Inpatient Progress Report the Weeks of October 1st through 8th 2025

P1

Age/Sex: 63-year-old male

Past Medical History: 

PSDU (tobacco and cocaine), COPD, CAD, paroxysmal atrial fibrillation (previously on apixaban), mood disorder, GERD, medication nonadherence.

Initial Admission: 

September 10th, for new-onset chest pain; found to have segmental and subsegmental pulmonary embolism.

Current Admission: 

Readmitted for ongoing chest pain, thought to be pleuritic pain secondary to pulmonary embolism/pulmonary infarct.

Status: AOx4. Possible discharge today or tomorrow.

Assessment and Plan

1. Chest Pain

• Reproducible; unlikely related to pulmonary emboli.

• ACS ruled out.

• Start standing acetaminophen.

2. Pulmonary Embolism / APLS

• Given AKI, continue heparin drip with bridge to warfarin.

• Patient unable to self-administer Lovenox at home.

• Likely discharge tomorrow if INR ≈ 2.

• Follow up with hematology.

• Repeat hypercoagulability panel recommended in 12 weeks (around mid-December).

3. AKI

• Baseline creatinine ~1.1; improving today.

• Continue heparin drip pending stability.

• Possibly secondary to contrast exposure from CTA on 9/30.

• Continue to monitor renal function.

4. COPD

• Continue Symbicort and tiotropium.

• PRN albuterol.

5. Tobacco and Cocaine Use

• Continue 21 mg nicotine patch + gum.

• Patient educated on use by prior physician.

6. Atrial Fibrillation on Anticoagulation

• Continue diltiazem 120 mg CD.

• Heparin drip to warfarin bridge as above.

7. Hypothyroidism

• Reports diaphoresis and heat intolerance.

• Check TSH.

• Continue levothyroxine 125 µg daily.

P2

Age/Sex: 48-year-old female

Past Medical History: GERD, vasovagal syncope, IBS-C with chronic constipation.

Presentation: Four days of severe LLQ pain with BR blood per rectum and fatigue. Found to have acute on chronic anemia and sepsis secondary to colitis.

Assessment and Plan

1. Sepsis secondary to Acute Rectosigmoid Colitis
2. Lower GI Bleed (Hematochezia)
3. Acute Normocytic Anemia (Hgb 13 → 10)

• CT: Sigmoid colon and rectal inflammation.

• Blood cultures: NGTD. MRSA PCR negative. C. diff PCR/toxin negative.

• Iron studies: Mixed picture of AoCD/IDA; B12 within normal limits.

• Status post IV fluids; diet advanced as tolerated.

• Pain control: Acetaminophen, oxycodone 2.5/5 mg Q4H PRN.

• GI consulted—appreciate recommendations.

• Flex sig: Eroded, hemorrhagic, inflamed, and plaque-covered rectal mucosa; biopsied.

• Antibiotics: s/p Ceftriaxone + Metronidazole→ Augmentin x5–7 days.

• Stool pathology results pending.

4. Severe Constipation / IBS-C
5. Diarrhea (Resolved)

• Optimize bowel regimen.

6. Chest Pain

• Suspect musculoskeletal/costochondritis; reproducible to palpation.

• EKG: No acute ST/T wave changes.

• Multimodal pain regimen as above.

• Patient reports pain is tolerable; declines changes or lidocaine patch.

Diet: Regular
VTE Prophylaxis: Lovenox
Communication: RN, consultants, and case management updated.

Discharged!

P3

Age/Sex: 59-year-old female
Past Medical History: Paroxysmal AFib (not on AC), thyroid cancer, osteomyelitis, multiple sclerosis with spastic paraplegia, neurogenic bowel/bladder with suprapubic tube (placed 09/2024), bilateral hydronephrosis s/p indwelling ureteral stents.

Presentation: From O.H. with weakness and fatigue; found to have catheter-associated UTI.

Assessment and Plan

1. Sepsis secondary to UTI

• Neurogenic bladder with suprapubic catheter (exchanged 10/4/25).

• Bilateral hydronephrosis with indwelling ureteral stents.

• 10/4 UA positive; urine culture pending.

• 10/4 blood cultures NGTD.

• Leukocytosis improving: WBC 19.2 → 14.4.

• S/p cath changed 10/4.

• Urology consulted for leakage (chronic issue ~9 months).

• Bladder scan: 0 mL; irrigation successful.

• Continue Vancomycin (Day #2).

2. AKI on CKD

• Renal consult appreciated.

• Cr 3.8 → 3.7 (10/5).

• FeNa 24.9% (intrinsic etiology).

• Add sodium bicarbonate 1300 mg PO TID.

• Continue LR at 75 mL/hr.

• Discontinue Fleet enema at STR; obtain records for last administration.

• Check renal ultrasound.

3. Hyponatremia (Improving)

• Na 131 → 134.

• Restrict free water.

4. Multiple Sclerosis with Spastic Paraplegia

• Wheelchair-bound.

• Hold gabapentin 200 mg PO BID until AKI resolves.

5. Paroxysmal Atrial Fibrillation

• Continue amiodarone 200 mg PO daily.

• Not on anticoagulation.

6. Isolated Alkaline Phosphatase Elevation

• Alk Phos 169 (previously up to 244).

• Check LFTs.

• Consider RUQ ultrasound.

7. Hypothyroidism

• Continue Synthroid 100 µg PO daily.

8. Psychiatry

• Continue Remeron 7.5 mg PO nightly.

Comorbidities

• Hypercoagulable state due to atrial fibrillation.

• Also PMH of COVID.

Secondary Diagnoses (During Hospitalization)

• Hypocalcemia.

• Hyponatremia.

Diet: Dysphagia diet.
VTE Prophylaxis: Heparin (porcine) 5,000 Units.
Medication Reconciliation: Complete.
Communication: Family

P4

Age/Sex: 73-year-old female
Past Medical History: Advanced dementia (non-verbal at baseline), seizure disorder, SDH s/p burr holes (2023), OSA, atrial fibrillation (not on anticoagulation).

Presentation: 

Generalized weakness and lethargy. Initially admitted to MICU for septic shock secondary to UTI vs. CAP, complicated by metabolic encephalopathy requiring intubation for airway protection. Now medically stable and transferred to the floor.

Hospital Course: Complicated by dysphagia requiring NGT; now cleared for dysphagia diet and undergoing calorie counts.

Assessment and Plan

1. Acute Metabolic Encephalopathy / Advanced Dementia / Seizure Disorder / History of SDH

• EEG negative for seizures.

• Continue Keppra 500 mg BID.

• Continue thiamine and folic acid.

• Currently requires NGT (see below for nutrition plan).

2. Hypothermia – Resolved

• Hypothermic episode noted on 10/3; no evidence of active sepsis.

• TSH and cortisol on 9/25 within normal limits.

• Continue to monitor; vitals otherwise stable.

3. Dysphagia / Vocal Cord Edema / Suboptimal PO Intake / Hypomagnesemia

• FEES: “Frank red blood vs hemorrhagic appearance of left false vocal fold.”

• ENT consulted: Findings consistent with vocal cord hemorrhage likely secondary to intubation trauma and exacerbated by coughing.

  • Recommendations: Avoid NSAIDs, ensure voice rest, outpatient ENT follow-up.

• Maintain aspiration precautions.

• SLP re-evaluation: Cleared for pureed solids and nectar-thickened liquids.

• Continue Vital AF 1.2 at 60 cc/hr x24h while optimizing PO intake (restarted).

  • Calorie counts to be reassessed by RD.

• If patient fails to meet caloric needs (likely), discuss goals of care with family and consider G-tube placement (family previously expressed openness in MICU).

• Discontinued sliding-scale insulin and glucose checks due to stable BG levels and no insulin requirements.

• Continue daily electrolyte monitoring and replete as needed.

Resolved Issues:

• AKI – Resolved: Creatinine back to baseline; Foley removed; bladder scans normal. Nephrology signed off.

• Hypotension – Resolved: Previously on midodrine in Step D/U; now discontinued.

  • Restart losartan 25 mg daily (home dose 50 mg BID).

• Septic Shock secondary to UTI vs Aspiration Pneumonia – Resolved: Completed 7-day course of Zosyn.

• Anemia and Thrombocytopenia: Hgb stable, platelets improving; continue to monitor.

Chronic Conditions:

• OSA: Continue nightly CPAP.

• HTN: Resume losartan as above.

Nutrition: Tube feed with tray (Vital AF 1.2).
VTE Prophylaxis: Heparin SQ.
Communication: RN and Case Management updated.
Code Status: Full Code.

P5

Age/Sex: 86-year-old female
Past Medical History: Advanced dementia, hypertension, prior VTE, Raynaud’s phenomenon, osteoporosis complicated by pathologic fractures, APLS, GERD, osteoarthritis.

Presentation: Admitted for evaluation of right hip pain following an unwitnessed fall at her facility. Imaging confirmed an acute right pelvic ring fracture.

Assessment and Plan

1. Acute Right Pelvic Ring Fracture (Post Fall)

• Orthopedic Surgery consulted: Non-operative management recommended.

• Pain management:

  • Acetaminophen 1000 mg q8h scheduled.

  • Lidocaine patch to right hip.

  • Toradol 7.5 mg IV q6h PRN for severe pain.

  • Zofran PRN for nausea.

• PT/OT evaluation ordered.

• Unclear if loss of consciousness occurred; obtain EKG and place on cardiac telemetry.

2. Chronic Medical Problems

• Dementia with Mood Disturbance: Continue Lexapro 5 mg daily and melatonin nightly PRN. Donepezil previously discontinued by PCP due to lack of benefit.

• History of APLS with VTE: Warfarin recently discontinued due to recurrent falls and risk of head injury.

• History of Hypertension: BP has remained stable off prior antihypertensive medications.

Diet: Regular diet.
VTE Prophylaxis: Enoxaparin (prophylactic dose).
Medication Reconciliation: Completed prior medical records.
Code Status: Full Code.
Disposition: Admit to inpatient for further management.