H and P with Update

Derick Shepherd, 43 year old caucasian male admitted following a syncopal episode and a fall resulting in a minor head laceration. The patient has a history of hypothyroidism, hypertension, obesity, and diabetes, well controlled by diet. The patient had a severely painful abscessed tooth for which he reports taking “ a lot of ” ibuprofen over the course of 6 weeks. The tooth was extracted yesterday.   He presents with guiac positive stool on rectal exam with remote history of blood noted in stool for previous 7 days. He denies nausea and vomiting but c/o burning abdominal pain with lying down and eating for past 3 weeks. His HTN is well controlled with no reports of unusual eating habits. He uses a CPAP for significant sleep apnea.   Home medication: Lisinopril 40 mg. daily by mouth. Metoprolol 12.5 mg. bid by mouth. Ibuprofen 800 mg. q 6hr by mouth.  Oxycodone 5 mg. q 4 hrs. by mouth prn.  PenVK 500 mg. bid by mouth. Zantac 150 mg po daily. Synthroid 50 mcg daily

Physical unremarkable. CN II- XII intact. AA0x3 PERRLA. Labs were sent, results pending.

Plan: Volume resuscitation. Monitor in ICU. CT of abdomen. Consider transfusion.

Admission orders

Oxycodone 5 mg. q 4 hrs. by mouth prn.  
PenVK 500 mg. bid by mouth.
Zantac 150 mg po daily
Synthroid 50 mcg  daily
Lisinopril 40 mg. daily by mouth beginning tomorrow.
Metoprolol 12.5 mg. bid by mouth beginning tomorrow.
Protonix drip 40 mg in 100 ml at 8ml/hr for 24 hr
IV fluids: initial fluid bolus of NS 500 ml over 30 minutes then  NSS 125 ml/hr,
Diet: soft
Sliding scale insulin - low dose coverage for blood glucose ac and hs
Labs: CMP.
CT abdomen, no contrast.
Orthostatic vitals q 4 hrs.
Bathroom privileges with assist.
Respiratory Therapy consult for CPAP