[Expert Solution]: Admission History and Physical Source:…

Admission History and Physical Source: Patient with assistance from daughter; reliability: good Occupation: retired welder Birthplace: Mexico Marital Status: widowed CC: This 83 year old male was transported to the emergency room, by ambo, after slipping and falling in the kitchen. It is estimated that he was on the floor for more than 8 hours before being found. He is complaining of pain in his left hip. HPI: The patient and daughter give a history of decreasing sight, hearing and osteoarthritis. The daughter has been assisting patient with activities of daily living for several years. Surgical History: 1990 Appendectomy 1995 Open cholecystectomy 2000 Angioplasty with right collateral stent Social: Quit smoking 5 years ago but smoked cigarettes for 30 years; No history of alcohol use; no illicit drug use; diet regular (although was requested by PMD to follow low cholesterol diet) Family History: Father: deceased at age 56 from heart attack Mother: deceased at age 99 from “old age” One Sister: deceased at age 57 due to Lupus complications One brother age 79 alive in Mexico –no contact about health Children: Female age 55 in good health, Male age 52 with emphysema ROS: Allergies: Erythromycin, Zantac General: decreased strength as aging HEENT: macular degeneration, wears glasses; slight hearing loss Respiratory: Pneumonia 1977 and 1999; negative PPD from 1997 & 1999 CV: angina in 2000 with subsequent angioplasty; heart murmur GI: history of one GB attack in 1995 with subsequent cholecystectomy; no pancreatitis or liver abnormalities MS: arthritis- degenerative type of hands, hips; osteoporosis of spine Skin: Herpes zoster in 2000 Childhood diseases: Varicella, measles, mumps, and Rubella Current Medications: ASA 81 mg daily Lipitor 20 mg po daily Denies use of OTC medications, herbals, or supplements PE: Height: 5’9 Weight: 180 lbs BMI: 26.6 BP: 112/58 P: 112 regular R: 28 T: 35 General: Appearance as stated years Skin: generally pink without lesions or rashes; 2 scars on abdomen: one 8 cm vertical scar to RUQ and one 6 cm angular scar to RLQ Head: Normocephalic; No facial tenderness; symmetrical facial features; no facial edema; no temporal bruits Eyes: Conjunctiva is pale; fundoscopy shows right lens opacity; Vision is 20/80 with glasses; intact EOM Ears: Auricles are aligned; TMs normal; Weber + for right conductive loss Nose: no nasal septum deviation; membrane is pale; Mouth and Throat: Upper dentures, lower teeth in fair condition. Tonsils pink without exudates. Neck: Supple; midline trachea; thyroid is not enlarged Chest: Normal shape; no use of accessory muscles with breathing Lungs: no tactile fremitus; Lungs clear Heart: S1, S2 with grade 3/6 systolic murmur best heard at the mitral area, no lift or heave; no bruit or clicks; EKG shows NSR with occasional PAC’s. Vessels: No JVD; no neck, carotid, or abdominal bruits Abdomen: Flat with +4 BS; non-tender; with slight liver distention (1)/(2) cm below the CV margin Genitalia and Breasts: deferred Lymphatic: no enlarged lymph nodes Musculoskeletal: Curvature of the thoracic spine; muscle tone is intact but wasted; several phalanges with enlarged joints; ROM intact. Left hip is shorter and turned outward. Left hip area is deformed. Neuro: Alert and oriented with appropriateness; CN 2-12 grossly assessed and intact;, +2 reflexes; muscle strength +5 except for left leg (not assessed due to deformity of hip). Assessment: Fractured left hip: femoral neck fracture Heart murmur: systolic with mitral regurgitation DJD Macular degeneration AP; GB; angioplasty with stent Hx of zoster Slight hearing loss- conductive Plan 1. Admit patient to orthopedic unit 2. Obtain tests: CBC; CMP; coagulation; UA, Type & Cross 3 units 3. CXR, EKG, Left hip & pelvis xray 4. Hold current medications for now 5. IV to stabilize fluid and electrolytes 6. Foley catheter in ED 7. Morphine 2 mg IVP Q4H for pain