65 y.o. 2/28/1957   Admit Date:  8/7/2022   Discharge Date:  8/16/2022   Principal Diagnoses:  Active Problems:   Encephalopathy     Discharge Diagnosis:  Acute metabolic encephalopathy ESBL Proteus UTI Hypotension Hyperkalemia hypokalemia Hypomagnesemia Acute renal failure, prerenal, ACE Left parotitis Possible posterior cerebral CVA     Hospital Course: admitted from facility with confusion. Appeared to have UTI, started on antibx, turned to be ESBL as above and changed to meropenem. Creatinine 1.2, above normal baseline. ACE/diuretic held. Betablocker held due to low BP. CTA head and neck done on admit to evaluate her encephalopathy, no occlusion but showed mass left parotid. ? Of posterior cerebral artery CVA.  On antibx for this and seen by ENT. CT abdomen benign. She improved with above. Renal functions normalized, mental status cleared. Sx likely primarily from UTI. At discharge baseline, 3 more days of Invanz. Is on statin and APT.    Disposition:     Discharge Condition:    Discharge Medications:   Current Discharge Medication List   START taking these medications   Details 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). Refills: 0   Associated Diagnoses: Acute cystitis without hematuria   doxycycline monohydrate (MONODOX) 100 mg capsule Take 1 Capsule by mouth Twice a day for 3 days. Refills: 0   Associated Diagnoses: Acute cystitis without hematuria   NS (sodium chloride 0.9%) mini-bag 100 mL with ertapenem (INVanz) 1 g Administer 1 g intravenously Every 24 hours for 3 days. Start on 8/17/2022  Indications: inflammation of the bladder, an infection of the skin and the tissue below the skin Refills: 0   Associated Diagnoses: Acute cystitis without hematuria   Lactobacillus rhamnosus GG (CULTURELLE) 15 billion cell sprinkle capsule Take 1 Capsule by mouth Twice a day. Qty: 60 Capsule, Refills: 0   Associated Diagnoses: Acute cystitis without hematuria   magnesium oxide (MAG-OX) 400 mg tablet Take 1 Tablet by mouth Twice a day for 10 days. Refills: 0   Associated Diagnoses: Acute cystitis without hematuria   menthol-zinc oxide (CALMOSEPTINE) 0.44-20.625 % ointment Use as directed Refills: 0   Associated Diagnoses: Acute cystitis without hematuria   nystatin (MYCOSTATIN) 100,000 unit/mL suspension Take 5 mL by mouth Four times a day for 7 days. Refills: 0   Associated Diagnoses: Acute cystitis without hematuria   pantoprazole (PROTONIX) 40 mg DR tablet Take 1 Tablet by mouth Once Daily for 30 days. Refills: 0   Associated Diagnoses: Acute cystitis without hematuria   QUEtiapine (SEROQUEL) 25 mg Take 1 Tablet by mouth Twice a day. Refills: 0   Associated Diagnoses: Acute cystitis without hematuria     CONTINUE these medications which have CHANGED   Details atorvastatin (LIPITOR) 40 mg tablet Take 1 Tablet by mouth At bedtime for 90 days. Qty: 90 Tablet, Refills: 0   Associated Diagnoses: Cerebrovascular accident (CVA), unspecified mechanism   busPIRone (BUSPAR) 5 mg tablet Take 1 Tablet by mouth Three times a day as needed. Refills: 0   Associated Diagnoses: Acute cystitis without hematuria   clonazePAM (KLONOPIN) 0.5 mg tablet Take 1 Tablet by mouth Once daily as needed for Anxiety for up to 3 days. Qty: 9 Tablet, Refills: 0   Associated Diagnoses: Anxiety and depression   traMADoL (ULTRAM) 50 mg tablet Take 1 Tablet by mouth Every 6 hours as needed for Pain for up to 3 days. Qty: 12 Tablet, Refills: 0   Associated Diagnoses: Acute cystitis without hematuria     CONTINUE these medications which have NOT CHANGED   Details senna (SENOKOT) 8.6 mg tablet Take 8.6 mg by mouth At bedtime.   nystatin (NYSTOP) powder by Topical route Twice a day.   polyethylene glycol 3350 (MIRALAX) 17 gram packet Take 17 g by mouth Once Daily.   isosorbide mononitrate (IMDUR) 30 mg CR tablet Take 1 Tablet by mouth Once Daily. Qty: 30 Tablet, Refills: 11   clopidogreL (PLAVIX) 75 mg tablet Take 1 Tablet by mouth Daily. Qty: 90 Tablet, Refills: 3   Associated Diagnoses: History of CVA (cerebrovascular accident)   loratadine (CLARITIN) 10 mg tablet Take 10 mg by mouth.   oxybutynin (DITROPAN-XL) 5 mg ER tablet Take 5 mg by mouth Daily.   aspirin (ASPIRIN) 81 mg DR tablet Take 1 Tab by mouth Daily. Refills: 0   Associated Diagnoses: Essential hypertension; Atypical chest pain   dicyclomine (BENTYL) 20 mg tablet Take 20 mg by mouth Twice a day.   escitalopram oxalate (LEXAPRO) 20 mg Take 1 Tab by mouth Daily. Qty: 30 Tab, Refills: 2   Associated Diagnoses: Anxiety and depression   amitriptyline (ELAVIL) 50 mg tablet Take 1 Tab by mouth At bedtime. Qty: 30 Tab, Refills: 2   Associated Diagnoses: Anxiety and depression   levothyroxine (SYNTHROID) 50 mcg tablet Take 1 Tab by mouth Daily. Qty: 30 Tab, Refills: 2   Budesonide-Formoterol (SYMBICORT 160-4.5 MCG) 160-4.5 mcg/Actuation inhaler Take 2 Puffs by inhalation Every 12 hours.   clobetasoL (TEMOVATE) 0.05 % cream Apply twice daily after soaks, then immediately apply Cetaphil or CeraVe cream all over. Do not use on face, underarms, breast or groin. Qty: 45 g, Refills: 1   Associated Diagnoses: LSC (lichen simplex chronicus)   halobetasol (ULTRAVATE) 0.05 % cream Apply twice daily after soaks, then immediately apply Cetaphil or CeraVe cream all over. Do not use on face, underarms, breast or groin. Qty: 50 g, Refills: 1   Associated Diagnoses: LSC (lichen simplex chronicus)   nitroglycerin (NITROSTAT) 0.4 mg SL tablet Take 1 Tab sublingually Every 5 minutes as needed for Chest pain. Qty: 30 Tab, Refills: 0   Associated Diagnoses: Atypical chest pain     STOP taking these medications     potassium chloride (KLOR-CON) 20 mEq tablet Comments:  Reason for Stopping:        carvediloL (COREG) 6.25 mg tablet Comments:  Reason for Stopping:        famotidine (PEPCID) 20 mg tablet Comments:  Reason for Stopping:        hydrochlorothiazide (HYDRODIURIL) 25 mg tablet Comments:  Reason for Stopping:          Diabetic diet AAT Mid line out after antibx finished   CBC CMP Mg++ within 3-5 days BP meds held due to low BP, resume as indicated CT neck 2 weeks, follow up ENT after Resume PT/OT