tokens: 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 ******