Patient ID:  74 y.o.    Admit Date:  7/31/2022   Discharge Date: 8/5/22   Principal Dx/ Final Dx: Sepsis   Relevant Inpt Dx: Principal Problem:   Sepsis Active Problems:   Chronic systolic CHF (congestive heart failure)   Pulmonary emphysema   S/P AKA (above knee amputation) bilateral   HTN (hypertension)   Type 2 diabetes mellitus with hyperglycemia, with long-term current use of insulin   Atrial fibrillation       HPI:   Hospital Course:   This 74 year old man with bilateral AKA was admitted with sepsis.  He had uti due to chronic foley catheter.  Urine culture grew pseudomonas.  He will complete 10 days or iv cefepime as unable to find oral medication based on sensitivities.  He had midline placed and this should be removed when antibiotics are done.  Follow up with pcp.   His sepsis syndrome is resolved He tested positive for covid but did not require treatment for this        Consults:   IP CONSULT TO SEPSIS NURSE NAVIGATOR IP CONSULT TO SOCIAL WORK IP CONSULT TO WOUND CARE IP CONSULT TO IV THERAPY     Disposition:  home   Discharge Condition:  fair   Discharge Medications:   Current Discharge Medication List   START taking these medications   Details Lactobacillus rhamnosus GG (CULTURELLE) 15 billion cell sprinkle capsule Take 1 Capsule by mouth Twice a day for 14 days. Qty: 28 Capsule, Refills: 0   Associated Diagnoses: Sepsis due to Pseudomonas species without acute organ dysfunction   NS (sodium chloride 0.9%) mini-bag 100 mL with cefepime (MAXIPIME) 2 g Administer 2 g intravenously Every 8 hours for 10 days. Indications: sepsis Qty: 30 Each, Refills: 0   Associated Diagnoses: Urinary tract infection without hematuria, site unspecified     CONTINUE these medications which have CHANGED   Details magnesium oxide (MAG-OX) 400 mg tablet Take 1 Tablet by mouth Twice a day for 7 days. Qty: 14 Tablet, Refills: 0   Associated Diagnoses: Hypomagnesemia   !! oxybutynin chloride (DITROPAN XL) 15 mg ER tablet Take 1 Tablet by mouth Once Daily. Qty: 90 Tablet, Refills: 3   Associated Diagnoses: BPH with obstruction/lower urinary tract symptoms    !! - Potential duplicate medications found. Please discuss with provider.   CONTINUE these medications which have NOT CHANGED   Details !! oxybutynin chloride (DITROPAN-XL) 10 mg ER tablet Take 10 mg by mouth Once Daily.   sennosides-docusate sodium (SENOKOT-S) 8.6-50 mg Take 1 Tablet by mouth At bedtime as needed.   lactulose (CHRONULAC) 20 gram/30 mL solution Take 30 mL by mouth Twice a day. Qty: 1000 mL, Refills: 0   Associated Diagnoses: Hyperammonemia   metoprolol (LOPRESSOR) 25 mg tablet Take 1 Tablet by mouth Twice a day for 30 days. Qty: 60 Tablet, Refills: 0   Associated Diagnoses: Primary hypertension   pantoprazole (PROTONIX) 40 mg DR tablet Take 1 Tablet by mouth Once Daily for 30 days. Qty: 30 Tablet, Refills: 0   Associated Diagnoses: Gastric ulcer, unspecified chronicity, unspecified whether gastric ulcer hemorrhage or perforation present   furosemide (LASIX) 40 mg tablet Take 1 Tablet by mouth Once Daily. Indications: fluid in the lungs due to chronic heart failure Qty: 90 Tablet, Refills: 3   insulin detemir U-100 (LEVEMIR U-100 INSULIN) 100 unit/mL injection Administer 25 Units subcutaneously At bedtime. Qty: 10 mL, Refills: 0   Associated Diagnoses: S/P AKA (above knee amputation) bilateral   !! insulin aspart U-100 (NOVOLOG) 100 unit/mL injection Administer 0.1 mL subcutaneously Before meals. Qty: 10 mL, Refills: 0   Associated Diagnoses: S/P AKA (above knee amputation) bilateral   !! insulin aspart U-100 (NOVOLOG) 100 unit/mL injection SCALE 2  Blood Sugars:  101-150 - None 151-200 - 2 Units 201-250 - 4 Units 251-300 - 6 Units 301-350 - 8 Units Greater than 350 - 10 Units Qty: 10 mL, Refills: 0   Associated Diagnoses: S/P AKA (above knee amputation) bilateral   ipratropium-albuteroL (DUO-NEB) 0.5 mg-3 mg(2.5 mg base)/3 mL nebulizer solution Take 3 mL by nebulization Every 4 hours. Qty: 180 Each, Refills: 0   Associated Diagnoses: COPD with acute exacerbation   albuterol (PROVENTIL) 2.5 mg /3 mL (0.083 %) nebulization Take 1 Vial by nebulization Every 6 hours. Indications: chronic obstructive pulmonary disease   tiotropium bromide 1.25 mcg/actuation Mist Take 2 Sprays by inhalation Daily.   Calcium-Cholecalciferol, D3, 250-125 mg-unit Tab Take 1 Tablet by mouth Daily. Indications: prevention of a low amount of calcium in the blood   Famotidine 40 mg tablet Take 20 mg by mouth Twice a day. Indications: gastroesophageal reflux disease   acetaminophen (TYLENOL) 325 mg tablet Take 2 Tabs by mouth Every 6 hours as needed for Fever, temp greater than or equal to 100.5F (for oral temperature (or equivalent) of 100.5 degrees Fahrenheit or greater). Indications: pain Qty: 0 Tablet, Refills: 0   tamsulosin (FLOMAX) 0.4 mg capsule Take 0.4 mg by mouth Daily. Indications: enlarged prostate   apixaban (ELIQUIS) 5 mg tablet Take 5 mg by mouth Twice a day. Indications: a flutter   methocarbamoL (ROBAXIN) 500 mg tablet Take 500 mg by mouth Three times a day as needed for Other (muscle spasm). Indications: muscle spasm   RT OXYGEN PER DELIVERY DEVICE 4 L/min by Nasal Cannula route RT Continuous. Indications: COPD/SOB   menthol-zinc oxide (CALMOSEPTINE) 0.44-20.625 % ointment 1 Dose by Topical route Every 3 days. and PRN  Indications: a wound   ferrous sulfate 325 mg (65 mg iron) DR tablet Take 325 mg by mouth Daily. Indications: anemia from inadequate iron   Budesonide-Formoterol (SYMBICORT 160-4.5 MCG) 160-4.5 mcg/Actuation inhaler Take 2 Puffs by inhalation Twice a day. Indications: COPD with Chronic Bronchitis   polyethylene glycol 3350 (MIRALAX) 17 gram packet Take 17 g by mouth Daily as needed for Constipation. Indications: constipation   nystatin (NYSTOP) powder 1 Applicator by Topical route Twice a day. Indications: skin infection due to a Candida yeast    !! - Potential duplicate medications found. Please discuss with provider.         Antibiotics - Dx and expected end date: Cefepime iv to complete 10 days treatment   Lines/ Catheters and expected date of removal: Mid line Remove when antibiotics are complete