Ms [**Known patient lastname 241**] is a [**Age over 90 2398**] year old woman with past medical history significant for hypertension, severe aortic stenosis, hyperlipidemia, arthroplasty.
    .
   Per the patient, she was standing and felt a snap of her right leg and fell to the ground. 
   No head trauma or LOC. She was evaluated by orthopedics and transferred to
   medicine for optimization of her cardiac status. 
   
   Review of systems:
   Ear, Nose, Throat: Dry mouth
   Cardiovascular: Edema, Orthopnea
   Respiratory: Dyspnea
   Flowsheet Data as of [**3294-3-6**] 10:33 PM
   Vital Signs
   Hemodynamic monitoring
   Fluid Balance 24 hours Since [**96**] AM
   Tmax: 37.5 C (99.5)
   Tcurrent: 37.5 C (99.5)
   HR: 102 (93 - 102) bpm
   BP: 117/54(70) {117/54(70) - 117/54(70)} mmHg
   RR: 24 (15 - 24) insp/min
   SpO2: 100%
   Heart rhythm: ST (Sinus Tachycardia)
           
   .
   -- Clarify She appears comfortable with adequate pain
   control with prn morphine. Given her tight valvular stenosis,
   she is high risk for general anesthesia.
   - would start standing tylenol 1g q8
   - continue morphine IV prn for breakthrough
   - plan for OR tomorrow am per ortho pending optimization of her cardiac
   function, and improvement in renal function
   .
   # CAD: No clear documentation, however given age calcific
   atherosclerosis is highly likely
   -- continue statin
   -- Hold beta blocker for now
   -- hold aspirin in perioperative period
   .
   # ATRIAL FIBRILLATION: In setting of acute pain and peri-op. Will need
 to monitor as pt with high CHADS score, however in periop period would
   not be able to have systemic anticoagulation
   -- Rate control with beta blocker once stable
   -- If unstable, would use esmolol first, cardiovert last option.
   .
   # HTN: Better controlled on floor. Good BP control essential for
   preventing flash pulmonary edema in setting of AS.
   - continue metoprolol, as above
   - continue to monitor BP and consider adding another [**Doctor Last Name **] such
   as amlodipine 5mg daily if BP sustains above SBP 150s
   .
   # Hyperlipidemia
   - continue simvastatin 40mg PO daily
   .
   # FEN/GI: Low sodium diet, replete lytes PRN
   .
   # CODE: Confirmed DNR/DNI