Age: 82.0
Sex: M
Vaccine: COVID19
Symptoms: Anaemia, Atrial flutter, Atrioventricular block, Bradycardia, COVID-19
Clinical narrative: ate of Admission: 10/15/2023   Date of Discharge: 10/25/23   Issues to be Addressed at Follow-up: Pain, wound check, mobility    Pending Study Results at Discharge:  Unresulted Lab Orders    No orders found from 9/19/2023 to 10/20/2023.       Final Diagnoses:  Active Hospital Problems   Diagnosis   ? (Principal) LEFT FEMORAL NECK FX   ? ASYMPTOMATIC COVID-19 DISEASE   ? HX OF FALL   ? ANEMIA       6/23/2023: Chronic established diagnosis. Briefly reviewed plan today, cont current regimen.  Multiple medical problems will do basic anemia evaluation after released from hospital Had spep while admitted        Sept 1 2022    Message:       Hi, it looks like his anemia has improved and given the ferritin, I agree       that GI evaluation probably not indicated at this time (the low iron       levels can also be seen with anemia of chronic inflammation).  Would       continue to observe CBC again in 4 months if he is otherwise clinically       asymptomatic.            June 2022 heme        Message:       Would add on serum immunofixation, but overall labs not c/w MGUS given no       M spike on SPEP and K/L ratio normal.  Regarding the anemia, would advise       checking vitamin B12, folate, copper, retic count, iron studies.            March 2022 heme  Here is the message for your reference: (M.D.) Labs reviewed.  SPEP showed unquantifiable M spike, IFE negative.  K/L ratio normal.  Advise repeating CBC, Cr, Ca, SPEP, SFLC in 3 months to follow up.  Feel free to contact with questions.           ? HX OF ISCHEMIC STROKE       ACUTE STROKE DUE TO ISCHEMIA, UNSPECIFIED TYPE AND ARTERY [I63.9] » HX OF ISCHEMIC STROKE [Z86.73]   ? ATHEROSCLEROSIS OF AORTA       6/21/2021: Chronic established diagnosis. Briefly reviewed plan today, cont current regimen.    Re aotra comment from June 2021 echo cards  The referral sent by you has been closed with Status code 60 Advice Message To Referring Provider and you don't need to add a response. Here is the message for your reference: (M.D.) Hi - I wouldn't do anything. 4.1 cm is barely aneurysmal and based on his age, I doubt CT Surgery would even do surveillance. ( Just an FYI -ascending aortic issues go to CT surg in medical facility. We deal with the descending thoracic aorta on down. )     To review and respond, click the "Reply" link below. (Not applicable for "Closed Referrals" and "Remote in-basket")           ? ATRIAL FIBRILLATION, PERMANENT       5/8/2023: Chronic established diagnosis. Briefly reviewed plan today, cont current regimen.  Declines anticoag while admitted feb 2022  Dizzy and brady on BB - holding for now     1/29/2022 EKG: Atrial flutter with predominant 3:1 AV block. Compared to the prior ECG, the RBBB is no longer. present    9/09/2021 Cardiac Echo: Technically difficult study due to poor acoustic windows and/or the  patient's body habitus.  Probably normal LV systolic function with a visually estimated ejection  fraction of 60%. Endocardial definition is poor.  Diastolic function could not be interpreted because of atrial  fibrillation.       ? ESRD ON DIALYSIS W MINERAL BONE DISEASE W SECONDARY HYPERPARATHYROIDISM   ? ADULT OBSTRUCTIVE SLEEP APNEA   ? CAD WO ANGINA, PRESENCE OF STENT       Resolute onyx mid rca 1/22/18     ? HTN (HYPERTENSION)       4/1/2021: Chronic established diagnosis. Briefly reviewed plan today, cont current regimen.  coreg     ? HYPERLIPIDEMIA       4/1/2021: Chronic established diagnosis. Briefly reviewed plan today, cont current regimen.  statin       Resolved Hospital Problems No resolved problems to display.     Discharge Disposition:  SNF   Medications, instructions, follow up information: See patient Discharge Instructions/AVS.   Hospital Course and Significant Findings: 85 year old male with PMHx of HTN, HLD, Glaucoma, Hx of Tobb Abuse, BPH (hx of TURP), OSA, hx of Stroke, Meningioma, Cognitive Decline, AAA, ESRD on HD,  CAD (s/p PCI 1/22/18), Atrial Fibrillation, admitted on 10/15/23 after an unwitnessed fall with leg pain foundto have Left Femoral Neck Fracture and asymptomatic COVID 19 positive..   Pt with covid without symptoms.  Pt also with small about of blood per rectum, no active bleeding.  Pt transfused total of 2 units prbc during hospitalization.  Pt with ongoing HD.  Stable for discharge to SNF. Pt to be in isolation through 10/25/23   Per progress note: "LEFT FEMORAL NECK FX (10/15/2023)  HX OF FALL (7/25/2023)   Assessment: S/P OR   Plan:  SNF, ortho follow up.    ESRD ON DIALYSIS W MINERAL BONE DISEASE W SECONDARY HYPERPARATHYROIDISM (4/19/2021)   Assessment: No signs of fluid overload   Plan: Dialysis per Nephrology. Con't Torsemide.   Constipation. - cont bowel regimen.  Added dulcolax.    ADULT OBSTRUCTIVE SLEEP APNEA (4/19/2021)   Assessment: Noted   Plan: CPAP ordered    ATRIAL FIBRILLATION, PERMANENT (6/16/2021)   Assessment: Not on anticoagulation outpatient   Plan: Outpatient follow up    CAD WO ANGINA, PRESENCE OF STENT (4/19/2021)  HYPERLIPIDEMIA (4/1/2021)  ATHEROSCLEROSIS OF AORTA (6/21/2021)  HX OF ISCHEMIC STROKE (1/29/2022)   Assessment: Noted   Plan: Con't ASA, Statin    ANEMIA (6/3/2022)   Assessment: Nephrogenic. Slightly lower today   Plan: s/p  1U PRBC, no bleeding clinically    ASYMPTOMATIC COVID-19 DISEASE (10/15/2023)   Assessment: (+) of 10/15   Plan: 10-day isolation    HTN (HYPERTENSION) (4/1/2021)   Assessment: Stable not on meds   Plan: Con't t monitor   Dementia/cognitive decline.   severe.  Pt largely aphasic.  Barely oriented X 1."     Primary Procedures:  Procedure(s): HIP HEMIARTHROPLASTY   Secondary Procedures: None   Reason for Hospital Admission (Admitting Diagnosis):      Complications: none   Consults:  HOSPITAL MEDICINE - INITIAL INPATIENT CONSULTATION. HOSPITAL MEDICINE - ONGOING INPATIENT CONSULTATION. ORTHOPEDIC MEDICINE - INITIAL INPATIENT CONSULTATION. ORTHOPEDIC MEDICINE - ONGOING INPATIENT CONSULTATION. NEPHROLOGY - ONGOING INPATIENT CONSULTATION. Smoker: No.   Condition on Discharge: stable   Code Status at Time of Discharge: Data unavailable    Inactive Attestations      Attestation signed by (M.D.) at 10/19/2023  5:33 PM to a previous version   I have reviewed and verified the content of this Discharge Summary. The Discharge Summary accurately reflects the outcome of the patient?s hospitalization and/or treatment, the disposition of the patient, and the patient?s final diagnosis. I have verified that the Discharge Summary also provides for appropriate follow-up care to facilitate proper continuity of care. Attestation signed by (M.D.) at 10/18/2023  4:00 PM to a previous version   I have reviewed and verified the content of this Discharge Summary. The Discharge Summary accurately reflects the outcome of the patient?s hospitalization and/or treatment, the disposition of the patient, and the patient?s final diagnosis. I have verified that the Discharge Summary also provides for appropriate follow-up care to facilitate proper continuity of care.        Note Details  Author (M.D.) File Time 10/26/2023  3:15 PM Author Type Physician Status Addendum Last Editor (M.D.) Specialty Hospital Medicine Hospital Acct #  Admit Date 10/15/2023  ED to Hosp-Admission (Discharged) on 10/15/2023  ED to Hosp-Admission (Discharged) on 10/15/2023   Revision History   Detailed Report  Note shared with patient Additional Orders and Documentation   Results Imaging   Meds    Orders Procedures   Flowsheets   Encounter Info:  History, Allergies, Education, Care Plan, Detailed Report   Linked Episodes  HIP HEMIARTHROPLASTY From 10/15/2023 to 10/17/2023  Hospital Problem List   HTN (HYPERTENSION)  HYPERLIPIDEMIA  CAD WO ANGINA, PRESENCE OF STENT  ESRD ON DIALYSIS W MINERAL BONE DISEASE W SECONDARY HYPERPARATHYROIDISM  ATRIAL FIBRILLATION, PERMANENT  ATHEROSCLEROSIS OF AORTA  HX OF FALL  LEFT FEMORAL NECK FX  ADULT OBSTRUCTIVE SLEEP APNEA  HX OF ISCHEMIC STROKE  ANEMIA  COGNITIVE DISORDER  ASYMPTOMATIC COVID-19 DISEASE Care Timeline  10/15   Admitted from ED (Observation) 1145 10/16   HIP HEMIARTHROPLASTY 10/17   Admitted 0947 10/25   Discharged 1712  Discharge   SNF - Skilled bed (or Subacute)   SNF Orders (Printed 10/25/2023) Medication List at Discharge   acetaminophen 1,000 mg Oral EVERY 8 HOURS, X 10 days and then as needed for pain  aspirin 81 mg 1 tab po BID for 30 days after surgery and then resume prior regimen of 1 tab po at bedtime on 11/14/23  atorvastatin calcium 40 mg Oral DAILY, to prevent heart attacks and strokes  calcitriol 0.25 mcg Oral 3 TIMES A WEEK  cetirizine HCl 5 mg Oral EVERY OTHER DAY  docusate sodium 100 mg Oral 2 TIMES A DAY  fexofenadine HCl 60 mg Oral 2 TIMES A DAY AS NEEDED  fluticasone propionate 50 mcg/actuation Use 2 sprays in each nostril daily for seasonal allergy symptoms. Then may adjust to 1 or 2 sprays in each nostril daily  folic acid/vit B complex and C 0.8 mg 1 tablet Oral DAILY  ipratropium bromide 21 mcg (0.03 %) 2 Sprays Each nostril 2 TIMES A DAY  methocarbamol 500 mg Take one tablet orally twice a day on Dialysis days for cramping  midodrine HCl 10 mg Take 1 tablet by mouth during or after dialysis if Blood pressure is less than 100/80. May take 1 tablet by mouth  as needed 3 times a day if Blood pressure is less than 100/80 mmHg.Check BP before taking this medication.  naloxone HCl 4 mg/actuation For Recipient Use. Use 1 spray in one nostril. Seek immediate emergency medical help. If response is not obtained after 2 or 3 minutes, administer 2nd dose using new device in other nostril until emergency help arrives. Emergency use only  oxycodone HCl 5 mg Half- tab po q 4 hours PRN moderate pain OR 1 tabs po q 4 hours PRN severe pain only  polyethylene glycol 3350 17 gram/dose Mix 17 Grams in 4 to 8 ounces of water or juice and drink by mouth daily as directed for constipation  sennosides 8.6 mg Oral 2 TIMES A DAY  sodium polystyrene sulfon/sorb 15-20 gram/60 mL Take 60 mL by mouth daily if unable to do dialysis. Please talk to your dialysis nurse before taking the medication for high potassium. Please go to emergency department if not feeling well.  torsemide 100 mg Take one tablet orally on non-dialysis days to produce more urine (Diuretic)