[Answered]: Inpatient Discharge Summary Patient Name: Vincent…

Inpatient Discharge Summary Patient Name: Vincent MontoyaDOB: 01-09-65 Sex: MDate of Admission: 08-19-XX Attending Physician: Alfred Morning, MD Date of Discharge: 08-20-XX Discharge Diagnoses: Fecal impaction and rectal distention. Stage IV lung cancer with bone metastasis Hospital Course: A 53-year-old, very pleasant gentleman came to the hospital with severe abdominal pain. His CAT scan showed the patient had rectal distention with fecal impaction and stool retention in the sigmoid as well. He was given magnesium citrate as well as a suppository with Dulcolax in the Emergency Department. The patient is already on Miralax and docusate sodium at home with no help. The fecal impaction is secondary to the fact that the patient is on fentanyl patch and on oxycodone for pain. His fecal impaction got better. The patient had two large bowel movements overnight. He was kept in the hospital for observation. This morning, I saw him and he is doing well. He has no more abdominal pain. His belly feels okay. He has good bowel sounds. He is able to keep his food down. The plan is to discontinue his liquid diet. Give him a solid food and see how he does and that he will go home. At the time of discharge, he is being continued on all his home medications. I am adding Senna with docusate to help with the stool softener and I am adding prn Dulcolax suppository. The patient is advised to drink more water to keep hydrated and to increase fiber in his food and hopefully that will help. If not, then the dose of Miralax can be increased by the primary care physician. History of Present Illness: Intractable abdominal pain due to fecal impaction and rectal distention. The patient has stage IV lung cancer with bone metastasis. The patient is on chemotherapy and radiation therapy. The patient has history of pulmonary embolism. The patient is on anticoagulation with Xarelto. Discharge Medications: Acidophilus-pectin, citrus (Acidophilus Probiotic) 100 million cell-10 mg Capsule 2 capsule oral twice a day Alpha lipoic acid 200 mg Capsule, 1 capsule oral twice a day Ascorbic acid (Vitamin C) 5,000 Tablet, 2 tablets oral twice a day Cholecalciferol (vitamin D3) 1,000-unit Capsule, 1 capsule oral daily Dexamethasone 4 mg Tablet as directed oral before chemo Fentanyl 50 mcg/hour patch 72-hour 1 patch transdermal every 72-hours APPLY ONE PATCH EVERY 72 HOURS, TOTAL DOSE OF 37MCG Fluoxetine (Prozac) 20 mg Capsule, 1 capsule oral daily Folic Acid 1 mg Tablet, 1 tablet oral daily Nystatin 100,000 unit/mL Suspension, 5 mL oral four times daily Ondansetron HCl 4 mg Tablet, 1 tablet oral every six hours prn for nausea & vomiting Oxycodone 20 mg Tablet I tablet oral every four hours prn for pain Polyethylene glycol 3350 (Miralax) 17g Powder in Packet, 1 packet oral daily Rivaroxaban (Xarelto) 20 mg Tablet, 1 tablet oral daily Sennosides-docusate sodium (Senna-S) 8.6 mg-50 mg Tablet, 2 tablets oral twice a day hold for diarrhea Bisacodyl 10mg suppository, 1 suppository per rectum daily prn for constipation Discharge Diet: Going to be on a regular diet. The patient is advised to increase the fiber intake and eat more vegetative and fruits to keep the bowels going.