12/6/95 Allergies: No known allergies

COLORS: RED - PAIN ORANGE - AGITATION GREEN - TERMINAL

Judith Larsen Physician's Orders

12/6/95 Allergies: No known allergies.
Verbal order Dr. Weitzel to Lynn Long, RN
Admit to Geropsychiatric unit
Preliminary diagnosis: Provisional Psychosis
Activity: Assist with all activities
Diet: Regular, mechanical soft
Labs: CBC, Chem 20, RPR, T-7, TSH, Urinalysis with culture and sensitivity if indicated
EKG
AIMES Test
Chest X-ray
Occupational Therapy evaluation and treatment
Physical Therapy evaluation and treatment
Vital signs: Twice a day
Medications
Tylenol 1-2 by mouth every 4 hours as needed for pain.
Mylanta 30 cc by mouth every 4 hours as needed for dyspepsia
Milk of Magnesia 30 cc by mouth at bedtime as needed for constipation
Special Precautions: every 15 minutes check for 24 hours
Betagan 0.5% one drop both eyes twice a day
Surfax one by mouth every day at bedtime
Klonopin 0.5 mg by mouth three times a day
Trazodone 100 mg by mouth every bedtime
Synthroid 0.088 mg one by mouth every day
Baby aspirin one by mouth every day
Isosorbide 10 mg by mouth twice a day
Ativan 1 to 2 mg by mouth or intramuscularly every six hours as needed for agitation
Trazodone 100 mg by mouth once as needed for insomnia after bedtime dose
Zantac 150 mg by mouth every day as needed for abdominal pain
Do Not Resuscitate
Signed Robert Weitzel, M.D.
Noted Lynn Long, RN 12/6/95 1500

I CERTIFY THAT THIS PATIENT
NEEDS INPATIENT ACUTE CARE
HOSPITAL SERVICES
SIGNED Robert Weitzel, M.D.
DATE 12/6/95

12/6/95 1700
Oxygen at 2 liters per nasal cannula to keep saturations above 90%
Telephone order Dr. Weitzel/ B. Hardy, RN
Signed Robert Weitzel, M.D.
Noted B. Hardy, RN 1700 12/6/95
24 hour chart check 12/7/95 0330 T. Scholl, RN
12/7/95
Straight catheterization for urinalysis
Telephone order - Dr. Weitzel/E.Cozzins,RN
Signed Robert Weitzel, M.D.

12/7/95
1. Oxygen saturation check, please document here º
2. Serzone 50 mg by mouth twice a day until 12/9/95, then start 100 mg by mouth twice a day.
3. Foam restraint wedge to prevent patient from sliding out of her chair.
Thanks, Robert Weitzel, M.D.
12/7/95
Risperdol 1 mg by mouth every morning, 1700 and bedtime.
Signed Robert Weitzel, M.D.
Noted D. Kley, RN 12/7/95 2125

RESPIRATORY CARE
PULSE OXIMETRY
OXYGEN SATURATION
DATE 12/7/95 TIME 2145
ON O2 AT 0 L/MIN. OR %
SpO2 (SaO2) ___________%
OFF O2; SpO2 (SaO2) 94%
TECH: ?

24 hour chart check 12/8/95 0345 T. Scholl, RN

12/8/95 8 a.m.
Nystatin swab to mouth and tongue 4 times a day or Nystatin 10 cc swish and swallow 4 times a day until next week
Serum protein electrophoresis
Oxygen saturation at bedtime while sleeping
Glycosalated hemoglobin
Signed D. Dienhart, M.D.
Noted L. Wilson, RN 12/8/95

12/8/95
Klonopin: Decrease to 0.5 mg by mouth twice a day, today through 12/12/95, then on 12/13/95 begin Klonopin 0.25 mg by mouth twice a day for one week.
Thanks, Robert Weitzel, M.D.
Noted L. Wilson, RN 12/8/95 2000

12/8/95 8 a.m. Medicine Consult Note
(asked to see by Dr. Weitzel)
Impression:
1. Severe dementia / confusion
2. History of Cerebral Vascular Accident - January 95
3. History ischemic heart disease with angina
4. Hypothyroidism, status-post thyroidectomy
5. Status-post multiple falls
6. Cardiomegaly
7. Status-post hysterectomy
8. Status-post nephrolithiasis
9. Probable oral thrush
10. Large hiatal hernia - history gastroesophageal reflux disease
11. Decreased albumin, increased globulin
12. Question decreased oxygen saturation on admit
13. History of increased glucose 9/95
Recommendation:
1. Treat oral thrush with Nystatin
2. Serum protein electrophoresis screen for monoclonal (unreadable word)
Elderly female increased dementia since January 1995 CVA. Apparently living in retirement center in (indecipherable).
Worsened over past three weeks. Certainly component of dementia may be due to multiple infarctions. Cardiac failure appears to be compensated. Question intermittent decreased oxygen saturation.
Laboratory: thyroid function, decreased albumin, increased globulin noted.
Chest x-ray: cardiomegaly, hiatal hernia, no infiltrate.
EKG: sinus rhythm, question of ectopic focus.
Rest per dictation.
Thanks, D. Dienhart, M.D.

12/8/95 2330
Patient asleep during spot check. Saturations on room air 89 to 91%. Respiratory rate is irregular and saturations did drop to 85% once. Average is 89 to 91%.
J. d=Hulst (?) RRT

24 hour chart check 12/9/95 0430 T. Scholl, RN

12/9/95
1. Risperdol 1 mg by mouth every morning, 2 mg by mouth at 1700 2 mg by mouth every bedtime.
2. Trazodone 150 mg by mouth every bedtime
Thanks, Robert Weitzel, M.D.
12/9/95

Ativan 2 mg intramuscularly now.
Thanks, Robert Weitzel, M.D.
Noted L. Wilson, RN 12/9/95 2200

24 hour check L. Wilson, RN 12/10/95 2400

24 hour check L. Wilson, RN 12/11/95 2400

12/11/95
1. Risperdol 1 mg by mouth every morning, every 1700, and every bedtime.
2. Discontinue Nystatin
Thanks, Robert Weitzel, M.D.
Noted 12/11/95 at 1200 S. Hansen, RN

24 hour check L. Wilson, RN 12/12/95 2400

24 hour check L. Wilson, RN 12/13/95 2400

RESPIRATORY CARE
PULSE OXIMETERY OXYGEN SATURATION

DATE 12/12/95 TIME 1000
ON O2 AT 4 L/MIN. OR %
SpO2 (SaO2) ___90%
OFF O2; SpO2 (SaO2) 81%
TECH: ?

12/13/95
Morphine sulfate 15 mg intramuscularly every 4 hours as needed for severe pain/agitation.
Thanks, Robert Weitzel, M.D.
Noted (Unreadable name) 1250 12/13/95

24 hour chart check 12/14/95 0145 T. Scholl, RN

AUTOMATIC DRUG STOP ORDER
Patient: Judith Room:Drug(s) Exp. Date Last Dose
1. Ativan 1 mg po/IM q 6 hrs prn agitation 12/14
2. Ativan 2 mg po/IM 1 6 hrs prn agitation 12/14
3.
4.
According to hospital policy orders for these medications must be reordered or they will be discontinued.
Signature: Robert Weitzel, M.D.
Noted T. Scholl, RN 12/14/95 0715

24 hour chart check 12/15/95 0200 T. Scholl, RN

12/15/95
Ducolax suppository one now.
Fleets enema as needed.
Verbal order Dr. Weitzel / E. Cozzins, RN
Noted 12/15/95 E. Cozzins, RN 1530
Signed Robert Weitzel, M.D.

24 hour chart check 12/16/95 0115 T. Scholl, RN

12/15/95 0730
SpO2 on room air - 88 to 89% oxygen saturation
(Unreadable name) Respiratory Care

AUTOMATIC DRUG STOP ORDER
Patient: Judith Room: Drug(s) Exp. Date Last Dose
1. Betagon 0.5% 1 gtt OU bid 12/16 12/15
2. Synthroid 0.088mg 1 po qd 12/16 12/15
3. Baby ASA 1 po qd 12/16 12/15
4. Isosorbide 10 mg po bid 12/16 12/15
According to hospital policy orders for these medications must be reordered or they will be discontinued.
Signature: Robert Weitzel, M.D.

AUTOMATIC DRUG STOP ORDER Patient: Judith Room:
Drug(s) Exp. Date Last Dose
1. Surfax 1 po qhs 12/16 12/15
2. Tylenol 1-2 q4h prn pain 12/16
3. Mylanta 30 cc q4h prn dyspepsia 12/16
. Zantac 150 mg qd prn pain 12/16
According to hospital policy orders for these medications must be reordered or they will be discontinued.
Signature: Robert Weitzel, M.D.

AUTOMATIC DRUG STOP ORDER Patient: Judith Room:
Drug(s) Exp. Date Last Dose
1. MS 15 mg IM q4h prn severe pain/agitation 12/16
2. MOM 30 cc qhs prn constipation 12/16
3.Trazodone 100 mg x 1 prn insomnia post
4. hs dose 12/16
According to hospital policy orders for these medications must be reordered or they will be discontinued.
Signature: Robert Weitzel, M.D.
Noted D. Kley, RN 12/16/95 2100

12/17/95 1915
Physical Therapy evaluation secondary to improved condition (more alert)
Telephone order Dr. Weitzel/D.Kley, RN
Noted D. Kley, RN 12/17/95 1915
Signed Robert Weitzel, M.D.
24 hour check 12/18/95 0115 T. Scholl, RN

AUTOMATIC DRUG STOP ORDER
Patient: Judith Room:
Drug(s) Exp. Date Last Dose
1. Serzone 100 mg bid 12/17
2.
3.
4.
According to hospital policy orders for these medications must be reordered or they will be discontinued.
Signature: Robert Weitzel, M.D.

12/18/95
Risperdol 0.5 mg by mouth every morning, every 1700 and every bedtime
Thanks, Robert Weitzel, M.D.
(Noted) 12/18/95 E. Cozzins, RN 1145

AUTOMATIC DRUG STOP ORDER
Patient: Judith Room
Drug(s) Exp. Date Last Dose
1. ~~MS 15mg IM q4h prn severe pain/agitation~~ 12/19 D/C
2. Trazodone 150mg po qhs 12/19
3.
4.
According to hospital policy orders for these medications must be reordered or they will be discontinued.
Signature: Robert Weitzel, M.D.

12/19/95
Discontinue Morphine sulfate Aas needed@
Thanks, Robert Weitzel, M.D.
12/19/95 2300 Noted B. Hardy, RN

24 hour check 12/20/95 0330 T. Scholl, RN

RESPIRATORY CARE
PULSE OXIMETRY
OXYGEN SATURATION
DATE 12/18 TIME 1045
ON O2 AT ___L/MIN. Or %
SpO2(SaO2) ________%
OFF O2; SpO2(SaO2) 89%
TECH: S. Jensen, CRTT

24 hour check 12/21/95 0245 T. Scholl, RN

AUTOMATIC DRUG STOP ORDER
Patient: Judith Room
Drug(s) Exp. Date Last Dose
1. Ativan 1-2 mg po/IM q6h prn agitation
2.
3.
4.
According to hospital policy orders for these medications must be reordered or they will be discontinued.
Signature: Robert Weitzel, M.D.
Noted D. Kley, RN 12/21/95 2315

24 hour check 12/22/95 0415 T. Scholl, RN

12/22/95 1700
Hold 1700. and 2000 p.m. Risperdol 12/22/95
Telephone order Dr. Weitzel/D. Kley, RN
Noted D. Kley, RN 12/22/95
Signed Robert Weitzel, M.D.

12/22/95 2000
Hold all medications tonight
Telephone order Dr. Weitzel/D. Kley, RN
Noted D. Kley, RN 12/22/95
Signed Robert Weitzel, M.D.

24 hour check 12/23/95 0345 L. Long, RN

24 hour check 12/24/95 0100 L. Long, RN

12/24/95
1. Decrease Risperdol to 0.5 mg by mouth every 1700 and every bedtime.
2. Change Trazodone to 50 mg by mouth every bedtime as needed, may repeat once (as needed)
Thanks, Robert Weitzel, M.D.

12/24/95
Prune juice with breakfast every morning
Thanks, Robert Weitzel, M.D.
1850 noted 12/24/95 B. Hardy, RN

24 hour check 12/25/95 0150 T.Scholl, RN

12/25/95
Morphine sulfate 2 mg intramuscularly now.
Thanks, Robert Weitzel, M.D.
Noted L. Long, RN 12/25 0730

12/25/95 0930
Telephone order Dr. Weitzel / L. Long, RN
Morphine sulfate 2 mg intramuscularly now.
Signed Robert Weitzel, M.D.
Noted L. Long, RN 12/25/95 0930

12/25/95 1130
Telephone order Dr. Weitzel / L. Long, RN
Morphine sulfate 2 mg now
Signed Robert Weitzel, M.D.
Noted L. Long, RN 12/25/95 1130

24 hour check 12/26/96 0045 T. Scholl, RN

AUTOMATIC DRUG STOP ORDER
Patient: Judith Room
Drug(s) Exp. Date Last Dose
1. Betagon 0.5% 1 gtt OU bid 12/26
2. Synthroid 0.088mg po qd 12/26
3.Baby ASA 1 qd 12/26
4.Isosorbide 10 mg bid 12/26
According to hospital policy orders for these medications
must be reordered or they will be discontinued.
Signature: Robert Weitzel, M.D.

AUTOMATIC DRUG STOP ORDER
Patient: Judith Room
Drug(s) Exp. Date Last Dose
1. Surfax 1 po qhs 12/26
2. Tylenol 1-2 q4h prn pain 12/26
3. Mylanta 30 cc q4h prn dyspepsia 12/26
4. MOM 30 cc qhs prn constipation 12/26
According to hospital policy orders for these medications
must be reordered or they will be discontinued.
Signature: Robert Weitzel, M.D.

AUTOMATIC DRUG STOP ORDER
Patient: Judith Room
Drug(s) Exp. Date Last Dose
1. Fleets prn 12/26
2. Zantac 150 mg qd prn abd pain 12/26
3.
4.
According to hospital policy orders for these medications must be reordered or they will be discontinued.
Signature: Robert Weitzel, M.D.
Noted B. Hardy RN

12/26/95 0605
Telephone Order: Dr. Dienhart / T. Scholl, RN
IV: D5
Ativan IV Titrate 1 to 3 mg over 5 minutes until seizure stops.
12/26/96 0620 Telephone order Dr. Dienhart / T. Sholes, RN
Give additional 1 mg Ativan IV now
Signed D. Dienhart, M.D.
Noted T. Scholl, RN 12/26/95

12/26/95 7 a.m.
Oxygen saturation/ oxygen at 2 liters per nasal cannula
titrate oxygen saturation to greater than or equal to 90%.
IV D5 2 NS at 70cc per hour with Dilantin infusion
Dilantin 1 gm IV load over 40 minutes in normal saline line then 100 mg IV every 8 hours.
EKG
Chem-20, CBC
CT scan head now - rule out cerebral bleed.
Dilantin level every morning at 9 am
Blood pressure every 10 minutes during Dilantin infusion
Signed D. Dienhart, M.D.
Noted 12/26/95 0800 S. Hansen, RN

12/26/95 0650 Medicine Consult Note:
(Asked to see by Dr. Weitzel)
93 year old female admitted 12/20 to Geropsychiatry Unit for increased dementia.
Past medical history significant for past CVA. Called to see for nursing witnessed tonic-clonic seizure - total duration 40-45 minutes, relieved after Ativan 4 mg slow IV. Nurse described right arm and right leg and right facial jerking.
Note: Risperdol / Serzone / Thyroid
Now apparently post-ictal - during seizure (blood pressure) 160/100, now dosing Dilantin - 104/60
Mouth - decreased gag, (unreadable word) lower denture, no visible bleeding.
Lungs decreased breath sounds
Abdomen: soft
Neuro: 2 + and roughly equal at biceps and knees. Increased (unknown word) on right.
Impression:
Seizure, post-ictal
Right-sided activity
Rule out left event
Recommendation:
Rule out cerebral vascular accident - new event - with CT scan
Maintain Dilantin 100 mg three times a day for now
Oxygen as needed
for EKG and (unknown word) changes.
Signed D. Dienhart, M.D.

12/26/95
Telephone order Dr. Weitzel
1. Give Morphine sulfate 2 mg intramuscularly now.
2. Stop IV therapy.
3. Observe for symptoms of pain.
Telephone Order Dr. Weitzel / S. Hansen, RN
Signed Robert Weitzel, M.D.
Noted 12/26/95 0800 S. Hansen, RN

24 hour check B. Hardy, RN 0130

AUTOMATIC DRUG STOP ORDER
Patient: Judith Room
Drug(s) Exp. Date Last Dose
1. Serzone 100 mg bid po exp - 12/27
2.
3.
4.
According to hospital policy orders for these medications
must be reordered or they will be discontinued.
Signature: Robert Weitzel, M.D.
Noted 12/28/95 0130 T. Scholl, RN

24 hour check 12/28/95 0130 T. Scholl, RN

24 hour check 12/29/95 0230 T. Scholl, RN

AUTOMATIC DRUG STOP ORDER
Patient: Judith Room Drug(s) Exp. Date Last Dose
1. Ativan 1-2 mg IM q 6 hrs prn agitation 12/28
2.
3.
4.
According to hospital policy orders for these medications must be reordered or they will be discontinued.
Signature: Robert Weitzel, M.D.

12/29/95
Discontinue Dilantin
Signed Robert Weitzel, M.D.
Noted E. Cozzins, RN 12/30/95 0030

12/21 0010 Respiratory Care Note
Sp02 check done on room air.
Sp02 - 87% on room air. Oxygen
increased to 2 liters per minute.
Sp02 - 93% on 2 liters per minute.
Thanks, (unreadable signature) RRT

24 hour check 12/30/95 0600 T. Scholl, RN

12/30/95
Morphine sulfate 5 mg intramuscularly every 4 hours around the clock.
Thanks, Robert Weitzel, M.D.
12/30/95 1430 B. Hardy, RN

24 hour check L. Wilson RN 12/31/95 0145

12/31/95
1. Vitals every four hours around the clock
2. Morphine sulfate 5 mg intramuscularly every 4 hours around the clock and 5 mg intramuscularly every 2 hours as needed for pain.
Thanks, Robert Weitzel, M.D.
12/31/95 Noted 1345 B. Hardy, RN

12/31/95 1930 Telephone Order: Dr. Weitzel
Morphine sulfate 5 mg intramuscularly now.
Signed Robert Weitzel, M.D.
Noted L. Long, RN 12/31/95 1930

24 hour check L. Wilson, RN 1/1/96 0100

1/1/96 1730
1. Morphine sulfate 5 mg intramuscularly now.
2. Morphine sulfate 5 mg intramuscularly every 3 hours - routine, around the clock
Thanks, Robert Weitzel, M.D.
Noted L. Long, RN 1/1/96 1745

1/1/96 2300
Morphine sulfate 5 mg intramuscularly now.
Signed Robert Weitzel, M.D.
Noted L. Long, RN 1/1/96 2300
1/02/96 0100 24 hour check L. Wilson, RN

24 hour check 1/03/96 0230 T. Scholl, RN

AUTOMATIC DRUG STOP ORDER
Patient: Judith RoomDrug(s) Exp. Date Last Dose
1. Risperdol 0.5 mg q 1700 & qhs 1/03 12/28
2. Trazodone 50 mg qhs prn MR x 1 1/03
3. MS 5 mg IM q2h prn pain 1/03 1/02
4.
According to hospital policy orders for these medications must be reordered or they will be discontinued.
Signature: Robert Weitzel, M.D.

1000 1/03/96
Morphine sulfate 25 mg intramuscularly now.
Signed Robert Weitzel, M.D.
1/03/96 E. Cozzins, RN 1100

1/03/96
If any morphine sulfate is to be withheld, please call me first
Signed Robert Weitzel, M.D.
Noted L. Long, RN 1/03/96 1030

1/03/96 1100
1. Morphine sulfate 30 mg intramuscularly now
2. Natural tears both eyes 4 times a day
Thanks, Robert Weitzel, M.D.

1/03/96
Vital signs to every shift, please.
Signed, Robert Weitzel, M.D.
1/03/96 E. Cozzins, RN 1100

1/03/96 1445 Telephone Order Dr. Weitzel
Morphine sulfate 30 mg intramuscularly now
Robert Weitzel, M.D.
Noted L. Long, R.N. 1/03/96 1445

1/03/96 1820 Morphine sulfate 15 mg intramuscularly now Morphine sulfate 10 mg intramuscularly every 3 hours Telephone order Dr. Weitzel / B. Hardy RN Signed Robert Weitzel, M.D. 1/03/96 Noted B. Hardy, RN 1825 1/03/96 2017 Release body to mortuary Telephone order / Dr. Robert Weitzel Signed Robert Weitzel, M.D. 1/03/96 Noted B. Hardy, RN 2020		1/03/96 Patient expired 2017 Robert Weitzel, M.D.

Psych Eval History & Physical Discharge Summary

Living Will / Medical Treatment Plan

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