Name: Mary McDermott metoprolol (LOPRESSOR) 75 mg (3-25 mg tabs) BID

MRN#: 22273502 phenytoin (DILANTIN) 300 mg ER (3-100 mg tabs) BID

Surgical Attending: Vernon
Admit Date: 2/24/2017
Procedure: Diagnostic laparoscopy ALL: Oxycodone (seizures), sulfa (GI upset)

HPI: Mary McDermott is a 63 y.o. female with hx of DM, pAF, TIA,
ESRD on HD(MWF last 2/22), LRYGB 2010 who presents in transfer
from OSH with severe abdominal pain. She woke up to acute
abdominal pain this morning. It was sharp, constant and localized to
the epigastrum. She had nausea but no vomiting, had a bowel
movement. She denies smoking or NSAID use. Presented to Cape
Code hospital where a CT scan showed free air, contrast
extravasation near the GJ anastomosis. She was given a dose of
zosyn and transferred to BWH.
Assessment: Mary McDermott is a 63 y.o. female with hx of DM,
pAF, TIA, ESRD on HD(MWF last 2/22), LRYGB 2010 who presents
in transfer from OSH with abdominal pain found to have a perforation
near the GJ anastomosis with free air and contrast extravasation. She
is peritoneal on exam but hemodynamically normal.
She was taken emergently to the OR for diagnostic lap, washout, and
gram patch repair. 1 drain left at end of procedure

PMH:
Diabetes mellitus on insulin, morbid obesity, ESRD on HD,
Initial Plan:
hypercholesterolemia, hypothyroidism, hypertension, gout,
N: dPCA, no toradol; home phenytoin for Hx seizures
paroxysmal atrial fibrillation, thalassemia minor, Hx of TIA,
CV: Monitor, continue home metoprolol, hydralazine, diltiazem
Hx of C diff colitis
P: Wean O2
GI: NPO; NGT to LWS until Sunday; IV PPI and zofran; UGI next
PSH: LRGYM 2010, AV fistula @ LUE for dialysis 2013, c-section
Monday
1983, R radial shaft and L femur fractures
GU: Consult nephrology
ID: Continue levo/flagyl 5-7 d pending washing cultures (received 1x
Social: former smoker, nondrinker cipro, fluconzaole, flagyl, and zosyn on 2/24)
f/u washout cultures; monitor drain output+quality
Meds: f/u H. Pylori testing
allopurinol (ZYLOPRIM) 100 MG H: SQH
B complex with C#20-folic acid (B COMPLEX-C-FOLIC ACID) 1 mg Endo: insulin
calcium acetate (PHOSLO) 2001 mg (3-668 mg tabs) TID
cinacalcet (SENSIPAR) 30 mg QD
clopidogrel (PLAVIX) 75 mg QD
diltiazem (CARDIZEM CD) 360 MG 24 hr QD
hydrALAZINE (APRESOLINE) 75 mg (3-25 mg tabs)
TID on S/T/Th/Sat; BID on M/W/F
insulin glargine (LANTUS) 100 unit/mL, 6U nightly
insulin lispro (HUMALOG) 100 unit/mL