Weatherspoon9/1: she seen for a follow-up visit. She had a bilateral knee replacement secondary to other riders. Therapy states that when she’s working with them she’s screaming in pain. Review of her medication shows that she is on oxycodone every six hours as needed for pain. She’s not requesting her pain medicine like she’s supposed to so she is not tolerating it well. I will consult in-house MD about scheduling her pain medicine. She does have some stage two with the appearance of a stage one healing ulcers to her bottom. Cream was applied to it. There was no sign of infection noted. She has a history of diabetes, blood sugar in the past week has been ranging between 141 and 294. She is to continue her metformin and Actos. Daughter currently at the bedside. Her blood pressure is well controlled, ranging from 112 to 148 since admission. She continues to be on Carter’s him, Norvasc and all that tone. She does have a history of hyper lipidemia and is tolerating her statin. Daughter denies any other issues at this time. I will add her back into her plan of care. No recent falls reported. Not in distress. Staff will continue to monitor. No recent falls reported. Not in distress. see below for most recent set of labs, she’s not to have hyponatremia with a sodium of 129. I will go ahead and put her on fluid restrictions. Her potassium is noted to be 6.0, and hyper kalemia. She is on aldactone which as a potassium sparing diuretic. Will discontinue that medication and give her a EKG. She does not want to have a bowel movement. Will reassess bloodwork and see if she needs to be on lokalma for hyperkalemia.8/31: sodium 129, potassium 36.0, BUN 43, creatinine 1.40, WBC 12.8, hemoglobin 8.5, hematocrit 25.7Sorensen9/1: he is seen for a follow up visit. He saw his surgeon, Dr. Courtney yesterday. He had orders to go ahead and change his clean head affected area with soap and water daily pat dry and leave open to air. His left knee from his joint replacement and artificial knee joint is clean dry and intact. The incision site is approximated with no signs of infection. He does have a history of heart failure, current weight 213 pounds. On a mission he was 220 pounds, he has lost 7 pounds. Daughter stated that the surgeon also wanted him to have a decrease in his pain medicine. He is on Norco 10, I will consult in health MD about making Norco 5 mg every four hours as needed for pain. He continues to have issues with his blood pressure however when he saw his cardiologist on Tuesday he was told that he would need a aortic valve replacement. His blood pressure has been running between 83 to 127. He is to continue the Midodrine for hypotension. He denies any issues or pain secondary to hyper lipidemia. he is on aspirin and some of us that in. He is on Eliquis and aspirin for DVT prophylaxis. No other issues made known at this time. No recent falls reported. Not in distress.See below for most recent set of labs. He is noted to have better hyponatremia control. His calcium 7.1 and albumin 1.9.  I will make sure he has supplements added to his plan of care. Otherwise no abnormalities noted in his lab work.8/27: sodium 136, potassium 3.9, BUN 24, creatinine 1.50, calcium 7.1, albumin 1.9, WBC 9.2, hemoglobin 9.4, hematocrit 27.7, platelets 262 8/25: sodium 133, potassium 3.9, BUN 27, creatinine 1.58, calcium 7.3, albumin 2.08/23: sodium 130, p

Kathleen Lewis is a 77-year-old black female admitted to hospice with a diagnosis of hemiplegia following his cerebral infarct affecting the right non-dominant side. PMHX includes vascular dementia, secondary hypertension. According to hospital records PMHX also include anemia, arthritis, blood transfusion, diabetes, hyperlipidemia, hypertension, localized related epilepsy, peripheral vascular disease, right carotid artery occlusion, and stroke due to embolism of the left middle cerebral artery.  She usually resides at home with family but is currently at the print it at Princeton Baptist Medical Center.  Due to Covid restrictions,  face-to-face was performed via FaceTime. Hospice nurse and eldest son are currently available for assessment. The following hospice indicators were noted on NP assessment.New recent hospitalization: on Saturday, October 22, she presented to the ED for new episodes of unresponsive. Son states that she was in her usual state of health until she became unresponsive. He believes she ate breakfast but has since not responded. She was noted to have a Hemorrhagic CVA. Son states that normally she is alert and oriented and able to answer questions. She is not responding at this time. She is normally able to feed herself and is not able to do so at this time.  CT shows ICH. She was lying in a fetal position and moaning and yelling out. She is not able to track or follow commands. Son stays that she continues to make eye contact and she moves her mouth like she wants to speak however she’s unable to do so. Family wishes comfort care measures only.Impaired skin integrity: she is noted to have wounds to her sacrum.In this recertification visit, she presented to the ED for new onset non-responsiveness. She was noted to have a I CH and family wishes to pursue comfort measures only.

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