University of the East

UNIVERSITY OF THE EAST

RAMON MAGSAYSAY MEMORIAL MEDICAL CENTER

Aurora Boulevard, Quezon City

DEPARTMENT OF PSYCHIATRY

Daily Patient Endorsements

June 26, 2009

Service Consultant of the Month: Dr. Germar

Resident on Duty: Dr. Elham Mae Bocalbos

Senior Interns on Duty: SI Bermejo/Manaloto/Mandapat

Junior Interns on Duty: JI Mendoza/Mojica

PAY / SERVICE / ER Calls / 3
New Admission / 1 / New Admission / 1 / Discharges / 0
Old In-patients male / 1 / Old In-patients male / 4 / Out on Pass / 0
Old In-patients female / 1 / Old In-patients female / 6 / DAMA / 0
New Referrals / 1 / New Referrals / 0 / Absconded / 0
Old Referrals / 1 / Old Referrals / 1 / Sign out of Service / 0
Total In-patients / 5 / Total In-patients / 12 / Mortality / 0

PAY = 5

NEW ADMISSION = 1

MOSTOLES, Rianne Gilbert
25/M
Dr. Rodriguez/Dr Bocalbos
SI Bermejo/Manaloto/Mandapat
JIIC Morales
436
Date of Admission: 06.26.09
1st admission
Axis I: Substance-induced Psychosis vs. Schizophreniform
Axis II: Deferred
Axis III: None
Axis IV: Unemployment
Axis V: GAF 31-40 / Medications:
Quetiapine (Seroquel XR) 100mg/tab 1 tab HS
06.26.09
Please admit to MPW under the service of Dr. Germar/Bocalbos.
Secure consent for admission and management
DAT
TPR q shift
Weigh patient and record please
Ensure 24hr responsible male adult watcher
Strict suicide and escape precautions
Psych JIIC/JIOD to do initial summary, trauma form
Psych JIIC to do complete database, anamnesis, case discussion, lab flow sheet, drug charting, daily progress notes
Psych SIOD to do admitting notes
Psych JIIC/JIOD to monitor VS q4, sleep monitoring q1
Problem 1: substance induced psychosis vs schizophreniform
Diagnostics: CBC, Urinalysis, SGPT, SGOT, BUN, Crea, 12-L ECG, metamphetamine and cannabinoid assay
Therapeutics: Quetiapine (Seroquel XR) 100mg/tab 1 tab at 8pm
Problem 2: assault risk
May give Haloperidol 5mg/amp 1cc + Diphenhydramine 500mg/amp IM as cocktail dose OR
May give Olanzapine 10mg/vial IM OR
May give Risperidone 2mg/tab prn for restlessness, agitation, refusal to take oral meds
May place patient on ISO with 4 point restriction
Refer to Psych ROD/SIOD prior to administration of prn meds
Will inform service consultant
NOD to inform Psych ROD/SIOD once patient is in ward
Refer accordingly
7.20pm
May transfer to Rm 436 under the service of Dr. Rodriguez

OLD ADMISSION = 2

ESTRELLA, Justiniano
56/M
Dr. Luspo/Bocalbos
SI Bermejo/Manaloto/Mandapat
JIIC Olarte
332
Date of Admission: 06.20.09
6th HD
Axis I: Generalized Anxiety Disorder R/O Mood Disorder secondary to Hypothyroidism; DM II
Axis II: None
Axis III: R/O hypothyroidism; R/O diabetes mellitus type 2
Axis IV: Psychosocial problems
Axis V: GAF 71-80 / Medications:
Sertraline 2mg/tab 1 tab @ 8pm
Clonazepam (Rivotil) 2mg/tab 1 tab at bedtime
Atenolol 50mg/tab 1 tab OD
Ciprofloxacin 500mg/tab 1tab BID
Therabloc 50mg/tab OD
06.26.09
MGH in AM
Therabloc 50mg/tab OD
Ciprofloxacin 500mg/tab 2x a day for 5 days
TCB after 1 week
Allow relative to photocopy all lab results
7.40pm MGH in am, please inform Dr. Ramos and Dr. San Luis
Home meds: Sertraline 2mg/tab 1 tab at 8pm
Clonazepam 2mg/tab 1 tab at bedtime, ¼ tab anytime when needed
For follow up on 07.07.09 room 119.
06.25.09
12:15pm: Rounds with Dr. San Luis
May go home neuro wise
7pm: Continue meds
06.24.09
6pm: Rounds with Dr. Ramos
No objection if for discharge
8:50am: Follow-up EEG result
06.23.09
For ECG today
Rounds with Dr. Ramos
Shift Felodipine to Atenolol 50mg/tab 1 tab OD
For repeat Ca tom AM
Include PSA in tom
Problem: Cholecystitis
Start Ciprofloxacin 500mg/tab 1tab BID for 7 days
7.30pm Sidenotes:
With complaints of LE trembling and feeling of warmth
Rounds with Dr. Luspo
Revised medication: give Rivotril 2mg/tab 1tab @ bedtime
During day time may give Rivotril ¼ tab if needed for anxiety. Pleae inform psych ROD/SIOD prior to giving of PRN / 06.24.09
Routine Fecalysis: Parasites or ova – negative
PSA: 0.56
Calcium 2.3
06.22.09
CXR: consider pulmonary tuberculosis with cicatricial atelectasis of the RUL
Atherosclerotic aorta
Thyroid UTZ: right thyroid lobe solid nodules; normal left thyroid and isthmus
Abdominal UTZ: cholelithiasis with evidence of cholecystitis, non-dilated biliary tree; normal liver, pancreas, spleen, GB, kidneys and urinary bladder; grade 1 prostatic enlargement. Negative for hyperechoic nodule. Benign prostatic hypertrophy is considered.
06.21.09
Calcium subs 1.8
Glycosylated Hemoglobin 7.1
Albumin mass C 39
Na 140, K 3.9, Glucose subs 4.6, BUN 4.6, Crea 83
Urinalysis: Color yellow, Turbidity clear, Reaction acidic, Sp. Gr. 1.030, Protein negative, Sugar negative, RBC none, WBC none, Casts none, Bacteria none, epithelial cells few, Mucus threads none
CBC: Hgb 136, MCH 28.1, Hct 40, MCV 83, MCHC 33, RBC 4.8, WBC 8.2, N 59, L 38, M 1, E 1, B 1, Platelet N, RBC normochromic, normocytic
Impression: Right lobe several solid and cystic nodules
Unremarkable ultrasound of the left and isthmus lobe
FT3 5.11, FT4 15.61, 3rd gen. TSH 0.615
PASAMBA, Rebecca
52/F
Dr. Soriano/Bocalbos
SI Bermejo/Manaloto/Mandapat
JIIC Magtibay
427
Date of Admission: 06.21.09
5th HD
Axis I: Bipolar I, MRE manic w/ mood congruent psychotic features
Axis II: Deferred
Axis III: S/P thyroidectomy, 1995; HTN, uncontrolled
Axis IV: conflict with husband
Axis V: GAF 61-70 / Medications:
Quetiapine (Seroquel XR) 400 mg/tab, 1 tab at 8 pm
Divalproate Na 250mg/tab 1tab BID
Clonazepam (Rivotril) 2mg/tab ½ tab at 8am
½ tab at 1pm
½ tab at 8pm
06.25.09
11:30am Please make sure Seroquel XR is available @ 400mg tab tonight.
Refer accordingly.
7:30pm Rounds with Dr. Soriano
Psychotherapy done
Please give Fluphenazine decanoate (Modezine) 25mg/ml ½ cc thru IM c/o Psych-OPD tom
06.24.09
2pm Please give Clonazepam (Rivotril) 2mg/tab ½ tab at 8am
½ tab at 1pm
½ tab at 8pm
Please increase Quetiapine (Seroquel XR) 400mg/tab 1 tab at 8pm
06.23.09
Starting tonight please give Divalproate Na 250mg/tab 1 tab BID
Please inform psych ROD/SIOD if patient’s husbands visits
Sidenotes: (+) labile mood, talkative, pressured speech, preoccupied with thoughts of being talked about; (+) delusions of reference; jealousy; projection
06.22.09
9:30 am Please hold giving of Clonazepam temporarily.
Previous order of IVF insertion temporarily on hold.
Refer accordingly.
Please encourage increased OFI.
Side note: improving appetite
Good sleep
10:50 am Rounds with Dra. Soriano.
Discontinue Sertraline.
Starting tonight, shift to Qutiapine (Seroquel XR) 300 mg/tab, 1 tab at 8 pm.
Side note: Bipolar
7 pm Patient for portable CXR per patient and relative’s request. / 06.22.09
CXR, 8 pm wet read:
Clear lung fields.
True cardiac size not ascertained.
Aorta unremarkable.
Other chest structures not remarkable.
06.21.09
Special Urinalysis: Metamphetamines – negative, Cannabinoids – negative
Urinalysis: Color – yellow, Turbidity – cloudy, Reaction – acidic, Sp. Gr. – 1.030, Protein – trace, Sugar – negative, RBC – none, WBC – 3-5/hpf, Casts – none, Bacteria – few, Epithelial cells – many, Mucus threads – none
BUN – 5.6 mmol/L, Crea – 82 mmol/L, SGOT – 31 Iu/L, SGPT – 23 Iu/L
CBC: Hgb 127, MCH 27.4, Hct 37, MCV 81, MCHC 33, RBC 4.6, WBC 9.7, Neutrophils 62, Lymphocytes 38, Platelet Normal, RBC Morphology N,N

NEW REFERRAL = 0

OLD REFERRALS = 2

ABCEDE, Molly
14/F
Dra. Germar/Bocalbos
SI Gatmaitan/Panga
JIIC Mangotara
407
Date of Admission: 06.20.09
6th HD
Date of Referral: 06.25.09
1st RD
Axis I: t/c Mood d/o due to GMC
Axis II: Deferred
Axis III: DM type I, DKA, R/O dengue fever
Axis IV: illness
Axis V: GAF 81-90 / Medications:
Dulcolax supp, 1 supp at bedtime
Ciprofloxacin 500 mg/tab, 1 tab q12
Humulin N 24 ‘u’ SQ q6am
Humulin N 18 ‘u’ SQ q6pm
06.26.09
9.30am
Psychiatry Patient seen and examined, history reviewed
Patient shows normal expected reactions to having been diagnosed with a chronic medical illness. She feels sad and worrie3d about her condition, with questions regarding potential impact on her level of activities. However, strengths in her personality-maturity for her age, flexibility, intelligence, are expected to help her cope well with her condition
Psycho evaluation and counseling done. Patient was advised to know more about her illness. Possibility of joining local support group for individuals with juvenile DM was also raised. Thank you for the referral.
11am
Rounds with Dr. Ramos
Revise insulin coverage as follows:
HN 24 u SQ qam
HN 18 u SQ qpm
Dec CBG monitoring to q12
MGH endo wise
06.25.09
6:15 pm Psychiatry Notes:
Seen patient, parents interviewed, and history reviewed and laboratory requests noted.
Will inform Dr. Germar of this referral.
Thank you.
Please refer to Dr. Germar for evaluation.
Problem: chronic illness juvenile DM / 06.25.09
CBC
Hgb 112, Hct 32, RBC 3.9, WBC 7.2, N 67, L 33, Plt 229, morpho N/N
06.23.09
CBC, 6:38 am
Hgb 123, Hct 33, RBC 4.3, WBC 9.2, N 73, L 27, Plt 66, morpho N/N
6:11 am
Hgb 121, Hct 33, Plt 86
K+ - 3.1
Urinalysis
Urinalysis: Color – lt yellow, Turbidity – hazy, Reaction – acidic, Sp. Gr. – 1.005, Protein – trace, Sugar – positive, RBC – 2-4/hpf, WBC – many, Casts – none, Bacteria – few, Epithelial cells – occasional
RAMOS, Maria Milagrosa
38/F
Dr. Los Banos/Bocalbos
SI Gatmaitan/Panga
JIIC Morales
311
Date of Admission: 05.24.09
33rd HD
Date of Referral: 05.24.09
33rd RD
Axis I: Major Depressive Disorder, Panic Disorder
Axis II: None
Axis III: Hyperthyroidism
Axis IV: Psychosocial Stress (Conflict with partner and relatives)
Axis V: GAF 91-100 / Medications:
Alprazolam 250mg/tab BID
Sertraline 50mg/tab, ½ tab QHS
Inderal 40mg, 1 tab BID
Neomecrazole 10mg/tab OD
06.01.09
2:10 pm: May go home Psych wise
Continue medications
1.  Alprazolam 250mg/tab BID
2.  Sertraline 50mg/tab ½ tab HS
Follow up with Dr. Los Banos after 2 weeks.
3:10pm: Dr. Guiang updated
No objections to discharge

SERVICE = 11

NEW ADMISSION = 1

MOJARES, William
27/M
Dr Germar/Dr Bocalbos
SI Bermejo/Manaloto/Mandapat
JIIC Nadal
MPW
Date of Admission 06.26.09
1st admission
Axis I: Chronic Alcohol Abuse
Axis II: Deferred
Axis III: Impaired Liver Function
Axis IV: Deferred
Axis V: GAF 61-70 / Medications:
Essential Forte 1 cap OD
Seroquel XR 100mg/tab, 1 tab qHS
Rivotril 2mg/tab, ½ tab q8am
06.29.09
Please admit to male psych ward under the service of Dr Germar
Secure consent for admission and management
DAT, TPR every shift
Weigh patient and record please
Ensure 24 hour responsible male adult watcher
Strict suicide and escape precautions
Psych JIIC/JIOD to do initial summary
Psych JIIC to do complete database, anamnesis, case discussion, lab flow sheet, drug charting, and daily progress notes
Psych SIOD to do admitting notes
Psych JIIC/JIOD to monitor VS q4; sleep monitoring q1’
Problem: psychosis with alcohol abuse; alcohol withdrawal
Diagnostics: CBC, U/A SGPT/SGOT, CXR, 12 L ECG done
Therapeutics: continue Essential Forte 1 cap OD
Seroquel XR 100mg/tab, 1 tab qHS
Rivotril 2mg/tab, ½ tab q8am
WOF: seizures and tremors
Problem: assault risk
May give Haloperidol 5mg/amp 1cc + Diphenhydramine 50mg/amp IM as cocktail dose or
May give Olanzapine 10mg/vial IM or
May give Risperidone (Risperdal quicklet) 2mg/tab, 1 tab PRN for restlessness, agitation and refusal to take oral meds
May place patient on ISO with 4 pt restraints
Refer to psych ROD/SIOD prior to administration of PRN meds
Will inform service consultants
NOD to inform psych ROD/SIOD once patient is in psych ward
Refer accordingly

OLD IN PATIENTS = 10

Male = 4

AGUILAR, Ernesto
67/M
Dr. Germar/Bocalbos
SI Jacoba/Medina
JIIC Mangotara
MPW
Date of Admission 06.18.09
8th HD
Axis I: Bipolar Disorder, MRE, Depressed
Axis II: Deferred
Axis III: None
Axis IV: Transfer of residence, financial problems
Axis V: GAF 61-70 / Medications:
Chlorpromazine 100mg/tab 1 tab at 8pm
Valproic acid 250mg/tab 1 tab OD
06.24.09
11am Please decrease Valproic Acid 250mg/tab à OD
06.18.09
2:35pm Side notes: BP 140/90, HR 70, RR 14, T 35.7
Please admit to Male Psych Ward under the service of Dr. Germar/Bocalbos
Secure consent for admission and management.
DAT, TPR q shift and then record please, Weigh patient and record please.
Ensure 24 hour male responsible watcher at all times, Strict suicide and escape precautions please.
Psych JIIC/OD to do initial summary and trauma form. Psych JIIC to do complete database, anamnesis, case discussion, lab flow sheet, drug charting, and daily progress notes, Psych SIOD to do admitting notes. Psych JIIC/JIOD to monitor VS q4, sleep monitoring q1.
Problem: Bipolar I MRE Depressed
Diagnostics: CBC, Urinalysis, SGPT, SGOT, BUN, Crea, 12 lead ECG, Chest X-ray, Valproic acid assay
Therapeutics: Chlorpromazine 100mg/tab 1 tab OD (8pm), Valproic acid 250mg/tab 1 tab BID
Will inform service consultant, NOD to inform Psych ROD/SIOD once patient is in ward, Refer accordingly. / 06.24.09
Valproic 126
06.19.09
Urinalysis: Color – yellow, Turbidity – clear, Reaction – acidic, Sp. Gr. – 1.010, Protein – negative, Sugar – negative, RBC – 2-4/hpf, WBC – 0-2/hpf, Casts – none, Bacteria – none, Epithelial cells – none
06.18.09
CBC: Hgb 147 MCH 29.4, Hct 42, MCV 84, MCHC 34, RBC 5.0, WBC 8.0, Neutro 76, Lympho 22, Eosino 2, Platelet Normal, RBC Normochromic, Normocytic
BUN 3.9, Crea 82, SGOT 21, SGPT 16
Na 138, K 3.7
ALCALDE, Rex
24/M
Dr. Germar/Bocalbos
SI Bermejos/Manaloto/Mandapat
JIIC Mojica
MPW
Date of Admission 06.23.09
3rd HD
Axis I:t/c Bipolar I d/o; r/o alcoholic withdrawal syndrome
Axis II: deferred
Axis III: none
Axis IV: family conflict
Axis V: 51-60 / Medications:
Epival 250mg/tab 1 tab BID
Rivotril 2mg/tab, ¼ tab at 8am, ¼ tab at 1pm, ½ tab at 8pm
Aspidon 2mg/tab, ½ tab at 8pm
06.25.09
Please give Clonazepam (Rivotril) 2mg/tab:
¼ tab @ 8am
¼ tab @ 1pm
½ tab @ 8pm for 2 days
Start Aspidon 2mg/tab, ½ tab @ 8am; may give 1st dose now.
SIDE NOTES 11am: Imp: T/C Bipolar I, MRE Manic, R/o Alcohol withdrawal syndrome
06.24.09
9:40pm Problem: Pressured speech
Please give Clonazepam (Rivotril) 2mg/tab ½ tab now
Side notes: (+) tangential
12:10am Please start Epival 250mg/tab, 1 tab BID
Please give Zoldipem 10mg/tab, ½ tab now
06.23.09
2:35pm Please admit to Male Psych Ward under the service of Dr. Germar/Bocalbos
Secure consent for admission and management.
DAT, TPR q shift and then record please, Weigh patient and record please.
Ensure 24 hour male responsible watcher at all times, Strict suicide and escape precautions please.