tokens: 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&apos;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 &gt; 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 ******