Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: Lethargy, Mouth breathing, Pain, SARS-CoV-2 test negative, Skin warm
Clinical narrative: view     2/5/2021 09:23 e Progress Note Note Text: Patient passed away in the facility this morning.  view     2/5/2021 08:39 Orders - Administration Note Note Text: Resident passed.  view     2/5/2021 08:33 Nurses Note Note Text: Body released to funeral home at this time. Personal effects sent with resident include: 1 pair of glasses, 1 yellow wedding band, 1silver spoon ring, 1 ring with black and clear stones. Resident has own teeth  view     2/5/2021 08:32 Nurses Note Note Text: cause of death per CRNP failure to thrive.  view     2/5/2021 07:44 Orders - Administration Note Note Text: Take and document temp & PO2  every 4 hours for MONITORING  Resident passed.  view     2/5/2021 06:49 Nurses Note Note Text: Son returned call and was updated of resident's passing this am  view     2/5/2021 06:33 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Unknown  Resident expired @ 0604 [linked]  view     2/5/2021 06:06 Nurses Note Note Text: Res found without pulse or respirations. Pronounced at 0604. Updated. N/o's for RN to pronounce, release body to funeral home, dispose of medications per facility policy. Daughter updated. Funeral Home called to release body.  view     2/5/2021 05:26 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Pulse ox 60% on O2 @ 5L/min via mask. Resps 44 per minute.  view     2/5/2021 01:57 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/5/2021 00:52 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Residents resps are 40 per minute, pulse ox 76% on O2 @ 5L/min via mask. Resps are labored, shallow and rapid.  view     2/5/2021 00:48 Nurses Note Note Text: Nonresponsive to verbal and tactile stimulation. Appears comfortable.  view     2/4/2021 22:01 Nurses Note Note Text: Resident resting comfortably, breathing becoming increasingly shallow, wearing O2 via mask at 5L via mask, no dyspnea noted, feet are mottled, oral and peri care provided Q2H. No s/s of pain or discomfort.  view     2/4/2021 21:40 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective [linked]  view     2/4/2021 19:32 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  medicated for air hunger, RR 28 to 32/ min  view     2/4/2021 19:22 Nurses Note Note Text: Daughter updated on N/O to increase Morphine Sulfate 20mg/mL 0.25mL to Q2H prn from Q6H prn.  view     2/4/2021 18:06 Nurses Note Note Text: POA Daughter and daughter aware of residents current condition.  view     2/4/2021 11:58 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/4/2021 11:13 Nurses Note Note Text: Pt. noted to be lethargic at this time. Does respond to verbal and tactile stimuli by opening her eyes but non verbal currently. Skin warm and dry. No mottling or apnea observed at this time. O2 sat 88% with O2 at 2 LPM via n/c. On increased to 3 LPM via mask as pt. noted to be mouth breathing. Respirations 28. F/U O2 sat 93%. HOB elevated. Pt. medicated with morphine by LPN. Daughter updated on pt.'s condition. Does not want pt. sent out to hospital and would like comfort measures to continue. Daughter also in agreement with delay in d/c d/t pt.'s condition.CRNP updated on pt.'s condition, delay in d/c and daughter's wishes. No n/o's at this time.  view     2/4/2021 10:56 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  Resident showing s/s of discomfort. SOB at this time and high respirations. Repositioned, changed for incontinence care and mouth care provided.    view     2/4/2021 10:34  Progress Note Note Text: Spoke with RN regarding change in condition. Updated Sr Living regarding change. Recommendation to cancel d/c/transfer for today, see how resident does through the weekend and re-evaluate on Monday. Daughter updated on cancellation of d/c today.  view     2/4/2021 10:04 Nurses Note Note Text: Daughter aware that resident's O2 sat was 88% on room air on 3-11 shift and that oxygen was applied via nasal cannula.  view     2/4/2021 10:03 Nurses Note Note Text: N/O: Discharge 2/4/21 with scripts to Sr. Living. Daughter aware.  view     2/4/2021 09:53 Nurses Note Note Text: Pt. to be d/c'd to another facility this am as per MD order. Pt. alert and responsive. Skin assessment done as per facility policy. No pressure areas noted at this time. No s/sx of pain or discomfort observed at this time. V.S. 97.0 67 20 O2 sat 95% with O2 at 2 LPM via n/c.  view     2/4/2021 07:45 Nurses Note Note Text: Resident seen by Dr. for discharge. Orders pending at this time.  view     2/4/2021 07:36 Nurses Note Note Text: CRNP and Dr. updated on O2 sat 88% on RA with f/u of 93% with O2 on at 2 LPM as well as rest of VS, 3-11 shift 2/3/21. No n/o's at this time.  view     2/3/2021 21:17 Nurses Note Note Text: Resident Sp02 88% on RA. Pulse 124. Respirations 40. PRN morphine given and O2 applied via NC at 2L/min. After recheck pulse ox up to 93%, pulse 100, and respirations 22. Resident appears comfortable at this time.  view     2/3/2021 20:05 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective [linked]  view     2/3/2021 19:48 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN given for SOB after elevation of HOB not effective.  view     2/3/2021 11:51 Nurses Note Note Text: CRNP updated rapid COVID test done for d/c tomorrow was negative. No n/o's at this time.  view     2/3/2021 11:44 Nurses Note Note Text: Daughter notified of rapid covid swab being negative.  view     2/3/2021 09:50 Orders - Administration Note Note Text: Obtain Rapid Covid test on 2/3/2021 for discharge. Please give copy of results to Social Worker  every day shift for covid testing for 1 Day  Completed and negative.  view     2/3/2021 08:45 Skilled Nursing Note Reason for skilled service: Therapy  describe skilled service: Nursing, therapy  assessment: V.S. 97.8 79 18 138/84  Orientation: Oriented to self only.  Oxygen: O2 sat 94% on RA  Edema: Trace edema noted BLE. Pedal pulses present.  Pain: Denies pain or discomfort at this time.  Nursing note: Pt. alert and responsive. Skin warm and dry. Lung sounds diminished. No respiratory distress observed at this time. Abdomen soft. BS+ in all 4 quads. Continent/Incontinent of B&B. 1 assist with ambulation, transfers. 1 assist with ADL's. Working with therapy on gait training, therapeutic exercise, therapeutic activities & neuromuscular reeducation.  view     2/2/2021 14:37 Progress Note Note Text: Per health professional at Sr Living, prepared to accept patient to their Memory Care Unit 2/4. Transportation arranged for 11 AM per family request. Daughter (POA) updated on d/c time on 2/4/21. Facility requesting rapid COVID test completed prior to d/c and results sent to them. All other information sent for continuity of care.