adcon oct 9-10

8/19/2019 ADCON Oct 9-10

http://slidepdf.com/reader/full/adcon-oct-9-10 1/73

Admitting conferencOctober 9 - 10

DRs MACASPAC/ RONQUILLO-SARMIENTO

PGIs SHRESTHA/ VITUG

8/19/2019 ADCON Oct 9-10


` OB-CASES GYNE-CASES

RESOLVED:

(i) Seri!e " (#$%&''i!) *

(ii) Pri$%e + (,',-#$%&''i!) *

UNRESOLVED:

(i) Seri!e * *

(ii) Pri$%e " (#$%&''i!) +

T'%$:

8/19/2019 ADCON Oct 9-10


Ward Census

FLOOR OLD NEW REFERRAL TOTAL

.RD MB " + * .

.RD MT * " * "

TH MB " * * "

TH MT " " * +

0T& MT " + * .

ICU * * * *

TOTAL "*

8/19/2019 ADCON Oct 9-10


Patient Profile # 1

MB1 .. G+P"("**")

2ii#i,' G3$3$

CC: i,!re$se i, 4''5 #ress3re

8/19/2019 ADCON Oct 9-10

http://slidepdf.com/reader/full/adcon-oct-9-10 5/73History of Present I

2e6 &'3rs PTA

• (7) ↑ BP '8 "09/".*•

(7) He$5$!&e• (-) N$3se$/ V'i%i,• (-) $i,$ 4ee5i,• (-) &;#'$s%ri! #$i,

• C',s3%

8/19/2019 ADCON Oct 9-10


PASTMEDICAL• (7) HPN < " ;r

• A5'e%• (-) DM• (7) As%&$

•

L$s% $%%$!=- +;r $'• As%&$i,

• (-) Aer;• (-) G'i%er• (-) &e#$%i%is

2AMILY H>

• (7) DM- $%er,$• (7) HTN- #$%er,$• (-) ASTHMA• (-) CA•

(-) &e$r% 5ise$se

P AND

• (-) S'=e• (-) A!'&'

Dri,=er• C$%&'i!•

!'ee • 3,e#';• M$rrie5

8/19/2019 ADCON Oct 9-10


Obstetrics History

G+P" ("**")

G" : +**1 2TBB1 CSI < Pree!$#si$1Pri$%e H's#i%$1 +?+ =1 $ie

G+ : Prese,% Pre,$,!;

LMP: 3,s3reEDC: "+/+*/+*"9 4; UT@AOG: + / 6=s

8/19/2019 ADCON Oct 9-10


Gynecologic History

M". Y/O

I Irre3$r1 .- '

D DAYS

A PPD/2ULLY SOAED

S(-) DYSMENORRHEA

"s% SC:

SP:

(7) OCP 3se F " YEAR (+**)

(-) P's%-C'i%$ Bee5i,

(-) D;s#$re3,i$

(-) P$# Se$r

8/19/2019 ADCON Oct 9-10


PH!ICA" $A%I&A'IO&

Ge,er$: $6$=e1 !',s!i'3s1 !'&ere,%1 ,'% i,!$r5i'-res#ir$%'r; 5is%ress

Vi%$ si,s:BP: "*/"+* PR: 0 RR: " Te#: .'C

Hei&%: Prei'3s ei&%: " =1 BMI "0? =/+C3rre,% ei&%: * =1 BMI ++ =/+%? $i,: =

8/19/2019 ADCON Oct 9-10


PH!ICA" $A%I&A'IO&

HEENT: #i,= #$#e4r$ !',J3,!%i$e1$,i!%eri! s!er$e

L3,s: s;e%ri!$ !&es% e<#$,si',1 (-)re%r$!%i',s1 !e$r 4re$%& s'3,5s

He$r%: $5;,$i! #re!'r5i31 (-) 3r3r1

,'r$ r$%e $,5 r&;%&

8/19/2019 ADCON Oct 9-10


PH!ICA" $A%I&A'IO& Abdomen: '43$r1 ,', %e,5er1 7 s%ri$e

2H: .*! 2HT "9*s

Le'#'5s $,e3er:

LM": $re1 ,'53$r $ss '!!3#ies %&e 83,53s (4ree!&)

LM+: &$r5 resis%$,% s%r3!%3re ', %&e ri&% $%er,$ si5e1 irre3$r e8% $%er,$ si5e

LM.: &$r51 r'3,5 ,',-4$'%$4e s%r3!%3re (!e#&$i!1 e,$e5)

LM9: &e$5 5es!e,%1 !e#&$i! #r'i,e,!e ', %&e '##'si%e si5e '8 %&

IE: Ceri< !'se5

Extremities: 83 $,5 eK3$ #3ses1 (-) e5e$

8/19/2019 ADCON Oct 9-10


Initial C'G

B 2HT: "*-"s1 '5er$%e $ri$4ii%;1 (7) $!!eer$%i',s1 (-) 5e!eer$%

8/19/2019 ADCON Oct 9-10


Admitting diagnosis

G+P" ("**") PU + / 6ee=s AOG1N'% i, $4'r

C&r',i! &;#er%e,si', 6i%&s3#eri#'se5 seere #ree!$#si$

8/19/2019 ADCON Oct 9-10


P"A&

MSO9 5ee# IM ', e$!& 43%%'!=sH;5r$$i,e /IV

De<$e%&$s',e /IM

MSO9 5ri# F MSO9 "* i, PNSS **!! < "**!

8/19/2019 ADCON Oct 9-10


Patient Profile # (

MG1 ." G+P"("**")

2ii#i,'M$4$$!$%

CC: H;#'$s%ri! #$i,

8/19/2019 ADCON Oct 9-10


History of Present I

2e6 &'3rs PTA

• (7) H;#'$s%ri! #$i,• (7) B''5; 3!'i5 5is!&$re• (-) $%er; $i,$ 5is!&$re• (7) G''5 8e%$ 'ee,%

• C',s3%

8/19/2019 ADCON Oct 9-10


PASTMEDICAL

• (-) HPN• (-) DM• (-) As%&$•

(-) Aer;• (-) G'i%er• (-) &e#$%i%is

2AMILY H>

• (7) DM- #$%er,$• (7) HTN- #$%er,$• (-) PTB•

(-) ASTHMA• (-) CA• (-) &e$r% 5ise$se

P AND

• (-) S'=e• (-) A!'&'

Dri,=er•

M$rrie5• C$%&'i!• C'ee • O#&%&$ N

8/19/2019 ADCON Oct 9-10


Obstetrics History

G+P" ("**")G" +*"+1 2TBG1 NSD1 ;i,-i, !i,i!14s?1 (-) !'#i!$%i',s1 $ie

G+ Prese,% #re,$,!;

LMP $,? +*"9EDC "*/"/"9 4; UT@AOG .0 /

"s% PNCU F 6ee=s AOG

PNCU - "*

8/19/2019 ADCON Oct 9-10


Gynecologic History

M". Y/O

I Re3$r1 .* 5$; !;!eD 9 DAYS

A 9- PPD/MODERATELY SOAED

S(-) DYSMENORRHEA

"s% SC: +*

SP: "

(-) OCP 3se

(-) P's%-C'i%$ Bee5i,

(-) D;s#$re3,i$

(-) P$# Se$r

8/19/2019 ADCON Oct 9-10


PH!ICA" $A%I&A'IO&


Vi%$ si,s:BP: ".*/0* PR: 09 RR: "0 Te#: .?'C

Hei&%: Prei'3s ei&%: ".9 4s1 BMI ++?9 =/+Prei'3s ei&%: "* 4s1 BMI +? =/+%? $i,: + 4s

8/19/2019 ADCON Oct 9-10


PH!ICA" $A%I&A'IO&



He$r%: $5;,$i! #re!'r5i31 (-) 3r3r1

,'r$ r$%e $,5 r&;%&

8/19/2019 ADCON Oct 9-10


PH!ICA" $A%I&A'IO& Abdomen: '43$r1 ,', %e,5er

2H: .9! 2HT "9*s E2: .9"*

Le'#'5s $,e3er:


LM+: &$r5 resis%$,% s%r3!%3re ', %&e ri&% $%er,$ si5e1 irre3$r '4ie #$$%er,$ si5e

LM.: &$r51 r'3,5 ,',-4$'%$4e s%r3!%3re (!e#&$i!1 e,$e5)

LM9: &e$5 5es!e,%1 !e#&$i! #r'i,e,!e ', %&e '##'si%e si5e '8 %&e 8e%$ 4$

IE: Ceri< . ! 5i$%e5 (+)1 #'s%eri'r #'si%i', (*)1 * e88$!e5 (+)1 e5? s'8(7) BO1 S%$%i', -. (*)

Bis&'# s!'re:

i i l

8/19/2019 ADCON Oct 9-10


Initial C'G

B 2HT: "*-"1 M'5er$%e $ri$4ii%;1 (7) $!!eer$%i',s1 (-) 5e!eer$%i',!',%r$!%i',s eer; +-. i,3%es i, $ +* i,? s%ri#1 M',%ei5e' 3,

Labor Curve

HNBB " $# HNBB " $#

8/19/2019 ADCON Oct 9-10


- "*

7 *

7. +

79 "

-9

-. 0

-+

-"

*

7+ .

7" 9

* " + . 9 0 "* ""

# "* "" "+ "$ + . 9

Labor Curve

E#i53r$$,es%&esi$

N34$i, 7Pr'e%&$i,e

+/IV

DLRS IL.*%%s/i,

HNBB " $# HNBB " $#

N34$i, 7Pr'e%&$i,e

+/IV

8/19/2019 ADCON Oct 9-10


Admitting diagnosis

G+P" ("**") Pre,$,!; U%eri,e .0/ 6ee=s AOG1 Ce#&$i!1 i, $4'r

8/19/2019 ADCON Oct 9-10


P"A&

A6$i%s 5eier;

P i P fil *! i ,

8/19/2019 ADCON Oct 9-10


Patient Profile # ) *!er+ice,

SM1 + G+P*(**"*)

2ii#i,'A,ees

!i%;

CC: 6$%er; $i,$ 5is!&$re

8/19/2019 ADCON Oct 9-10



2e6 &'3rs PTA

• (7) $%er; $i,$ 5is!&$re• (7) &;#'$s%ri! #$i,• (-) $i,$ 4ee5i,• (7) ''5 8e%$ 'ee,%

• C',s3%

8/19/2019 ADCON Oct 9-10


PASTMEDICAL• (-) HPN• (-) DM• (7) As%&$

• L$s% $%%$!= : HS

• (7) Aer;: Ce8$e<i,• (-) G'i%er• (-) &e#$%i%is

2AMILY H>

• (7) DM- #$%er,$• (-) HTN• (-) ASTHMA• (7) CA- 4re$s% C$-

$%er,$• (-) &e$r% 5ise$se

P AND

• (-) S'=e• (-) A!'&'

Dri,=er• C$%&'i!•

V'!$%i',$• C$s&ier• M$rrie5 F

8/19/2019 ADCON Oct 9-10


Obstetrics History

G+P*G" : +**01 " '1 !'#e%e is!$rri$eG+: PP

LMP: *"/*./+*"9EDC: "*/"*/+*"9

8/19/2019 ADCON Oct 9-10


Gynecologic History

M". Y/O

I Re3$r1 +0 5$; !;!eD .-9 DAYS


S(7) DYSMENORRHEA

"s% SC: "

SP: 9

(-) OCP 3se

(-) P's%-C'i%$ Bee5i,

(-) D;s#$re3,i$

(-) P$# Se$r

8/19/2019 ADCON Oct 9-10


PH!ICA" $A%I&A'IO&


Vi%$ si,s:BP: "+*/0* PR: 00 RR: " Te#: .?'C

Hei&%: 9Prei'3s ei&%: + =1 BMI "? =/+C3rre,% ei&%: =1 BMI +9? =/+%? $i,: ". =

8/19/2019 ADCON Oct 9-10


PH!ICA" $A%I&A'IO&



He$r%: $5;,$i! #re!'r5i31 (-) 3r3r1

,'r$ r$%e $,5 r&;%&

8/19/2019 ADCON Oct 9-10



2H: .9! 2HT "9*s E2: .9"*

Le'#'5s $,e3er:



LM.: &$r51 r'3,5 ,',-4$'%$4e s%r3!%3re (!e#&$i!1 e,$e5)

LM9: &e$5 5es!e,%1 !e#&$i! #r'i,e,!e ', %&e '##'si%e si5e '8 %&

IE: Ceri< . ! 5i$%e5 (+)1 #'s%eri'r #'si%i', (*)1 * e88$!e5 (")1(-) BO1 S%$%i', -+ (")

Bis&'# s!'re:

Initial C'G

8/19/2019 ADCON Oct 9-10


Initial C'G

B 2HT: "9-"*s1 i,i$-'5er$%e $ri$4ii%;1 (7) $!!eer$%i',s1 (-) 5e'5er$%e !',%r$!%i',s eer; +-. i,3%es i, $ +* i,? s%ri#1 M',%ei5

DLRS IL 7 "* 3O i "*

8/19/2019 ADCON Oct 9-10


# "* "" "+

- "*

7 *

7. +

79 "

-9

-. 0

-+

-"

*

7+ .

7" 9

O<;%'!i, "*%%s/i,

" $# HNBB" $# HNBB

8/19/2019 ADCON Oct 9-10


Admitting diagnosis

G+P* (**"*) PU . / 6ee=s AOG1Ce#&$i!1 i, $4'r1 GDM - 5ie%!',%r'e5

8/19/2019 ADCON Oct 9-10


P"A&A6$i%s 5eier;

8/19/2019 ADCON Oct 9-10


inal .iagnosis

G+P* (**"*) PU %er !e#&$i! 5eiere5 i$ NSie 4ir%& 4$4; 4';1 B +?9=1 BL : "!1 AS NMR . 6ee=s AGA1 %&i!=; e!',i3 s%$i,e5$,i'%i! 83i51 GDM - 5ie% !',%r'e5

8/19/2019 ADCON Oct 9-10


8/19/2019 ADCON Oct 9-10



2e6 &'3rs PTA

• (7) 6$%er; $i,$ 5is!&$re•

(-) $i,$ 4ee5i,• (-) &;#'$s%ri! #$i,• (7) ''5 8e%$ 'ee,%

• C',s3%

8/19/2019 ADCON Oct 9-10


PASTMEDICAL• (-) HPN• (-) DM• (-) As%&$• (-) Aer;•

(-) G'i%er• (-) &e#$%i%is

2AMILY H>

• (7) DM- #$%er,$• (7) HTN- #$%er,$• (-) ASTHMA• (-) CA•

(-) &e$r% 5ise$se

P AND

• (-) S'=e• (-) A!'&'

Dri,=er• B'r, $$i•

V'!$%i',$• Te!&,i!i$• M$rrie5

8/19/2019 ADCON Oct 9-10


Obstetrics History

G"P*G" : Prese,% Pre,$,!;

LMP "//"9EDC "*/"9/"9

AOG . +/

G l i Hi t

8/19/2019 ADCON Oct 9-10


Gynecologic History

M"+ Y/O

I Re3$r1 +0 5$; !;!e

D 9- DAYS


S(-) DYSMENORRHEA

"s% SC: +SP: "

(-) OCP 3se

(-) P's%-C'i%$ Bee5i,

(-) D;s#$re3,i$

(-) P$# Se$r

8/19/2019 ADCON Oct 9-10


PH!ICA" $A%I&A'IO&


Vi%$ si,s:BP: "+*/0* PR: 00 RR: " Te#: .?'C

Hei&%: 9Prei'3s ei&%: ".+ 4s1 BMI ++? =/+C3rre,% ei&%: " 4s1 BMI +? =/+%? $i,: + 4s

8/19/2019 ADCON Oct 9-10


PH!ICA" $A%I&A'IO&HEENT: #i,= #$#e4r$ !',J3,!%i$e1$,i!%eri! s!er$e


He$r%: $5;,$i! #re!'r5i31 (-) 3r3r1

,'r$ r$%e $,5 r&;%&

PH!ICA" $A%I&A'IO&

8/19/2019 ADCON Oct 9-10



2H: .9! 2HT "9*s E2: .9"*

Le'#'5s $,e3er:



LM.: &$r51 r'3,5 ,',-4$'%$4e s%r3!%3re (!e#&$i!1 e,$e5)LM9: &e$5 5es!e,%1 !e#&$i! #r'i,e,!e ', %&e '##'si%e si5e '8 %&

IE: Ceri< . ! 5i$%e5 (+)1 #'s%eri'r #'si%i', (*)1 * e88$!e5 (")1(7) BO1 S%$%i', -+ (")

Bis&'# s!'re:

Initial C'G

8/19/2019 ADCON Oct 9-10


Initial C'G

B 2HT: ".*-".s1 M'5er$%e $ri$4ii%;1 (7) $!!eer$%i',s1 (-) 5e!eer$%i',!',%r$!%i',s eer; 9- i,3%es i, $ +* i,? s%ri#1 M',%ei5e' 3,

DLRS IL 7 "* 3O<;%'!i, "*

N34$i, 7Pr'e%&$i,e

+/IV

8/19/2019 ADCON Oct 9-10


"+# " + . 9

- "*

7 *

7. +

79 "

-9

-. 0-+

-"

*

7+ .

7" 9

%%s/i,+/IV

" $# HNBB " $# HNBB

8/19/2019 ADCON Oct 9-10


Admitting diagnosis

G"P* PU . +/ 6ee=s AOG1Ce#&$i!1 i, $4'r

8/19/2019 ADCON Oct 9-10


P"A&A6$i%s 5eier;

8/19/2019 ADCON Oct 9-10


inal .iagnosis

G"P" ("**") PU Ter !e#&$i! 5eiere5 NSVD1 LBBB B +?0 =1 BL 90! AS 01 N. 6ee=s AGA1 Si,e ,3!&$ !'r5 !'i

8/19/2019 ADCON Oct 9-10


Patient Profile # )

A1 ++ G"P*(**"*)

2ii#i,'

C$%&'i! M$4$$!$%

CC: V$i,$ 4ee5i,

8/19/2019 ADCON Oct 9-10



6ee=s

PTA

• (7) V$i,$ 4ee5i, 6i%& !'%s• (7) !',s3% 6$s 5',e• TVS: %&i!=e,e5 e,5'e%ri3• DC 6$s 5',e

+ 6ee=s

PTA

• (7) V$i,$ 4ee5i,1 .-9 ##5• N' !',s3%

8/19/2019 ADCON Oct 9-10



2e6 &'3rs PTA

• Persis%e,!e '8 $i,$

4ee5i,• C',s3% $% $,'%&er PMD• A5ise5 $5issi',

8/19/2019 ADCON Oct 9-10


PAST

MEDICAL• (-) HPN• (-) DM• (-) As%&$• (-) Aer;• (-) G'i%er

2AMILY H>

• (-) DM• (-) HTN• (-) PTB• (-) ASTHMA• (-) Bre$s%

P AND S H

• (-) S'=er• (-) A!'&'i!

4e? 5ri,=er• Si,e• INC• Hi&s!&''

3,5err$53$• U,e#';e5

Obstetrics History

8/19/2019 ADCON Oct 9-10


G"P* (**"*)G" +*"91 9 ',%&s AOG1 e$!3$%e5 4; DC1 Pri

&'s#i%$

Gynecologic History

8/19/2019 ADCON Oct 9-10


Gy eco og c sto yM". Y/O

I Re3$r1 .* 5$;s !;!e

D .-9 DAYS

A 0 PPD/MODERATELY SOAED

S (-) DYSMENORRHEA

"s% Se<3$ C',%$!%: "

N34er '8 Se<3$ #$r%,ers: .

(-) OCP

(-) P's%-C'i%$ Bee5i,

(-) D;s#$re3,i$

(-) P$# Se$r

8/19/2019 ADCON Oct 9-10


PH!ICA" $A%I&A'IO&


Vi%$ si,s:BP: ""*/* PR: + RR: "0 Te#: .?.

Hei&%:

C3rre,% 6ei&%: .=

BMI " =/+ (U,5er6ei&%)

8/19/2019 ADCON Oct 9-10


PH!ICA" $A%I&A'IO&

HEENT: #i,= #$#e4r$ !',J3,!%i$e1 $,i!%eri!s!er$e


He$r%: $5;,$i! #re!'r5i31 (-) 3r3r1,'r$ r$%e $,5 r&;%&

Abdomen: 2$44;1 NABS1 ,', %e,5er


PH!ICA" $A%I&A'IO&

8/19/2019 ADCON Oct 9-10


PH!ICA" $A%I&A'IO&

Abdomen: 2$%1 NABS1 s'8%1 ,', %e,5er

SE: !eri< #i,=1 s''%&1 (-) er'si',s1 (-) $!%ie 4ee5i,

IE: !eri< !'se5


8/19/2019 ADCON Oct 9-10


Admitting diagnosis

G"P* (**"*) A4,'r$ U%eri,e Bee5i,s/# DC Se#%e4er 91 +*"9

8/19/2019 ADCON Oct 9-10


Plan

IV2: DLRS "L < VO2'r CBC1 B''5 %;#i,

Tr$,e<$i! $!i5 "/IV

i fil

8/19/2019 ADCON Oct 9-10


Patient Profile # /

PA1 ."G.P+(+*"+)

2ii#i,'

C$%&'i!A,ees

Ci%;

CC: Pr'',e5 e,ses

8/19/2019 ADCON Oct 9-10



+ 6ee=s

PTA

• (7) V$i,$ 4ee5i,1 .-9 ##5• (-) H;#'$s%ri! #$i,•

N' !',s3%

" 5$;

PTA

• Persis%e,!e '8 $i,$ 4ee5i,• C',s3% 5',e1 TVS: %&i!=e,e5

e,5'e%ri3•

S!&e53e5 8'r DC

8/19/2019 ADCON Oct 9-10


PASTMEDICAL

• (-) HPN• (-) DM• (-) As%&$• (-) Aer;• (-) G'i%er

2AMILY H>

• (-) DM• (-) HTN• (-) PTB• (-) ASTHMA• (-) Bre$s%

P AND S H

• (-) S'=er• (7) O!!?

$!'&'i! 4e5ri,=er

• Si,e• C$%&'i!• C'ee

r$53$%e• C$ !e,%er

$e,%

Obstetrics History

8/19/2019 ADCON Oct 9-10


G.P+ (+*"+)G" +**91 . ',%&s AOG1 e$!3$%e5 4; DC1 Pri

&'s#i%$G+ +**91 2TBB1 CS I < 8e%$ 5is%ress1 Pri$%e &'s#? 4s1 (-) !'#i!$%i',s1 $ie

G. +**01 2TBG1 CS II < re#e$%1 Pri$%e &'s#i%$1 (-) !'#i!$%i',s1 $ie

Gynecologic History

8/19/2019 ADCON Oct 9-10


M". Y/O

I Irre3$r1 +0 5$;s - . ',%&s

D .-9 DAYS

A . PPD/2ULLY SOAED

S (-) DYSMENORRHEA

"s% Se<3$ C',%$!%: "0

N34er '8 Se<3$ #$r%,ers: "

(-) OCP

(-) P's%-C'i%$ Bee5i,

(-) D;s#$re3,i$

(7) P$# Se$r +**0 ,'r$

PH!ICA" $A%I&A'IO&

8/19/2019 ADCON Oct 9-10


PH!ICA" $A%I&A'IO&


Vi%$ si,s:BP: ".*/* PR: 09 RR: " Te#: .?.

Hei&%:

C3rre,% 6ei&%: "+ 4s

BMI .? =/+

PH!ICA" $A%I&A'IO&

8/19/2019 ADCON Oct 9-10


PH!ICA" $A%I&A'IO&

HEENT: #i,= #$#e4r$ !',J3,!%i$e1 $,i!%eri!s!er$e


He$r%: $5;,$i! #re!'r5i31 (-) 3r3r1

,'r$ r$%e $,5 r&;%&Abdomen: 2$44;1 NABS1 ,', %e,5er


Ad itti di i

8/19/2019 ADCON Oct 9-10


Admitting diagnosis

G.P+ (+*"+) A4,'r$ U%eri,e Bee5i,E,5'e%ri$ P$%&'';

Pl

8/19/2019 ADCON Oct 9-10


Plan

Di$%$%i', $,5 C3re%%$e

'an o

8/19/2019 ADCON Oct 9-10


'an you

adcon oct 9-10

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