On January 11, 2013 at 7:30 in the evening, the patient was brought at Northern Mindanao Medical Center, emergency

room. In there, the client was assessed thoroughly through series of laboratory tests obtained to him such as Complete Blood Count to detect deviation on patients blood components where there were signs and symptoms manifested. Urea leve was also tested to evaluate kidney function and to monitor patient with kidney failure due to chronic circulation problem where sodium test also was checked to know how much sodium is in the blood. Potassium was also tested to measures its amount in the patients blood. Blood, Urea, Nitrogen test measures the level of urea nitrogen in a sample of the patient's blood in relation to circulation problem. Urinalysis was done to support screening in helping to detect substances or cellular material in the urine associated with different metabolic and kidney disorders that might encountered by the patient, and electrocardiogram, checking patients heart electrical activity through small electrode patches attached to the skin of patients chest, arms, and legs because of the tendency of heart problem.

The client also undergone for CT-scan of his brain because of his stroke symptoms and he was then diagnosed with Cerebrovascular disease, hemorrhagic. Client was then brought to Stroke ward at P1F3 so that the medical staff and personnel will be able to monitor the patients condition with orders of Consent to care and management was secured to ensure that all procedures and treatment done are in accordance to patients will adhering to his rights. Venoclysis of Plain normal saline solution 1L at 30 drops per minute was ordered as it is indicated as a source of water and electrolytes in general, and used for fluid replenishment or medication administration to the patient. The doctor ordered for client on NPO (nothing per orem) status temporarily except medications because patient is still for blood chemistry to identify the numerous chemical substances found in the blood and to identify any possible disease

Orders of medications such as Nicardipine ampule in 20cc at 10cc per hour via soluset to control patients blood pressure of 180/130mmHg during admission. Along with Nicardipine is Captopril 25 mg per nasogastric tube (NGT) every 6 hours and hold for blood pressure below 160/100 mmHg, Citicoline 500mg 1 tablet twice a day was ordered since there was brain injuhry, Simvastatin 40 mg after meal to reduce the risk of another cerebrovascular accident, Omeprazole 40 mg 1 tablet every 8 hours for the relief of possible hypersecretion of acid in the gastric surface, Lactulose 30cc after meal to soften stool aiding in easy evacuation preventing valsalva maneuver of the patient. Celecoxib 200mg 1 cap twice a day per nasogastric tube (NGT) to control inflammation and possible pain felt due to vasospasm of the affected arteries and veins in the injured area of the brain.

January 11, 2013, the doctr ordered to monitor vital signs, oxygen saturation every 4 hours to monitor level of oxygen saturation inside the patients system and was done through pulse oximetry. The reading was 100 beats per minute then gets highr to 60 beats per minute, the doctor then ordered to refer for blood pressure higher than 160/100 mmHg or lower than 90/60 mmHg to monitor client for further examination. Refer if heart rate is greater than 100 beats per minute or lower than 60 beats per minute, and sodium level if higher than 30 millimoles per liter or lower than 12 millimoles per liter. And also monitor the oxygen saturation if lower than 95%. These will be evaluated for further observation and could be a sign of danger when occurred because these were not within normal values.

These were the diagnostic examinations results of client; the blood chemistry revealed that the client had 223mg/dL glucose which is higher than the normal range of 100mg/dL which leads to viscosity of the blood due to dehydration in the intravascular space that could double up the working of the heart making the blood pressure more higher than usual readings, and the rest of the results were within normal ranges. For the Complete blood count, the following were the results of the examination, white blood cells is 12.2 10^3/uL indicates higher level due to immunity response of inflammation, eosinophils was increase due to hematologic disorders. Red blood count was at 5.52 10^6/dL higher than the normal range of 4.5 5.4 1^6/dL which indicates that the body compensated from the blood loss due to rupture of blood vessel and the other hematology results was identified as normal. Prothrombin time, Prothrombin activity, and activated partial thromboplastin time were all normal and found to be no problem in clotting factors. Platelet count was 256 %, which is within the normal range of 150-400%

On January 14, 2013 at 6:30am the doctor ordered to increase nicardipine drip to 20cc per hour to manage hypertension in which the clients blood pressure was 210/130mmHg, and repeat blood pressure monitoring for 30 minutes to monitor clients blood pressure since his blood pressure was high. And also, it was ordered by the physician to terminate mgSO4 side drip once consumed. Vital signs was ordered to monitor every 4 hours to check the status of the client if his vital signs were stable and monitor any abnormalities to continue medications to treat underlying condition of client. Capillary blood glucose was ordered to monitor every 2 hours. At 8:00 in the morning his capillary blood glucose result was 110 mg/dL which is in normal range of (100140 mgdL).
At 10:00 in the morning his capillary blood glucose result was 105 mg/dL which is in normal range of 100-140 mg/dL. Monitor clients capillary blood glucose every two hours. Fasting blood sugar was ordered to measure blood glucose level and lipid profile to check clients cholesterol level. These laboratory tests were ordered to be done for further examination of clients condition, but were not obtained from the chart. Sodium level was checked last January 16, 2013 with result of 142.8 mmol/l which is in normal range of 153-148 mmol/l. And also ordered to check Potassium level with the result of 3.98 mml/l which is in normal range of 3.5-5.3 mml/l. Creatinine was checked with the result of result of 0.8 mg/dL which is also in normal range of 0.6-1.5mg/dL for further examination of the clients status. Client was then referred accordingly.

At 12:30 in the afternoon on the same date, orders of chest x-ray for further examination of the client status to check if there was accumulation of fluid in the lungs related to consistent high blood pressure, and result was not seen in the chart. Orders of creactive protein to detect very-low-grade inflammatory responses that may result to cardiovascular disease or myocardial infarction, and the result was also not seen in the chart.

An ultrasound of the kidney, urinary bladder and prostate gland were also ordered to check if there were complications due to consistent of high blood pressure. The tests were done on January 16, 2013 and the findings were as follows: The right and left kidney measures 11.36cm x 5.52cm and 11.36cm x 6.06cm which is in normal range of (10-13 cm) respectively with parenchymal thickness of 2.0cm both which is also in normal range of (2-2.5 cm thick). The central echo complexes are intact. No calcification, lithiasis or caliectasia seen. The urinary bladder is well filled. No intralumind echoes seen. Its wall is hot thickness. Prostate gland measures 4.08cm x 2.69cm (approximately 17.07 grams) which is in normal range it is typically weighs about 20 grams. And the diagnosis was unremarkable ultrasound findings of the kidney, urinary bladder and prostate gland. Client was for repeat complete blood count to check if there is any change in the previous result. 2D echo was ordered to assess the hearts function and determine the presence of disease of the heart muscle, valves and pericardium. It is used to provide pictures of the hearts valves and chambers and help the sonographer evaluate the pumping action of the heart.

On January 12, 2013 the doctor ordered to remove nasogastric tube, this is to prevent aspiration and the patient was able to swallow and the doctor ordered to continue the medication to promote wellness. The doctor ordered soft diet with low salt and fat, this is to decrease levels of cholesterol in clients blood and decrease blood pressure then refer.

On January 16, 2013 the doctor ordered to facilitate 2D echo, a technique that is used to see the actual motion of the heart structures and to the patient who presenting for acute chest pain. The doctor ordered to facilitate the complete blood count at 7:30pm, the results were increased for White Blood Cell which was 12.86 cells/mm3 (normal range 5.0-10 cells/mm3) , this is a normal immunity response to combat pathogenic invasion, the Red Blood Cell was now within the normal range of 5.39 106/mm3 (normal range 4.2 5.4 106/mm3), the hemoglobin that carries oxygen and gives the blood cell its red color with the result of 16.5 g/dL (normal range 12.0-16.0 g/dL), a high hemoglobin level indicates abnormal clotting and be bad for circulation. Hematocrit test is a ratio of red blood cells to the total volume of blood and a result of 48.5 % (normal range 37.0 - 47.0 %) which indicated dehydration.

The doctor ordered to facilitate troponin I and CK-MB, to evaluate if the patient is having chest pain , CKMB levels, are tested in persons who have chest pain to diagnosed whether they have had a heart attack, and the doctor ordered to facilitate Electrocardiogram 12 leads a test that records the electrical activity of the heart. The doctor ordered to continue all medication regimens to help promote or maintain mental, physical, and psychosocial wellbeing, at the same day the doctor ordered uptitrate nicardipine drip to D5W 50ml which demonstrates a relatively rapid onset/offset of actions requiring the rapid control of blood pressure. The doctor ordered to give captopril 25mg 1 tablet per orem now, and then to recheck blood pressure to be used to treat high blood pressure and heart failure. This decreases certain chemicals that tighten the blood vessels, so blood flows more smoothly and the heart can pump blood more efficiently. The doctor ordered blood pressure monitoring every two hours to check if the patients vital signs were within normal range, and refer for any unusualities if the patient manifested side effects to the drug like tachycardia, etc.

January 17, 2013 at 7:00am the doctor ordered to follow up 2D echo result to know if there are some unusualities to the heart movement and structure. The doctor ordered to continue medication to promote wellness and to repeat electrocardiogram 12 leads, to check if there is cardiac arrhythmia, blood pressure monitoring for every 4 hours and refer for any unusualities to detect if there is some abnormality manifested by the patient.