Osteoarthrosis localized not specified whether primary or secondary lower leg Personal history of transient ischemic attack (TIA) and cerebral infarction without residual deficits Other and unspecified hyperlipidemia Unspecified glaucoma Unspecified essential hypertension Heart valve replaced by transplant Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS) Atherosclerosis of native arteries of the extremities unspecified Unspecified hearing loss Unspecified cataract Coronary atherosclerosis of native coronary artery Old myocardial infarction Percutaneous transluminal coronary angioplasty status Personal history of tobacco use
 
Name:  ___               Unit No:   ___
 
Admission Date:  ___              Discharge Date:   ___
 
Date of Birth:  ___             Sex:   M
 
Service: ORTHOPAEDICS
 
Allergies: 
Lisinopril
 
Attending: ___.
 
Chief Complaint:
right knee pain
 
Major Surgical or Invasive Procedure:
right total knee replacement

 
History of Present Illness:
Mr ___ has had progressive right knee pain that has been 
refractory to conservative management.  He elects for definitive 
treatment.
 
Past Medical History:
PMH: (per OMR)
-stroke in ___  
-question of a pinhole ventricular septal on prior cardiac
imaging
-HLD
-Glaucoma  
-HTN
-MV s/p repair w/ porcine valve per OMR as did not tolerate 
metal
valve (details not clear from preliminary review in OMR)
-aortic valve replacement with 25 mm ___
-OA
-BPH 
-CEA on R with a saphenous vein patch w/ complication of a large
hematoma and a small pseudoaneurysm 
-PVD
-Lumbar stenosis with spondylolisthesis s/p laminectomy as well
as L2 to S1 incision with drainage and debridement of infection
and closure of left L3-4 dural opening
-abdominal aortic aneurysm repaired in ___. 
-hearing loss as a child which was secondary to an ear
infection and subsequent abscess. He has an approximate 50%
hearing loss.  He has 50% normal hearing with a hearing aid.
-Cataracts bilaterally
-R knee surgery
-myocardial infarction in ___ with subsequent balloon
angioplasty of his mid RCA.  A stent was placed in the RCA in
___
-ventral hernia that was surgically repaired in the ___
-HF and AF per one note, but not listed in others

 
Social History:
___
Family History:
father w/ heart disease per OMR

 
Brief Hospital Course:
The patient was admitted to the orthopaedic surgery service and 
was taken to the operating room for above described procedure. 
Please see separately dictated operative report for details. The 
surgery was uncomplicated and the patient tolerated the 
procedure well. Patient received perioperative IV antibiotics.

Postoperative course was remarkable for the following:
1. Transfused 1 unit autologous PRBCs in PACU
2. Geriatrics co-managing
3. On telemetry - SR with frequent PVCs. EKG - NSR.
4. Patient was very disgruntled during admission. Patient felt 
he was being sent to rehab too soon. Seen by Patient Advocate by 
patient request and CNS in addition to usual staff with 
resolution of the problem. 

Otherwise, pain was initially controlled with a PCA followed by 
a transition to oral pain medications on POD#1.  The patient 
received lovenox for DVT prophylaxis starting on the morning of 
POD#1.  The foley was removed on POD#2 and the patient was 
voiding independently thereafter. The surgical dressing was 
changed on POD#2 and the surgical incision was found to be clean 
and intact without erythema or abnormal drainage. The patient 
was seen daily by physical therapy. Labs were checked throughout 
the hospital course and repleted accordingly. At the time of 
discharge the patient was tolerating a regular diet and feeling 
well.  The patient was afebrile with stable vital signs.  The 
patient's hematocrit was acceptable and pain was adequately 
controlled on an oral regimen. The operative extremity was 
neurovascularly intact and the wound was benign. 

The patient's weight-bearing status is weight bearing as 
tolerated on the operative extremity. 

Mr ___ is discharged to rehab in stable condition.

 
Medications on Admission:
felodipine and finasteride, folate,
hydrochlorothiazide, Vicodin for knee and back pain, metoprolol,
simvastatin, spironolactone, terazosin, aspirin, vitamin D, and
Prilosec.

 
Discharge Medications:
1. enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) syringe 
Subcutaneous DAILY (Daily) for 3 weeks.
Disp:*21 syringe* Refills:*0*
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. aspirin, buffered 325 mg Tablet Sig: One (1) Tablet PO twice 
a day for 3 weeks: AFTER completing all lovenox injections, 
please take 325 mg aspirin twice daily with food for an 
additional 3 weeks.  AFTER the additional 3 weeks, you may 
resume you home dose of 325mg aspirin daily.
Disp:*42 Tablet(s)* Refills:*0*
4. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).  

5. hydrochlorothiazide 50 mg Tablet Sig: One (1) Tablet PO DAILY 
(Daily).  
6. metoprolol succinate 50 mg Tablet Sustained Release 24 hr 
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).  
7. felodipine 2.5 mg Tablet Sustained Release 24 hr Sig: Two (2) 
Tablet Sustained Release 24 hr PO DAILY (Daily).  
8. eplerenone 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a 
day).  
9. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) 
Capsule, Delayed Release(E.C.) PO BID (2 times a day).  
10. finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY 
(Daily).  
11. simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY 
(Daily).  
12. terazosin 5 mg Capsule Sig: Two (2) Capsule PO HS (at 
bedtime).  
13. oxycodone 5 mg Tablet Sig: ___ Tablets PO Q3H (every 3 
hours) as needed for pain.
Disp:*90 Tablet(s)* Refills:*0*
14. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q 8H 
(Every 8 Hours).  

 
Discharge Disposition:
Extended Care
 
Facility:
___
 
Discharge Diagnosis:
right knee osteoarthritis

 
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker 
or cane).

 
Discharge Instructions:
1. Please return to the emergency department or notify your 
physician if you experience any of the following: severe pain 
not relieved by medication, increased swelling, decreased 
sensation, difficulty with movement, fevers greater than 101.5, 
shaking chills, increasing redness or drainage from the incision 
site, chest pain, shortness of breath or any other concerns.

2. Please follow up with your primary physician regarding this 
admission and any new medications and refills.  

3. Resume your home medications unless otherwise instructed.

4. You have been given medications for pain control. Please do 
not drive, operate heavy machinery, or drink alcohol while 
taking these medications. As your pain decreases, take fewer 
tablets and increase the time between doses. This medication can 
cause constipation, so you should drink plenty of water daily 
and take a stool softener (such as colace) as needed to prevent 
this side effect.  Call your surgeons office 3 days before you 
are out of medication so that it can be refilled.  These 
medications cannot be called into your pharmacy and must be 
picked up in the clinic or mailed to your house.  Please allow 
an extra 2 days if you would like your medication mailed to your 
home.

5. You may not drive a car until cleared to do so by your 
surgeon or your primary physician.

6. Please keep your wounds clean. You may shower starting five 
(5) days after surgery, but no tub baths or swimming for at 
least four (4) weeks. No dressing is needed if wound continues 
to be non-draining. Any stitches or staples that need to be 
removed will be taken out by the visiting nurse (___) or rehab 
facility two weeks after your surgery.

7. Please call your surgeon's office to schedule or confirm your 
follow-up appointment in four (4) weeks.

8. Please DO NOT take any non-steroidal anti-inflammatory 
medications (NSAIDs such as celebrex, ibuprofen, advil, aleve, 
motrin, etc).

9. ANTICOAGULATION: Please continue your lovenox for three (3) 
weeks to help prevent deep vein thrombosis (blood clots).  After 
completing the lovenox, please take Aspirin 325mg  TWICE  daily 
for an additional three weeks.  ___ STOCKINGS x 6 WEEKS.

10. WOUND CARE: Please keep your incision clean and dry. It is 
okay to shower five days after surgery but no tub baths, 
swimming, or submerging your incision until after your four (4) 
week checkup. Please place a dry sterile dressing on the wound 
each day if there is drainage, otherwise leave it open to air. 
Check wound regularly for signs of infection such as redness or 
thick yellow drainage. Staples will be removed by the visiting 
nurse or rehab facility in two (2) weeks.

11. ___ (once at home): Home ___, dressing changes as instructed, 
wound checks, and staple removal at two weeks after surgery.

12. ACTIVITY: Weight bearing as tolerated on the operative 
extremity. ROM as tolerated. No strenuous exercise or heavy 
lifting until follow up appointment.

Physical Therapy:
WBAT
ROM - unrestricted
Mobilize

Treatments Frequency:
dry, sterile dressing daily as needed for drainage
wound checks
ice and elevate
staple removal at POD 17
 
Followup Instructions:
___

{'right knee pain': ['Osteoarthrosis'], 'stroke': ['Personal history of transient ischemic attack (TIA)', 'and cerebral infarction without residual deficits'], 'hyperlipidemia': ['Other and unspecified hyperlipidemia'], 'glaucoma': ['Unspecified glaucoma'], 'hypertension': ['Unspecified essential hypertension'], 'heart valve transplant': ['Heart valve replaced by transplant'], 'hypertrophy of prostate': ['Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'], 'atherosclerosis of extremities': ['Atherosclerosis of native arteries of the extremities', 'unspecified'], 'hearing loss': ['Unspecified hearing loss'], 'cataract': ['Unspecified cataract'], 'coronary atherosclerosis': ['Coronary atherosclerosis of native coronary artery'], 'myocardial infarction': ['Old myocardial infarction'], 'angioplasty': ['Percutaneous transluminal coronary angioplasty status'], 'tobacco use': ['Personal history of tobacco use']}