12/05/19

9PM BARTOLOME, JOSEFINA MARIANO

90/F/RPVD

S> Patient was seen and examined with the following subjective complaints/findings:
(-) seizure (-) fever (-) decreased sensorium
(-) dyspnea/desaturations (-) chest pain (-) abdominal pain (-) melena/hematochezia

O> GCS 11 E4VTM5

BP 110/70 HR 80 RR: A T: 37 O2 Sat: 97%
Pink palpebral conjunctivae, anicteric sclerae, no nasoaural discharge, no tonsillopharyngeal congestion
Supple neck, no cervicolymphadenopathy
Symmetrical chest expansion, no retraction, (+) crackles, bilateral
Adynamic precordium, bradycardic, regular rhythm, no murmur
Flabby, soft, nontender, normoactive bowel sounds
No gross deformities, full and equal pulses, CRT <2 seconds

12/4 ETA GS:

gram positive cocci in pairs 1+ singly 1+ pus cells 2+ epithelial cells 1+

A> #Chronic ventilator dependence secondary to deconditioned state

#VAP (Pseudomonas aeruginosa)
#COPD Gold D
#HASCD ACC/AHA St. B

P> IVF: Heplock

Diet: as ordered
Diagnostics: Repeat CBC PC Bun Crea Na K Cl in Day 7 of Cefepime
Therapeutics:
1. Cefepime 2g IV Q8 Day 4
2. Start Amikacin 750mg IV OD
Continue other medications
Still awaiting 1 unit pRBC properly typed and crossmatched
 1 TASAP once available
MV setting
SIMV F8 PEEP 5
TV 370 PS10 FiO2 30%
Refer

12/05/19
9PM BELANIO, FRANCISCA CERDINIA
93/F/RPVD

S> Patient was seen and examined with the following subjective complaints/findings:
(-) seizure (-) fever
(-) dyspnea/desaturations (-) chest pain
(-) abdominal pain (-) melena/hematochezia

O> GCS 8 E3VTM4

BP 120/80 HR 71 RR A T: 36.5 O2 Sat 98%
Pink palpebral conjunctivae, anicteric sclerae, no nasoaural discharge, no tonsillopharyngeal congestion
Supple neck, no cervicolymphadenopathy
Symmetrical chest expansion, no retraction, (+) rhonchi, bilateral
 Adynamic precordium, normal rate and regular rhythm, no murmur
Flabby, normoactive bowel sounds, soft, nontender
Full and equal pulses, (+) edema, upper extremities and lower extremities

12/2 ETA CS:

Isolated Organism: Klebsiella pneumoniae heavy growth; R: amoxicillin, cefazolin S: amoxicillin-clavulanate,
ampicillin-sulbactam, ceftriaxone, cefoxitin, sulfamethoxazole/trimethoprim, cefuroxime, ciprofloxacin, levofloxacin,
tetracycline, ofloxacin

A> #CRF sec to HAP (MRSA)

#Bacteremia (MRSA)
#Subacute CVD Infarct L Occipital & R Parietal NIHSS 10 - Day 15
#Seizure disorder secondary to PSG
#HASCVD ACC/AHA St. B
#Hyponatremia secondary to hypervolemia
#Hypoalbuminemia
#AKI, Multifactorial

P> IVF: Heplock

Diet: as ordered
Diagnostics: 2D echo c DS on call
CXR once stable
Therapeutics: Linezolid 600mgT IV Q12 (D8/14)
Continue other medications
Contact precaution at all times
MV setting
AC F16 PEEP 5
TV 370 FiO2 30%
Refer
12/05/19
10PM BERNARDO, ERLINDA SACRAMENTO
88/F/RPVD

S> Patient was seen and examined with the following subjective complaints:
(-) dyspnea (-) fever (-) cough
(-) hypotension (-) chest pain (-) desaturation
(+) melena

O> GCS 15 E4V5M6 weak looking

BP 120/70 PR 79 RR 20 T 36.5 O2sat 96%
Conscious, coherent, not in cardiorespiratory distress
Anicteric sclerae, pink palpebral conjunctivae, (-) CLAD
Adynamic precordium, normal rate, regular rhythm
Symmetrical chest expansion, (-) retractions, clear breath sounds
Flabby, normoactive bowel sounds, soft, nontender, no mass
Full and equal pulses, no edema

12/05 Hgb 107 Hct 0.32 Na 129 K 2.9 Cl 98 Ca 1.9

A> #Severe UGIB prob sec. to 1. BPUD 2.Drug-induced

#HASCVD ACC/AHA St. B
#Chronic CVD Infract MRS 4
#Chronic Bedridden state sec. to deconditioned state
#Anemia secondary
#Hypoosmolar hypovolemia hyponatremia
#Hypoalbuminemia
#CAP-MR
#Presumptove PTB

P> IVF: PNSS 1L 40cc/hr

Diet: NPO
Diagnostics:
 Blood GS/CS
Sputum GS/CS
Therapeutics:
1. Start Ceftriaxone 2g IV now then OD
2. Start Azithromycin 500mg/tab now then OD
3. Start NAC 600mg/tab ODAC
4. Start Duavent Nebule q8 prn for dyspnea
Continue other medications
WOF: hypotension, persistence of bleeding, chest pain, dyspnea & desaturation
Refer

12/05/19
10PM GRAFIL, ORO
82/M/RPV

S> Patient was seen and examined with no subjective complaints

(-) seizure (-) fever (-) desaturation (-) cough
(-) dyspnea (-) chest pain (-) hypotension

O> GCS 6 E2VTM3

BP: 120/80 HR: 83 RR: A T: 36.8 O2: 99%
Pink palpebral conjunctiva, anicteric sclerae, no nasoaural discharge, no tonsillopharyngeal congestion
Supple neck, no palpable lymph node, no neck vein engorgement
Adynamic precordium, normal rate, regular rhythm, no murmur
Symmetrical chest expansion, (-) retractions, (+) bilateral crackles
Flat, normoactive bowel sounds, soft, non tender, no palpable mass
No edema, full and equal pulses, CRT < 2

12/5 Hgb 82 Hct 0.25 WBC 17.1 Plt 593 Stab 0.02 Seg 0.89 Eos 0.02 Lymph 0.0.07 Mono 0.02 PT 17.2 PA 68 INR
1.29 PTT 33.70
A> #VAP (Pseudomonas aerugonisa)
#Infected Sacral decubitus ulcer grade III
#Chronic Ventilator Dependence sec to central apnea
#Chronic CVD infarct L MCA, MRS 5

P> IVF: Heplock

Diet: as ordered
Therapeutics:
1. Clopidogrel on HOLD day 8
2. Piperacillin Tazobactam 4.5 g/IV now then 4.5 g/IV Q6 Day 7/14
3. Vitamin K 1 amp now then q8 x 3 doses Day 3/3
4. Amikacin 500mg IV q12 Day 2
Continue other medications
Daily wound care with Dakins solution
WOF: dyspnea, desaturation
Refer
12/05/19
10PM HOFILENA, RODOLFO GUSTILO
94/F/RPV-RG

S> Patient was seen and examined with the following subjective findings:
(-) fever (-) hypotension (-) desaturations
(-) dyspnea (-) chest pain (-) melena/hematochezia

O> GCS 7 E3-4TM4

BP: 110/70 HR 86 RR: A T: 36.7 O2 sat: 97%
Anicteric sclerae, pink palpebral conjunctivae,
Supple neck, no cervical lymphadenopathy
Adynamic precordium, normal rate, regular rhythm
Symmetrical chest expansion, no retractions, decreased breath sounds, bases
Flabby, normoactive bowel sounds, soft, nontender, no palpable mass
(+) contracted extremities, (+) edema, UE and LE

A> #CRF Type 1 sec to HAP (Klebsiella pneumoniae)

#COPD suspect
#HF with pEF 65%sec to HASCVD CRBBB ACC/AHA St. C
#PE B probably Parapneumonic vs Hypoalbuminemia
#CAUTI
#Alzheimer’s Dementia
#Chronic bedridden state sec. to deconditioned state
#Chronic hyponatremia sec RSW
#AKI miultifactorial
#Grade 2 Sacral Ulcer

P> IVF: Heplock

Diet: OF based 2:1 dilution; regular salt, low fat, low cholesterol high fiber diet w/ 2 egg whites/meal
Diagnostics: Repeat CBC PC Bun Area Na K Cl CA Alb tomorrow (12/6/19)
CXR tomorrow
Therapeutics:
1. Meropenem 1g TIV q24 (D14/14)
2. Amikacin 500mg TIV Q24 (D9) to extend for 7 more days
3. Sodium Hyaluronate eye drops 1 drop TID on both eye
4. May give hydrocortisone 250mg IV 30mins prior to extubation
Continue other medications
For trial of Tpiece as tolerated
MV settings: SIMV VT490 F8 PS10 FiO2 30% PEEP5
Refer
12/05/19
10PM ARANDIA, ISIDRO AQUINO
94/M/RPV

S> Patient was seen and examined with the following subjective findings:
(-) fever (-) hypotension (-) desaturations
(-) dyspnea (-) chest pain (-) melena/hematochezia

O> GCS 11 E4VTM6

BP: 120/70 HR 83 RR: A T: 36.6 O2 sat: 97%
Anicteric sclerae, pink palpebral conjunctivae,
Supple neck, no cervical lymphadenopathy
Adynamic precordium, normal rate, regular rhythm
Symmetrical chest expansion, no retractions, clear breath sounds, bases
Flabby, normoactive bowel sounds, soft, nontender, no palpable mass
No gross deformities, full and equal pulses, CRT <2secs

A> #Acute Respiratory Failure type 1 sec. to CAP-HR with aspiration component
#HASCVD sinus tachycardia ACC/AHA st. B

P> IVF: 1L PNSS X 60CC/hr

DIET: Low salt low fat low cholesterol high fiber diet at 1800kcal/day 1:1 dilution
Diagnostics: Awaiting
ETA GS/CS 12/3
Blood CS x2 12/3
Therapeutics:
1. Ceftriaxone 2g TIV OD Day 2
 2. Clindamycin 600mg TIV q6 Day 1
Continue other medications
RSBI - 61
For trial of t-piece as tolearted if RSBI </= 105
WOF: Tachypnea, Desaturation, Chest Pain
SIMV mode
VT 450 FIo2 30 F14 Peep 5 PS 18
Refer