R. Orville is a 68-year-old community living male with past medical history of COPD, CHF, BPH, hypertension, stroke, short gut syndrome, status post 18 inches of small intestine removed, PEG tube in the past and then removal, chronic urine retention.
R. Orville is a 68-year-old community living male with past medical history of COPD, CHF, BPH, hypertension, stroke, short gut syndrome, status post 18 inches of small intestine removed, PEG tube in the past and then removal, chronic urine retention. At home, wife does one time straight= cath after the patient urinates. The patient is being followed by the urologist. Lives with the wife. The patient appears to be very weak, cachectic, thin appearance at baseline with underlying dementia, presented to Medical City Arlington from outside facility with a diagnosis of pneumonia and urinary tract infection. As per the patient’s wife, the patient has not been feeling well, has had a raspy voice and shortness of breath and low oxygen levels at home, went to one of the facility where the patient was noted to have bilateral pneumonia on the CAT scan. Urinalysis also was positive. The patient was transferred due to the capacity limitation at outside facility to Medical City Arlington, was evaluated by the ER physician. The decision was made to admit the patient to the hospitalist service. As I come to see the patient, the patient appears very weak, thin and cachectic. Oral mucosa is dry. The patient has mouth open. The patient appears to be chronically ill. I spoke to the patient’s wife, Ms. Alina at the bedside and she informed to me that this ismost of the time his baseline. He has dementia and he is very weak, poor appetite, has had history of short gut syndrome with 18 inches of small intestine removed as well as H. Pylori in the past and had PEG tube placed and subsequently it was pulled out and then, the patient has not been eating and drinking much. In the Emergency Room, the patient had a Foley catheter, which was placed by the outside facility. I confirmed with the patient’s wife and wife stated that the patient is able to urinate at home and after he urinates, wife does one time in and out catheterization to empty the bladder. The patient follows with urologist on outpatient basis.
GENERAL ASSESSMENT:
Acute hypoxic respiratory failure secondary to evidence of acute left basilar pneumonia with small left sided pleural effusion as well as chronic obstructive pulmonary disease exacerbation and acute chronic obstructive pulmonary disease and bronchitis, present on admission. Continue with nebulization treatments, supplemental oxygen to keep the saturation more than 92% and IV antibiotic, suppression medication and look for further improvement in the patient’s symptomatology. Patient is requiring 5 L of oxygen. Patient is saturating around 88-92 percentage.
Symptomatic GNB complicated urinary tract infection, complicated due to in and out catheterization at home by the wife. The patient at this point of time had a Foley placed from outside facility. The patient does not use Foley at home. Patient’s Foley was removed on 9/7/2023. Patient was seen by the urologist Discussed with Dr. Hay. Continue Flomax and finasteride. Discontinue oxybutynin. Check postvoid residual every shift and straight catheterize if residual greater than 300 mL. Check CT abdomen and pelvis without contrast secondary to recurrent urinary tract infections. The patient may follow up with the VA Urology for me at their discretion. We will follow with the final urine culture results Urine retention. Patient does have history of urine retention even in the past. Continue Flomax and finasteride. I was informed by the nursing staff that he had to do in and out catheterization for him due to urine retention 412 cc urine. After in and out catheterization, 400 mL of the urine was taken out on 9/8/2023.
Severe protein-calorie malnutrition with thin, cachectic appearance at baseline with underlying advanced dementia. Supportive care. PT, OT, ST and dietitian consultation initiated. Metabolic alkalosis with bicarbonate more than 45 with underlying COPD, unclear etiology, rule out CO2 retention. We will get ABG stat at this point of time. Will get ABG today. Still not done.
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