August 4, 2011JI Janill Magano

JI Shangrila DimolJI Jasper Pablo

SERVICE WARDADMISSION ROUNDS/

PATIENT UPDATES/ DISCHARGES

ADMISSIONS

UPDATES

502AT. S., 4 y/o, male21st hospital day,>2mos DOIWorking Diagnosis: ALL FAB L1 Subjective Complaints:

(-) abdominal pain(-) cough(-) nasal discharge(-) sore throat(-) myalgia/arthralgia(-) malaise

S

Far Eastern University – Dr. Nicanor Reyes Medical FoundationDepartment of Child Health

Conscious, coherent, afebrile, not in distress BP = 100/60mmHg CR = 86bpm RR = 25cpm T = 36.9oC P.E. findings are essentially normal

O

Far Eastern University – Dr. Nicanor Reyes Medical FoundationDepartment of Child Health

ALL FAB L1ADefer urine Specific GravityFacilitate Vincristine and DoxorubicinMay go home if well after chemotherapyP

503AJ.O., 8/12 mos, female5th hospital dayWorking Diagnosis: Dengue Hemorrhagic Fever I Subjective Complaints:

(-) abdominal pain(-) cough(-) nasal discharge(-) sore throat(-) myalgia/arthralgia(-) malaise

S

Far Eastern University – Dr. Nicanor Reyes Medical FoundationDepartment of Child Health

Conscious, coherent, afebrile, not in distress CR = 120bpm RR = 28cpm T = 36.7oC UO = cc/24 hr CRT = <2secsP.E. findings are essentially normal

O

Far Eastern University – Dr. Nicanor Reyes Medical FoundationDepartment of Child Health

Dengue Hemorrhagic Fever I - resolvedAMay go homeP

503CK.D., 1 y/o, male3rd hospital day,8th DOIWorking Diagnosis: Pneumonia prob. Viral

Some dehydration – corrected

Impacted cerumen, AD Subjective Complaints:

(-) productive cough(-) fever(-) vomiting(-) difficulty of breathing

S

Far Eastern University – Dr. Nicanor Reyes Medical FoundationDepartment of Child Health

Conscious, coherent, afebrile, not in distress CR = 112bpm RR = 32cpm T = 36.8oCCongested turbinates with post-nasal drip(+) crackles mid to base, bilateral with good air entry

O

Far Eastern University – Dr. Nicanor Reyes Medical FoundationDepartment of Child Health

Pneumonia probably viral - resolvedSome dehydration – correctedImpacted cerumen, AD

AFor possible dischargeP

503DV.L., 4 y/o, male4th hospital day, 8TH DOIWorking Diagnosis: Dengue Hemorrhagic Fever I Subjective Complaints:

(-) abdominal pain(-) headache(-) bleeding(+) hyperemic pharyngeal wall(+) rash on upper extremities

S

Far Eastern University – Dr. Nicanor Reyes Medical FoundationDepartment of Child Health

Conscious, coherent, fretful, afebrile, not in distress BP = 100/60mmHg CR = 88bpm RR = 32cpm T = 36.7oC UO = cc/24 hr CRT = <2secsCongested turbinatesGargling on RUQ and epigastric areaAbdominal girth: 53cm (from 47cm)Full and equal pulses

O

Far Eastern University – Dr. Nicanor Reyes Medical FoundationDepartment of Child Health

Dengue Hemorrhagic Fever IA

Far Eastern University – Dr. Nicanor Reyes Medical FoundationDepartment of Child Health

DAT except dark-colored foodsRepeat CBC with PC at 6 amIVF D5NSS at a rate of 42cc/hr (3cc/kg)P

503GT. B., 6 y/o, female5th hospital day, 10th DOIWorking Diagnosis: Dengue Hemorrhagic Fever I Subjective Complaints:

(-) abdominal pain(+) cough(-) nasal discharge(-) sore throat(-) myalgia/arthralgia(-) malaise

S

Far Eastern University – Dr. Nicanor Reyes Medical FoundationDepartment of Child Health

Conscious, coherent, afebrile, not in distress BP = 100/60mmHg CR = 84bpm RR = 23cpm T = 36.8oC UO = cc/24 hr CRT = <2secsFlushed skinHyperemic pharyngeal wallDecreased breath sound at low mid to base more on the rightTenderness on epigastrium and RUQFull and equal pulses

O

Far Eastern University – Dr. Nicanor Reyes Medical FoundationDepartment of Child Health

Dengue Hemorrhagic Fever IA

Far Eastern University – Dr. Nicanor Reyes Medical FoundationDepartment of Child Health

DAT except dark-colored foodsRepeat CBC with PC at 6 amIVF D5NSS 1L at a rate of 36 cc/hr (22cc/kg)Paracetamol 250 mg/5 ml temp > 37.8oCFamotidine 7mg q12o TSIVHydroxyzine 10mg BID for itchingAdvised high back rest

P

503HT. B., 17 y/o, female3rd hospital day, 8th DOIWorking Diagnosis: Dengue Hemorrhagic Fever II Subjective Complaints:

(+) cough(-) abdominal pain(-) bleeding(-) nasal discharge(-) sore throat(-) myalgia/arthralgia(-) malaise

S

Far Eastern University – Dr. Nicanor Reyes Medical FoundationDepartment of Child Health

Conscious, coherent, afebrile, not in distress BP = 90/60mmHg CR = 72bpm RR = 20cpm T = 37.1oC UO = cc/24 hr CRT = <2secsPalatal petechiaeClear breath soundsTenderness on epigastric area and RUQ

O

Far Eastern University – Dr. Nicanor Reyes Medical FoundationDepartment of Child Health

Dengue Hemorrhagic Fever IIA

Far Eastern University – Dr. Nicanor Reyes Medical FoundationDepartment of Child Health

DAT except dark-colored foodsRepeat CBC with PC at 6 amIVF D5NSS at a rate of 83cc/hr (22cc/kg)Paracetamol 250 mg/5 ml,

P

ISO7K.A., 9 y/o, male31st hospital day, 33rd DOIWorking Diagnosis: Miliary TB malnutrition sec.

Anemia of chronic disease sec.

Otomycosis, AUChronic OM, AUSome dehydration –

correctedIntracranial abscess

vs TuberculomaAural polyp, AS

Subjective Complaints:(-) cough(-) fever(-) headache(-) abdominal pain

S

Far Eastern University – Dr. Nicanor Reyes Medical FoundationDepartment of Child Health

Conscious, coherent, afebrile, not in distress BP = 100/60mmHg CR = 86bpm RR = 25cpm T = 36.9oCAdynamic precordium, regular rate, regular rhythm, with skip beats, no palpable thrills, no heaves, no murmurs

O

Far Eastern University – Dr. Nicanor Reyes Medical FoundationDepartment of Child Health

Dengue Hemorrhagic Fever IA

Far Eastern University – Dr. Nicanor Reyes Medical FoundationDepartment of Child Health

DAT Lumbar puncture deferredRefer to Cardio serviceContinue medications

P

DISCHARGE

J.B.

• 10 years old• Male• Admitted last July 29, 2011• Discharged August 3, 2011• ADMITTING DIAGNOSIS:– Systemic Viral Infection

• FINAL DIAGNOSIS:– Dengue Hemorrhagic Fever Grade II

COURSE IN THE WARD

UPON ADMISSION

• Awake, weak looking, not in cardiorespiratory distress with some signs of dehydration

• BP: 110/70mmHg CR: 99/min• RR: 21/min Temp: 38.4oC• Whitish iris, OS• (-) ROR reflex, OU• Congested turbinates• Hyperemic pharyngeal wall with post-

nasal drip• Dry lips with moist buccal mucosa

UPON ADMISSION

• Diet as tolerated except for dark colored foods

• Venoclysed with D5 0.3NaCl to run at 133cc/hr for 6hrs (30cc/kg)

• CBC w/ PC revealed RBC Ct.: 5.04, Hgb: 14.00, Hct: 0.42, WBC Ct.: 2.85, Seg: 0.66, Lymph: 0.25, Mono: 0.07, Eo: 0.02, Plt: 151

• Urinalysis was requested• Paracetamol, 250mg/5mL, 6mL q4o for temp.

> 37.8oC (TD: 11.2mkd)• IVF was regulated to 89cc/hr to run for 18hrs

and D5IMB to follow at same rate (60cc/kg)

2ND HOSPITAL DAY (5TH DOI)• Afebrile, conscious, weak-looking, not in

cardiopulmonary distress• BP: 80/60mmHgCR: 86/min• RR: 21/min Temp: 36.9oC• Whitish iris, OS• (-) ROR reflex, OU• Congested turbinates• Hyperemic pharyngeal wall with post-nasal drip• Dry lips with moist buccal mucosa• (+) tenderness at epigastric area and right

upper quadrant• Liver span of 7.5cm with palpable 2cm liver

edge

2ND HOSPITAL DAY (5TH DOI)• Diet as tolerated except for dark

colored foods• Repeat CBC w/ PC was done which

revealed RBC Ct.: 5.29, Hgb: 14.90, Hct: 0.44, WBC Ct.: 3.30, Seg: 0.50, Lymph: 0.39, Mono: 0.11, Plt: 126

• Urinalysis was done which revealed 2-4/hpf WBC and 1-2/hpf RBC

• IVF was shifted to D5NSS to run at same rate.

• IVF was decreased to 66cc/hr (2.5cc/kg)

3RD HOSPITAL DAY (6TH DOI)• Afebrile, conscious, weak-looking, not in

cardiopulmonary distress• BP: 90/60mmHg CR: 78/min• RR: 21/min Temp: 37.3oC• Whitish iris, OS• (-) ROR reflex, OU• Congested turbinates• Hyperemic pharyngeal wall with post-nasal drip• Dry lips with moist buccal mucosa• (+) tenderness at epigastric area and right upper

quadrant• Liver span of 7.5cm with palpable 2cm liver edge• (+) gum bleeding

3RD HOSPITAL DAY (6TH DOI)• Diet as tolerated except for dark colored

foods• Repeat CBC w/ PC was done at 6am

which revealed RBC Ct.: 5.08, Hgb: 14.30, Hct: 0.42, WBC Ct.: 3.77, Seg: 0.59, Lymph: 0.32, Mono: 0.09, Plt: 63

• Repeat CBC w/ PC was done at 9pm which revealed RBC Ct.: 4.96, Hgb: 13.70, Hct: 0.41, WBC Ct.: 6.51, Seg: 0.54, Lymph: 0.40, Mono: 0.04, Eo: 0.02, Plt: 50

• IVF continued

4TH HOSPITAL DAY (7TH DOI)• Afebrile, conscious, weak-looking, not in

cardiopulmonary distress, with good appetite• BP: 90/60mmHg CR: 72/min• RR: 22/min Temp: 36.5oC• Whitish iris, OS• (-) ROR reflex, OU• Congested turbinates• Hyperemic pharyngeal wall with post-nasal drip• Moist lips with moist buccal mucosa• (+) tenderness at epigastric area and right upper

quadrant• Liver span of 7.5cm with palpable 2cm liver edge• (+) gum bleeding

4TH HOSPITAL DAY (7TH DOI)• Diet as tolerated except for dark colored

foods• Repeat CBC w/ PC was done at 6am

which revealed RBC Ct.: 4.99, Hgb: 13.90, Hct: 0.41, WBC Ct.: 7.75, Seg: 0.62, Lymph: 0.32, Mono: 0.04, Eo: 0.02, Plt: 52

• Started on Hydroxyzine dihydrochloride (Iterax) 2mg/ml, 7ml q12o or PRN for itchiness (TD: 1mkd)

• IVF site was changed and decreased to 53cc/hr (2cc/kg)

5TH HOSPITAL DAY (8TH DOI)• Afebrile, conscious, coherent, playful, not in

cardiopulmonary distress, with good appetite• BP: 90/60mmHg CR: 81/min• RR: 20/min Temp: 36.5oC• Whitish iris, OS• (-) ROR reflex, OU• Congested turbinates• Hyperemic pharyngeal wall with post-nasal drip• Moist lips with moist buccal mucosa• (-) tenderness at epigastric area and right upper

quadrant• Liver span of 7.5cm with palpable 2cm liver edge• (-) gum bleeding

5TH HOSPITAL DAY (8TH DOI)• Diet as tolerated except for dark

colored foods• Repeat CBC w/ PC was done at 6am

which revealed RBC Ct.: 5.23, Hgb: 14.60, Hct: 0.44, WBC Ct.: 9.56, Seg: 0.50, Lymph: 0.44, Mono: 0.03, Eo: 0.03, Plt: 100

• Medications continued• IVF was continued

6TH HOSPITAL DAY (9TH DOI)• Afebrile, conscious, weak-looking, not in

cardiopulmonary distress, with good appetite• BP: 90/60mmHg CR: 76/min• RR: 20/min Temp: 36.9oC• Whitish iris, OS• (-) ROR reflex, OU• Congested turbinates• Hyperemic pharyngeal wall with post-nasal drip• Moist lips with moist buccal mucosa• (+) tenderness at epigastric area and right upper

quadrant• Liver span of 7.5cm with palpable 2cm liver edge• (-) gum bleeding

6TH HOSPITAL DAY (9TH DOI)• Diet as tolerated except for dark

colored foods• Repeat CBC w/ PC was done which

revealed RBC Ct.: 4.70, Hgb: 13.10, Hct: 0.39, WBC Ct.: 5.95, Seg: 0.41, Lymph: 0.48, Mono: 0.05, Eo: 0.06, Plt: 162

• IVF was discontinued• Patient was discharged