Date of admission: 09/15/2013
Date of transfer: 09/23/2013
Admission diagnosis: Left hip displaced. Femoral neck fracture.
Discharge diagnosis: Left hip displaced. Femoral neck fracture.
Additional diagnosis: Chronic Fatigue Syndrome.
Hospital course: Please see the admission note and medicine consultation for full history and physical examination. Briefly, the patient is a 71-year-old male who lives independent and is a previous independent community ambulator with 6 stairs to enter his home. He injured his left hip when pursuing a thief who stole his iPad on the day of admission.
The patient was admitted to the hospital and medically cleared for surgery by the hospitalist. He was taken to the operating room on the day following admission for left hip hemiarthroplasty. He tolerated the procedure well without complications. He has had 24 hours of perioperative IV antibiotics and has had DVT prophylaxis with Loveniox beginning on postoperative day #1. He participated well with physical therapy for the first few days, but on the third day they did stair training with him. Subsequent to that he felt more fatigued and felt that it really set him back. He became extremely anxious about the idea of discharge, where as previously it seemed likely that he would be able to be discharged to home. An attempt was made to get him into our skilled nursing facility at CPMC. However, he was judged not to qualify for our skilled nursing facility and therefore we attempted to contact a community skilled nursing facility for his placement. His insurance company has been contacted and authorization is still pending. Since his initial experience on stairs, in which he did very well and was cleared for stairs, he has not tried them again. He has felt fatigued subsequently and says that he is just recovering from that. He says that with his chronic fatigue syndrome, he is likely to get a major setback if he over does it and is afraid that the stairs will set him back another week. Because of this comment, while being generally cooperative with physical therapy for the most part and able to ambulate independently with a front wheel walker, he has been refusing to do stairs.
He has remained hemodynamically stable since admission and has not required transfusion. He has been cleared by physical therapy based on the 1st experience on stairs as well as his subsequent daily physical therapy.
I had a lengthy conversation with the patient to0day regarding his condition. He is very anxious about being home independently after this injury with his history of chronic fatigue and with the fact that he does have 6 stairs at home and no one to help him. Considering these concerns, it is reasonable to have him have treatment in a community skilled nursing facility for several weeks until he feels strong enough to be discharged to home. In the meantime, I strongly encouraged him to continue to participate fully with physical therapy including some limited stair training. I do not think he is likely to get stronger doing stairs unless he does them to some extent. He voices agreement with that. Our case manager is coordinating with his insurance company to try to arrange transfer to outside skilled nursing facility.
Addendum
Medications:
Please see the MIR for doses and frequency of each of those medications. Each of those are medications that patient was on when he was admitted to the hospital and has been continued on throughout his hospitalization. These medications should be continued upon his discharge.
Allergies: No known drug allergies.
Diet: Regular diet.
Other instructions: The patient is to get physical and occupational therapy in skilled nursing facility until judged medically stable and safe for discharge.
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