044687343 ELMVH
01719921
1626859
3/13/2006 12:00:00 AM
COPD flare
DIS
Admission Date :
03/13/2006
Report Status :
Discharge Date :
03/19/2006
****** FINAL DISCHARGE ORDERS ******
FREIERMLINKENEIGHCAABLINFARST , ANEA
770-09-54-2 O32
Room :
39K-128
Service :
MED
DISCHARGE PATIENT ON :
03/19/06 AT 01:00 PM
CONTINGENT UPON
Not Applicable
WILL D / C ORDER BE USED AS THE D / C SUMMARY :
YES
Attending :
ALBFYFEAYLES , LORRE EZO , M.D.
CODE STATUS :
Full code
DISPOSITION :
Villeflardsbroo Ands Tho Cardhako General Hospital
DISCHARGE MEDICATIONS :
ACETYLSALICYLIC ACID 81 MG PO DAILY ALBUTEROL NEBULIZER 2.5 MG NEB Q4H Starting Today ( 03/17 ) PRN Shortness of Breath LISINOPRIL 10 MG PO DAILY NIFEREX-150 150 MG PO BID PREDNISONE Taper PO Give 50 mg q 24 h X 1 dose ( s ) , then Give 40 mg q 24 h X 1 dose ( s ) , then Give 30 mg q 24 h X 1 dose ( s ) , then Give 20 mg q 24 h X 1 dose ( s ) , then Give 10 mg q 24 h X 1 dose ( s ) , then Starting Today ( 03/17 ) CLARITIN ( LORATADINE ) 10 MG PO DAILY
Food / Drug Interaction Instruction
Avoid grapefruit unless MD instructs otherwise .
Give on an empty stomach ( give 1hr before or 2hr after food ) SINGULAIR ( MONTELUKAST ) 10 MG PO BEDTIME ADVAIR DISKUS 500/50 ( FLUTICASONE PROPIONATE/... ) 1 PUFF INH BID CALTRATE + D 1 TAB PO BID LANTUS ( INSULIN GLARGINE ) 35 UNITS SC QAM DUONEB ( ALBUTEROL AND IPRATROPIUM NEBULIZER ) 3/0.5 MG NEB Q6H Starting Today ( 03/17 ) PRN Shortness of Breath , Wheezing NOVOLOG ( INSULIN ASPART ) 4 UNITS SC AC
Instructions :
standing pre-meal novolog .
give when patient will eat and food is in the room .
NOVOLOG ( INSULIN ASPART ) Sliding Scale ( subcutaneously ) SC AC
Instructions :
pre-meal correction dose .
give in addition to standing pre-meal novolog when patient will eat and food is in the room .
If BS is less than 125 , then give 0 units subcutaneously If BS is 125-150 , then give 2 units subcutaneously If BS is 151-200 , then give 3 units subcutaneously If BS is 201-250 , then give 4 units subcutaneously If BS is 251-300 , then give 6 units subcutaneously If BS is 301-350 , then give 8 units subcutaneously If BS is 351-400 , then give 10 units subcutaneously and call HO Call HO if BS is greater than 400 PROTONIX ( PANTOPRAZOLE ) 40 MG PO DAILY COMBIVENT ( IPRATROPIUM AND ALBUTEROL SULFATE ) 2 PUFF INH QID FOSAMAX ( ALENDRONATE ) 70 MG PO QWEEK
Food / Drug Interaction Instruction
Give on an empty stomach ( give 1hr before or 2hr after food )
Take with 8 oz of plain water SPIRIVA ( TIOTROPIUM ) 18
MCG INH DAILY DIET :
House / Low chol / low sat. fat
DIET :
House / ADA 1800 cals / dy
ACTIVITY :
walk with assist per PT eval
FOLLOW UP APPOINTMENT ( S ) :
Dr Zuknocegrend PCP 4/24 130 ,
Dr. Pump 3/25/05 1:30 ,
ALLERGY :
NKA ADMIT DIAGNOSIS :
COPD flare
PRINCIPAL DISCHARGE DIAGNOSIS ;
Responsible After Study for Causing Admission ) COPD flare
OTHER DIAGNOSIS ;
Conditions , Infections , Complications , affecting Treatment / Stay
COPD ( chronic obstructive pulmonary disease ) DM cervical DJD ( ) iron deficiency anemia ( iron deficiency anemia ) cervical and lumbar djd ( 12 ) osa ( sleep apnea ) s / p tb treatment ( 5 )
OPERATIONS AND PROCEDURES :
OTHER TREATMENTS / PROCEDURES ( NOT IN O.R. )
na
BRIEF RESUME OF HOSPITAL COURSE :
CC :
weakness
HPI :
75 y / o F with DM , COPD on 2L NC and Bipap at night p / w generalized weakness and fatigue , urinary incontinence and shaking as well as increased sputum production .
Per daughter these symptoms are typical of COPD flare .
ROS otherwise negative .
Admission Status :
ED :
REc'd duonebs , solumedrol 125
Vitals :
t97.5 , hr 117 , bp156/81 , rr28 , o2 sats 87% RA ; 95% 4L
Exam :
NAD , pleasant , speaking in complete sentences , poor air movement bilaterally , L > R , no wheezes or rales , rrr , distant , abd benign , no edema , alert and oriented times three , no focal deficits , conversant Studies :
- EKG sinus 92 , no ST changes
- CXR no focal consolidation or edema , old biapical scarring ABG 7.34/79/74 U / A negative
Daily Status :
improving , but still poor air movement , diffusely wheezy on exam , at baseline 2L o2 requirement
A / P :
75 y / o F with h / o COPD c / b frequent exacerbations p / w typical flare symptoms .
Problem List :
CV - Ischemia ASA , lisinopril Pump no evidence of failure
Rhythm Resp - COPD
flare - steroids , cont prednisone 60 , taper slowly as tolerated , duonebs , advair , singulair , spiriva , claritin azithromycin for atypical bronchitis to complete a 5 day course , keep o2 sat 90-94 , home nocturnal CPAP not tolerated in house , does well on nc , appears ato be at baseline
Renal -
Cr 0.8 , stress incontinence by symptoms with increased cough , no evidence of uti , cont to closely monitor
GI - Bowel regimen
Heme - Chronic Fe deficiency anemia , cont iron
Endo - DM on insulin with steroids
ID - afebrile , no wbc , started on Azithromycin for COPD flare
FEN - ADA diet
PPx - Lovenox , PPI
Dispo - to rehab when resp status improved , PT consulted
Code - FC
ADDITIONAL COMMENTS :
DISCHARGE CONDITION :
Stable
TO DO / PLAN :
f / u with PCP and Dr. Pump as scheduled , return to ED with worsening sob or increased cough or sputum production
No dictated summary
ENTERED BY :
TIKWELD , WILLAIDE V. , M.D. ( QT296 ) 03/19/06 10:53 AM
****** END OF DISCHARGE ORDERS ******