allergies: no known allergies / adverse drug reactions attending: chief complaint: left femoral neck fracture major surgical or invasive procedure: left hip hemiarthroplasty history of present illness: 79f who has been using walker for past week due to unsteadiness on feet, who had mech fall am, hit head, no loc, osh films: neg head/c-spine; with new left femoral neck fracture. past medical history: colon ca s/p resection, svt s/p successful ablation, htn, scoliosis & kyphosis, anxiety social history: na family history: na physical exam: nad, aox3 ventilating comfortably severe scoliosis/kyphosis lle skin clean and intact, resolving hematoma under incision staples in place over incision no tenderness, deformity thighs and legs are soft resolving 0-1+ edema bilateral le no pain with passive motion saph sural dpn spn mpn lpn fhl gs ta pp fire 1+ pt and dp pulses pertinent results: 11:20am blood ltgrnhd-hold 04:53pm blood calcium-8.6 phos-4.1 mg-1.8 01:39am blood calcium-7.9* phos-3.7 mg-1.7 12:50pm blood calcium-8.4 phos-2.0*# mg-2.1 06:05am blood calcium-8.5 phos-2.1* mg-1.9 05:41am blood calcium-8.9 phos-2.8 mg-2.1 11:20am blood estgfr-using this 11:20am blood glucose-93 urean-29* creat-0.6 na-139 k-3.9 cl-102 hco3-31 angap-10 04:53pm blood glucose-133* urean-29* creat-0.8 na-137 k-4.4 cl-103 hco3-30 angap-8 01:39am blood glucose-121* urean-30* creat-0.7 na-135 k-4.2 cl-102 hco3-29 angap-8 12:50pm blood glucose-135* urean-35* creat-0.7 na-138 k-4.2 cl-101 hco3-31 angap-10 06:05am blood glucose-90 urean-31* creat-0.6 na-141 k-4.3 cl-103 hco3-34* angap-8 05:41am blood glucose-104* urean-28* creat-0.6 na-142 k-4.4 cl-101 hco3-36* angap-9 04:52pm blood 01:39am blood 12:50pm blood 06:09am blood 06:23am blood 05:57am blood 06:05am blood 05:41am blood 11:20am blood pt-10.6 ptt-25.0 inr(pt)-1.0 11:20am blood plt ct-265 04:52pm blood plt ct-259 01:39am blood plt ct-177 12:50pm blood plt ct-181 06:09am blood plt ct-147* 06:23am blood plt ct-138* 05:57am blood plt ct-164 06:05am blood plt ct-215 05:41am blood plt ct-280 11:20am blood neuts-83.5* lymphs-11.4* monos-4.8 eos-0.2 baso-0.2 11:20am blood wbc-13.9*# rbc-3.45* hgb-11.1* hct-34.4* mcv-100* mch-32.2* mchc-32.3 rdw-15.4 plt ct-265 04:52pm blood wbc-12.8* rbc-3.05* hgb-9.8* hct-30.6* mcv-100* mch-32.0 mchc-31.9 rdw-15.6* plt ct-259 01:39am blood wbc-7.8 rbc-2.63* hgb-8.4* hct-25.6* mcv-97 mch-31.8 mchc-32.7 rdw-16.2* plt ct-177 12:50pm blood wbc-8.7 rbc-3.06* hgb-9.6* hct-29.7* mcv-97 mch-31.4 mchc-32.4 rdw-16.7* plt ct-181 06:09am blood wbc-9.3 rbc-2.63* hgb-8.4* hct-25.9* mcv-99* mch-31.9 mchc-32.4 rdw-16.7* plt ct-147* 04:20pm blood hct-25.5* 06:23am blood wbc-6.8 rbc-1.96*# hgb-6.1*# hct-19.9* mcv-98 mch-31.2 mchc-31.8 rdw-16.6* plt ct-138* 03:50pm blood hct-27.6*# 05:57am blood wbc-8.1 rbc-2.84*# hgb-8.9*# hct-26.9* mcv-95 mch-31.3 mchc-33.0 rdw-16.6* plt ct-164 06:05am blood wbc-7.6 rbc-2.96* hgb-8.9* hct-28.5* mcv-96 mch-30.1 mchc-31.2 rdw-15.8* plt ct-215 05:41am blood wbc-7.1 rbc-2.96* hgb-9.4* hct-28.7* mcv-97 mch-31.6 mchc-32.6 rdw-15.4 plt ct-280 brief hospital course: the patient was admitted to the orthopaedic trauma service for repair of a left femoral neck fracture. the patient was taken to the or and underwent an uncomplicated left hip hemiarthroplasty. the patient tolerated the procedure without complications and was transferred to the pacu stable. please see operative report for details. post operatively pain was controlled with a pca with a transition to po pain meds once tolerating pos. the patient tolerated diet advancement without difficulty and made steady progress with pt. the patient required oxygen therapy with 4l nasal cannula post-operatively. on pod 3, her o2 saturations decreased to the 80s and she was placed on a venturi mask at 40% oxygen. this was found to be a result of subacute pulmonary edema caused by volume overload by fluid resuscitation intraoperatively/blood transfusions for acute blood loss anemia all in the setting of underlying diastolic dysfunction. she was diuresed approximately 3.5 l over the course of the next 3 days, and her oxygen requirement has been weaned down to 2l nasal cannula. the patient was transfused 3 units of blood for acute blood loss anemia. weight bearing status: as tolerated. the patient received peri-operative antibiotics as well as lovenox for dvt prophylaxis. the incision was clean, dry, and intact without evidence of erythema or drainage; and the extremity was nvi distally throughout. the patient was discharged in stable condition with written instructions concerning precautionary instructions and the appropriate follow-up care. the patient will be continued on chemical dvt prophylaxis for 8 days post-discharge. all questions were answered prior to discharge and the patient expressed readiness for discharge. medications on admission: aspirin, caltrate, colace, norvasc, vit d3, paroxetine, eye drops discharge medications: 1. acetaminophen 650 mg po q6h standing dose 2. aspirin 81 mg po daily 3. docusate sodium 100 mg po bid 4. erythromycin 0.5% ophth oint 0.5 in left eye qid corneal abrasion 5. fluorometholone 0.1% ophth susp. 1 drop right eye daily 6. enoxaparin sodium 40 mg sc q24h duration: 8 days rx *enoxaparin 40 mg/0.4 ml inject into abdomen once a day disp #*8 syringe refills:*0 7. dorzolamide 2%/timolol 0.5% ophth. 1 drop right eye 8. diclofenac sodium *nf* 0.1 % od tid 1 drop to right eye tid * patient taking own meds * 9. calcium carbonate 500 mg po tid 10. albuterol 0.083% neb soln 1 neb ih q6h:prn wheezing 11. artificial tear ointment 1 appl left eye tid:prn irritation, dry eye 12. artificial tears preserv. free 1-2 drop left eye qid:prn dry eye 13. milk of magnesia 30 ml po bid:prn constipation 14. paroxetine 20 mg po daily 15. senna 1 tab po bid 16. tropicamide 1 % 1 drop right eye daily duration: 1 doses 17. vitamin d 800 unit po daily 18. multivitamins 1 cap po daily 19. tramadol (ultram) 25-50 mg po q4h:prn pain rx *ultram 50 mg 0.5-1 tablet(s) by mouth every four (4) hours disp #*60 tablet refills:*0 20. furosemide 40 mg po daily discontinue lasix once patient is felt to have reached dry weight or cr increases >0.2 rx *furosemide 40 mg 1 tablet(s) by mouth once a day disp #*30 tablet refills:*0 discharge disposition: extended care facility: discharge diagnosis: left femoral neck fracture discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). weight bearing as tolerated. discharge instructions: ******signs of infection********** should experience severe pain, increased swelling, decreased sensation, difficulty with movement; fevers >101.5, chills, redness or drainage at the incision site; chest pain, shortness of breath or any other concerns. wound care: you can get the wound wet, but no baths or swimming for at least 3 weeks. any stitches or staples that need to be removed will be taken out at 2-weeks following your operation at your rehab facility (around ). no dressing is needed if wound is non-draining. ******weight-bearing******* weight bearing as tolerated ******medications*********** - resume your pre-hospital medications. - you had excess fluid in your body for which we gave you iv lasix to help you void the excess. you should continue to take po lasix to help maintain your fluid status as an outpatient. instructions will be on your prescriptions. - you have been given medication for your pain control. please do not operate heavy machinery or drink alcohol when taking this medication. as your pain improves please decrease the amount of pain medication. this medication can cause constipation, so you should drink 8-8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. -medication refills cannot be written after 12 noon on fridays. *****anticoagulation****** - take lovenox for dvt prophylaxis for 8 days post-discharge. physical therapy: weight bearing as tolerated. treatments frequency: please have your staples removed at your rehabilitation facility at post-operative day 14 (around ). followup instructions: ******follow-up********** please follow up with in one week post-discharge for evaluation. call to schedule appointment upon discharge. please follow up with your pcp regarding this admission and any new medications/refills. Procedure: Partial hip replacement Diagnoses: Other iatrogenic hypotension Unspecified essential hypertension Acute posthemorrhagic anemia Anxiety state, unspecified Osteoporosis, unspecified Personal history of malignant neoplasm of large intestine Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation Scoliosis [and kyphoscoliosis], idiopathic Fall from other slipping, tripping, or stumbling Acute edema of lung, unspecified Other closed transcervical fracture of neck of femur History of fall Other fluid overload