DATE OF ADMISSION: MM/DD/YYYY
DATE OF DISCHARGE: MM/DD/YYYY
PRIMARY DISCHARGE DIAGNOSES:
1. Right facial droop/unresponsiveness, possibly secondary to transient ischemic attack.
2. Possible seizure disorder.
3. Right perihilar pneumonia.
SECONDARY DISCHARGE DIAGNOSES:
1. Essential hypertension.
2. Chronic renal insufficiency.
3. Recent admission for bilateral pneumonia.
4. Dysphagia secondary to dementia/advanced parkinsonism, status post percutaneous endoscopic gastrostomy.
5. History of advanced Parkinson disease.
BRIEF HISTORY AND HOSPITAL COURSE: The patient is a (XX)-year-old female well known to our service with a history of advanced dementia and Parkinson disease. The patient was recently admitted for bilateral pneumonia, underwent PEG placement due to dysphagia associated with Parkinson disease, and was brought to the hospital because of an episode of unresponsiveness. The patient is well known to our service and had this one episode of such unresponsiveness during previous admission to the hospital.
At that time, the patient was seen by Neurology, and EEG was performed and showed an epileptogenic focus in the brain, and at that time, the patient was started on valproic acid. During this admission, she was found to have right facial droop, which apparently was not present before. The patient was admitted for further evaluation. Carotid Doppler did not reveal any significant stenosis.
Telemonitoring did not reveal any arrhythmia, and hemodynamically, she stayed stable. Further care was discussed with family members who do not want any active or advanced intervention at this time. The patient became more awake and alert within 24-48 hours. Chest x-ray had revealed questionable perihilar infiltrate, and the patient was started on Avelox 400 mg IV daily. She stayed hemodynamically stable in the hospital. At the time of discharge, she was responsive to verbal stimulus and answered appropriately.
LABORATORY AND DIAGNOSTIC DATA: White count 7200, hemoglobin 11.6, hematocrit 35.8, and platelet count 108,000. BMP on admission revealed BUN 50 and creatinine 1.8; at the time of discharge, BUN 36 and creatinine 1.2. Calcium 7.8, sodium 139, potassium 4.6, chloride 108, and bicarbonate 22.
Portable chest x-ray showed infiltrate, right perihilar space and persistent infiltrate, left lower lobe. This is probably consistent with the patient’s recent admission for bilateral pneumonia. MRI of the brain showed involutional changes consistent with the patient’s age, small vessel disease throughout the cerebral white matter, basal ganglia, and brainstem as well as small infarction in the cerebellum. No hemorrhage, enhancement or mass effect is seen. Negative for any cortical lesion.
DISCHARGE DISPOSITION: The patient will be discharged back to the nursing home.
The patient’s family has some concerns about removing the PEG tube as per the patient’s request. We have told them to discuss with the doctors in the nursing home and possible legal aspects of doing that and to determine the patient’s competency in the nursing home.
DISCHARGE MEDICATIONS: Avelox 400 mg via PEG daily for 5 days, Plavix 75 mg via PEG daily, carbidopa/levodopa 25/250 t.i.d., and Depakote 250 mg p.o. t.i.d.
