSIS PHYSICIAN REASON REMARKS SERVICES
ADMITTED NAME SEX COMPLAINT FOR
REFERRAL

DISCHARGED: 1

DATE RM PATIENT’S AGE/ SEX CHIEF ADMITTING DIAGNOSIS PHYSICIAN REASON FINAL DIAGNOSIS SERVICE
ADMITTED/ NAME COMPLAINT FOR S
DISCHARGED REFERRAL

08/18/23 40 RIMORIN, 82/M HEMOPTYSIS ANEMIA SECONDARY TO HEMOPTYSIS SEC TO BLEEDING DR. BANICO (PC) HEALTH CARE ASSOCIATED PNEUMONIA IM
JOSE DIATHESIS ON TOP OF RENAL ANEMIA
08/28/2023 DR. QUIBO (TSP) CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTION
HOSPITAL ACQUIRED PNEUMONIA
DR. MACROHON END STAGE RENAL DISEASE SECONDARY TO HYPERTENSIVE NEPHROSCLEROSIS
END STAGE RENAL DISEASE SECONDARY TO HYPERTENSIVE (IDS)
NEPHROSCLEROSIS HYPERTENSIVE CARDIOVASCULAR DISEASE, LEFT VENTRICULAR HYPERTROPHY,
DR. B. CHIEW VALVULAR HEART DISEASE AORTIC STENOSIS
HYPERTENSIVE CARDIOVASCULAR DISEASE, VALVULAR (EVAL)
HEART DISEASE, T/C MITRAL REGURGITATION, NOT IN
FAILURE

INTERCRITICAL GOUT

BENIGN PROSTATIC HYPERPLASIA

8/27

HCAP

ESRD SEC TO HPNSS

HCVD, VHD, SENILE AORTIC STENOSIS

BPH

8/26/23 RM ANDALES, 65/M DYSPNEA BILATERAL PLEURAL EFFUSION SECONDARY TO HEART DR. ORCASITAS Z IM
08/28/2023 20 EDGARDO FAILURE ON TOP OF CHRONIC KIDNEY DISEASE BILATERAL PLEURAL EFFUSION SECONDARY TO PULMONARY TUBERCULOSIS VS
GEN MALIGNANCY
ME HYPERTENSIVE CARDIOVASCULAR DISEASE, ISCHEMIC HEART
D3 DISEASE, HEART FAILURE FUNCTIONAL CLASS III-IV HYPERTENSIVE CARDIOVASCULAR DISEASE, ISCHEMIC HEART DISEASE, HEART
FAILURE FUNCTIONAL CLASS III-IV
CHRONIC KIDNEY DISEASE SECONDARY TO HYPERTENSIVE
KIDNEY DISEASE/ DIABETIC KIDNEY DISEASE CHRONIC KIDNEY DISEASE SECONDARY TO HYPERTENSIVE KIDNEY DISEASE/
DIABETIC KIDNEY DISEASE
INTERCRITICAL GOUT
INTERCRITICAL GOUT
TYPE 2 DIABETES MELLITUS – INSULIN REQUIRING
TYPE 2 DIABETES MELLITUS INSULIN REQUIRING
S/P ACS NSTEMI FROM JUNE 9 - 14, 2023
S/P ALS - NSTEMI

08/21/23 34 ALIMAN, 56/M RIGHT SPIRAL FRACTURE DISTAL HUMERUS RIGHT DR. QUIBO (PC) FRACTURE, CLOSED DISTAL HUMERUS RIGHT SURG/
MICHAEL SHOULDER PAIN IM
08/28/2023 ESRD SEC TO DKD DR. DIAZ CHRONIC KIDNEY DISEASE STAGE V SECONDARY TO DIABETIC KIDNEY DISEASE
(ORTHO)
TYPE 2 DM - INSULIN REQUIRING

HYPERTENSION STAGE 2

8/267

FRACTURE CLOSED DISTAL HUMERUS RIGHT

ESRD SEC TO DKD AND HKD

T2DM-IR

HTN STAGE 2

S/P OPEN REDUCTION/PLATE FIXATION, DITSAL HUMERUS

RIGHT
 08/27/23 18 KASER, 88/M DIFFICULTY OF DELIRIUM ETIOLOGY TO BE DETERMINED, TO CONSIDER DR. YBANEZ (PC) CM INSOMNIA SECONDARY TO REACTIVE PSYCHOSIS (POST CATARACT LEFT EYE), IM
ADOLF SLEEPING DEMENTIA HEART FAILURE PROBABLY WITH REDUCED EJECTION FRACTION SECONDARY
08/28/23 DR. ANUTA (CM) TO CORONARY ARTERY DISEASE, FUNCTIONAL CLASS III
HF PROBABLY WITH REDUCED EF SEC TO CAD, FC II

8/28

T/C INSOMNIA

08/22/23 33 ABOGATAL, 87/F RIGHT LOWER UROSEPSIS SECONDARY TO COMPLICATED URINARY TRACT DR LACUNA HYPERGLYCEMIC CRISIS IM
GEN REMEDIOS QUADRANT INFECTION
08/28/2023 3 PAIN DR.MANGAOIL COMPLICATED URINARY TRACT INFECTION
HYPERGLYCEMIC CRISIS (CM)
TYPE 2 DIABETES MELLITUS - UNCONTROLLED
TYPE 2 DM- UNCONTROLLED DR. QUIBO
(NEPHRO ACUTE KIDNEY INJURY SECONDARY TO INFECTION
ACUTE KIDNEY INJUDRY SECONDARY TO INFECTION CLEARANCE)

8/27

UROSEPSIS SEC TO COMPLICATED UTI

HYPERGLYCEMIC CRISIS

T2DM UNCONTROLLED

AKI SEC TO INFECTION

8/28

HYPERGLYCEMIC CRISIS

COMPLICATED UTI

T2 DM UNCOMTROLLED

AKI SEC TO INFECTION

08/24/23 GEN LEUENBERGE 52/F COUGH CAP MR DR. MT 1. LOWER RESPIRATORY TRACT INFECTION IM
3 R, KIM BERNARDO (PC)
08/28/23
 24 BA IN AE 2. BRONCHIAL ASTHMA IN EXACERBATION

8/267

CAP-MR

ASTHMA IN ACUTE AE

8/28

BA IN AE

LRTI

TRANSFER TO OTHER HOSPITAL: 0

DATE RM PATIENT’S AGE/SEX CHIEF ADMITTING DIAGNOSIS PHYSICIAN REASON FOR FINAL DIAGNOSIS SERVICE
ADMITTED NAME COMPLAINT REFERRAL

TRANSFER TO ICU: 0

DATE RM PATIENT’S AGE/SEX CHIEF ADMITTING DIAGNOSIS PHYSICIAN REASON REMARKS SERVICES
ADMITTED NAME COMPLAINT FOR
REFERRAL

TRANSOUT FROM ICU TO WARD: 0

DATE RM PATIENT’S AGE/ CHIEF ADMITTING DIAGNOSIS PHYSICIAN REASON REMARKS SERVICES
ADMITTED NAME SEX COMPLAINT FOR
REFERRAL

WARD MORTALITY: 0

DATE RM PATIENT’S AGE/ CHIEF ADMITTING DIAGNOSIS PHYSICIAN REASON FOR FINAL DIAGNOSIS SERVICES
ADMITTED NAME SEX COMPLAINT REFERRAL
 ER MORTALITY: 0

DATE RM PATIENT’S AGE/SEX CHIEF ADMITTING DIAGNOSIS PHYSICIAN REASON FINAL DIAGNOSIS SERVICES
ADMITTED NAME COMPLAINT FOR
REFERRAL

ICU MORTALITY: 0

DATE RM PATIENT’S AGE/SEX CHIEF ADMITTING DIAGNOSIS PHYSICIAN REASON FINAL DIAGNOSIS SERVICES
ADMITTED NAME COMPLAINT FOR
REFERRAL