Course Outline July 11,2011 8:15 pm Arrived at E.R requested to be admitted to ICU, under the service of Dr. J.B.

. Vital sign taken temp. 36c, CR: 62, RR: 21, PR: 58, BP 190/110mmHg. AP ordered NPO PNSS 1LX40 cc/hr. CBG result -160mg/dL Given Citicoline 1 gm IV@ 12Hr. Given Ranitidine 5omg IV Q8 Oral hygiene with Bactidol QID Administered oxygen @ 2L/min via nasal cannula. ECG 12 leads done, cranial CT scan plain done, Chest X-ray AP view done. Mannitol 200mL given IV (+) preferential gaze R GCS of 11 (+) mental retardation Monitor V/S and NVS Q hourly MIO Q shift CBG Q6

11 pm No available bed at ICU. Admitted to SJW from ER per stretcher with IVF going on transferred to bed safely and made Comfortable. GCS=11

July 12, 2011 12 am NGT inserted by Dr. O.A. Foley catheter inserted obtain 200 cc urine output. 12:20 am Nimotopp 30mg 2 caps and Dilantin 200mg 1 cap, given through patent NGT as tolerated. 2:00 6:00 am GCS monitored ranges from 9-11. 4:00 pm (+) for jerky movements for ICU admission, sorry without available bed. 6:00 pm Bleeding started/ OTF not yet available, GCS=10-11 as assessed. 7:45pm ICU transferred hold as ordered. Started OTF 1800 cal of 1200 ml volume into 6 feedings.

July 13,2011 10:00 am Anointed by Fr. Bolante. (+) Headache, febrile noted temp. 38.1, performed TSB.

7:45 pm Ordered PLRS 1L x 40cc per hour DC CBG monitoring Nyoric 1 cap per NGT. Stat.

2:00 pm (+) headache, TSB done, and diaper changed. 8:00 P.M (+) throat pain (+) right leg cramps, right leg elevated.

8:30 pm Febrile noted temp. 37.7 C TSB done. 10:00 pm Persistent febrile. (+) headache Given Paracetamol 500mg 1 tab Q4. PRN (-) BM x 3days Given Lactulose 30 cc @ H.S OD

July 14,2011 3:40 am NGT accidentally pulled out by patient referred to ROD, NGT insertion done by ROD. 10:00 A.M Turn to sides alternately. Complaints of headache referred to ROD, Norgesic forte given through patent NGT. O2 inhalation discontinued. IVF to KVO Shifted Ranitidine to Omeprazole 40mg 1 cap OD Calmoseptine ointment applied to pressure sores BID

July 15, 2011 9:00 amComplaints of headache made referred to ROD seen and examined. BP: 150/100 mmHg. May have small amount of Lugaw, Oatmeal, mashed banana P.O.

9:20 am Mannitol 100cc given advanced. 10:00 am BP re-checked 140/90mmHg. Headache lessened. Turned to alternate sides. 7:00 pm Dulcolax suppository 1 stick per order given as ordered. 8:30pm (+) for BM. 9:15 pm NGT pulled out accidentally. Re-inserted aseptically thereafter ROD. July 16, 2011 Decreased Mannitol 100ml Q6

8:00 pm Given Catapres 5mg Decreased Nimotopp to BID Referred to Dr. J.A for rehab evaluation and co-management

July 17, 2011 8:00 pm Losartan 100g 1 tab OD July 18, 2011 Stroke rehab ordered. Decreased Mannitol to 75ml Q8 Mosegor Vita Syrup 10ml via NGT OD with every feeding ordered.

July 19, 2011 Decreased Mannitol to 75ml Q12 x 3 doses and DC

Bladder training by clamping for 30 minutes and release. Consume IVF and discontinue DC NGT after morning NGT feeding and start soft diet.