H and P with Update

Katniss Everdeen a 28 year old Caucasian female was admitted from the pulmonologist office with a history of cystic fibrosis since age 3.  Past medical history significant for Type II DM, chronic anemia, depression and anxiety, and chronic back pain. She is on 2 liters nasal cannula prn at home.

She is a cashier part time but states she having difficulty holding that position because of increasing shortness of breath with activity.

She presents with shortness of breath at rest, harsh non-productive cough, crackles and expiratory wheezes throughout. Pursed lip breathing. No murmurs,  S3, or S4.  Denies fever and chills. She appears very stressed. She denies chest pain, no vomiting but states she has intermittent nausea. She is requesting pain medication immediately for pain 8/10 on deep breathing. EKG and troponin negative. She states her DM is poorly controlled, she does not adhere to a diet or perform her glucometer checks.  She reports increasing inability to complete ADL’s  Neuro  II - XII intact. GU GI wnl

She is admitted to a regular pulmonary floor.  PE ruled out.  Her mother is with her.  Labs were sent this AM from the doctor’s office.

Day of discharge: Your physical exam reveals significant improvement from admission above.  You have taken your VS and checked your labs. (Review these results and consider their implications.)

Home Medications

Prednisone 5 mg. po daily                                Hycodan Elixir 5-10 ml. q 6 hrs. 
Glipizide 10 mg. po bid
Janumet 50/500 mg. po bid
Ferrous Sulfate 325 mg. po bid
Pancrelipase 6 tabs po ac/hs
Celexa 20 mg. po bid
Setraline 100 mg. po bid
Hydrocodone 5/325 mg one tablet q 4 hrs. prn pain

 

Admission orders

Continuous Oxygen via N/C at 4 liters, titrate to >than 92%
IV fluids NSS + 20 MEq of KCL at 125cc/hr
Low Fat diet
Methylprednisilone Sodium 80mg. IV q 4hrs. Daily                            
Hycodan Elixir 5-10 ml.  q 4hrs. by mouth qd prn
Glipizide 10 mg. po bid
Humalog Insulin Sliding Scale MODERATE  dose
<70 HYPOGLYCEMIC PROTOCOL
70-140             0 units subq
141-180           2 units subq
181-220          4 units subq
221-260          6 units subq
261-300          8 units subq
301-340         10 units subq
341   plus     12 units subq and call MD
Ferrous Sulfate 325mg. po qid
Pancrelipase 6 tabs po ac/hs
Celexa 20 mg. po bid
Sertraline 100 mg. po bid
Hydrocodone 5/325mg one tablet q 4hrs. prn pain
Zosyn 1.5 grams bid