767751445 ELMVH
45154940
6035801
12/6/2005 12:00:00 AM
COPD exacerbation with NSTEMI
DIS
Admission Date :
12/06/2005
Report Status :
Discharge Date :
12/10/2005
****** FINAL DISCHARGE ORDERS ******
SCHOELLSULLKOTEFONG , MAUSTINIE
161-66-98-5 W53
Room :
66R-249
Service :
MED
DISCHARGE PATIENT ON :
12/09/05 AT 08:00 PM
CONTINGENT UPON
Attending evaluation
WILL D / C ORDER BE USED AS THE D / C SUMMARY :
YES
Attending :
FREIERMFUSC , SHAIGAYDONA , M.D. , M.DIV.
CODE STATUS :
Full code
DISPOSITION :
Home w/ services
DISCHARGE MEDICATIONS :
VITAMIN C ( ASCORBIC ACID ) 1,000 MG PO QD ECASA ( ASPIRIN ENTERIC COATED ) 81 MG PO QD CALCIUM CARBONATE ( 500 MG ELEMENTAL CA++ ) 500 MG PO BID PREDNISONE 20 MG PO QAM Starting Today ( 12/09 )
Instructions :
taper over 2 weeks MULTIVITAMIN THERAPEUTIC ( THERAPEUTIC MULTIVI ... ) 5 MILLILITERS PO QD
Override Notice :
Override added on 12/07/05 by BELB , BRITHERL , M.D. on order for ATORVASTATIN PO ( ref # 33823759 )
POTENTIALLY SERIOUS INTERACTION :
NIACIN , VIT .
B-3 and ATORVASTATIN CALCIUM
Reason for override :
md aware
Previous override information :
Override added on 12/06/05 by BELB , BRITHERL , M.D. on order for ZOCOR PO ( ref # 33033281 )
POTENTIALLY SERIOUS INTERACTION :
NIACIN , VIT .
B-3 and SIMVASTATIN
Reason for override :
md aware
FLOVENT ( FLUTICASONE PROPIONATE ) 44 MCG INH BID Starting Today ( 12/09 ) LEVAQUIN ( LEVOFLOXACIN ) 500 MG PO QD
Food / Drug Interaction Instruction
Administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose
If on tube feeds , please cycle ( hold 1 hr before to 2 hr after )
Take 2 hours before or 2 hours after dairy products .
Alert overridden :
Override added on 12/06/05 by BELB , BRITHERL , M.D.
POTENTIALLY SERIOUS INTERACTION :
SALMETEROL XINAFOATE and LEVOFLOXACIN
Reason for override :
md aware
SEREVENT DISKUS ( SALMETEROL DISKUS ) 1 PUFF INH BID
Override Notice :
Override added on 12/06/05 by BELB , BRITHERL , M.D. on order for LEVAQUIN PO ( ref # 57095042 )
POTENTIALLY SERIOUS INTERACTION :
SALMETEROL XINAFOATE and LEVOFLOXACIN
Reason for override :
md aware
LISINOPRIL 5 MG PO QD
Alert overridden :
Override added on 12/08/05 by :
POTENTIALLY SERIOUS INTERACTION :
POTASSIUM CHLORIDE and LISINOPRIL
Reason for override :
md aware
TOPROL XL ( METOPROLOL SUCCINATE EXTENDED RELEASE ) 25 MG PO QD Starting Today ( 12/09 )
Food / Drug Interaction Instruction
Take consistently with meals or on empty stomach .
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 ALBUTEROL INHALER 2 PUFF INH QID Starting Today ( 12/09 ) ATROVENT INHALER ( IPRATROPIUM INHALER ) 2 PUFF INH QID Starting Today ( 12/09 )
DIET :
No Restrictions
ACTIVITY :
Resume regular exercise
FOLLOW UP APPOINTMENT ( S ) :
Gento Yaneslaunt 03/17/06 scheduled ,
Arois Maillliepslighsint 02/18/06 scheduled ,
ALLERGY :
NKA ADMIT DIAGNOSIS :
COPD exacerbation
PRINCIPAL DISCHARGE DIAGNOSIS ;
Responsible After Study for Causing Admission ) COPD exacerbation with NSTEMI
OTHER DIAGNOSIS ;
Conditions , Infections , Complications , affecting Treatment / Stay
severe COPD Pneumonia recovering alcoholic recovering barbituate abuse unexplained hct drop poor appetite x 1 week
STEROID PSYCHOSIS NO BENZOS
OPERATIONS AND PROCEDURES :
none
OTHER TREATMENTS / PROCEDURES ( NOT IN O.R. )
Heparin while having a demand ischemic episode
BRIEF RESUME OF HOSPITAL COURSE :
* CC :
82F with COPD exacerpation
* DDx :
COPD exacerpation with troponin leak likely NSTEMI secondary to demand ischemia .
* HPI :
4 days of worsening SOB with sore throat and cough productive of yellow / green sputum .
Fatigue secondary to worsening dyspnea .
took Prednisone 40 at home and presented to ED where found to have 1mm lateral ST depressions and slight troponin and MB leak .
no N / V/HA / D no sweats , no chills , of abdominal pain , no chest pain , no pleuricy , no LEE , no paresthesias , no numbness , no shoulder pain , no jaw pain .
* PMH :
COPD ( s / p lung resection FEV1 25% ) , chronic pericardial effusion , PVD , R renal artery stenosis , osteoporosis , presbylaryngis
************** PATIENT STATUS ********************
98.4 , 94 , 22 , 120/96 , 98% on 2L. NAD , using scalenes , AT / NC , no oral lesions , Bibasilar rales otherwise clear , good air movement , RRR , no MRG , NTND +BS , no CCE , 2+ DPs .
Guiac negative
*************** STUDIES ***********************
LABS :
WBC 12.91
CXR :
small pleural effusion , flat diaphrams no acute changes
Echo -
*********** HOSPITAL COURSE ****************
1. CV :
likely having a NSTEMI secondary to demand .
Cardiac enzymes trending down on 12.7.05 , anticoagulated while having leak .
I - heparin for PTT 50-70 durin enzyme leak . metoprolol 12 QID .
Cardiac enzymes BID while actively having leak , ASA
R - monitor on telemetry
P - no evidence of failure
- Echo :
2. COPD :
likely exacerbation possibly from URI / pneumonia .
Aputum cultures pending .
Treated with :
atrovent NEB QID , albuterol Neb QID , ipratropium NEB BID , flovent INH BID , Serevent INH BID , and prednisone 30 QD taper .
Levaquin 500 QD empirically
3. GI :
PPI prophylaxis
4. FEN :
MVI , Cardiac diet
ADDITIONAL COMMENTS :
Please make an appointment to see dr. Arois Maillliepslighsint within2-3 weeks after you leave the hospital
Please taper off your prednisone within 2 weeks
DISCHARGE CONDITION :
Stable
TO DO / PLAN :
PT :
please evaluate ambutlation ability and O2 requirement
Please evaluate resolution of cardiac troponin leak and stable EKG .
Please evaluate resolution of COPD exacerbation and need for any further antibiocis
No dictated summary
ENTERED BY :
BELB , BRITHERL , M.D. ( IL35 ) 12/10/05 02:50 PM
****** END OF DISCHARGE ORDERS ******