New Week of October 19th

SBAR REPORTS

91 y/o Male – Hematuria, UTI, Parkinson’s

Situation:
Admitted with hematuria after Foley exchange on 10/17.

Background:
PMHx: Parkinson’s disease, BPH with chronic Foley, HTN, HLD, anxiety, bilateral lower extremity edema.

Assessment:
UA consistent with UTI, lactate 2.2 → 2.0, mild leukocytosis. Hypertensive and tachycardic on arrival. R eye conjunctivitis noted. Hb stable, Parkinson’s symptoms controlled on Sinemet.

Recommendation:

• Continue CTX pending cultures/susceptibility

• Trend fever curve and leukocytosis

• Continue Doxazosin for BPH

• PT recommends STR; daughter agrees

• Supportive care for viral conjunctivitis

60 y/o Male – Chronic Urinary Retention, HIV, SI/HI

Situation:
Presented with flank pain, abdominal pain, decreased urine output, and hematuria; also endorsed suicidal and homicidal ideation.

Background:
PMHx: HIV (noncompliant with meds), HFrEF (EF 47%), nephrolithiasis, chronic urinary retention, PSUD (cocaine). Recently discharged from correctional facility.

Assessment:
UA consistent with UTI (E. faecalis <50k CFU). CT showed chronic bladder outlet obstruction with diverticula. Foley placed 10/17, removed 10/18; now voiding spontaneously. Hep C Ab positive. CD4 count 109. Psychiatry following for SI/HI.

Recommendation:

• Continue Flomax 0.4mg daily

• Monitor bladder scans for PVR

• Belbuca 300 mcg q12h (patient refusing AM dose)

• Continue Olanzapine 5mg QHS; no 1:1 sitter as of 10/19

• Restart Biktarvy, ID consult for ART resistance

• Trend LFTs, follow-up Hep C PCR

• Caution with beta-blockers due to possible cocaine use

76 y/o Female – GI Bleed, IDA, AKI

Situation:
Presented with vomiting, diarrhea, weakness, AMS; found to have severe IDA (Hg 6.4), AKI, and suspected GIB.

Background:
PMHx: C5 quadriparesis (post-fall SCI), PUD, NIDDM2, HTN, HFpEF (EF 65%), chronic pain on narcotics.

Assessment:
Anemia improved post 2U PRBC + IV iron; AKI resolved. Colonoscopy/EGD scheduled for 10/20 after failed prep. HTN persistent but improving on losartan 50mg + PRN clonidine. Stable mild pulmonary edema; resumed home torsemide post-procedure.

Recommendation:

• Proceed with EGD/colonoscopy today

• Continue cyanocobalamin 1000mcg daily

• Protonix 40mg IV BID

• Monitor BP; continue losartan/clonidine PRN

• Resume torsemide post-procedure

• PT/OT: moderate complexity, discharge planning for home

• Replace K⁺ for hypokalemia (3.3)

45 y/o Female – L Thumb Infection, PSUD

Situation:
Admitted with L thumb cellulitis/abscess after trauma; MRSA positive.

Background:
PMHx: ADHD, MDD, PSUD (cocaine/opiate), hx of abuse.

Assessment:
Superficial infection, no osteomyelitis. I&D performed by Plastics. On methadone maintenance, addiction medicine following. Oxycodone PRN reduced due to lethargy.

Recommendation:

• Continue warm soapy soaks TID and elevation

• Continue Vancomycin x7d (consider switch to doxycycline once appropriate)

• Continue methadone, monitor for sedation

• Maintain COWS/CIWA protocol

• Continue Abilify and topiramate

• Referral to medical respite in progress

Quick Note to All Using the Systems

• Please verify Foley catheter details and record exact exchange/removal dates in all patients with urinary retention.

• Document infection trends (fever, WBC, cultures) daily and notify if worsening.

• For patients with psychiatric or addiction issues, ensure medication compliance and psych follow-up are tracked.

• Reconcile meds carefully—several are on complex regimens (methadone, ART, antihypertensives, diuretics).

• Update SBAR handoffs each shift to reflect any med change, lab trends, or consult follow-up.

Situation:

56-year-old female with abdominal and left flank pain x1 day, dysuria, and known history of kidney stones. Imaging revealed a partially obstructing left renal stone with concern for UTI. CT also shows large stool burden with possible focal colitis, without obstruction or diverticulitis. Currently A&O×4, on room air, NPO, and receiving NS at 75 mL/hr.

B – Background:
PMH: Endometriosis, anemia, neuropathy, HTN, chronic constipation/IBS, GERD, kidney stones.
Home meds include: Toprol (HTN), Protonix (GERD), gabapentin (neuropathy).
Symptoms began 1 day ago. Care plans reviewed.

A – Assessment:

• Obstructive uropathy secondary to left renal stone, possible associated UTI.

• Large stool burden consistent with chronic constipation; focal colitis possible on CT.

• No bowel obstruction noted.

• Patient hemodynamically stable, pain ongoing but controlled with medication.

R – Recommendation:

• Maintain NPO status

• Continue ceftriaxone, IV fluids, pain and nausea management

• Consult IR for possible PCNT

• Resume bowel regimen once eating; consider PRN enema

• Continue home meds (Toprol, Protonix, gabapentin)

• Arrange outpatient urology follow-up

Brief Progress Note

Principal Problems:

• Obstructive uropathy / left renal stone

• Severe constipation / large stool burden

• HTN, GERD, neuropathy (chronic)

Plan:
1. Left renal stone with obstructive uropathy

• NPO

• Continue ceftriaxone

• IR consult for possible PCNT

• Oxycodone for pain, Zofran for nausea

• Outpatient urology follow-up

2. Large stool burden / chronic constipation / hx IBS

• Resume bowel regimen when diet restarted

• PRN enema if no relief

3. HTN

• Continue Toprol

4. GERD

• Continue Protonix

5. Neuropathy

• Continue gabapentin

Status: A&O×4, room air, NPO, NS at 75 mL/hr.