289811204
FIH
2696998
22684/ukjj
819579
4/16/1993 12:00:00 AM
RIGHT HIP , OSTEOARTHRITIS .
Unsigned
DIS
Report Status :
Unsigned
ADMISSION DATE :
4/16/93
DISCHARGE DATE :
4/23/93
PRINCIPAL DIAGNOSIS :
Right hip , osteoarthritis .
HISTORY OF PRESENT ILLNESS :
The patient is a generally healthy 85 year old female , who has had a five year history of right hip pain , worsening over the past several months .
Her pain is located in the groin and thigh .
It is aggravated by activity and improved by sitting or lying down .
It is associated with rest pain as well .
She uses a cane or walker for ambulation , and is limited to one to two blocks .
She does stairs one at a time and only with help .
She has difficulty with shoes and socks and foot care .
The patient 's pain has not been relieved by Darvocet and Advil .
Radiographs demonstrate right hip osteoarthritis .
Having failed conservative management , the patient presented for elective right total hip replacement .
PAST MEDICAL HISTORY :
Hypertension , possible peptic ulcer disease 1959 , history of left ankle and knee fractures , 1980 .
Recent urinary tract infection , E. coli 03/93 .
Recent herpes zoster .
PAST SURGICAL HISTORY :
cholecystectomy , total abdominal hysterectomy , cataract excision .
MEDICATIONS ON ADMISSION :
hydrochlorothiazide 50 mg. PO qday , KayCiel .
ALLERGIES :
The patient has no known drug allergies .
HABITS :
The patient does not smoke or drink .
REVIEW OF SYSTEMS :
Negative in detail .
PHYSICAL EXAMINATION :
The patient was an elderly woman in no acute distress .
The head and neck exam was within normal limits .
The lungs were clear to auscultation .
Cardiac :
regular rate and rhythm without murmur .
The abdomen was soft , nontender , nondistended , with normal active bowel sounds .
Extremities :
left hip 110 degrees of flexion , 0 degrees of extension , 30 degrees of abduction , 45 degrees of adduction , 10 degrees of internal rotation and flexion , 45 degrees of external rotation and flexion .
Right hip 90 degrees of flexion , minus 30 degrees of extension , 20 degrees of abduction , 30 degrees of adduction , less than 5 degrees of internal rotation and flexion and less than 5 degrees of external rotation and flexion .
There was no leg length discrepancy .
The patient 's gait was halting , stooped and slow .
The patient used the cane in her left hand .
The patient 's neurovascular examination was intact .
LABORATORY DATA :
the sodium was 140 , potassium 3.7 , chloride 96 , bicarbonate 30 , BUN and creatinine 14/0.9 , glucose 105 , hematocrit 42 , white blood count 8.6 , platelet count 644,000 , prothrombin time 10.4 , partial thromboplastin time 28.7 , urinalysis trace white blood cells , slight occult red blood cells .
The electrocardiogram showed normal sinus rhythm at a rate of 80 with intraventricular conduction delay and poor R wave progression .
There were no acute ischemic changes .
The chest X-ray showed borderline cardiomegaly but no acute cardiac or pulmonary disease .
HOSPITAL COURSE :
The patient was admitted to the Orthopedic Service on 4/16/93 .
On that day she underwent clearance from the Cardiology Service , Dr. Shuff .
It was his impression that the patient 's hypertension was controlled on hydrochlorothiazide .
Given the patient 's low potassium level of 2.4 on the day of admission , he suggested supplementation with potassium .
The patient was cleared from surgery from a cardiology standpoint .
On the following morning 4/17/93 , the patient was taken to the operating room where she underwent a right total hip replacement , using a hybrid S-ROM system .
Postoperatively , the patient did extremely well .
The patient was seen in consultation with the physical therapy service initially for routine rehabilitation after a total hip replacement .
Her hemovac drains were removed on postoperative day # 2 as was her Foley catheter .
Her hematocrit remained stable in the low to mid 30 's and she did not require a transfusion .
The patient did have postoperatively hypokalemia to a level of 2.7 and subsequently was corrected with oral and intravenous potassium on 4/22/93 , the patient underwent a duplex ultrasound examination , which showed no evidence of of deep venous thrombosis .
The patient 's Coumadin was thus stopped and she was switched to Bufferin .
The patient 's hospitalization was uncomplicated .
She was discharged to the Encharlea Il Medical Center in New Hampshire .
DISCHARGE DIAGNOSIS :
Right hip osteoarthritis , status post right total hip replacement on 4/17/93 .
Hypertension .
Postoperative hypokalemia , resolved .
Postoperative confusion , transient and resolved spontaneously .
CONDITION ON DISCHARGE :
Satisfactory .
MEDICATIONS ON DISCHARGE :
hydrochlorothiazide 50 mg. PO qday , KayCiel 40 mEq. b.i.d. , Ecotrin 1 tablet qday , Ferrous sulfate 325 mg. PO b.i.d. , Folate 1 mg. PO qday , multivitamins one tablet qday , Tylenol # 3 1 to 2 PO q3hours PRN .
DISPOSITION / PLAN ON DISCHARGE :
The patient is discharged to the Encharlea Il Medical Center .
There she should received physical therapy to consist of a routine post total hip replacement rehabilitation protocol , with emphasis on gait training , partial weight bearing on the right lower extremity , using a walker or crutches .
The patient should also have her potassium levels checked two times per week to insure that she is not becoming hypokalemic .
The patient should have a follow up appointment arranged with Dr. Level .
LAYMIE M HE , M.D.
DICTATING FOR :
LILLBI SERVICE , M.D.
TR :
il / bmot
DD :
4/22/93
TD :
04/22/93
CC :
Dr. Lako Service STAT