instruction string | input string | output string |
|---|---|---|
List all known allergies. | Admission Date: [**2126-8-30**] Discharge Date: [**2126-9-8**]
Date of Birth: [**2054-2-16**] Sex: F
Service: CARDIOTHORACIC
Allergies:
Relafen
Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Recurrence of lung cancer
Major Surgical or Invasive Procedure:
[**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer.
History of Present Illness:
Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time.
Past Medical History:
Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema
PSH: RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy
Social History:
She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient.
Family History:
She has two daughters who are healthy. There is a history of
allergies and emphysema in her family.
Physical Exam:
Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE
Pertinent Results:
ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema.
Brief Hospital Course:
Patient was admitted on [**2126-8-30**] to the thoracic surgery service
for a planned right thoracotomy, right lower lobe wedge
resection with decortication. She tolerated the procedure well,
was extubated and recovered in the PACU prior to being
transferred to the ICU in stable condition. For full details
please see the operative report. Three chest tubes were placed
during the procedure and a postoperative chest x-ray showed
expected right pneumothorax post surgery with three chest tubes
in place. Pathology revealed a 1.8 cm poorly differentiated
adenocarcinoma with negative margins and no positive nodes. She
was started on a clear liquid diet, her pain was controlled with
an epidural and she was started on her home medications. On POD
1 her diet was advanced to regular and she was transferred to
the surgical floor from the ICU. On POD 2 she was noted to have
increased somnolence which was thought to be related to her pain
medications so her epidural was turned down and narcotics for
breakthrough pain were discontinued. She was given a unit of
PRBC for a Hct of 20.3 with an appropriate increase to 24.4 and
improved somnolence. On POD 3 metoprolol was started because of
elevated systolic blood pressures. She continued to have an air
leak from all three chest tubes. Her epidural was discontinued
and her foley catheter was removed. She was started on oxycodone
and tramadol for pain. By POD 4 the air leak had stopped in the
anterior chest tube so it was removed. The posterior chest tube
was removed on POD 6. On POD 7 she noted that she felt dizzy
when she was getting out of bed and was found to be in atrial
fibrillation with RVR. She was given metoprolol once without
effect and was then given IV diltiazem once with return to sinus
rhythm. Cardiac enzymes were negative and she was monitored with
telemetry without recurrence. On POD 8 the air leak had resolved
in the basilar chest tube so it was removed. A post pull chest
xray showed no PTX. Because her pain was well controlled, she
was tolerating her diet and was ambulating without assistance,
she was discharged to home on POD 9 with instructions to follow
up in Dr.[**Name (NI) 5067**] clinic with a chest x-ray.
Medications on Admission:
1. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
2. Nortriptyline 30 mg PO HS
3. Pravastatin 40 mg PO DAILY
4. Tiotropium Bromide 1 CAP IH DAILY
5. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours Disp
#*60 Tablet Refills:*0
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*30 Capsule Refills:*0
3. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
4. Nortriptyline 30 mg PO HS
5. OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**12-10**] tablet(s) by mouth every 4 hours Disp
#*50 Tablet Refills:*0
6. Pravastatin 40 mg PO DAILY
7. Senna 1 TAB PO BID
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp
#*30 Tablet Refills:*0
8. Tiotropium Bromide 1 CAP IH DAILY
9. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
10. Metoprolol Tartrate 12.5 mg PO BID HTN
Hold for SBP < 100 or HR < 60
RX *metoprolol tartrate 25 mg Half tablet(s) by mouth twice a
day Disp #*15 Tablet Refills:*0
Discharge Disposition:
Home With Service
Facility:
[**Hospital 119**] Homecare
Discharge Diagnosis:
Recurrent lung cancer
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
You were admitted to the hospital for surgery on your lung. You
have done well after the procedure and may return home to
continue your recovery.
There is a dressing over the site of your chest tube- this may
be removed in 24 hours. You can leave the incision open to air
after that. You may shower with the dressing in place.
Please take the prescribed pain medication as needed.
Constipation can be a problem with narcotic use, therefore drink
plenty of fluid to stay well hydrated and use a stool softener
while taking narcotics. Do NOT drive while taking narcotic pain
medications.
While in the hospital, you were noticed to have a heart rhythm
called atrial fibrillation. We were able to convert the rhythm
back to normal using medication; please ask your primary care
doctor if you need further tests or treatment. We also started
you on a new medication called Metoprolol for your high blood
pressure and new dysrhythmia, please ask your primary care
doctor if you need to continue it.
If you develop any chest pain, shortness of breath or any other
symptoms that concern you, please call your surgeon or go to the
nearest Emergency Room.
Thank you for allowing us to participate in your care.
Followup Instructions:
Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. Please call
[**Telephone/Fax (1) 2348**] to schedule a follow up appointment in 2 weeks with
a chest x ray.
Please report to the [**Location (un) **] of the [**Hospital Ward Name 23**] center 30 min
prior to your appointment for a chest x-ray.
Please follow up with your primary care doctor within a week
from discharge.
| Relafen |
Mention any medication or food allergies. | Admission Date: [**2126-8-30**] Discharge Date: [**2126-9-8**]
Date of Birth: [**2054-2-16**] Sex: F
Service: CARDIOTHORACIC
Allergies:
Relafen
Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Recurrence of lung cancer
Major Surgical or Invasive Procedure:
[**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer.
History of Present Illness:
Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time.
Past Medical History:
Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema
PSH: RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy
Social History:
She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient.
Family History:
She has two daughters who are healthy. There is a history of
allergies and emphysema in her family.
Physical Exam:
Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE
Pertinent Results:
ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema.
Brief Hospital Course:
Patient was admitted on [**2126-8-30**] to the thoracic surgery service
for a planned right thoracotomy, right lower lobe wedge
resection with decortication. She tolerated the procedure well,
was extubated and recovered in the PACU prior to being
transferred to the ICU in stable condition. For full details
please see the operative report. Three chest tubes were placed
during the procedure and a postoperative chest x-ray showed
expected right pneumothorax post surgery with three chest tubes
in place. Pathology revealed a 1.8 cm poorly differentiated
adenocarcinoma with negative margins and no positive nodes. She
was started on a clear liquid diet, her pain was controlled with
an epidural and she was started on her home medications. On POD
1 her diet was advanced to regular and she was transferred to
the surgical floor from the ICU. On POD 2 she was noted to have
increased somnolence which was thought to be related to her pain
medications so her epidural was turned down and narcotics for
breakthrough pain were discontinued. She was given a unit of
PRBC for a Hct of 20.3 with an appropriate increase to 24.4 and
improved somnolence. On POD 3 metoprolol was started because of
elevated systolic blood pressures. She continued to have an air
leak from all three chest tubes. Her epidural was discontinued
and her foley catheter was removed. She was started on oxycodone
and tramadol for pain. By POD 4 the air leak had stopped in the
anterior chest tube so it was removed. The posterior chest tube
was removed on POD 6. On POD 7 she noted that she felt dizzy
when she was getting out of bed and was found to be in atrial
fibrillation with RVR. She was given metoprolol once without
effect and was then given IV diltiazem once with return to sinus
rhythm. Cardiac enzymes were negative and she was monitored with
telemetry without recurrence. On POD 8 the air leak had resolved
in the basilar chest tube so it was removed. A post pull chest
xray showed no PTX. Because her pain was well controlled, she
was tolerating her diet and was ambulating without assistance,
she was discharged to home on POD 9 with instructions to follow
up in Dr.[**Name (NI) 5067**] clinic with a chest x-ray.
Medications on Admission:
1. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
2. Nortriptyline 30 mg PO HS
3. Pravastatin 40 mg PO DAILY
4. Tiotropium Bromide 1 CAP IH DAILY
5. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours Disp
#*60 Tablet Refills:*0
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*30 Capsule Refills:*0
3. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
4. Nortriptyline 30 mg PO HS
5. OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**12-10**] tablet(s) by mouth every 4 hours Disp
#*50 Tablet Refills:*0
6. Pravastatin 40 mg PO DAILY
7. Senna 1 TAB PO BID
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp
#*30 Tablet Refills:*0
8. Tiotropium Bromide 1 CAP IH DAILY
9. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
10. Metoprolol Tartrate 12.5 mg PO BID HTN
Hold for SBP < 100 or HR < 60
RX *metoprolol tartrate 25 mg Half tablet(s) by mouth twice a
day Disp #*15 Tablet Refills:*0
Discharge Disposition:
Home With Service
Facility:
[**Hospital 119**] Homecare
Discharge Diagnosis:
Recurrent lung cancer
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
You were admitted to the hospital for surgery on your lung. You
have done well after the procedure and may return home to
continue your recovery.
There is a dressing over the site of your chest tube- this may
be removed in 24 hours. You can leave the incision open to air
after that. You may shower with the dressing in place.
Please take the prescribed pain medication as needed.
Constipation can be a problem with narcotic use, therefore drink
plenty of fluid to stay well hydrated and use a stool softener
while taking narcotics. Do NOT drive while taking narcotic pain
medications.
While in the hospital, you were noticed to have a heart rhythm
called atrial fibrillation. We were able to convert the rhythm
back to normal using medication; please ask your primary care
doctor if you need further tests or treatment. We also started
you on a new medication called Metoprolol for your high blood
pressure and new dysrhythmia, please ask your primary care
doctor if you need to continue it.
If you develop any chest pain, shortness of breath or any other
symptoms that concern you, please call your surgeon or go to the
nearest Emergency Room.
Thank you for allowing us to participate in your care.
Followup Instructions:
Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. Please call
[**Telephone/Fax (1) 2348**] to schedule a follow up appointment in 2 weeks with
a chest x ray.
Please report to the [**Location (un) **] of the [**Hospital Ward Name 23**] center 30 min
prior to your appointment for a chest x-ray.
Please follow up with your primary care doctor within a week
from discharge.
| Relafen |
State the main reason for hospital visit. | Admission Date: [**2126-8-30**] Discharge Date: [**2126-9-8**]
Date of Birth: [**2054-2-16**] Sex: F
Service: CARDIOTHORACIC
Allergies:
Relafen
Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Recurrence of lung cancer
Major Surgical or Invasive Procedure:
[**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer.
History of Present Illness:
Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time.
Past Medical History:
Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema
PSH: RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy
Social History:
She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient.
Family History:
She has two daughters who are healthy. There is a history of
allergies and emphysema in her family.
Physical Exam:
Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE
Pertinent Results:
ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema.
Brief Hospital Course:
Patient was admitted on [**2126-8-30**] to the thoracic surgery service
for a planned right thoracotomy, right lower lobe wedge
resection with decortication. She tolerated the procedure well,
was extubated and recovered in the PACU prior to being
transferred to the ICU in stable condition. For full details
please see the operative report. Three chest tubes were placed
during the procedure and a postoperative chest x-ray showed
expected right pneumothorax post surgery with three chest tubes
in place. Pathology revealed a 1.8 cm poorly differentiated
adenocarcinoma with negative margins and no positive nodes. She
was started on a clear liquid diet, her pain was controlled with
an epidural and she was started on her home medications. On POD
1 her diet was advanced to regular and she was transferred to
the surgical floor from the ICU. On POD 2 she was noted to have
increased somnolence which was thought to be related to her pain
medications so her epidural was turned down and narcotics for
breakthrough pain were discontinued. She was given a unit of
PRBC for a Hct of 20.3 with an appropriate increase to 24.4 and
improved somnolence. On POD 3 metoprolol was started because of
elevated systolic blood pressures. She continued to have an air
leak from all three chest tubes. Her epidural was discontinued
and her foley catheter was removed. She was started on oxycodone
and tramadol for pain. By POD 4 the air leak had stopped in the
anterior chest tube so it was removed. The posterior chest tube
was removed on POD 6. On POD 7 she noted that she felt dizzy
when she was getting out of bed and was found to be in atrial
fibrillation with RVR. She was given metoprolol once without
effect and was then given IV diltiazem once with return to sinus
rhythm. Cardiac enzymes were negative and she was monitored with
telemetry without recurrence. On POD 8 the air leak had resolved
in the basilar chest tube so it was removed. A post pull chest
xray showed no PTX. Because her pain was well controlled, she
was tolerating her diet and was ambulating without assistance,
she was discharged to home on POD 9 with instructions to follow
up in Dr.[**Name (NI) 5067**] clinic with a chest x-ray.
Medications on Admission:
1. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
2. Nortriptyline 30 mg PO HS
3. Pravastatin 40 mg PO DAILY
4. Tiotropium Bromide 1 CAP IH DAILY
5. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours Disp
#*60 Tablet Refills:*0
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*30 Capsule Refills:*0
3. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
4. Nortriptyline 30 mg PO HS
5. OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**12-10**] tablet(s) by mouth every 4 hours Disp
#*50 Tablet Refills:*0
6. Pravastatin 40 mg PO DAILY
7. Senna 1 TAB PO BID
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp
#*30 Tablet Refills:*0
8. Tiotropium Bromide 1 CAP IH DAILY
9. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
10. Metoprolol Tartrate 12.5 mg PO BID HTN
Hold for SBP < 100 or HR < 60
RX *metoprolol tartrate 25 mg Half tablet(s) by mouth twice a
day Disp #*15 Tablet Refills:*0
Discharge Disposition:
Home With Service
Facility:
[**Hospital 119**] Homecare
Discharge Diagnosis:
Recurrent lung cancer
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
You were admitted to the hospital for surgery on your lung. You
have done well after the procedure and may return home to
continue your recovery.
There is a dressing over the site of your chest tube- this may
be removed in 24 hours. You can leave the incision open to air
after that. You may shower with the dressing in place.
Please take the prescribed pain medication as needed.
Constipation can be a problem with narcotic use, therefore drink
plenty of fluid to stay well hydrated and use a stool softener
while taking narcotics. Do NOT drive while taking narcotic pain
medications.
While in the hospital, you were noticed to have a heart rhythm
called atrial fibrillation. We were able to convert the rhythm
back to normal using medication; please ask your primary care
doctor if you need further tests or treatment. We also started
you on a new medication called Metoprolol for your high blood
pressure and new dysrhythmia, please ask your primary care
doctor if you need to continue it.
If you develop any chest pain, shortness of breath or any other
symptoms that concern you, please call your surgeon or go to the
nearest Emergency Room.
Thank you for allowing us to participate in your care.
Followup Instructions:
Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. Please call
[**Telephone/Fax (1) 2348**] to schedule a follow up appointment in 2 weeks with
a chest x ray.
Please report to the [**Location (un) **] of the [**Hospital Ward Name 23**] center 30 min
prior to your appointment for a chest x-ray.
Please follow up with your primary care doctor within a week
from discharge.
| Recurrence of lung cancer |
Describe the patient's chief complaint. | Admission Date: [**2126-8-30**] Discharge Date: [**2126-9-8**]
Date of Birth: [**2054-2-16**] Sex: F
Service: CARDIOTHORACIC
Allergies:
Relafen
Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Recurrence of lung cancer
Major Surgical or Invasive Procedure:
[**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer.
History of Present Illness:
Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time.
Past Medical History:
Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema
PSH: RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy
Social History:
She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient.
Family History:
She has two daughters who are healthy. There is a history of
allergies and emphysema in her family.
Physical Exam:
Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE
Pertinent Results:
ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema.
Brief Hospital Course:
Patient was admitted on [**2126-8-30**] to the thoracic surgery service
for a planned right thoracotomy, right lower lobe wedge
resection with decortication. She tolerated the procedure well,
was extubated and recovered in the PACU prior to being
transferred to the ICU in stable condition. For full details
please see the operative report. Three chest tubes were placed
during the procedure and a postoperative chest x-ray showed
expected right pneumothorax post surgery with three chest tubes
in place. Pathology revealed a 1.8 cm poorly differentiated
adenocarcinoma with negative margins and no positive nodes. She
was started on a clear liquid diet, her pain was controlled with
an epidural and she was started on her home medications. On POD
1 her diet was advanced to regular and she was transferred to
the surgical floor from the ICU. On POD 2 she was noted to have
increased somnolence which was thought to be related to her pain
medications so her epidural was turned down and narcotics for
breakthrough pain were discontinued. She was given a unit of
PRBC for a Hct of 20.3 with an appropriate increase to 24.4 and
improved somnolence. On POD 3 metoprolol was started because of
elevated systolic blood pressures. She continued to have an air
leak from all three chest tubes. Her epidural was discontinued
and her foley catheter was removed. She was started on oxycodone
and tramadol for pain. By POD 4 the air leak had stopped in the
anterior chest tube so it was removed. The posterior chest tube
was removed on POD 6. On POD 7 she noted that she felt dizzy
when she was getting out of bed and was found to be in atrial
fibrillation with RVR. She was given metoprolol once without
effect and was then given IV diltiazem once with return to sinus
rhythm. Cardiac enzymes were negative and she was monitored with
telemetry without recurrence. On POD 8 the air leak had resolved
in the basilar chest tube so it was removed. A post pull chest
xray showed no PTX. Because her pain was well controlled, she
was tolerating her diet and was ambulating without assistance,
she was discharged to home on POD 9 with instructions to follow
up in Dr.[**Name (NI) 5067**] clinic with a chest x-ray.
Medications on Admission:
1. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
2. Nortriptyline 30 mg PO HS
3. Pravastatin 40 mg PO DAILY
4. Tiotropium Bromide 1 CAP IH DAILY
5. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours Disp
#*60 Tablet Refills:*0
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*30 Capsule Refills:*0
3. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
4. Nortriptyline 30 mg PO HS
5. OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**12-10**] tablet(s) by mouth every 4 hours Disp
#*50 Tablet Refills:*0
6. Pravastatin 40 mg PO DAILY
7. Senna 1 TAB PO BID
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp
#*30 Tablet Refills:*0
8. Tiotropium Bromide 1 CAP IH DAILY
9. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
10. Metoprolol Tartrate 12.5 mg PO BID HTN
Hold for SBP < 100 or HR < 60
RX *metoprolol tartrate 25 mg Half tablet(s) by mouth twice a
day Disp #*15 Tablet Refills:*0
Discharge Disposition:
Home With Service
Facility:
[**Hospital 119**] Homecare
Discharge Diagnosis:
Recurrent lung cancer
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
You were admitted to the hospital for surgery on your lung. You
have done well after the procedure and may return home to
continue your recovery.
There is a dressing over the site of your chest tube- this may
be removed in 24 hours. You can leave the incision open to air
after that. You may shower with the dressing in place.
Please take the prescribed pain medication as needed.
Constipation can be a problem with narcotic use, therefore drink
plenty of fluid to stay well hydrated and use a stool softener
while taking narcotics. Do NOT drive while taking narcotic pain
medications.
While in the hospital, you were noticed to have a heart rhythm
called atrial fibrillation. We were able to convert the rhythm
back to normal using medication; please ask your primary care
doctor if you need further tests or treatment. We also started
you on a new medication called Metoprolol for your high blood
pressure and new dysrhythmia, please ask your primary care
doctor if you need to continue it.
If you develop any chest pain, shortness of breath or any other
symptoms that concern you, please call your surgeon or go to the
nearest Emergency Room.
Thank you for allowing us to participate in your care.
Followup Instructions:
Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. Please call
[**Telephone/Fax (1) 2348**] to schedule a follow up appointment in 2 weeks with
a chest x ray.
Please report to the [**Location (un) **] of the [**Hospital Ward Name 23**] center 30 min
prior to your appointment for a chest x-ray.
Please follow up with your primary care doctor within a week
from discharge.
| Recurrence of lung cancer |
List major surgeries or procedures. | Admission Date: [**2126-8-30**] Discharge Date: [**2126-9-8**]
Date of Birth: [**2054-2-16**] Sex: F
Service: CARDIOTHORACIC
Allergies:
Relafen
Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Recurrence of lung cancer
Major Surgical or Invasive Procedure:
[**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer.
History of Present Illness:
Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time.
Past Medical History:
Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema
PSH: RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy
Social History:
She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient.
Family History:
She has two daughters who are healthy. There is a history of
allergies and emphysema in her family.
Physical Exam:
Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE
Pertinent Results:
ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema.
Brief Hospital Course:
Patient was admitted on [**2126-8-30**] to the thoracic surgery service
for a planned right thoracotomy, right lower lobe wedge
resection with decortication. She tolerated the procedure well,
was extubated and recovered in the PACU prior to being
transferred to the ICU in stable condition. For full details
please see the operative report. Three chest tubes were placed
during the procedure and a postoperative chest x-ray showed
expected right pneumothorax post surgery with three chest tubes
in place. Pathology revealed a 1.8 cm poorly differentiated
adenocarcinoma with negative margins and no positive nodes. She
was started on a clear liquid diet, her pain was controlled with
an epidural and she was started on her home medications. On POD
1 her diet was advanced to regular and she was transferred to
the surgical floor from the ICU. On POD 2 she was noted to have
increased somnolence which was thought to be related to her pain
medications so her epidural was turned down and narcotics for
breakthrough pain were discontinued. She was given a unit of
PRBC for a Hct of 20.3 with an appropriate increase to 24.4 and
improved somnolence. On POD 3 metoprolol was started because of
elevated systolic blood pressures. She continued to have an air
leak from all three chest tubes. Her epidural was discontinued
and her foley catheter was removed. She was started on oxycodone
and tramadol for pain. By POD 4 the air leak had stopped in the
anterior chest tube so it was removed. The posterior chest tube
was removed on POD 6. On POD 7 she noted that she felt dizzy
when she was getting out of bed and was found to be in atrial
fibrillation with RVR. She was given metoprolol once without
effect and was then given IV diltiazem once with return to sinus
rhythm. Cardiac enzymes were negative and she was monitored with
telemetry without recurrence. On POD 8 the air leak had resolved
in the basilar chest tube so it was removed. A post pull chest
xray showed no PTX. Because her pain was well controlled, she
was tolerating her diet and was ambulating without assistance,
she was discharged to home on POD 9 with instructions to follow
up in Dr.[**Name (NI) 5067**] clinic with a chest x-ray.
Medications on Admission:
1. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
2. Nortriptyline 30 mg PO HS
3. Pravastatin 40 mg PO DAILY
4. Tiotropium Bromide 1 CAP IH DAILY
5. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours Disp
#*60 Tablet Refills:*0
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*30 Capsule Refills:*0
3. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
4. Nortriptyline 30 mg PO HS
5. OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**12-10**] tablet(s) by mouth every 4 hours Disp
#*50 Tablet Refills:*0
6. Pravastatin 40 mg PO DAILY
7. Senna 1 TAB PO BID
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp
#*30 Tablet Refills:*0
8. Tiotropium Bromide 1 CAP IH DAILY
9. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
10. Metoprolol Tartrate 12.5 mg PO BID HTN
Hold for SBP < 100 or HR < 60
RX *metoprolol tartrate 25 mg Half tablet(s) by mouth twice a
day Disp #*15 Tablet Refills:*0
Discharge Disposition:
Home With Service
Facility:
[**Hospital 119**] Homecare
Discharge Diagnosis:
Recurrent lung cancer
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
You were admitted to the hospital for surgery on your lung. You
have done well after the procedure and may return home to
continue your recovery.
There is a dressing over the site of your chest tube- this may
be removed in 24 hours. You can leave the incision open to air
after that. You may shower with the dressing in place.
Please take the prescribed pain medication as needed.
Constipation can be a problem with narcotic use, therefore drink
plenty of fluid to stay well hydrated and use a stool softener
while taking narcotics. Do NOT drive while taking narcotic pain
medications.
While in the hospital, you were noticed to have a heart rhythm
called atrial fibrillation. We were able to convert the rhythm
back to normal using medication; please ask your primary care
doctor if you need further tests or treatment. We also started
you on a new medication called Metoprolol for your high blood
pressure and new dysrhythmia, please ask your primary care
doctor if you need to continue it.
If you develop any chest pain, shortness of breath or any other
symptoms that concern you, please call your surgeon or go to the
nearest Emergency Room.
Thank you for allowing us to participate in your care.
Followup Instructions:
Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. Please call
[**Telephone/Fax (1) 2348**] to schedule a follow up appointment in 2 weeks with
a chest x ray.
Please report to the [**Location (un) **] of the [**Hospital Ward Name 23**] center 30 min
prior to your appointment for a chest x-ray.
Please follow up with your primary care doctor within a week
from discharge.
| [**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer. |
Mention any invasive procedures performed. | Admission Date: [**2126-8-30**] Discharge Date: [**2126-9-8**]
Date of Birth: [**2054-2-16**] Sex: F
Service: CARDIOTHORACIC
Allergies:
Relafen
Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Recurrence of lung cancer
Major Surgical or Invasive Procedure:
[**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer.
History of Present Illness:
Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time.
Past Medical History:
Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema
PSH: RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy
Social History:
She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient.
Family History:
She has two daughters who are healthy. There is a history of
allergies and emphysema in her family.
Physical Exam:
Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE
Pertinent Results:
ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema.
Brief Hospital Course:
Patient was admitted on [**2126-8-30**] to the thoracic surgery service
for a planned right thoracotomy, right lower lobe wedge
resection with decortication. She tolerated the procedure well,
was extubated and recovered in the PACU prior to being
transferred to the ICU in stable condition. For full details
please see the operative report. Three chest tubes were placed
during the procedure and a postoperative chest x-ray showed
expected right pneumothorax post surgery with three chest tubes
in place. Pathology revealed a 1.8 cm poorly differentiated
adenocarcinoma with negative margins and no positive nodes. She
was started on a clear liquid diet, her pain was controlled with
an epidural and she was started on her home medications. On POD
1 her diet was advanced to regular and she was transferred to
the surgical floor from the ICU. On POD 2 she was noted to have
increased somnolence which was thought to be related to her pain
medications so her epidural was turned down and narcotics for
breakthrough pain were discontinued. She was given a unit of
PRBC for a Hct of 20.3 with an appropriate increase to 24.4 and
improved somnolence. On POD 3 metoprolol was started because of
elevated systolic blood pressures. She continued to have an air
leak from all three chest tubes. Her epidural was discontinued
and her foley catheter was removed. She was started on oxycodone
and tramadol for pain. By POD 4 the air leak had stopped in the
anterior chest tube so it was removed. The posterior chest tube
was removed on POD 6. On POD 7 she noted that she felt dizzy
when she was getting out of bed and was found to be in atrial
fibrillation with RVR. She was given metoprolol once without
effect and was then given IV diltiazem once with return to sinus
rhythm. Cardiac enzymes were negative and she was monitored with
telemetry without recurrence. On POD 8 the air leak had resolved
in the basilar chest tube so it was removed. A post pull chest
xray showed no PTX. Because her pain was well controlled, she
was tolerating her diet and was ambulating without assistance,
she was discharged to home on POD 9 with instructions to follow
up in Dr.[**Name (NI) 5067**] clinic with a chest x-ray.
Medications on Admission:
1. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
2. Nortriptyline 30 mg PO HS
3. Pravastatin 40 mg PO DAILY
4. Tiotropium Bromide 1 CAP IH DAILY
5. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours Disp
#*60 Tablet Refills:*0
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*30 Capsule Refills:*0
3. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
4. Nortriptyline 30 mg PO HS
5. OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**12-10**] tablet(s) by mouth every 4 hours Disp
#*50 Tablet Refills:*0
6. Pravastatin 40 mg PO DAILY
7. Senna 1 TAB PO BID
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp
#*30 Tablet Refills:*0
8. Tiotropium Bromide 1 CAP IH DAILY
9. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
10. Metoprolol Tartrate 12.5 mg PO BID HTN
Hold for SBP < 100 or HR < 60
RX *metoprolol tartrate 25 mg Half tablet(s) by mouth twice a
day Disp #*15 Tablet Refills:*0
Discharge Disposition:
Home With Service
Facility:
[**Hospital 119**] Homecare
Discharge Diagnosis:
Recurrent lung cancer
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
You were admitted to the hospital for surgery on your lung. You
have done well after the procedure and may return home to
continue your recovery.
There is a dressing over the site of your chest tube- this may
be removed in 24 hours. You can leave the incision open to air
after that. You may shower with the dressing in place.
Please take the prescribed pain medication as needed.
Constipation can be a problem with narcotic use, therefore drink
plenty of fluid to stay well hydrated and use a stool softener
while taking narcotics. Do NOT drive while taking narcotic pain
medications.
While in the hospital, you were noticed to have a heart rhythm
called atrial fibrillation. We were able to convert the rhythm
back to normal using medication; please ask your primary care
doctor if you need further tests or treatment. We also started
you on a new medication called Metoprolol for your high blood
pressure and new dysrhythmia, please ask your primary care
doctor if you need to continue it.
If you develop any chest pain, shortness of breath or any other
symptoms that concern you, please call your surgeon or go to the
nearest Emergency Room.
Thank you for allowing us to participate in your care.
Followup Instructions:
Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. Please call
[**Telephone/Fax (1) 2348**] to schedule a follow up appointment in 2 weeks with
a chest x ray.
Please report to the [**Location (un) **] of the [**Hospital Ward Name 23**] center 30 min
prior to your appointment for a chest x-ray.
Please follow up with your primary care doctor within a week
from discharge.
| [**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer. |
Summarize the present illness. | Admission Date: [**2126-8-30**] Discharge Date: [**2126-9-8**]
Date of Birth: [**2054-2-16**] Sex: F
Service: CARDIOTHORACIC
Allergies:
Relafen
Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Recurrence of lung cancer
Major Surgical or Invasive Procedure:
[**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer.
History of Present Illness:
Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time.
Past Medical History:
Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema
PSH: RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy
Social History:
She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient.
Family History:
She has two daughters who are healthy. There is a history of
allergies and emphysema in her family.
Physical Exam:
Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE
Pertinent Results:
ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema.
Brief Hospital Course:
Patient was admitted on [**2126-8-30**] to the thoracic surgery service
for a planned right thoracotomy, right lower lobe wedge
resection with decortication. She tolerated the procedure well,
was extubated and recovered in the PACU prior to being
transferred to the ICU in stable condition. For full details
please see the operative report. Three chest tubes were placed
during the procedure and a postoperative chest x-ray showed
expected right pneumothorax post surgery with three chest tubes
in place. Pathology revealed a 1.8 cm poorly differentiated
adenocarcinoma with negative margins and no positive nodes. She
was started on a clear liquid diet, her pain was controlled with
an epidural and she was started on her home medications. On POD
1 her diet was advanced to regular and she was transferred to
the surgical floor from the ICU. On POD 2 she was noted to have
increased somnolence which was thought to be related to her pain
medications so her epidural was turned down and narcotics for
breakthrough pain were discontinued. She was given a unit of
PRBC for a Hct of 20.3 with an appropriate increase to 24.4 and
improved somnolence. On POD 3 metoprolol was started because of
elevated systolic blood pressures. She continued to have an air
leak from all three chest tubes. Her epidural was discontinued
and her foley catheter was removed. She was started on oxycodone
and tramadol for pain. By POD 4 the air leak had stopped in the
anterior chest tube so it was removed. The posterior chest tube
was removed on POD 6. On POD 7 she noted that she felt dizzy
when she was getting out of bed and was found to be in atrial
fibrillation with RVR. She was given metoprolol once without
effect and was then given IV diltiazem once with return to sinus
rhythm. Cardiac enzymes were negative and she was monitored with
telemetry without recurrence. On POD 8 the air leak had resolved
in the basilar chest tube so it was removed. A post pull chest
xray showed no PTX. Because her pain was well controlled, she
was tolerating her diet and was ambulating without assistance,
she was discharged to home on POD 9 with instructions to follow
up in Dr.[**Name (NI) 5067**] clinic with a chest x-ray.
Medications on Admission:
1. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
2. Nortriptyline 30 mg PO HS
3. Pravastatin 40 mg PO DAILY
4. Tiotropium Bromide 1 CAP IH DAILY
5. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours Disp
#*60 Tablet Refills:*0
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*30 Capsule Refills:*0
3. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
4. Nortriptyline 30 mg PO HS
5. OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**12-10**] tablet(s) by mouth every 4 hours Disp
#*50 Tablet Refills:*0
6. Pravastatin 40 mg PO DAILY
7. Senna 1 TAB PO BID
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp
#*30 Tablet Refills:*0
8. Tiotropium Bromide 1 CAP IH DAILY
9. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
10. Metoprolol Tartrate 12.5 mg PO BID HTN
Hold for SBP < 100 or HR < 60
RX *metoprolol tartrate 25 mg Half tablet(s) by mouth twice a
day Disp #*15 Tablet Refills:*0
Discharge Disposition:
Home With Service
Facility:
[**Hospital 119**] Homecare
Discharge Diagnosis:
Recurrent lung cancer
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
You were admitted to the hospital for surgery on your lung. You
have done well after the procedure and may return home to
continue your recovery.
There is a dressing over the site of your chest tube- this may
be removed in 24 hours. You can leave the incision open to air
after that. You may shower with the dressing in place.
Please take the prescribed pain medication as needed.
Constipation can be a problem with narcotic use, therefore drink
plenty of fluid to stay well hydrated and use a stool softener
while taking narcotics. Do NOT drive while taking narcotic pain
medications.
While in the hospital, you were noticed to have a heart rhythm
called atrial fibrillation. We were able to convert the rhythm
back to normal using medication; please ask your primary care
doctor if you need further tests or treatment. We also started
you on a new medication called Metoprolol for your high blood
pressure and new dysrhythmia, please ask your primary care
doctor if you need to continue it.
If you develop any chest pain, shortness of breath or any other
symptoms that concern you, please call your surgeon or go to the
nearest Emergency Room.
Thank you for allowing us to participate in your care.
Followup Instructions:
Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. Please call
[**Telephone/Fax (1) 2348**] to schedule a follow up appointment in 2 weeks with
a chest x ray.
Please report to the [**Location (un) **] of the [**Hospital Ward Name 23**] center 30 min
prior to your appointment for a chest x-ray.
Please follow up with your primary care doctor within a week
from discharge.
| Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time. |
Describe how the illness developed. | Admission Date: [**2126-8-30**] Discharge Date: [**2126-9-8**]
Date of Birth: [**2054-2-16**] Sex: F
Service: CARDIOTHORACIC
Allergies:
Relafen
Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Recurrence of lung cancer
Major Surgical or Invasive Procedure:
[**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer.
History of Present Illness:
Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time.
Past Medical History:
Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema
PSH: RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy
Social History:
She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient.
Family History:
She has two daughters who are healthy. There is a history of
allergies and emphysema in her family.
Physical Exam:
Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE
Pertinent Results:
ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema.
Brief Hospital Course:
Patient was admitted on [**2126-8-30**] to the thoracic surgery service
for a planned right thoracotomy, right lower lobe wedge
resection with decortication. She tolerated the procedure well,
was extubated and recovered in the PACU prior to being
transferred to the ICU in stable condition. For full details
please see the operative report. Three chest tubes were placed
during the procedure and a postoperative chest x-ray showed
expected right pneumothorax post surgery with three chest tubes
in place. Pathology revealed a 1.8 cm poorly differentiated
adenocarcinoma with negative margins and no positive nodes. She
was started on a clear liquid diet, her pain was controlled with
an epidural and she was started on her home medications. On POD
1 her diet was advanced to regular and she was transferred to
the surgical floor from the ICU. On POD 2 she was noted to have
increased somnolence which was thought to be related to her pain
medications so her epidural was turned down and narcotics for
breakthrough pain were discontinued. She was given a unit of
PRBC for a Hct of 20.3 with an appropriate increase to 24.4 and
improved somnolence. On POD 3 metoprolol was started because of
elevated systolic blood pressures. She continued to have an air
leak from all three chest tubes. Her epidural was discontinued
and her foley catheter was removed. She was started on oxycodone
and tramadol for pain. By POD 4 the air leak had stopped in the
anterior chest tube so it was removed. The posterior chest tube
was removed on POD 6. On POD 7 she noted that she felt dizzy
when she was getting out of bed and was found to be in atrial
fibrillation with RVR. She was given metoprolol once without
effect and was then given IV diltiazem once with return to sinus
rhythm. Cardiac enzymes were negative and she was monitored with
telemetry without recurrence. On POD 8 the air leak had resolved
in the basilar chest tube so it was removed. A post pull chest
xray showed no PTX. Because her pain was well controlled, she
was tolerating her diet and was ambulating without assistance,
she was discharged to home on POD 9 with instructions to follow
up in Dr.[**Name (NI) 5067**] clinic with a chest x-ray.
Medications on Admission:
1. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
2. Nortriptyline 30 mg PO HS
3. Pravastatin 40 mg PO DAILY
4. Tiotropium Bromide 1 CAP IH DAILY
5. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours Disp
#*60 Tablet Refills:*0
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*30 Capsule Refills:*0
3. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
4. Nortriptyline 30 mg PO HS
5. OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**12-10**] tablet(s) by mouth every 4 hours Disp
#*50 Tablet Refills:*0
6. Pravastatin 40 mg PO DAILY
7. Senna 1 TAB PO BID
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp
#*30 Tablet Refills:*0
8. Tiotropium Bromide 1 CAP IH DAILY
9. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
10. Metoprolol Tartrate 12.5 mg PO BID HTN
Hold for SBP < 100 or HR < 60
RX *metoprolol tartrate 25 mg Half tablet(s) by mouth twice a
day Disp #*15 Tablet Refills:*0
Discharge Disposition:
Home With Service
Facility:
[**Hospital 119**] Homecare
Discharge Diagnosis:
Recurrent lung cancer
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
You were admitted to the hospital for surgery on your lung. You
have done well after the procedure and may return home to
continue your recovery.
There is a dressing over the site of your chest tube- this may
be removed in 24 hours. You can leave the incision open to air
after that. You may shower with the dressing in place.
Please take the prescribed pain medication as needed.
Constipation can be a problem with narcotic use, therefore drink
plenty of fluid to stay well hydrated and use a stool softener
while taking narcotics. Do NOT drive while taking narcotic pain
medications.
While in the hospital, you were noticed to have a heart rhythm
called atrial fibrillation. We were able to convert the rhythm
back to normal using medication; please ask your primary care
doctor if you need further tests or treatment. We also started
you on a new medication called Metoprolol for your high blood
pressure and new dysrhythmia, please ask your primary care
doctor if you need to continue it.
If you develop any chest pain, shortness of breath or any other
symptoms that concern you, please call your surgeon or go to the
nearest Emergency Room.
Thank you for allowing us to participate in your care.
Followup Instructions:
Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. Please call
[**Telephone/Fax (1) 2348**] to schedule a follow up appointment in 2 weeks with
a chest x ray.
Please report to the [**Location (un) **] of the [**Hospital Ward Name 23**] center 30 min
prior to your appointment for a chest x-ray.
Please follow up with your primary care doctor within a week
from discharge.
| Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time. |
List the patient's past medical issues. | Admission Date: [**2126-8-30**] Discharge Date: [**2126-9-8**]
Date of Birth: [**2054-2-16**] Sex: F
Service: CARDIOTHORACIC
Allergies:
Relafen
Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Recurrence of lung cancer
Major Surgical or Invasive Procedure:
[**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer.
History of Present Illness:
Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time.
Past Medical History:
Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema
PSH: RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy
Social History:
She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient.
Family History:
She has two daughters who are healthy. There is a history of
allergies and emphysema in her family.
Physical Exam:
Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE
Pertinent Results:
ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema.
Brief Hospital Course:
Patient was admitted on [**2126-8-30**] to the thoracic surgery service
for a planned right thoracotomy, right lower lobe wedge
resection with decortication. She tolerated the procedure well,
was extubated and recovered in the PACU prior to being
transferred to the ICU in stable condition. For full details
please see the operative report. Three chest tubes were placed
during the procedure and a postoperative chest x-ray showed
expected right pneumothorax post surgery with three chest tubes
in place. Pathology revealed a 1.8 cm poorly differentiated
adenocarcinoma with negative margins and no positive nodes. She
was started on a clear liquid diet, her pain was controlled with
an epidural and she was started on her home medications. On POD
1 her diet was advanced to regular and she was transferred to
the surgical floor from the ICU. On POD 2 she was noted to have
increased somnolence which was thought to be related to her pain
medications so her epidural was turned down and narcotics for
breakthrough pain were discontinued. She was given a unit of
PRBC for a Hct of 20.3 with an appropriate increase to 24.4 and
improved somnolence. On POD 3 metoprolol was started because of
elevated systolic blood pressures. She continued to have an air
leak from all three chest tubes. Her epidural was discontinued
and her foley catheter was removed. She was started on oxycodone
and tramadol for pain. By POD 4 the air leak had stopped in the
anterior chest tube so it was removed. The posterior chest tube
was removed on POD 6. On POD 7 she noted that she felt dizzy
when she was getting out of bed and was found to be in atrial
fibrillation with RVR. She was given metoprolol once without
effect and was then given IV diltiazem once with return to sinus
rhythm. Cardiac enzymes were negative and she was monitored with
telemetry without recurrence. On POD 8 the air leak had resolved
in the basilar chest tube so it was removed. A post pull chest
xray showed no PTX. Because her pain was well controlled, she
was tolerating her diet and was ambulating without assistance,
she was discharged to home on POD 9 with instructions to follow
up in Dr.[**Name (NI) 5067**] clinic with a chest x-ray.
Medications on Admission:
1. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
2. Nortriptyline 30 mg PO HS
3. Pravastatin 40 mg PO DAILY
4. Tiotropium Bromide 1 CAP IH DAILY
5. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours Disp
#*60 Tablet Refills:*0
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*30 Capsule Refills:*0
3. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
4. Nortriptyline 30 mg PO HS
5. OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**12-10**] tablet(s) by mouth every 4 hours Disp
#*50 Tablet Refills:*0
6. Pravastatin 40 mg PO DAILY
7. Senna 1 TAB PO BID
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp
#*30 Tablet Refills:*0
8. Tiotropium Bromide 1 CAP IH DAILY
9. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
10. Metoprolol Tartrate 12.5 mg PO BID HTN
Hold for SBP < 100 or HR < 60
RX *metoprolol tartrate 25 mg Half tablet(s) by mouth twice a
day Disp #*15 Tablet Refills:*0
Discharge Disposition:
Home With Service
Facility:
[**Hospital 119**] Homecare
Discharge Diagnosis:
Recurrent lung cancer
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
You were admitted to the hospital for surgery on your lung. You
have done well after the procedure and may return home to
continue your recovery.
There is a dressing over the site of your chest tube- this may
be removed in 24 hours. You can leave the incision open to air
after that. You may shower with the dressing in place.
Please take the prescribed pain medication as needed.
Constipation can be a problem with narcotic use, therefore drink
plenty of fluid to stay well hydrated and use a stool softener
while taking narcotics. Do NOT drive while taking narcotic pain
medications.
While in the hospital, you were noticed to have a heart rhythm
called atrial fibrillation. We were able to convert the rhythm
back to normal using medication; please ask your primary care
doctor if you need further tests or treatment. We also started
you on a new medication called Metoprolol for your high blood
pressure and new dysrhythmia, please ask your primary care
doctor if you need to continue it.
If you develop any chest pain, shortness of breath or any other
symptoms that concern you, please call your surgeon or go to the
nearest Emergency Room.
Thank you for allowing us to participate in your care.
Followup Instructions:
Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. Please call
[**Telephone/Fax (1) 2348**] to schedule a follow up appointment in 2 weeks with
a chest x ray.
Please report to the [**Location (un) **] of the [**Hospital Ward Name 23**] center 30 min
prior to your appointment for a chest x-ray.
Please follow up with your primary care doctor within a week
from discharge.
| Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema |
Mention previous health conditions. | Admission Date: [**2126-8-30**] Discharge Date: [**2126-9-8**]
Date of Birth: [**2054-2-16**] Sex: F
Service: CARDIOTHORACIC
Allergies:
Relafen
Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Recurrence of lung cancer
Major Surgical or Invasive Procedure:
[**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer.
History of Present Illness:
Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time.
Past Medical History:
Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema
PSH: RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy
Social History:
She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient.
Family History:
She has two daughters who are healthy. There is a history of
allergies and emphysema in her family.
Physical Exam:
Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE
Pertinent Results:
ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema.
Brief Hospital Course:
Patient was admitted on [**2126-8-30**] to the thoracic surgery service
for a planned right thoracotomy, right lower lobe wedge
resection with decortication. She tolerated the procedure well,
was extubated and recovered in the PACU prior to being
transferred to the ICU in stable condition. For full details
please see the operative report. Three chest tubes were placed
during the procedure and a postoperative chest x-ray showed
expected right pneumothorax post surgery with three chest tubes
in place. Pathology revealed a 1.8 cm poorly differentiated
adenocarcinoma with negative margins and no positive nodes. She
was started on a clear liquid diet, her pain was controlled with
an epidural and she was started on her home medications. On POD
1 her diet was advanced to regular and she was transferred to
the surgical floor from the ICU. On POD 2 she was noted to have
increased somnolence which was thought to be related to her pain
medications so her epidural was turned down and narcotics for
breakthrough pain were discontinued. She was given a unit of
PRBC for a Hct of 20.3 with an appropriate increase to 24.4 and
improved somnolence. On POD 3 metoprolol was started because of
elevated systolic blood pressures. She continued to have an air
leak from all three chest tubes. Her epidural was discontinued
and her foley catheter was removed. She was started on oxycodone
and tramadol for pain. By POD 4 the air leak had stopped in the
anterior chest tube so it was removed. The posterior chest tube
was removed on POD 6. On POD 7 she noted that she felt dizzy
when she was getting out of bed and was found to be in atrial
fibrillation with RVR. She was given metoprolol once without
effect and was then given IV diltiazem once with return to sinus
rhythm. Cardiac enzymes were negative and she was monitored with
telemetry without recurrence. On POD 8 the air leak had resolved
in the basilar chest tube so it was removed. A post pull chest
xray showed no PTX. Because her pain was well controlled, she
was tolerating her diet and was ambulating without assistance,
she was discharged to home on POD 9 with instructions to follow
up in Dr.[**Name (NI) 5067**] clinic with a chest x-ray.
Medications on Admission:
1. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
2. Nortriptyline 30 mg PO HS
3. Pravastatin 40 mg PO DAILY
4. Tiotropium Bromide 1 CAP IH DAILY
5. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours Disp
#*60 Tablet Refills:*0
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*30 Capsule Refills:*0
3. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
4. Nortriptyline 30 mg PO HS
5. OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**12-10**] tablet(s) by mouth every 4 hours Disp
#*50 Tablet Refills:*0
6. Pravastatin 40 mg PO DAILY
7. Senna 1 TAB PO BID
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp
#*30 Tablet Refills:*0
8. Tiotropium Bromide 1 CAP IH DAILY
9. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
10. Metoprolol Tartrate 12.5 mg PO BID HTN
Hold for SBP < 100 or HR < 60
RX *metoprolol tartrate 25 mg Half tablet(s) by mouth twice a
day Disp #*15 Tablet Refills:*0
Discharge Disposition:
Home With Service
Facility:
[**Hospital 119**] Homecare
Discharge Diagnosis:
Recurrent lung cancer
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
You were admitted to the hospital for surgery on your lung. You
have done well after the procedure and may return home to
continue your recovery.
There is a dressing over the site of your chest tube- this may
be removed in 24 hours. You can leave the incision open to air
after that. You may shower with the dressing in place.
Please take the prescribed pain medication as needed.
Constipation can be a problem with narcotic use, therefore drink
plenty of fluid to stay well hydrated and use a stool softener
while taking narcotics. Do NOT drive while taking narcotic pain
medications.
While in the hospital, you were noticed to have a heart rhythm
called atrial fibrillation. We were able to convert the rhythm
back to normal using medication; please ask your primary care
doctor if you need further tests or treatment. We also started
you on a new medication called Metoprolol for your high blood
pressure and new dysrhythmia, please ask your primary care
doctor if you need to continue it.
If you develop any chest pain, shortness of breath or any other
symptoms that concern you, please call your surgeon or go to the
nearest Emergency Room.
Thank you for allowing us to participate in your care.
Followup Instructions:
Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. Please call
[**Telephone/Fax (1) 2348**] to schedule a follow up appointment in 2 weeks with
a chest x ray.
Please report to the [**Location (un) **] of the [**Hospital Ward Name 23**] center 30 min
prior to your appointment for a chest x-ray.
Please follow up with your primary care doctor within a week
from discharge.
| Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema |
Document previous surgeries. | Admission Date: [**2126-8-30**] Discharge Date: [**2126-9-8**]
Date of Birth: [**2054-2-16**] Sex: F
Service: CARDIOTHORACIC
Allergies:
Relafen
Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Recurrence of lung cancer
Major Surgical or Invasive Procedure:
[**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer.
History of Present Illness:
Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time.
Past Medical History:
Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema
PSH: RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy
Social History:
She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient.
Family History:
She has two daughters who are healthy. There is a history of
allergies and emphysema in her family.
Physical Exam:
Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE
Pertinent Results:
ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema.
Brief Hospital Course:
Patient was admitted on [**2126-8-30**] to the thoracic surgery service
for a planned right thoracotomy, right lower lobe wedge
resection with decortication. She tolerated the procedure well,
was extubated and recovered in the PACU prior to being
transferred to the ICU in stable condition. For full details
please see the operative report. Three chest tubes were placed
during the procedure and a postoperative chest x-ray showed
expected right pneumothorax post surgery with three chest tubes
in place. Pathology revealed a 1.8 cm poorly differentiated
adenocarcinoma with negative margins and no positive nodes. She
was started on a clear liquid diet, her pain was controlled with
an epidural and she was started on her home medications. On POD
1 her diet was advanced to regular and she was transferred to
the surgical floor from the ICU. On POD 2 she was noted to have
increased somnolence which was thought to be related to her pain
medications so her epidural was turned down and narcotics for
breakthrough pain were discontinued. She was given a unit of
PRBC for a Hct of 20.3 with an appropriate increase to 24.4 and
improved somnolence. On POD 3 metoprolol was started because of
elevated systolic blood pressures. She continued to have an air
leak from all three chest tubes. Her epidural was discontinued
and her foley catheter was removed. She was started on oxycodone
and tramadol for pain. By POD 4 the air leak had stopped in the
anterior chest tube so it was removed. The posterior chest tube
was removed on POD 6. On POD 7 she noted that she felt dizzy
when she was getting out of bed and was found to be in atrial
fibrillation with RVR. She was given metoprolol once without
effect and was then given IV diltiazem once with return to sinus
rhythm. Cardiac enzymes were negative and she was monitored with
telemetry without recurrence. On POD 8 the air leak had resolved
in the basilar chest tube so it was removed. A post pull chest
xray showed no PTX. Because her pain was well controlled, she
was tolerating her diet and was ambulating without assistance,
she was discharged to home on POD 9 with instructions to follow
up in Dr.[**Name (NI) 5067**] clinic with a chest x-ray.
Medications on Admission:
1. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
2. Nortriptyline 30 mg PO HS
3. Pravastatin 40 mg PO DAILY
4. Tiotropium Bromide 1 CAP IH DAILY
5. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours Disp
#*60 Tablet Refills:*0
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*30 Capsule Refills:*0
3. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
4. Nortriptyline 30 mg PO HS
5. OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**12-10**] tablet(s) by mouth every 4 hours Disp
#*50 Tablet Refills:*0
6. Pravastatin 40 mg PO DAILY
7. Senna 1 TAB PO BID
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp
#*30 Tablet Refills:*0
8. Tiotropium Bromide 1 CAP IH DAILY
9. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
10. Metoprolol Tartrate 12.5 mg PO BID HTN
Hold for SBP < 100 or HR < 60
RX *metoprolol tartrate 25 mg Half tablet(s) by mouth twice a
day Disp #*15 Tablet Refills:*0
Discharge Disposition:
Home With Service
Facility:
[**Hospital 119**] Homecare
Discharge Diagnosis:
Recurrent lung cancer
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
You were admitted to the hospital for surgery on your lung. You
have done well after the procedure and may return home to
continue your recovery.
There is a dressing over the site of your chest tube- this may
be removed in 24 hours. You can leave the incision open to air
after that. You may shower with the dressing in place.
Please take the prescribed pain medication as needed.
Constipation can be a problem with narcotic use, therefore drink
plenty of fluid to stay well hydrated and use a stool softener
while taking narcotics. Do NOT drive while taking narcotic pain
medications.
While in the hospital, you were noticed to have a heart rhythm
called atrial fibrillation. We were able to convert the rhythm
back to normal using medication; please ask your primary care
doctor if you need further tests or treatment. We also started
you on a new medication called Metoprolol for your high blood
pressure and new dysrhythmia, please ask your primary care
doctor if you need to continue it.
If you develop any chest pain, shortness of breath or any other
symptoms that concern you, please call your surgeon or go to the
nearest Emergency Room.
Thank you for allowing us to participate in your care.
Followup Instructions:
Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. Please call
[**Telephone/Fax (1) 2348**] to schedule a follow up appointment in 2 weeks with
a chest x ray.
Please report to the [**Location (un) **] of the [**Hospital Ward Name 23**] center 30 min
prior to your appointment for a chest x-ray.
Please follow up with your primary care doctor within a week
from discharge.
| RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy |
List surgical history with dates. | Admission Date: [**2126-8-30**] Discharge Date: [**2126-9-8**]
Date of Birth: [**2054-2-16**] Sex: F
Service: CARDIOTHORACIC
Allergies:
Relafen
Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Recurrence of lung cancer
Major Surgical or Invasive Procedure:
[**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer.
History of Present Illness:
Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time.
Past Medical History:
Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema
PSH: RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy
Social History:
She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient.
Family History:
She has two daughters who are healthy. There is a history of
allergies and emphysema in her family.
Physical Exam:
Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE
Pertinent Results:
ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema.
Brief Hospital Course:
Patient was admitted on [**2126-8-30**] to the thoracic surgery service
for a planned right thoracotomy, right lower lobe wedge
resection with decortication. She tolerated the procedure well,
was extubated and recovered in the PACU prior to being
transferred to the ICU in stable condition. For full details
please see the operative report. Three chest tubes were placed
during the procedure and a postoperative chest x-ray showed
expected right pneumothorax post surgery with three chest tubes
in place. Pathology revealed a 1.8 cm poorly differentiated
adenocarcinoma with negative margins and no positive nodes. She
was started on a clear liquid diet, her pain was controlled with
an epidural and she was started on her home medications. On POD
1 her diet was advanced to regular and she was transferred to
the surgical floor from the ICU. On POD 2 she was noted to have
increased somnolence which was thought to be related to her pain
medications so her epidural was turned down and narcotics for
breakthrough pain were discontinued. She was given a unit of
PRBC for a Hct of 20.3 with an appropriate increase to 24.4 and
improved somnolence. On POD 3 metoprolol was started because of
elevated systolic blood pressures. She continued to have an air
leak from all three chest tubes. Her epidural was discontinued
and her foley catheter was removed. She was started on oxycodone
and tramadol for pain. By POD 4 the air leak had stopped in the
anterior chest tube so it was removed. The posterior chest tube
was removed on POD 6. On POD 7 she noted that she felt dizzy
when she was getting out of bed and was found to be in atrial
fibrillation with RVR. She was given metoprolol once without
effect and was then given IV diltiazem once with return to sinus
rhythm. Cardiac enzymes were negative and she was monitored with
telemetry without recurrence. On POD 8 the air leak had resolved
in the basilar chest tube so it was removed. A post pull chest
xray showed no PTX. Because her pain was well controlled, she
was tolerating her diet and was ambulating without assistance,
she was discharged to home on POD 9 with instructions to follow
up in Dr.[**Name (NI) 5067**] clinic with a chest x-ray.
Medications on Admission:
1. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
2. Nortriptyline 30 mg PO HS
3. Pravastatin 40 mg PO DAILY
4. Tiotropium Bromide 1 CAP IH DAILY
5. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours Disp
#*60 Tablet Refills:*0
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*30 Capsule Refills:*0
3. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
4. Nortriptyline 30 mg PO HS
5. OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**12-10**] tablet(s) by mouth every 4 hours Disp
#*50 Tablet Refills:*0
6. Pravastatin 40 mg PO DAILY
7. Senna 1 TAB PO BID
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp
#*30 Tablet Refills:*0
8. Tiotropium Bromide 1 CAP IH DAILY
9. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
10. Metoprolol Tartrate 12.5 mg PO BID HTN
Hold for SBP < 100 or HR < 60
RX *metoprolol tartrate 25 mg Half tablet(s) by mouth twice a
day Disp #*15 Tablet Refills:*0
Discharge Disposition:
Home With Service
Facility:
[**Hospital 119**] Homecare
Discharge Diagnosis:
Recurrent lung cancer
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
You were admitted to the hospital for surgery on your lung. You
have done well after the procedure and may return home to
continue your recovery.
There is a dressing over the site of your chest tube- this may
be removed in 24 hours. You can leave the incision open to air
after that. You may shower with the dressing in place.
Please take the prescribed pain medication as needed.
Constipation can be a problem with narcotic use, therefore drink
plenty of fluid to stay well hydrated and use a stool softener
while taking narcotics. Do NOT drive while taking narcotic pain
medications.
While in the hospital, you were noticed to have a heart rhythm
called atrial fibrillation. We were able to convert the rhythm
back to normal using medication; please ask your primary care
doctor if you need further tests or treatment. We also started
you on a new medication called Metoprolol for your high blood
pressure and new dysrhythmia, please ask your primary care
doctor if you need to continue it.
If you develop any chest pain, shortness of breath or any other
symptoms that concern you, please call your surgeon or go to the
nearest Emergency Room.
Thank you for allowing us to participate in your care.
Followup Instructions:
Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. Please call
[**Telephone/Fax (1) 2348**] to schedule a follow up appointment in 2 weeks with
a chest x ray.
Please report to the [**Location (un) **] of the [**Hospital Ward Name 23**] center 30 min
prior to your appointment for a chest x-ray.
Please follow up with your primary care doctor within a week
from discharge.
| RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy |
Include lifestyle habits affecting health. | Admission Date: [**2126-8-30**] Discharge Date: [**2126-9-8**]
Date of Birth: [**2054-2-16**] Sex: F
Service: CARDIOTHORACIC
Allergies:
Relafen
Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Recurrence of lung cancer
Major Surgical or Invasive Procedure:
[**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer.
History of Present Illness:
Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time.
Past Medical History:
Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema
PSH: RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy
Social History:
She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient.
Family History:
She has two daughters who are healthy. There is a history of
allergies and emphysema in her family.
Physical Exam:
Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE
Pertinent Results:
ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema.
Brief Hospital Course:
Patient was admitted on [**2126-8-30**] to the thoracic surgery service
for a planned right thoracotomy, right lower lobe wedge
resection with decortication. She tolerated the procedure well,
was extubated and recovered in the PACU prior to being
transferred to the ICU in stable condition. For full details
please see the operative report. Three chest tubes were placed
during the procedure and a postoperative chest x-ray showed
expected right pneumothorax post surgery with three chest tubes
in place. Pathology revealed a 1.8 cm poorly differentiated
adenocarcinoma with negative margins and no positive nodes. She
was started on a clear liquid diet, her pain was controlled with
an epidural and she was started on her home medications. On POD
1 her diet was advanced to regular and she was transferred to
the surgical floor from the ICU. On POD 2 she was noted to have
increased somnolence which was thought to be related to her pain
medications so her epidural was turned down and narcotics for
breakthrough pain were discontinued. She was given a unit of
PRBC for a Hct of 20.3 with an appropriate increase to 24.4 and
improved somnolence. On POD 3 metoprolol was started because of
elevated systolic blood pressures. She continued to have an air
leak from all three chest tubes. Her epidural was discontinued
and her foley catheter was removed. She was started on oxycodone
and tramadol for pain. By POD 4 the air leak had stopped in the
anterior chest tube so it was removed. The posterior chest tube
was removed on POD 6. On POD 7 she noted that she felt dizzy
when she was getting out of bed and was found to be in atrial
fibrillation with RVR. She was given metoprolol once without
effect and was then given IV diltiazem once with return to sinus
rhythm. Cardiac enzymes were negative and she was monitored with
telemetry without recurrence. On POD 8 the air leak had resolved
in the basilar chest tube so it was removed. A post pull chest
xray showed no PTX. Because her pain was well controlled, she
was tolerating her diet and was ambulating without assistance,
she was discharged to home on POD 9 with instructions to follow
up in Dr.[**Name (NI) 5067**] clinic with a chest x-ray.
Medications on Admission:
1. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
2. Nortriptyline 30 mg PO HS
3. Pravastatin 40 mg PO DAILY
4. Tiotropium Bromide 1 CAP IH DAILY
5. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours Disp
#*60 Tablet Refills:*0
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*30 Capsule Refills:*0
3. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
4. Nortriptyline 30 mg PO HS
5. OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**12-10**] tablet(s) by mouth every 4 hours Disp
#*50 Tablet Refills:*0
6. Pravastatin 40 mg PO DAILY
7. Senna 1 TAB PO BID
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp
#*30 Tablet Refills:*0
8. Tiotropium Bromide 1 CAP IH DAILY
9. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
10. Metoprolol Tartrate 12.5 mg PO BID HTN
Hold for SBP < 100 or HR < 60
RX *metoprolol tartrate 25 mg Half tablet(s) by mouth twice a
day Disp #*15 Tablet Refills:*0
Discharge Disposition:
Home With Service
Facility:
[**Hospital 119**] Homecare
Discharge Diagnosis:
Recurrent lung cancer
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
You were admitted to the hospital for surgery on your lung. You
have done well after the procedure and may return home to
continue your recovery.
There is a dressing over the site of your chest tube- this may
be removed in 24 hours. You can leave the incision open to air
after that. You may shower with the dressing in place.
Please take the prescribed pain medication as needed.
Constipation can be a problem with narcotic use, therefore drink
plenty of fluid to stay well hydrated and use a stool softener
while taking narcotics. Do NOT drive while taking narcotic pain
medications.
While in the hospital, you were noticed to have a heart rhythm
called atrial fibrillation. We were able to convert the rhythm
back to normal using medication; please ask your primary care
doctor if you need further tests or treatment. We also started
you on a new medication called Metoprolol for your high blood
pressure and new dysrhythmia, please ask your primary care
doctor if you need to continue it.
If you develop any chest pain, shortness of breath or any other
symptoms that concern you, please call your surgeon or go to the
nearest Emergency Room.
Thank you for allowing us to participate in your care.
Followup Instructions:
Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. Please call
[**Telephone/Fax (1) 2348**] to schedule a follow up appointment in 2 weeks with
a chest x ray.
Please report to the [**Location (un) **] of the [**Hospital Ward Name 23**] center 30 min
prior to your appointment for a chest x-ray.
Please follow up with your primary care doctor within a week
from discharge.
| She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient. |
Mention smoking, alcohol, or drug use. | Admission Date: [**2126-8-30**] Discharge Date: [**2126-9-8**]
Date of Birth: [**2054-2-16**] Sex: F
Service: CARDIOTHORACIC
Allergies:
Relafen
Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Recurrence of lung cancer
Major Surgical or Invasive Procedure:
[**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer.
History of Present Illness:
Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time.
Past Medical History:
Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema
PSH: RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy
Social History:
She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient.
Family History:
She has two daughters who are healthy. There is a history of
allergies and emphysema in her family.
Physical Exam:
Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE
Pertinent Results:
ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema.
Brief Hospital Course:
Patient was admitted on [**2126-8-30**] to the thoracic surgery service
for a planned right thoracotomy, right lower lobe wedge
resection with decortication. She tolerated the procedure well,
was extubated and recovered in the PACU prior to being
transferred to the ICU in stable condition. For full details
please see the operative report. Three chest tubes were placed
during the procedure and a postoperative chest x-ray showed
expected right pneumothorax post surgery with three chest tubes
in place. Pathology revealed a 1.8 cm poorly differentiated
adenocarcinoma with negative margins and no positive nodes. She
was started on a clear liquid diet, her pain was controlled with
an epidural and she was started on her home medications. On POD
1 her diet was advanced to regular and she was transferred to
the surgical floor from the ICU. On POD 2 she was noted to have
increased somnolence which was thought to be related to her pain
medications so her epidural was turned down and narcotics for
breakthrough pain were discontinued. She was given a unit of
PRBC for a Hct of 20.3 with an appropriate increase to 24.4 and
improved somnolence. On POD 3 metoprolol was started because of
elevated systolic blood pressures. She continued to have an air
leak from all three chest tubes. Her epidural was discontinued
and her foley catheter was removed. She was started on oxycodone
and tramadol for pain. By POD 4 the air leak had stopped in the
anterior chest tube so it was removed. The posterior chest tube
was removed on POD 6. On POD 7 she noted that she felt dizzy
when she was getting out of bed and was found to be in atrial
fibrillation with RVR. She was given metoprolol once without
effect and was then given IV diltiazem once with return to sinus
rhythm. Cardiac enzymes were negative and she was monitored with
telemetry without recurrence. On POD 8 the air leak had resolved
in the basilar chest tube so it was removed. A post pull chest
xray showed no PTX. Because her pain was well controlled, she
was tolerating her diet and was ambulating without assistance,
she was discharged to home on POD 9 with instructions to follow
up in Dr.[**Name (NI) 5067**] clinic with a chest x-ray.
Medications on Admission:
1. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
2. Nortriptyline 30 mg PO HS
3. Pravastatin 40 mg PO DAILY
4. Tiotropium Bromide 1 CAP IH DAILY
5. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours Disp
#*60 Tablet Refills:*0
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*30 Capsule Refills:*0
3. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
4. Nortriptyline 30 mg PO HS
5. OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**12-10**] tablet(s) by mouth every 4 hours Disp
#*50 Tablet Refills:*0
6. Pravastatin 40 mg PO DAILY
7. Senna 1 TAB PO BID
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp
#*30 Tablet Refills:*0
8. Tiotropium Bromide 1 CAP IH DAILY
9. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
10. Metoprolol Tartrate 12.5 mg PO BID HTN
Hold for SBP < 100 or HR < 60
RX *metoprolol tartrate 25 mg Half tablet(s) by mouth twice a
day Disp #*15 Tablet Refills:*0
Discharge Disposition:
Home With Service
Facility:
[**Hospital 119**] Homecare
Discharge Diagnosis:
Recurrent lung cancer
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
You were admitted to the hospital for surgery on your lung. You
have done well after the procedure and may return home to
continue your recovery.
There is a dressing over the site of your chest tube- this may
be removed in 24 hours. You can leave the incision open to air
after that. You may shower with the dressing in place.
Please take the prescribed pain medication as needed.
Constipation can be a problem with narcotic use, therefore drink
plenty of fluid to stay well hydrated and use a stool softener
while taking narcotics. Do NOT drive while taking narcotic pain
medications.
While in the hospital, you were noticed to have a heart rhythm
called atrial fibrillation. We were able to convert the rhythm
back to normal using medication; please ask your primary care
doctor if you need further tests or treatment. We also started
you on a new medication called Metoprolol for your high blood
pressure and new dysrhythmia, please ask your primary care
doctor if you need to continue it.
If you develop any chest pain, shortness of breath or any other
symptoms that concern you, please call your surgeon or go to the
nearest Emergency Room.
Thank you for allowing us to participate in your care.
Followup Instructions:
Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. Please call
[**Telephone/Fax (1) 2348**] to schedule a follow up appointment in 2 weeks with
a chest x ray.
Please report to the [**Location (un) **] of the [**Hospital Ward Name 23**] center 30 min
prior to your appointment for a chest x-ray.
Please follow up with your primary care doctor within a week
from discharge.
| She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient. |
Record any hereditary conditions. | Admission Date: [**2126-8-30**] Discharge Date: [**2126-9-8**]
Date of Birth: [**2054-2-16**] Sex: F
Service: CARDIOTHORACIC
Allergies:
Relafen
Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Recurrence of lung cancer
Major Surgical or Invasive Procedure:
[**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer.
History of Present Illness:
Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time.
Past Medical History:
Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema
PSH: RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy
Social History:
She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient.
Family History:
She has two daughters who are healthy. There is a history of
allergies and emphysema in her family.
Physical Exam:
Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE
Pertinent Results:
ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema.
Brief Hospital Course:
Patient was admitted on [**2126-8-30**] to the thoracic surgery service
for a planned right thoracotomy, right lower lobe wedge
resection with decortication. She tolerated the procedure well,
was extubated and recovered in the PACU prior to being
transferred to the ICU in stable condition. For full details
please see the operative report. Three chest tubes were placed
during the procedure and a postoperative chest x-ray showed
expected right pneumothorax post surgery with three chest tubes
in place. Pathology revealed a 1.8 cm poorly differentiated
adenocarcinoma with negative margins and no positive nodes. She
was started on a clear liquid diet, her pain was controlled with
an epidural and she was started on her home medications. On POD
1 her diet was advanced to regular and she was transferred to
the surgical floor from the ICU. On POD 2 she was noted to have
increased somnolence which was thought to be related to her pain
medications so her epidural was turned down and narcotics for
breakthrough pain were discontinued. She was given a unit of
PRBC for a Hct of 20.3 with an appropriate increase to 24.4 and
improved somnolence. On POD 3 metoprolol was started because of
elevated systolic blood pressures. She continued to have an air
leak from all three chest tubes. Her epidural was discontinued
and her foley catheter was removed. She was started on oxycodone
and tramadol for pain. By POD 4 the air leak had stopped in the
anterior chest tube so it was removed. The posterior chest tube
was removed on POD 6. On POD 7 she noted that she felt dizzy
when she was getting out of bed and was found to be in atrial
fibrillation with RVR. She was given metoprolol once without
effect and was then given IV diltiazem once with return to sinus
rhythm. Cardiac enzymes were negative and she was monitored with
telemetry without recurrence. On POD 8 the air leak had resolved
in the basilar chest tube so it was removed. A post pull chest
xray showed no PTX. Because her pain was well controlled, she
was tolerating her diet and was ambulating without assistance,
she was discharged to home on POD 9 with instructions to follow
up in Dr.[**Name (NI) 5067**] clinic with a chest x-ray.
Medications on Admission:
1. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
2. Nortriptyline 30 mg PO HS
3. Pravastatin 40 mg PO DAILY
4. Tiotropium Bromide 1 CAP IH DAILY
5. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours Disp
#*60 Tablet Refills:*0
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*30 Capsule Refills:*0
3. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
4. Nortriptyline 30 mg PO HS
5. OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**12-10**] tablet(s) by mouth every 4 hours Disp
#*50 Tablet Refills:*0
6. Pravastatin 40 mg PO DAILY
7. Senna 1 TAB PO BID
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp
#*30 Tablet Refills:*0
8. Tiotropium Bromide 1 CAP IH DAILY
9. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
10. Metoprolol Tartrate 12.5 mg PO BID HTN
Hold for SBP < 100 or HR < 60
RX *metoprolol tartrate 25 mg Half tablet(s) by mouth twice a
day Disp #*15 Tablet Refills:*0
Discharge Disposition:
Home With Service
Facility:
[**Hospital 119**] Homecare
Discharge Diagnosis:
Recurrent lung cancer
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
You were admitted to the hospital for surgery on your lung. You
have done well after the procedure and may return home to
continue your recovery.
There is a dressing over the site of your chest tube- this may
be removed in 24 hours. You can leave the incision open to air
after that. You may shower with the dressing in place.
Please take the prescribed pain medication as needed.
Constipation can be a problem with narcotic use, therefore drink
plenty of fluid to stay well hydrated and use a stool softener
while taking narcotics. Do NOT drive while taking narcotic pain
medications.
While in the hospital, you were noticed to have a heart rhythm
called atrial fibrillation. We were able to convert the rhythm
back to normal using medication; please ask your primary care
doctor if you need further tests or treatment. We also started
you on a new medication called Metoprolol for your high blood
pressure and new dysrhythmia, please ask your primary care
doctor if you need to continue it.
If you develop any chest pain, shortness of breath or any other
symptoms that concern you, please call your surgeon or go to the
nearest Emergency Room.
Thank you for allowing us to participate in your care.
Followup Instructions:
Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. Please call
[**Telephone/Fax (1) 2348**] to schedule a follow up appointment in 2 weeks with
a chest x ray.
Please report to the [**Location (un) **] of the [**Hospital Ward Name 23**] center 30 min
prior to your appointment for a chest x-ray.
Please follow up with your primary care doctor within a week
from discharge.
| She has two daughters who are healthy. There is a history of
allergies and emphysema in her family. |
Mention illnesses in close family. | Admission Date: [**2126-8-30**] Discharge Date: [**2126-9-8**]
Date of Birth: [**2054-2-16**] Sex: F
Service: CARDIOTHORACIC
Allergies:
Relafen
Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Recurrence of lung cancer
Major Surgical or Invasive Procedure:
[**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer.
History of Present Illness:
Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time.
Past Medical History:
Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema
PSH: RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy
Social History:
She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient.
Family History:
She has two daughters who are healthy. There is a history of
allergies and emphysema in her family.
Physical Exam:
Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE
Pertinent Results:
ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema.
Brief Hospital Course:
Patient was admitted on [**2126-8-30**] to the thoracic surgery service
for a planned right thoracotomy, right lower lobe wedge
resection with decortication. She tolerated the procedure well,
was extubated and recovered in the PACU prior to being
transferred to the ICU in stable condition. For full details
please see the operative report. Three chest tubes were placed
during the procedure and a postoperative chest x-ray showed
expected right pneumothorax post surgery with three chest tubes
in place. Pathology revealed a 1.8 cm poorly differentiated
adenocarcinoma with negative margins and no positive nodes. She
was started on a clear liquid diet, her pain was controlled with
an epidural and she was started on her home medications. On POD
1 her diet was advanced to regular and she was transferred to
the surgical floor from the ICU. On POD 2 she was noted to have
increased somnolence which was thought to be related to her pain
medications so her epidural was turned down and narcotics for
breakthrough pain were discontinued. She was given a unit of
PRBC for a Hct of 20.3 with an appropriate increase to 24.4 and
improved somnolence. On POD 3 metoprolol was started because of
elevated systolic blood pressures. She continued to have an air
leak from all three chest tubes. Her epidural was discontinued
and her foley catheter was removed. She was started on oxycodone
and tramadol for pain. By POD 4 the air leak had stopped in the
anterior chest tube so it was removed. The posterior chest tube
was removed on POD 6. On POD 7 she noted that she felt dizzy
when she was getting out of bed and was found to be in atrial
fibrillation with RVR. She was given metoprolol once without
effect and was then given IV diltiazem once with return to sinus
rhythm. Cardiac enzymes were negative and she was monitored with
telemetry without recurrence. On POD 8 the air leak had resolved
in the basilar chest tube so it was removed. A post pull chest
xray showed no PTX. Because her pain was well controlled, she
was tolerating her diet and was ambulating without assistance,
she was discharged to home on POD 9 with instructions to follow
up in Dr.[**Name (NI) 5067**] clinic with a chest x-ray.
Medications on Admission:
1. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
2. Nortriptyline 30 mg PO HS
3. Pravastatin 40 mg PO DAILY
4. Tiotropium Bromide 1 CAP IH DAILY
5. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours Disp
#*60 Tablet Refills:*0
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*30 Capsule Refills:*0
3. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
4. Nortriptyline 30 mg PO HS
5. OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**12-10**] tablet(s) by mouth every 4 hours Disp
#*50 Tablet Refills:*0
6. Pravastatin 40 mg PO DAILY
7. Senna 1 TAB PO BID
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp
#*30 Tablet Refills:*0
8. Tiotropium Bromide 1 CAP IH DAILY
9. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
10. Metoprolol Tartrate 12.5 mg PO BID HTN
Hold for SBP < 100 or HR < 60
RX *metoprolol tartrate 25 mg Half tablet(s) by mouth twice a
day Disp #*15 Tablet Refills:*0
Discharge Disposition:
Home With Service
Facility:
[**Hospital 119**] Homecare
Discharge Diagnosis:
Recurrent lung cancer
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
You were admitted to the hospital for surgery on your lung. You
have done well after the procedure and may return home to
continue your recovery.
There is a dressing over the site of your chest tube- this may
be removed in 24 hours. You can leave the incision open to air
after that. You may shower with the dressing in place.
Please take the prescribed pain medication as needed.
Constipation can be a problem with narcotic use, therefore drink
plenty of fluid to stay well hydrated and use a stool softener
while taking narcotics. Do NOT drive while taking narcotic pain
medications.
While in the hospital, you were noticed to have a heart rhythm
called atrial fibrillation. We were able to convert the rhythm
back to normal using medication; please ask your primary care
doctor if you need further tests or treatment. We also started
you on a new medication called Metoprolol for your high blood
pressure and new dysrhythmia, please ask your primary care
doctor if you need to continue it.
If you develop any chest pain, shortness of breath or any other
symptoms that concern you, please call your surgeon or go to the
nearest Emergency Room.
Thank you for allowing us to participate in your care.
Followup Instructions:
Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. Please call
[**Telephone/Fax (1) 2348**] to schedule a follow up appointment in 2 weeks with
a chest x ray.
Please report to the [**Location (un) **] of the [**Hospital Ward Name 23**] center 30 min
prior to your appointment for a chest x-ray.
Please follow up with your primary care doctor within a week
from discharge.
| She has two daughters who are healthy. There is a history of
allergies and emphysema in her family. |
Summarize physical examination findings. | Admission Date: [**2126-8-30**] Discharge Date: [**2126-9-8**]
Date of Birth: [**2054-2-16**] Sex: F
Service: CARDIOTHORACIC
Allergies:
Relafen
Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Recurrence of lung cancer
Major Surgical or Invasive Procedure:
[**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer.
History of Present Illness:
Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time.
Past Medical History:
Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema
PSH: RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy
Social History:
She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient.
Family History:
She has two daughters who are healthy. There is a history of
allergies and emphysema in her family.
Physical Exam:
Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE
Pertinent Results:
ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema.
Brief Hospital Course:
Patient was admitted on [**2126-8-30**] to the thoracic surgery service
for a planned right thoracotomy, right lower lobe wedge
resection with decortication. She tolerated the procedure well,
was extubated and recovered in the PACU prior to being
transferred to the ICU in stable condition. For full details
please see the operative report. Three chest tubes were placed
during the procedure and a postoperative chest x-ray showed
expected right pneumothorax post surgery with three chest tubes
in place. Pathology revealed a 1.8 cm poorly differentiated
adenocarcinoma with negative margins and no positive nodes. She
was started on a clear liquid diet, her pain was controlled with
an epidural and she was started on her home medications. On POD
1 her diet was advanced to regular and she was transferred to
the surgical floor from the ICU. On POD 2 she was noted to have
increased somnolence which was thought to be related to her pain
medications so her epidural was turned down and narcotics for
breakthrough pain were discontinued. She was given a unit of
PRBC for a Hct of 20.3 with an appropriate increase to 24.4 and
improved somnolence. On POD 3 metoprolol was started because of
elevated systolic blood pressures. She continued to have an air
leak from all three chest tubes. Her epidural was discontinued
and her foley catheter was removed. She was started on oxycodone
and tramadol for pain. By POD 4 the air leak had stopped in the
anterior chest tube so it was removed. The posterior chest tube
was removed on POD 6. On POD 7 she noted that she felt dizzy
when she was getting out of bed and was found to be in atrial
fibrillation with RVR. She was given metoprolol once without
effect and was then given IV diltiazem once with return to sinus
rhythm. Cardiac enzymes were negative and she was monitored with
telemetry without recurrence. On POD 8 the air leak had resolved
in the basilar chest tube so it was removed. A post pull chest
xray showed no PTX. Because her pain was well controlled, she
was tolerating her diet and was ambulating without assistance,
she was discharged to home on POD 9 with instructions to follow
up in Dr.[**Name (NI) 5067**] clinic with a chest x-ray.
Medications on Admission:
1. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
2. Nortriptyline 30 mg PO HS
3. Pravastatin 40 mg PO DAILY
4. Tiotropium Bromide 1 CAP IH DAILY
5. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours Disp
#*60 Tablet Refills:*0
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*30 Capsule Refills:*0
3. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
4. Nortriptyline 30 mg PO HS
5. OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**12-10**] tablet(s) by mouth every 4 hours Disp
#*50 Tablet Refills:*0
6. Pravastatin 40 mg PO DAILY
7. Senna 1 TAB PO BID
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp
#*30 Tablet Refills:*0
8. Tiotropium Bromide 1 CAP IH DAILY
9. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
10. Metoprolol Tartrate 12.5 mg PO BID HTN
Hold for SBP < 100 or HR < 60
RX *metoprolol tartrate 25 mg Half tablet(s) by mouth twice a
day Disp #*15 Tablet Refills:*0
Discharge Disposition:
Home With Service
Facility:
[**Hospital 119**] Homecare
Discharge Diagnosis:
Recurrent lung cancer
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
You were admitted to the hospital for surgery on your lung. You
have done well after the procedure and may return home to
continue your recovery.
There is a dressing over the site of your chest tube- this may
be removed in 24 hours. You can leave the incision open to air
after that. You may shower with the dressing in place.
Please take the prescribed pain medication as needed.
Constipation can be a problem with narcotic use, therefore drink
plenty of fluid to stay well hydrated and use a stool softener
while taking narcotics. Do NOT drive while taking narcotic pain
medications.
While in the hospital, you were noticed to have a heart rhythm
called atrial fibrillation. We were able to convert the rhythm
back to normal using medication; please ask your primary care
doctor if you need further tests or treatment. We also started
you on a new medication called Metoprolol for your high blood
pressure and new dysrhythmia, please ask your primary care
doctor if you need to continue it.
If you develop any chest pain, shortness of breath or any other
symptoms that concern you, please call your surgeon or go to the
nearest Emergency Room.
Thank you for allowing us to participate in your care.
Followup Instructions:
Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. Please call
[**Telephone/Fax (1) 2348**] to schedule a follow up appointment in 2 weeks with
a chest x ray.
Please report to the [**Location (un) **] of the [**Hospital Ward Name 23**] center 30 min
prior to your appointment for a chest x-ray.
Please follow up with your primary care doctor within a week
from discharge.
| Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE |
List key observations from physical exam. | Admission Date: [**2126-8-30**] Discharge Date: [**2126-9-8**]
Date of Birth: [**2054-2-16**] Sex: F
Service: CARDIOTHORACIC
Allergies:
Relafen
Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Recurrence of lung cancer
Major Surgical or Invasive Procedure:
[**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer.
History of Present Illness:
Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time.
Past Medical History:
Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema
PSH: RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy
Social History:
She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient.
Family History:
She has two daughters who are healthy. There is a history of
allergies and emphysema in her family.
Physical Exam:
Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE
Pertinent Results:
ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema.
Brief Hospital Course:
Patient was admitted on [**2126-8-30**] to the thoracic surgery service
for a planned right thoracotomy, right lower lobe wedge
resection with decortication. She tolerated the procedure well,
was extubated and recovered in the PACU prior to being
transferred to the ICU in stable condition. For full details
please see the operative report. Three chest tubes were placed
during the procedure and a postoperative chest x-ray showed
expected right pneumothorax post surgery with three chest tubes
in place. Pathology revealed a 1.8 cm poorly differentiated
adenocarcinoma with negative margins and no positive nodes. She
was started on a clear liquid diet, her pain was controlled with
an epidural and she was started on her home medications. On POD
1 her diet was advanced to regular and she was transferred to
the surgical floor from the ICU. On POD 2 she was noted to have
increased somnolence which was thought to be related to her pain
medications so her epidural was turned down and narcotics for
breakthrough pain were discontinued. She was given a unit of
PRBC for a Hct of 20.3 with an appropriate increase to 24.4 and
improved somnolence. On POD 3 metoprolol was started because of
elevated systolic blood pressures. She continued to have an air
leak from all three chest tubes. Her epidural was discontinued
and her foley catheter was removed. She was started on oxycodone
and tramadol for pain. By POD 4 the air leak had stopped in the
anterior chest tube so it was removed. The posterior chest tube
was removed on POD 6. On POD 7 she noted that she felt dizzy
when she was getting out of bed and was found to be in atrial
fibrillation with RVR. She was given metoprolol once without
effect and was then given IV diltiazem once with return to sinus
rhythm. Cardiac enzymes were negative and she was monitored with
telemetry without recurrence. On POD 8 the air leak had resolved
in the basilar chest tube so it was removed. A post pull chest
xray showed no PTX. Because her pain was well controlled, she
was tolerating her diet and was ambulating without assistance,
she was discharged to home on POD 9 with instructions to follow
up in Dr.[**Name (NI) 5067**] clinic with a chest x-ray.
Medications on Admission:
1. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
2. Nortriptyline 30 mg PO HS
3. Pravastatin 40 mg PO DAILY
4. Tiotropium Bromide 1 CAP IH DAILY
5. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours Disp
#*60 Tablet Refills:*0
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*30 Capsule Refills:*0
3. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
4. Nortriptyline 30 mg PO HS
5. OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**12-10**] tablet(s) by mouth every 4 hours Disp
#*50 Tablet Refills:*0
6. Pravastatin 40 mg PO DAILY
7. Senna 1 TAB PO BID
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp
#*30 Tablet Refills:*0
8. Tiotropium Bromide 1 CAP IH DAILY
9. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
10. Metoprolol Tartrate 12.5 mg PO BID HTN
Hold for SBP < 100 or HR < 60
RX *metoprolol tartrate 25 mg Half tablet(s) by mouth twice a
day Disp #*15 Tablet Refills:*0
Discharge Disposition:
Home With Service
Facility:
[**Hospital 119**] Homecare
Discharge Diagnosis:
Recurrent lung cancer
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
You were admitted to the hospital for surgery on your lung. You
have done well after the procedure and may return home to
continue your recovery.
There is a dressing over the site of your chest tube- this may
be removed in 24 hours. You can leave the incision open to air
after that. You may shower with the dressing in place.
Please take the prescribed pain medication as needed.
Constipation can be a problem with narcotic use, therefore drink
plenty of fluid to stay well hydrated and use a stool softener
while taking narcotics. Do NOT drive while taking narcotic pain
medications.
While in the hospital, you were noticed to have a heart rhythm
called atrial fibrillation. We were able to convert the rhythm
back to normal using medication; please ask your primary care
doctor if you need further tests or treatment. We also started
you on a new medication called Metoprolol for your high blood
pressure and new dysrhythmia, please ask your primary care
doctor if you need to continue it.
If you develop any chest pain, shortness of breath or any other
symptoms that concern you, please call your surgeon or go to the
nearest Emergency Room.
Thank you for allowing us to participate in your care.
Followup Instructions:
Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. Please call
[**Telephone/Fax (1) 2348**] to schedule a follow up appointment in 2 weeks with
a chest x ray.
Please report to the [**Location (un) **] of the [**Hospital Ward Name 23**] center 30 min
prior to your appointment for a chest x-ray.
Please follow up with your primary care doctor within a week
from discharge.
| Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE |
List important lab or test results. | Admission Date: [**2126-8-30**] Discharge Date: [**2126-9-8**]
Date of Birth: [**2054-2-16**] Sex: F
Service: CARDIOTHORACIC
Allergies:
Relafen
Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Recurrence of lung cancer
Major Surgical or Invasive Procedure:
[**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer.
History of Present Illness:
Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time.
Past Medical History:
Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema
PSH: RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy
Social History:
She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient.
Family History:
She has two daughters who are healthy. There is a history of
allergies and emphysema in her family.
Physical Exam:
Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE
Pertinent Results:
ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema.
Brief Hospital Course:
Patient was admitted on [**2126-8-30**] to the thoracic surgery service
for a planned right thoracotomy, right lower lobe wedge
resection with decortication. She tolerated the procedure well,
was extubated and recovered in the PACU prior to being
transferred to the ICU in stable condition. For full details
please see the operative report. Three chest tubes were placed
during the procedure and a postoperative chest x-ray showed
expected right pneumothorax post surgery with three chest tubes
in place. Pathology revealed a 1.8 cm poorly differentiated
adenocarcinoma with negative margins and no positive nodes. She
was started on a clear liquid diet, her pain was controlled with
an epidural and she was started on her home medications. On POD
1 her diet was advanced to regular and she was transferred to
the surgical floor from the ICU. On POD 2 she was noted to have
increased somnolence which was thought to be related to her pain
medications so her epidural was turned down and narcotics for
breakthrough pain were discontinued. She was given a unit of
PRBC for a Hct of 20.3 with an appropriate increase to 24.4 and
improved somnolence. On POD 3 metoprolol was started because of
elevated systolic blood pressures. She continued to have an air
leak from all three chest tubes. Her epidural was discontinued
and her foley catheter was removed. She was started on oxycodone
and tramadol for pain. By POD 4 the air leak had stopped in the
anterior chest tube so it was removed. The posterior chest tube
was removed on POD 6. On POD 7 she noted that she felt dizzy
when she was getting out of bed and was found to be in atrial
fibrillation with RVR. She was given metoprolol once without
effect and was then given IV diltiazem once with return to sinus
rhythm. Cardiac enzymes were negative and she was monitored with
telemetry without recurrence. On POD 8 the air leak had resolved
in the basilar chest tube so it was removed. A post pull chest
xray showed no PTX. Because her pain was well controlled, she
was tolerating her diet and was ambulating without assistance,
she was discharged to home on POD 9 with instructions to follow
up in Dr.[**Name (NI) 5067**] clinic with a chest x-ray.
Medications on Admission:
1. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
2. Nortriptyline 30 mg PO HS
3. Pravastatin 40 mg PO DAILY
4. Tiotropium Bromide 1 CAP IH DAILY
5. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours Disp
#*60 Tablet Refills:*0
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*30 Capsule Refills:*0
3. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
4. Nortriptyline 30 mg PO HS
5. OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**12-10**] tablet(s) by mouth every 4 hours Disp
#*50 Tablet Refills:*0
6. Pravastatin 40 mg PO DAILY
7. Senna 1 TAB PO BID
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp
#*30 Tablet Refills:*0
8. Tiotropium Bromide 1 CAP IH DAILY
9. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
10. Metoprolol Tartrate 12.5 mg PO BID HTN
Hold for SBP < 100 or HR < 60
RX *metoprolol tartrate 25 mg Half tablet(s) by mouth twice a
day Disp #*15 Tablet Refills:*0
Discharge Disposition:
Home With Service
Facility:
[**Hospital 119**] Homecare
Discharge Diagnosis:
Recurrent lung cancer
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
You were admitted to the hospital for surgery on your lung. You
have done well after the procedure and may return home to
continue your recovery.
There is a dressing over the site of your chest tube- this may
be removed in 24 hours. You can leave the incision open to air
after that. You may shower with the dressing in place.
Please take the prescribed pain medication as needed.
Constipation can be a problem with narcotic use, therefore drink
plenty of fluid to stay well hydrated and use a stool softener
while taking narcotics. Do NOT drive while taking narcotic pain
medications.
While in the hospital, you were noticed to have a heart rhythm
called atrial fibrillation. We were able to convert the rhythm
back to normal using medication; please ask your primary care
doctor if you need further tests or treatment. We also started
you on a new medication called Metoprolol for your high blood
pressure and new dysrhythmia, please ask your primary care
doctor if you need to continue it.
If you develop any chest pain, shortness of breath or any other
symptoms that concern you, please call your surgeon or go to the
nearest Emergency Room.
Thank you for allowing us to participate in your care.
Followup Instructions:
Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. Please call
[**Telephone/Fax (1) 2348**] to schedule a follow up appointment in 2 weeks with
a chest x ray.
Please report to the [**Location (un) **] of the [**Hospital Ward Name 23**] center 30 min
prior to your appointment for a chest x-ray.
Please follow up with your primary care doctor within a week
from discharge.
| ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema. |
Include key findings from diagnostics. | Admission Date: [**2126-8-30**] Discharge Date: [**2126-9-8**]
Date of Birth: [**2054-2-16**] Sex: F
Service: CARDIOTHORACIC
Allergies:
Relafen
Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Recurrence of lung cancer
Major Surgical or Invasive Procedure:
[**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer.
History of Present Illness:
Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time.
Past Medical History:
Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema
PSH: RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy
Social History:
She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient.
Family History:
She has two daughters who are healthy. There is a history of
allergies and emphysema in her family.
Physical Exam:
Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE
Pertinent Results:
ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema.
Brief Hospital Course:
Patient was admitted on [**2126-8-30**] to the thoracic surgery service
for a planned right thoracotomy, right lower lobe wedge
resection with decortication. She tolerated the procedure well,
was extubated and recovered in the PACU prior to being
transferred to the ICU in stable condition. For full details
please see the operative report. Three chest tubes were placed
during the procedure and a postoperative chest x-ray showed
expected right pneumothorax post surgery with three chest tubes
in place. Pathology revealed a 1.8 cm poorly differentiated
adenocarcinoma with negative margins and no positive nodes. She
was started on a clear liquid diet, her pain was controlled with
an epidural and she was started on her home medications. On POD
1 her diet was advanced to regular and she was transferred to
the surgical floor from the ICU. On POD 2 she was noted to have
increased somnolence which was thought to be related to her pain
medications so her epidural was turned down and narcotics for
breakthrough pain were discontinued. She was given a unit of
PRBC for a Hct of 20.3 with an appropriate increase to 24.4 and
improved somnolence. On POD 3 metoprolol was started because of
elevated systolic blood pressures. She continued to have an air
leak from all three chest tubes. Her epidural was discontinued
and her foley catheter was removed. She was started on oxycodone
and tramadol for pain. By POD 4 the air leak had stopped in the
anterior chest tube so it was removed. The posterior chest tube
was removed on POD 6. On POD 7 she noted that she felt dizzy
when she was getting out of bed and was found to be in atrial
fibrillation with RVR. She was given metoprolol once without
effect and was then given IV diltiazem once with return to sinus
rhythm. Cardiac enzymes were negative and she was monitored with
telemetry without recurrence. On POD 8 the air leak had resolved
in the basilar chest tube so it was removed. A post pull chest
xray showed no PTX. Because her pain was well controlled, she
was tolerating her diet and was ambulating without assistance,
she was discharged to home on POD 9 with instructions to follow
up in Dr.[**Name (NI) 5067**] clinic with a chest x-ray.
Medications on Admission:
1. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
2. Nortriptyline 30 mg PO HS
3. Pravastatin 40 mg PO DAILY
4. Tiotropium Bromide 1 CAP IH DAILY
5. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours Disp
#*60 Tablet Refills:*0
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*30 Capsule Refills:*0
3. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
4. Nortriptyline 30 mg PO HS
5. OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**12-10**] tablet(s) by mouth every 4 hours Disp
#*50 Tablet Refills:*0
6. Pravastatin 40 mg PO DAILY
7. Senna 1 TAB PO BID
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp
#*30 Tablet Refills:*0
8. Tiotropium Bromide 1 CAP IH DAILY
9. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
10. Metoprolol Tartrate 12.5 mg PO BID HTN
Hold for SBP < 100 or HR < 60
RX *metoprolol tartrate 25 mg Half tablet(s) by mouth twice a
day Disp #*15 Tablet Refills:*0
Discharge Disposition:
Home With Service
Facility:
[**Hospital 119**] Homecare
Discharge Diagnosis:
Recurrent lung cancer
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
You were admitted to the hospital for surgery on your lung. You
have done well after the procedure and may return home to
continue your recovery.
There is a dressing over the site of your chest tube- this may
be removed in 24 hours. You can leave the incision open to air
after that. You may shower with the dressing in place.
Please take the prescribed pain medication as needed.
Constipation can be a problem with narcotic use, therefore drink
plenty of fluid to stay well hydrated and use a stool softener
while taking narcotics. Do NOT drive while taking narcotic pain
medications.
While in the hospital, you were noticed to have a heart rhythm
called atrial fibrillation. We were able to convert the rhythm
back to normal using medication; please ask your primary care
doctor if you need further tests or treatment. We also started
you on a new medication called Metoprolol for your high blood
pressure and new dysrhythmia, please ask your primary care
doctor if you need to continue it.
If you develop any chest pain, shortness of breath or any other
symptoms that concern you, please call your surgeon or go to the
nearest Emergency Room.
Thank you for allowing us to participate in your care.
Followup Instructions:
Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. Please call
[**Telephone/Fax (1) 2348**] to schedule a follow up appointment in 2 weeks with
a chest x ray.
Please report to the [**Location (un) **] of the [**Hospital Ward Name 23**] center 30 min
prior to your appointment for a chest x-ray.
Please follow up with your primary care doctor within a week
from discharge.
| ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema. |
Summarize patient's hospital stay. | Admission Date: [**2126-8-30**] Discharge Date: [**2126-9-8**]
Date of Birth: [**2054-2-16**] Sex: F
Service: CARDIOTHORACIC
Allergies:
Relafen
Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Recurrence of lung cancer
Major Surgical or Invasive Procedure:
[**2126-8-30**]: Redo right thoracotomy, Lysis of adhesions and
decortication of lung, Wedge resection of right lower lobe lung
cancer.
History of Present Illness:
Ms. [**Known lastname 6610**] is a 72 year-old woman on whom we performed a
right thoracotomy, right lower lobe superior segmentectomy on
[**2125-7-27**]. The pathology revealed a 2.5cm, moderately
differentiated, adenocarcinoma with negative margins. The lymph
nodes were negative. pT1bN0Mx, stage IA. She was seen in clinic
[**2126-7-16**] and local recurrence was noted on CT. On [**2126-7-19**] her PET
showed an FDG-avid subpleural nodule in the right lower lobe,
compatible with recurrence as well as in the chest wall in
the region of the right 5th and 6th ribs is new from [**2125-7-3**]
and also concerning for recurrence. She underwent a core biopsy
[**2126-8-2**] and path revealed recurrent adenocarcinoma. She denies
any symptoms at this time.
Past Medical History:
Hypertension
Hyperlipidemia
breast CA s/p lumpectomy in [**2118**] nodal negative and adjuvant
chemorads
Renal angiomyolipoma
Emphysema
PSH: RLL superior segmentectomy [**2125-7-27**], Recurrent PTX requiring
partial resection via thoracotomy
Social History:
She quit smoking in [**2109**] and smoked 40 years 2 packs a day.
Denies alcohol use. Unfortunately, husband has terminal gastric
cancer, is hospitalized at the VA which greatly upsets patient.
Family History:
She has two daughters who are healthy. There is a history of
allergies and emphysema in her family.
Physical Exam:
Gen: NAD, anxious
Neck: no [**Doctor First Name **]
Chest: clear ausc, incisions c,d,i
Cor: RRR no murmur
Ext: no CCE
Pertinent Results:
ADMISSION LABS
[**2126-8-30**] 11:30AM BLOOD WBC-10.5 RBC-3.27* Hgb-10.1* Hct-29.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-14.0 Plt Ct-333
[**2126-8-30**] 03:30PM BLOOD Glucose-167* UreaN-20 Creat-0.9 Na-140
K-4.1 Cl-106 HCO3-22 AnGap-16
[**2126-8-30**] 03:30PM BLOOD Calcium-8.1* Phos-3.9 Mg-1.5*
DISCHARGE LABS
[**2126-9-7**] 07:05AM BLOOD WBC-8.7 RBC-2.65* Hgb-8.0* Hct-24.2*
MCV-92 MCH-30.0 MCHC-32.8 RDW-14.9 Plt Ct-455*
[**2126-9-7**] 07:05AM BLOOD Glucose-127* UreaN-12 Creat-0.7 Na-136
K-3.9 Cl-96 HCO3-30 AnGap-14
[**2126-9-7**] 07:05AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.8
[**8-30**] CXR post op
Right pneumothorax post surgery with three chest tubes in place
[**9-7**] CXR
Interval removal of the right basilar chest tube. There
continues to be
some subcutaneous emphysema within the right lateral chest wall
soft tissues. Post-surgical changes of the right hemithorax and
lung are stable. Stable right lateral pleural thickening and
right basilar pleural thickening could be post-operative or
represent some pleural fluid. However, the appearance is
stable. No pneumothorax is seen. The left lung remains well
inflated and clear. Cardiac and mediastinal contours are
stable. Clips in the right upper quadrant are consistent with
cholecystectomy. No pulmonary edema.
Brief Hospital Course:
Patient was admitted on [**2126-8-30**] to the thoracic surgery service
for a planned right thoracotomy, right lower lobe wedge
resection with decortication. She tolerated the procedure well,
was extubated and recovered in the PACU prior to being
transferred to the ICU in stable condition. For full details
please see the operative report. Three chest tubes were placed
during the procedure and a postoperative chest x-ray showed
expected right pneumothorax post surgery with three chest tubes
in place. Pathology revealed a 1.8 cm poorly differentiated
adenocarcinoma with negative margins and no positive nodes. She
was started on a clear liquid diet, her pain was controlled with
an epidural and she was started on her home medications. On POD
1 her diet was advanced to regular and she was transferred to
the surgical floor from the ICU. On POD 2 she was noted to have
increased somnolence which was thought to be related to her pain
medications so her epidural was turned down and narcotics for
breakthrough pain were discontinued. She was given a unit of
PRBC for a Hct of 20.3 with an appropriate increase to 24.4 and
improved somnolence. On POD 3 metoprolol was started because of
elevated systolic blood pressures. She continued to have an air
leak from all three chest tubes. Her epidural was discontinued
and her foley catheter was removed. She was started on oxycodone
and tramadol for pain. By POD 4 the air leak had stopped in the
anterior chest tube so it was removed. The posterior chest tube
was removed on POD 6. On POD 7 she noted that she felt dizzy
when she was getting out of bed and was found to be in atrial
fibrillation with RVR. She was given metoprolol once without
effect and was then given IV diltiazem once with return to sinus
rhythm. Cardiac enzymes were negative and she was monitored with
telemetry without recurrence. On POD 8 the air leak had resolved
in the basilar chest tube so it was removed. A post pull chest
xray showed no PTX. Because her pain was well controlled, she
was tolerating her diet and was ambulating without assistance,
she was discharged to home on POD 9 with instructions to follow
up in Dr.[**Name (NI) 5067**] clinic with a chest x-ray.
Medications on Admission:
1. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
2. Nortriptyline 30 mg PO HS
3. Pravastatin 40 mg PO DAILY
4. Tiotropium Bromide 1 CAP IH DAILY
5. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
Discharge Medications:
1. Acetaminophen 650 mg PO Q6H
RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours Disp
#*60 Tablet Refills:*0
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*30 Capsule Refills:*0
3. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
twice a day Rinse mouth after use
4. Nortriptyline 30 mg PO HS
5. OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN pain
RX *oxycodone 5 mg [**12-10**] tablet(s) by mouth every 4 hours Disp
#*50 Tablet Refills:*0
6. Pravastatin 40 mg PO DAILY
7. Senna 1 TAB PO BID
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp
#*30 Tablet Refills:*0
8. Tiotropium Bromide 1 CAP IH DAILY
9. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY
10. Metoprolol Tartrate 12.5 mg PO BID HTN
Hold for SBP < 100 or HR < 60
RX *metoprolol tartrate 25 mg Half tablet(s) by mouth twice a
day Disp #*15 Tablet Refills:*0
Discharge Disposition:
Home With Service
Facility:
[**Hospital 119**] Homecare
Discharge Diagnosis:
Recurrent lung cancer
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Discharge Instructions:
You were admitted to the hospital for surgery on your lung. You
have done well after the procedure and may return home to
continue your recovery.
There is a dressing over the site of your chest tube- this may
be removed in 24 hours. You can leave the incision open to air
after that. You may shower with the dressing in place.
Please take the prescribed pain medication as needed.
Constipation can be a problem with narcotic use, therefore drink
plenty of fluid to stay well hydrated and use a stool softener
while taking narcotics. Do NOT drive while taking narcotic pain
medications.
While in the hospital, you were noticed to have a heart rhythm
called atrial fibrillation. We were able to convert the rhythm
back to normal using medication; please ask your primary care
doctor if you need further tests or treatment. We also started
you on a new medication called Metoprolol for your high blood
pressure and new dysrhythmia, please ask your primary care
doctor if you need to continue it.
If you develop any chest pain, shortness of breath or any other
symptoms that concern you, please call your surgeon or go to the
nearest Emergency Room.
Thank you for allowing us to participate in your care.
Followup Instructions:
Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. Please call
[**Telephone/Fax (1) 2348**] to schedule a follow up appointment in 2 weeks with
a chest x ray.
Please report to the [**Location (un) **] of the [**Hospital Ward Name 23**] center 30 min
prior to your appointment for a chest x-ray.
Please follow up with your primary care doctor within a week
from discharge.
| Patient was admitted on [**2126-8-30**] to the thoracic surgery service
for a planned right thoracotomy, right lower lobe wedge
resection with decortication. She tolerated the procedure well,
was extubated and recovered in the PACU prior to being
transferred to the ICU in stable condition. For full details
please see the operative report. Three chest tubes were placed
during the procedure and a postoperative chest x-ray showed
expected right pneumothorax post surgery with three chest tubes
in place. Pathology revealed a 1.8 cm poorly differentiated
adenocarcinoma with negative margins and no positive nodes. She
was started on a clear liquid diet, her pain was controlled with
an epidural and she was started on her home medications. On POD
1 her diet was advanced to regular and she was transferred to
the surgical floor from the ICU. On POD 2 she was noted to have
increased somnolence which was thought to be related to her pain
medications so her epidural was turned down and narcotics for
breakthrough pain were discontinued. She was given a unit of
PRBC for a Hct of 20.3 with an appropriate increase to 24.4 and
improved somnolence. On POD 3 metoprolol was started because of
elevated systolic blood pressures. She continued to have an air
leak from all three chest tubes. Her epidural was discontinued
and her foley catheter was removed. She was started on oxycodone
and tramadol for pain. By POD 4 the air leak had stopped in the
anterior chest tube so it was removed. The posterior chest tube
was removed on POD 6. On POD 7 she noted that she felt dizzy
when she was getting out of bed and was found to be in atrial
fibrillation with RVR. She was given metoprolol once without
effect and was then given IV diltiazem once with return to sinus
rhythm. Cardiac enzymes were negative and she was monitored with
telemetry without recurrence. On POD 8 the air leak had resolved
in the basilar chest tube so it was removed. A post pull chest
xray showed no PTX. Because her pain was well controlled, she
was tolerating her diet and was ambulating without assistance,
she was discharged to home on POD 9 with instructions to follow
up in Dr.[**Name (NI) 5067**] clinic with a chest x-ray. |
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