Patient Name : ST Age: 61years Code Status: Full Code

Patient Name : ST Age: 61years Code Status: Full Code Allergies: No known allergies Last Bowel Movement : Sept 11 Chief complaint: Fever, Chill, Severe abdominal pain Admit Reason : Pancreatitis ERCP The patient is a 61-year-old male with multiple comorbidities, including morbid obesity, gastroesophageal reflux disease, central retinal artery occlusion, heart failure with preserved ejection fraction, benign prostatic hypertrophy with lower urinary tract symptoms, previous stroke x 2 last occurring May of this year, carotid artery stenosis status post endarterectomy, T2DM, previous alcohol abuse and distant remission, hyperlipidemia, HTN. The patient had been fishing in Michigan when he suddenly noted severe abdominal pain and subsequently went to a local hospital where a cholecystectomy was done due to acute cholecystitis about 4 days ago. He was discharged yesterday and on his way home but had to stop in northern Indiana on account of persistent and worsening pain. A workup suggested that he had acute pancreatitis without any peripancreatic fluid collections or necrosis. The patient is transferred here to St. Vicent Indianapolis for further care. The patient reports chills but denies any fever. He describes abdominal pain as severe, 10/10, mainly in the right upper quadrant radiating to his back. He denies diarrhea, nausea, or vomiting. He has been NPO for the last 2 days. Of note, the patient was diagnosed with T2DM last May with a hemoglobin A1C of 13.8; he has since been started on Ozempic 5mg every week. He has no prior history of acute pancreatitis. Vitals Signs Vitals Morning Afternoon Temp 97.5 98.6 HR 69 74 RR 20 16 Sat O2 96 93 BP 160/92 198/104 Pain 0 0 Medication Carvedilol Immediate Release 12.5mg PO BID daily Humalog Insulin Correction Scale Piperacillin-Tazobactam IVPB 4.5Gm IVPB Q8hrs Sodium Chloride 0.9% 1000mL IV continuous) Tamsulosin 0.4mg PO at bedtime Vancomycin IVPB in NS 1250mg Q8hrs Acetaminophen 650mg PO Q4hrs PRN Hydromorphine inj 0.5mg IV Q4hrs PRN Labs CBC CMP WBC – 19.3 Sodium 131 RBC – 4.62 Potasium 5.0 PLT – 260 Chloride 103 HGB 13.1 CO2 – 18 HCT 39.9 BUN 13 MCHC 32.8 BUN/Creatinine Ratio 20 MCH 28.4 Creatinine Serum 0.66 RDW 15.2 Glucose 69 MPV 11.2 Calcium 7.6 MCV 86.4 Phosphorus 3.7 Magnessium 1.6 Anion Gap 10 eGFR 107 Bilirubin Total 2.7 Protein 6.8 AST 82 ALT 66 Alkaline Phosphate 350 Albumin 3.1 Physical Exam General Appearance: Well developed, well nourished, Patient was initially in severe pain this morning. After dose of Dilaudid (Hydromorphone) 1mg, pain relieved enough for adequate assessment Skin: warm and dry with no rash Head/Scalp: Normocephalic. No evidence of trauma Eyes/Nose/Ears/Mouth/Throat: Pupils are symmetry and reactive to light. Conjunctiva and eyelids are normal Neck/Thyroid: No JVD, no cervical masses Chest/Respiratory: Clear to auscultation bilaterally. Not labored, room air, normal breath sounds without crackles or stridor or wheezing. Cardiovascular: Regular sinus rhythm, no murmurs, rub or gallop. S1 and S2 normal Abdomen/ GI: Obese, Expanding erythema to ventral abdominal wall, no significant tenderness Musculoskeletal: Joints and limbs are grossly normal. Motor strength is grossly normal Neurological: Oriented x4, no speech disorders Genitourinary: Hypoactive bowel sounds, no masses or lesions. Problem List Acute Pancreatitis Sepsis, severe Patient with recent Cholecystectomy. There is leukocytosis of 22 and severe pain with chills. Blood cultures are pending, will continue Zosyn started at outside facility3 Appears euglycemic at this point. HTN Blood pressure elevated due to pain, antihypertensive medications held in the presence of sepsis and mild dehydration. Following adequate pain relief, BP is now within normal range Morbid Obesity HFpEF HLD Previous Stroke GERD Tasks Presenter is professional, visual aid is grammatically correct, and four (4) references are used, in APA format.

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