General Data Patient Marcelino B. Lumaioig, 70 y/o, male, married, Roman Catholic, Filipino, born on April 20, 1942.

Currently residing at Tayum, Abra. th This is patients 10 admission in this institution. His son is the informant with an 80% reliability rating. Chief Complaint th For 9 cycle of chemotherapy History of Present Illness Patient was apparently well until 9 months PTA, he had severe abdominal pain rated as 8-10/10. His bowel movement was irregular with stool characterized as goat stool-like progressively becoming ribbon-like. No melena, no gross bleeding, no nausea and vomiting. He sought consult and underwent colonoscopy with biopsy which revealed colonic cancer, stage IV. He was also diagnosed to have abdominal aortic aneurysm. He th had his first cycle chemotherapy on September 2011, his last cycle was on March 2012. He was scheduled to have his 9 cycle chemotherapy hence admission. Past Medical History Patient has no known allergies to food and drugs, he is a non-hypertensive, non diabetic, no asthma. Family History Positive for family history of hypertension, asthma and heart disease Social and Environmental History Patient is a 90 year pack smoker consuming about 2 packs of cigarettes per day for 45 years. He was an alcoholic drinker about 4-5 bottles of beer per week. He stopped smoking and drinking 3 years PTA. Physical Examination General Data Conscious, coherent, oriented to time, person and place, not in cardiopulmonary distress. Vital Signs BP: 70/50 mmHg, via left arm on sitting position CR: 80 bpm RR: 24 Temp: 36.6 Ht: 52 Wt: 54 kg Skin No cyanosis, pale skin, good skin turgor HEENT Head Face is symmetrical without any involuntary movement or lesions. No tenderness and masses of the scalp. No bony depression of the skull. Eyes Symmetrical with well distributed eyebrows, no lid lag. Conjunctiva is pinkish with anicteric sclera. Pupils are 2-3 mm in size both equally round and reactive to light and accomodation. No abnormal extraocular movements. Ears Ears are symmetrical, no deformities, discharges and lesions noted. Nose Septum at midline. No gross deformities. No discharges and congestion. Frontal and maxillary sinuses are non-tender upon palpation. Mouth and Throat Dry lips and mucosa, pinkish in color, no ulcers, lumps or cracking. Tongue is symmetrical, no lesions or deviation. Patient is able to protrude tongue. No tonsillopharyngeal enlargement seen, uvula at midline. Neck No gross deformities. No cervical lymphadenopathies.

Chest and Lungs Symmetrical chest wall expansion. No scars or lesions. No retractions or lagging. No tenderness. Resonant on all quadrants. Clear breath sounds. Heart
th

Adynamic precordium. PMI at 5 ICS left midclavicular line. No heaves or thrills. Regular heartbeat. No murmurs.

Abdomen Flabby. Linear scar on midline s/p. Hyperactive bowel sounds. Heart sounds heard at umbilical area. With direct tenderness on hypogastric and umbilical area. Extremities No clubbing, no gross deformities. 2+ equal and bilateral pulse on all extremities. 2-3 sec capillary refill. Neuro Cerebral function: Patient is oriented to time, place, person. GCS: 15 (M6, V5, E4) Cerebellar function: No nystagmus, no tremors, no dysmetria Cranial Nerve Function Test: I: not asssessed II: intact sense of sight III, IV, VI: intact EOMs, no preferential gaze V: Facial sensory functioning intact, muscles of masticatory intact VII: symmetric facial movement VIII: intact sense of hearing IX, X: uvula in midline, no deviation XI: able to turn head from left to right, able to raise and shrug shoulders XII: midline protrusion of the tongue, no fasciculation, no deviation Motor Sensory Reflexes POMR th P#1 Colonic cancer, stage IV for 9 cycle chemotherapy S: (+)weakness, (+)pale skin, (-)nausea, (-)vomiting, ()dizziness, (-)diarrhea, (-)constipation (-)cough and colds, (-)dyspnea (+)history of goat stool-like stool pregressively becoming ribbon-like O: GS: Conscious, coherent, oriented to time, person and place, not in cardiopulmonary distress. Vital Signs: BP: 70/50 mmHg, CR: 80 bpm, RR: 24, Temp: 36.6 Skin: No cyanosis, pale skin, good skin turgor HEENT: Conjunctiva is pinkish with anicteric sclera. Pupils are 2-3 mm in size both equally round and reactive to light and accomodation. No abnormal extraocular movements. Septum at midline. No gross deformities. No discharges and congestion. Frontal and maxillary sinuses are nontender. Dry lips and mucosa, pinkish in color, no ulcers, lumps or cracking. Tongue is symmetrical, no lesions or deviation. Patient is able to protrude tongue. No tonsillopharyngeal enlargement seen, uvula at midline.No gross deformities. No cervical lymphadenopathies. Chest and Lungs: Symmetrical chest wall expansion. No scars or lesions. No retractions or lagging. No tenderness. Clear breath sounds. Heart: Adynamic precordium. PMI at 5 ICS left midclavicular line. No heaves or thrills. Regular heartbeat. No murmurs. Abdomen: Flabby. Linear scar on midline s/p. Hyperactive bowel sounds. Heart sounds heard at umbilical area. With direct tenderness on hypogastric and umbilical area. Extremities: No clubbing, no gross deformities. 2+ equal and bilateral pulse on all extremities. 2-3 sec capillary refill. A: P: Colonic cancer, stage IV Diphenhydramine 50 mg Hydrocortisone 100 mg IV
th

Ramosetron 1 amp IV Dexamethasone 5 mg IV Metoclopramide 1 amp IV Ranitidine 50 mg IV Oxaliplatin + D5W 250cc Capecitabine #2 S: O: Hypotension (+)weakness, (-)dizziness, (-)nausea and vomiting BP ranging from 70/40 110/60 Pale skin th Heart: Adynamic precordium, PMI at 5 ICS L MCL, No

murmurs A: P: #3 S: O: Hypotension Dopamine drip Abdominal aortic aneurysm (+)History of abdominal aortic aneurysm Conscious, coherent, not in CP distress V/S BP ranging from 70/40-110/60, CR 85, RR, 24, T:36.6 th Heart: Adynamic precordium, PMI at 5 ICS L MCL, No Abdomen: Flabby, hyperactive bowel sounds, heart sounds heard on umbilical area, With direct tenderness on hypogastric and umbilical area. A: P: Abdominal aortic aneuirysm Eldicet 1 tab TID Omeprazole 40 mg 1 tab Cardiosel 50 mg 1 tab TID Nifezar 50 mg 1 tab TID Aldazide tab OD

murmurs