Emma Parker Case

DISCHARGE SUMMARY
Patient name: Emma Parker
Hospial No: 11259
Admitted: 09/25/13
Discharged: 10/01/13
Consultations: Carol Dodd, M.D, Orthopedics Saul Thompson, M.D., Cardiology
Procedure: Open reduction, internal fixation of right hip.
Complication: Elevated cardiac enzymes postop.
Admitting Diagnosis: Acute intertrochanteric fracture of right hip.
ENTERING STATEMENT: This 69-year-old black female patient was brought to the ER after she sustain an injury to her right hip. She states she was walking when her right leg “gave out.’’ She fell onto the right hip. She complained of mild pain in the right hip and there was mild pain in the right hip and there was mild edema noted in the ER. In addition, she had
external rotation of the right leg. Initial x-ray demonstrated findings of intertrochanteric fracture, nondisplaced, of the right hip. Consultation was obtained from Dr. Dodd, who concurred with the diagnosis and treatment. Patient was subsequently admitted for further evaluation and treatment, including surgical intervention.

HOSPITAL COURSE: Following admission the patient was taken to the OR was performed with a DePuy fixation device.
Patient tolerated the procedure well under endotracheal anesthesia and was in stable condition postoperatively. She was continued on lactated Ringer’s postoperatively, and Accu-Chek was used to monitor blood sugar q.i.d. Ancef 1 g IVPB was administered x 6 doses. Diet was advanced to a 1200-calorie ADA postoperatively, and Micronase 5 mg p.o.q.d. was started on September
27.

During her postoperative course she developed elevated cardiac enzymes with a CPK of 1590, LDH of 341, and SGOT of 136. Her actual physical status remained stable. She denied chest pain and dyspnea, was nondiaphoretic, and when reviewing her EKGs the admitting EKG demonstrated nonspecific ST-T wave changes. Postoperative findings were consistent with a possible inferior myocardial infraction with anterior ischemic changes. Dr. Thompson was requested for cardiac consultation. Dr. Thompson also noted elevated CPK, but it was his feeling she had no significant finding for MI. She continued to make good postoperative
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DISCHARGE SUMMARY
Patient Name: Emma Parker
Hospital No: 111259
Page 2
progress.
Social services were requested fro help with discharge planning. The patient and her husband are both elderly, and it was felt that prior to surgery she had been helping can care for her husband and could no longer do this; therefore, nursing hom placement was suggested. The family concurred with this, and she was dischared to Purdue in stable and improved condition.

DIAGNOSTIC LAB STUDIES: Urinalysis showed 4+ rods ( not a clean catch specimen).Preop RRR were 13.8 and 30.2. Blood type O, Rh positive. Admission blood glucose was 307 and creatinine was 12. Pestop H&H were 11.8 and 34.1. Transfusion was not necessary.

FINAL DISPOSITION: Transferred to Purdue Nursing Home, where she will be continued on Mieoonse.10 mg q.d.a.m., a 1200-calorie ADA iet, Nitro-Dur 0.2 mg p.r.n. h.s., and Wygesic 1 q. 4 h.p.r.n. Ambulate with walker. Minimal weightbearing with ambulation, right lower extremity. She will be followed in the nursing home by Dr. Dodd and Dr. Thmpson and myself within one month of dichare or earlier should there be further problems. Echocardiogram was performed showing no significant abnormalities.

DISCHARGE DIAGNOSIS: 1. Acute intertrochanteric fracture of right
hip. 2. Adult-onset diabetes, insulin dependent. 3. Organic brain syndrome. 4. Chronic brain syndrome. 5. Ischemic coronary artery disease.
Shermn Loyd, M.D. SL:CX
D:10/03/13
T: 10/02/13