Morbid obesity Calculus of gallbladder with other cholecystitis without mention of obstruction Body Mass Index 40 and over adult Benign neoplasm of liver and biliary passages Polycystic ovaries Other and unspecified hyperlipidemia Unspecified acquired hypothyroidism Obstructive sleep apnea (adult)(pediatric) Unspecified essential hypertension
 
Name:  ___               Unit No:   ___
 
Admission Date:  ___              Discharge Date:   ___
 
Date of Birth:  ___             Sex:   F
 
Service: SURGERY
 
Allergies: 
Sulfa (Sulfonamides) / Latex
 
Attending: ___.
 
Chief Complaint:
Patient admitted for ___ reduction surgery.
 
Major Surgical or Invasive Procedure:
Status Post open gastric bypass and ___ liver resection 

 
History of Present Illness:
___ has class III extreme morbid obesity with ___ of 
445.5
lbs as of ___ (her initial screen ___ on ___ was
451.3 lbs), height of 67.5 inches and BMI of 94.9. Her previous
___ loss efforts have included 2 months of hypnosis in ___
without any results, 3 months ___ Loss in ___ losing 5
lbs that she quickly regained, 6 months of Nutrisystem in ___
losing 70 lbs that she maintained for 6 months, 4 months of the
___ ___ Management Program liquid diet in 
___
losing 40 lbs that she gained back after 3 months, 6 months of
___ Watchers in ___ losing 50 lbs and 2 months ___ 
___
in ___ at age ___ losing 10 lbs. She has not taken prescription
___ loss medications or used over-the-counter
ephedra-containing appetite suppressants/herbal supplements. Her
___ at age ___ was 360 lbs with her lowest adult ___ 340 
lbs
and her highest ___ being her initial screen ___ of 451
lbs. She weighed 380 lbs one year ago. She has been struggling
with ___ as long as she can remember.
 
Past Medical History:
PCOS, Hypothyroidism, Hyperlipidemia, OSA CPAP, Recurrent 
urinary tract infections, HTN, Knee pain and foot pain, 
Occasional heartburn, History of gallbladder "gravel." 
 
Social History:
___
Family History:
Family history is
noted for father deceased had hyperlipidemia and obesity; mother
living age ___ with obesity; grandfather deceased with heart
disease; grandmother living age ___ with arthritis and other
grandmother with lupus.
 
Physical Exam:
Her blood pressure was 138/70, pulse 95 and O2 saturation 97% on
room air. On physical examination ___ was casually dressed,
mildly anxious but in no distress. Her skin was warm, dry with
mild facial erythema secondary to sun exposure, mild acne and
mild hirsutism. Sclerae were anicteric, conjunctiva clear, 
pupils
were equal round and reactive to light, fundi normal, mucous
membranes were moist, tongue pink and the oropharynx was without
exudates or hyperemia. Trachea was in the midline and the neck
was supple without adenopathy, thyromegaly or carotid bruits.
Chest was symmetric and the lungs were clear to auscultation
bilaterally with good air movement. Cardiac exam was regular 
rate
and rhythm, normal S1 and S2, no murmurs, rubs or gallops. The
abdomen was extremely obese with large pannus, soft, non-tender,
non-distended with bowel sounds present, no masses or hernias, 
no
incision scars. There were no spinal deformities or tenderness,
no flank pain. Lower extremities were noted for trace edema, no
venous insufficiency or clubbing. There was no evidence of joint
swelling or inflammation of the joints. There were no focal
neurological deficits and her gait was normal.

 
Pertinent Results:
___ 01:58PM BLOOD Hct-33.2*
___ 05:35AM BLOOD WBC-12.5* RBC-4.08* Hgb-10.1* Hct-30.7* 
MCV-75* MCH-24.7* MCHC-32.8 RDW-13.3 Plt ___
___ 05:35AM BLOOD WBC-14.2* RBC-4.13* Hgb-10.4* Hct-31.2* 
MCV-76* MCH-25.3* MCHC-33.4 RDW-13.7 Plt ___
___ 05:35AM BLOOD Glucose-100 UreaN-9 Creat-0.6 Na-138 
K-4.2 Cl-104 HCO3-24 AnGap-14
___ 05:35AM BLOOD ALT-69* AST-55* AlkPhos-127* Amylase-39 
TotBili-0.8
___ 05:35AM BLOOD ALT-59* AST-37 AlkPhos-118* TotBili-0.8
___ 05:35AM BLOOD Calcium-8.4 Phos-3.3 Mg-2.1
 
Brief Hospital Course:
Patient underwent an open gastric bypass with a liver resection 
for a large adenoma. She tolerated the procedure very well. 
Postoperative course was relatively stable with problems with 
pain and low urine output. She was bolused with intravenous 
fluid several times. Her hematocrit was followed and she was 
progressed from a bariatric stage one diet to stage 3 without 
nausea or vomiting.

Currently she is up ambulating, tolerating stage 3 diet and 
hydrating well. We will discharge today with follow up with Dr. 
___ the ___ clinic.

 
Medications on Admission:
LEVOTHYROXINE 25 mcg Tablet qday; ORTHO TRI-CYCLEN 0.18 mg-35 
mcg (7)/0.215 mg-35mcg (7)/0.25mg-35mcg (7) (28) Tablet - 
Tablet(s) by mouth, ACETAMINOPHEN 325 mg TabletPRN; 
CHOLECALCIFEROL (VITAMIN D3) 1,000 unit Tablet once a day 
SUDAFED 30 mg Tablet PRN  
Assessment: 

 
Discharge Medications:
1. Oxycodone-Acetaminophen ___ mg/5 mL Solution Sig: ___ MLs 
PO Q4H (every 4 hours) as needed.
Disp:*500 ML(s)* Refills:*0*
2. Levothyroxine 25 mcg Tablet Sig: One (1) Tablet PO DAILY 
(Daily): please crush.  
3. Colace 50 mg/5 mL Liquid Sig: Ten (10) ml PO twice a day as 
needed for constipation.
Disp:*500 ml* Refills:*0*
4. Actigall 300 mg Capsule Sig: One (1) Capsule PO twice a day: 
Please take for 6 months. You must open capsule and put in 
drink.
Disp:*60 Capsule(s)* Refills:*5*
5. Zantac 15 mg/mL Syrup Sig: Ten (10) ml PO twice a day: please 
take for one month.
Disp:*600 ml* Refills:*0*

 
Discharge Disposition:
Home with Service
 
Discharge Diagnosis:
Primary Diagnosis: Obesity

 
Discharge Condition:
Stable

 
Discharge Instructions:
 
Discharge Instructions: Please call your surgeon or return to 
the emergency department if you develop a fever greater than 
101.5, chest pain, shortness of breath, severe abdominal pain, 
pain unrelieved by your pain medication, severe nausea or 
vomiting, severe abdominal bloating, inability to eat or drink, 
foul smelling or colorful drainage from your incisions, redness 
or swelling around your incisions, or any other symptoms which 
are concerning to you.

Diet: Stay on Stage III diet until your follow up appointment. 
Do not self advance
diet, do not drink out of a straw or chew gum.

Medication Instructions:
Resume your home medications, CRUSH ALL PILLS.
You will be starting some new medications:
1.  You are being discharged on medications to treat the pain 
from your operation. These medications will make you drowsy and 
impair your ability to drive a motor vehicle or operate 
machinery safely. You MUST refrain from such activities while 
taking these medications.
2. You should begin taking a chewable complete multivitamin with 
minerals. No gummy vitamins.
3. You will be taking Zantac liquid ___ mg twice daily for one 
month. This medicine prevents gastric reflux.
4. You will be taking Actigall 300 mg twice daily for 6 months. 
This medicine prevents you from having problems with your 
gallbladder.
5. You should take a stool softener, Colace, twice daily for 
constipation as needed, or until you resume a normal bowel 
pattern.
6. You must not use NSAIDS (non-steroidal anti-inflammatory 
drugs) Examples are Ibuprofen, Motrin, Aleve, Nuprin and 
Naproxen. These agents will cause bleeding and ulcers in your 
digestive system.

Activity:
No heavy lifting of items ___ pounds for 6 weeks. You may 
resume moderate
exercise at your discretion, no abdominal exercises.

Wound Care:
You may shower, no tub baths or swimming. 
If there is clear drainage from your incisions, cover with 
clean, dry gauze. 
Your steri-strips will fall off on their own. Please remove any 
remaining strips ___ days after surgery.
Please call the doctor if you have increased pain, swelling, 
redness, or drainage from the incision sites. 

 
Followup Instructions:
___

{'morbid obesity': ['Morbid obesity'], 'gastric bypass': ['Morbid obesity'], 'liver resection': ['Benign neoplasm of liver and biliary passages'], 'adenoma': ['Benign neoplasm of liver and biliary passages'], 'pain': ['Morbid obesity', 'Calculus of gallbladder with other cholecystitis', 'Body Mass Index 40 and over'], 'urinary tract infections': ['Unspecified essential hypertension'], 'heartburn': ['Gastro-esophageal reflux disease'], 'knee pain': ['Morbid obesity'], 'foot pain': ['Morbid obesity'], 'hirsutism': ['Polycystic ovaries'], 'acne': ['Polycystic ovaries'], 'hypothyroidism': ['Unspecified acquired hypothyroidism'], 'hyperlipidemia': ['Other and unspecified hyperlipidemia'], 'sleep apnea': ['Obstructive sleep apnea (adult)(pediatric)']}