DATE OF ADMISSION: MM/DD/YYYY
DATE OF DISCHARGE: MM/DD/YYYY
ATTENDING PHYSICIAN: John Doe, MD
DISCHARGING PHYSICIAN: Jane Doe, MD
FINAL DIAGNOSES:
1. End-stage cardiomyopathy.
2. Cirrhosis of the liver with ascites.
3. History of polysubstance abuse disorder.
4. Noncompliance to medication treatment.
DISCHARGE MEDICATIONS: Bumex 1 mg p.o. twice daily, lisinopril 2.5 mg once daily, carvedilol 3.125 mg twice daily, digoxin 0.25 mg once daily, aspirin 325 mg once daily, spironolactone 25 mg once daily, morphine sulfate immediate release 10 mg p.o. every 4 hours p.r.n. pain, potassium chloride extended release 1 tablet p.o. p.r.n. and Tylenol 650 mg p.o. every 4 hours p.r.n. pain.
FOLLOWUP INSTRUCTIONS: The patient should be discharged to inpatient hospice, and he should have follow up with inpatient hospice for further management of his end-of-life care and end-stage cardiomyopathy care.
HOSPITAL COURSE: This unfortunate gentleman with history of end-stage cardiomyopathy with last ejection fraction of 15% was admitted with shortness of breath and severe edema. He also has a diagnosis of cirrhosis of the liver with ascites. The patient was seen by Cardiology, who recommended hospice care. His diuretic medications were optimized, and he was placed on Coreg.
The patient does have a very poor left ventricular function and has low blood pressure, which precludes aggressive diuretic management. However, the patient seems to be doing fairly well with his current regimen. He did have a paracentesis for therapeutic purposes with 1600 mL of fluid removed from his peritoneum. He tolerated the procedure well and albumin has been replaced prior to discharge.
The patient does have an artificially implanted cardioverter-defibrillator, which will be continued. The patient is being discharged back to the care for inpatient hospice, which he has agreed to.
Pertinent laboratory studies during this hospital course showed the following results. White cell count was 3.8, hemoglobin 10.4, platelet count 162,000. INR 1.62, prothrombin time 19.4. Sodium 130, potassium 4.2, creatinine 0.9. Total bilirubin 4.9, alkaline phosphatase 82, ALT 36, and AST 54.
DISPOSITION: Plan is for inpatient hospice.
