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DAVIS HOSPITAL AND MEDICAL CENTER
DISCHARGE SUMMARY
PATIENT: CRANE, MARY
ROBERT WEITZEL, M.D.
ADM: 12/28/95
Dis: 1/8/96
HISTORY
The patient was admitted to the Geropsychiatric Unit with preliminary diagnosis of depression with psychotic features. She had quite demented for some time and is status post CVA.
HOSPITAL COURSE
On admission she was started on Zantac 150mg b.i.d., Lopressor 100mg b.i.d., Glucotrol 5mg q.a.m, Accu-Cheks, Dyazide one tablet q.o.d., artificial tears, Carafate 1 gram b.i.d., Lasix 80 mg q.o.d., Ferrous sulfate, Metamucil t.i.d., Risperdal 1mg t.i.d., Serzone 50 mg b.i.d., times two days with an increase to 100mg b.i.d. and Trazodone 100mg q.h.s.- may repeat times one. Additional labs were notable for sodium which was low at 131 but acceptable. Rather low potassium at 3.3. Non-reactive RPR. A UTI on UA. Acceptable CBC. Iron was slightly low. Her C&S grew out Kluyvera sensitive to both Cipro and Bactrim. TFTs came back normal. Repeat chemistries on the 1st revealed rising sodium and potassium. Slightly elevated glucose. Repeat CBC on that day was essentially normal. B12 and folate were within normal limits. Repeat CBC on the 5th revealed white count of 15 and chemistry on that date revealed sodium of 159 and chloride up to 117.
aOn the 28th she was started on low-dose Duragesic patch and made DNR. On the 28th also, Relafen 1000mg was given as a one-time order. On the 28th the Duragesic was increased to 50mcg q. 3 days. On the 26th K-Dur 20mgEq b.i.d. was started. Moderate fluid restriction was instituted. On the 30th we discontinued her Dyazide and started Lasix 40mg p.o./q.a.m., Cipro 500mg p.o./bi.d. was given for six doses and once again DNR was ordered. On the 31st we ordered an EEG, Trazodone was ordered 150mg p.o./q.h.s.. On the 31st the patient was started on Haldol 5mg IM on refusing any Risperdal and Ativan was ordered as a p.r.n.. On the 1st we continued her Accu-Cheks and instituted an insulin sliding scale. Duragesic was continued. Trazodone was increased to 200mg q.h.s. and 100mg q.h.s./p.r.n.. On the second Glucotrol was increased to 5mg b.i.d.. On the 3rd she was started on Depakene syrup 250mg q.a.m., q. 1700 and 500mg q.h.s.. By the way, a Depakote level on the 6th came back at 40. On the 3rd she was also started on oxygen. On the 3rd a UA was ordered for the morning and on the 3rd low-fiber, low-residue diet was started
CONTINUED… DISCHARGE SUMMARY
DAVIS HOSPITAL AND MEDICAL CENTER
DISCHARGE SUMMARY
PATIENT: CRANE, MARY
Page 2…
I had talked to her gynecologist, Dr. Meek, and he felt okay with not doing surgery until after psychiatric care had been completed and felt that a low-residue diet and broad spectrum antibiotics were the best course. On the 3rd she was in some pain so she received some Morphine times two – 3mg and 5mg IM injections. On the 4th she again received some Morphine and it was re-ordered 5mg q. 4 hours p.r.n.. Duragesic patch was increased to 75mcg q. three days. On the 4th we asked respiratory therapy to see her for possible aspiration and a swallow and speech evaluation was ordered. On the 5th a chest x-ray was ordered for aspiration pneumonia. We got a CBC and some more MS was given. On the 5th pureed diet was ordered secondary to dietician’s recommendations. On the 5th I talked with Dr. Meek who recommended Keflex be used as a broad spectrum antibiotic. We started that at 250mg q.i.d.. On the morning of the 7th Mary appeared quite ill. She spiked a fever. She appeared to have a seizure and probably aspirated. Dr. Dienhart was in to see her. Her sodium was up to 159, chloride 117, glucose and other chemistries were elevated. CBC revealed a white count of 15. She was breathing very poorly so oxygen was started as well as chest x-ray ordered per Dr. Dienhart. I came in on the evening of the 7th, spoke with the family. She was quite ill at that point and the family did not want excessive or extraordinary measures taken so we discontinued all medications and started Morphine 5mg IM q. 3 hours. She expired approximately two hours later of respiratory failure. Dr. Nilson was kind enough to come up from the emergency room and pronounce her dead.
DISCHARGE DIAGNOSIS
Axis I: Major depression with psychotic features.
Axis II: Defer.
Axis III: Multiple systems failure.
Axis IV: Three.
Axis V: Zero, zero.
(Signed)
ROBERT WEITZEL, M.D.
RW/rn
D: 01/08/96 10:06
T: 01/10/96 0:35
JOB # 5260
DISCHARGE SUMMARY
Psych Eval History & Physical Discharge Summary Chemistries CBC's CXR's
Living Will / Medical Treatment Plan EKG Graphic Chart Nursing Admission Assessment
Physician's Orders Progress Notes Nursing Staff Notes Medication Administration Record
