PRIMARY DISCHARGE DIAGNOSES:
1. Breakthrough seizures.
2. Advanced dementia.
3. Dysphagia.
SECONDARY DISCHARGE DIAGNOSES:
1. Parkinson’s disease.
2. Alzheimer’s dementia.
3. Transient ischemic attack/cerebrovascular accident.
LABORATORY AND DIAGNOSTIC DATA: White count 6200, hemoglobin 10.8, hematocrit 32.8, and platelet count was 232,000. BMP was within normal limits. Vitamin B12 was 988. Valproic acid level was 74. At the time of discharge, urinalysis had revealed 1+ leukocyte esterase, 20-50 wbc’s.
Chest x-ray, as compared to previous study, there was PICC line and no infiltrate. EEG was performed that showed abnormal EEG with 1-2 hertz delta wave superimposed on the background rhythm suggestive of encephalopathy with etiologies including but not limited to toxic/metabolic hypoxic-ischemic CNS vascular disease.
CONSULTANTS:
1. John Doe, MD, Neurology.
2. Jane Doe, MD, Gastroenterology.
BRIEF HISTORY AND HOSPITAL COURSE: The patient is a (XX)-year-old male with full DNR who came to the hospital because of generalized convulsions. The patient has a history of seizures and was started on Depakote in the nursing home. However, the patient was having persistent seizures and was transferred.
Here, the patient was started on Depakote and also Dilantin was added. The patient was given Ativan p.r.n. for seizure activity. The patient stayed hemodynamically stable in the hospital and did not have any further seizures in the hospital. However, he was noticed to have very poor p.o. intake, and bedside swallow study was performed and that showed evidence of aspiration, and hence, GI consult was requested for possible PEG tube placement.
However, the patient’s brother came to the hospital, who is the health care proxy, and decided against the PEG tube placement. He understands the risks including death due to starvation but does not want any further active treatment, including the PEG tube placement. He has requested a hospice consult.
DISCHARGE DISPOSITION: This patient will be discharged back to the nursing home, and hospice consult would be requested as per the patient’s health care proxy’s request.
DISCHARGE INSTRUCTIONS: The patient will continue previous medications, including metoprolol, Plavix, Protonix, and Lipitor. We will also add Depakote and Dilantin.
