Understanding Clinical Progress

PATIENT 1

DOB / AGE: 99 y.o.
GENDER: Female
DATE OF ADMISSION: Oct 2025
ADMISSION FROM: SNF

C/O ON ADMISSION: Intermittent chest pain and altered mental status

TESTS PERFORMED:

• CXR: Bibasilar opacities and interstitial markings (infection vs pulmonary edema)

• ProBNP 40,000 (prior ≤25,000)

• HS troponin 80→93→90 (no EKG change)

• Procalcitonin negative

• RVP positive for rhinovirus

• Urine culture: Klebsiella (pan-sensitive)

DIAGNOSIS:

• Rhinovirus infection

• Acute on chronic HFpEF exacerbation (EF 55%)

• CKD4

• Pyuria due to chronic Foley

• Gout

• Hypothyroidism

• Mood disorder

PMH: Dementia, HFpEF (TTR cardiac amyloidosis), pulmonary HTN, HTN, HLD, A-fib, SSS s/p PPM, CKD3B→4, urinary retention (chronic Foley), gout, hypothyroidism, DM, PMH COVID, immunosuppression (prednisone), hypercoagulable (A-fib), hypocalcemia.

Meds Interventions:

• Hydralazine 50 mg Daily

• Bumex 2 mg PO BID

• Metolazone 5 mg BID

• Ceftriaxone for Klebsiella

• Continue prednisone, allopurinol, levothyroxine, mirtazapine, apixaban

• Strict I&O, daily weights, Foley care

BASIC ASSESSMENTS: 

AOx1, RA, no SOB, +JVD, +BLE edema, calm, intermittently confused, skin intact. Total assist with all meals.

DIET: Cardiac consistent carbohydrate (1:1 feeder, bedrest).

CARE PLANS: Monitor volume status, renal function, infection control, safety, continue diuretics and antibiotics.

LDAs /IVS: Left forearm #20G, chronic Foley.
DISPOSITION: Code DNR/DNI; inpatient care with SNF-level follow-up.

PATIENT 2

DOB / AGE: 78 y.o.
GENDER: Male
DATE OF ADMISSION: X
ADMISSION FROM: X

C/O ON ADMISSION: Progressive dementia and behavioral disturbance

TESTS PERFORMED: CXR, Echo etc.

DIAGNOSIS: Dementia with behavioral disturbance; fungal rash; severe malnutrition; CAD, COPD; orthostatic hypotension; BPH; chronic anemia.

PMH: Dementia, CAD, COPD, HTN, severe malnutrition.

INTERVENTIONS:

• Olanzapine 5 mg @ 6 pm

• Melatonin + trazodone 50 mg @ 8 pm

• Trazodone 25 mg TID PRN

• Clotrimazole BID ×2 weeks

• Aspirin, statin, thiamine, folic acid, multivitamin, Ensure TID

• Stiolto (tiotropium) inhaler

• Midodrine 2.5 mg TID

• Flomax

BASIC ASSESSMENTS: Cognitively impaired, dependent, thin, malnourished, stable vitals.

DIET: Regular with nutritional supplements (Ensure TID).

CARE PLANS: Manage behavioral symptoms, optimize nutrition, coordinate conservatorship with CM and RN.

IVS: None.
DISPOSITION: Awaiting conservatorship/T19 for LTC.
CODE STATUS: Full Code.
EDD: 10/28/2025.

PATIENT 3

DOB / AGE: 89 y.o.
GENDER: Female
DATE OF ADMISSION: Not specified
ADMISSION FROM: Home (lost 24h aide)

C/O ON ADMISSION: Increased confusion, agitation, and combativeness

TESTS PERFORMED:

• TSH elevated, low FT4

• iCal 5.50, mild PTH elevation

DIAGNOSIS: Dementia with behavioral disturbance; hypothyroidism; HTN; recurrent UTIs (colonization); chronic HFrEF (EF 29%); chronic hypercalcemia; thrombocytopenia; chronic anemia.

PMH: Dementia, HFrEF, CKD3b, TIA, HTN, HLD, recurrent UTIs, thrombocytopenia, chronic anemia, PMH COVID.

INTERVENTIONS:

• Continue Seroquel, risperidone, Lexapro

• PRNs: Atarax 25 mg TID, Seroquel 25–50 mg TID, Risperdal ODT PRN, Zyprexa 2.5 mg IM PRN

• Synthroid 112 mcg daily

• Losartan 100 mg daily

• Hold antibiotics; consider methenamine + vitamin C

• Monitor calcium and PTH

BASIC ASSESSMENTS: Confused, occasionally combative, vitals stable.

DIET: Regular with supplements.

CARE PLANS: Behavioral stabilization, endocrine monitoring, geriatrics and ID follow-up.

IVS: None mentioned.
DISPOSITION: Awaiting behavioral stabilization and dispo plan.
CODE STATUS: Full Code.
EDD: 10/13/2025.

PATIENT 4

DOB / AGE: 70 y.o.
GENDER: Female
DATE OF ADMISSION: Not specified
ADMISSION FROM: Jail (recent release)

C/O ON ADMISSION: Fever and back pain post-IVDU

TESTS PERFORMED:

• MRI spine: L4–S1 discitis/OM with ventral epidural and psoas phlegmon

• CT A/P, TTE, cortisol, D-dimer: non-revealing

DIAGNOSIS: Has bacteremia with discitis and epidural phlegmon; severe spinal stenosis; polysubstance use disorder.

PMH: Infections, OUD, cocaine use, PTSD, IVDU.

INTERVENTIONS:

• Ceftriaxone x6 weeks (EOT ~11/6/25)

• Pain regimen: oxycodone, Tylenol, Flexeril PRN, gabapentin, lidocaine patch

• Addiction medicine: started on suboxone

• ID and neurosurgery following

BASIC ASSESSMENTS: Initially febrile, now afebrile; pain controlled; ambulatory with assistance.

DIET: Regular.

CARE PLANS: Complete IV antibiotic course, manage pain, coordinate addiction placement, monitor for recurrence.

IVS: PICC deferred; peripheral IV maintained.
DISPOSITION: Inpatient; awaiting infection resolution/addiction follow-up.
CODE STATUS: Not specified.

PATIENT 5

DOB / AGE: 73 y.o.
GENDER: Female
DATE OF ADMISSION: Not specified
ADMISSION FROM: Not specified

C/O ON ADMISSION: Weakness and lethargy → septic shock (UTI vs CAP)

TESTS PERFORMED: CXR, labs (pancytopenia resolved).

DIAGNOSIS: CAP vs UTI (resolved), severe malnutrition, dysphagia, encephalopathy, dementia, seizure disorder, OSA, Afib, HTN.

PMH: Dementia (nonverbal), seizures, SDH (burr hole), OSA, Afib (not anticoagulated), HTN.

INTERVENTIONS:

• Completed Zosyn ×7 days

• NG feeds; encourage PO intake

• Continue Keppra, CPAP (day & night), losartan, ASA

• Family declined G-tube

BASIC ASSESSMENTS: Nonverbal baseline, intermittently follows commands, stable, tolerating NG.

DIET: NG feeds with PO encouragement.

CARE PLANS: Nutrition maintenance, aspiration precautions, seizure safety, evaluate GOC as needed.

IVS: Not stated.
DISPOSITION: Pending nutritional improvement; family to revisit GOC.
CODE STATUS: Full Code.

PATIENT 6

DOB / AGE: 51 y.o.
GENDER: Male
DATE OF ADMISSION: Not specified
ADMISSION FROM: Not specified

C/O ON ADMISSION: Suicide attempt via gabapentin overdose

TESTS PERFORMED: None listed

DIAGNOSIS: Psychotic, MDD with suicidal ideation; mild cognitive impairment; splenic infarct; T2DM; chronic pain; HTN; Afib; CVA/TIA; AUD; s/p L BKA.

PMH: Afib (Eliquis), CVA/TIA, T2DM, AUD, L BKA, MDD, chronic back pain, HTN.

INTERVENTIONS:

• Cymbalta 20 mg daily

• Pain regimen: APAP, Flexeril PRN, lidocaine patch, heat

• Eliquis + Plavix

• Linagliptin 5 mg daily + ISS

• Ropinirole 4 mg qhs

• Metoprolol 25 mg, amlodipine 10 mg, statin

• Buprenorphine, acetaminophen

• Psych and case management involved

BASIC ASSESSMENTS: Medically stable, mood improved, lacks capacity.

DIET: Regular.

CARE PLANS: Psychiatric stabilization, glycemic control, pain management, prepare for LTC/STR placement.

IVS: Not specified.
DISPOSITION: Awaiting conservatorship/T19; STR vs LTC placement.
EDD: 10/24/2025.
CODE STATUS: Full Code.