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instruction stringclasses 1 value	input stringlengths 1.47k 3.51M	output stringlengths 126 21.1k
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 44, 'gender': 'M', 'symptoms': 'Panniculitis\nAbdominal hernia', 'medical_history': ['Morbid obesity', 'Depression', 'Hyperlipidemia', 'Hypertension', 'Obstructive sleep apnea', 'Psychotic disorder', 'Vitamin B12 deficiency', 'Insomnia', 'Recurrent umbilical hernia', 'Cataract', 'Thyroid nodule', 'h/o Concussion (___) after a mechanical fall with left \nsided\nweakness and mild memory loss', 'h/o headache'], 'family_history': None, 'present_illness': 'The patient presents with a large periumbilical hernia with \nprevious umbilical incision. The patient also complains of \nrashes and skin breakdown from overlapping skin and moisture \nhaving lost weight. Patient seeks to have\nexcision of redundant skin and incisional hernia repair given \nthe large size of the incisional hernia.', 'medications': [{'medication': 'Nicotine Lozenge', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Nicotine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '81', 'valuenum': 81.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '76', 'valuenum': 76.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 104.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEGATIVE.'}, {'value': '199', 'valuenum': 199.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43.2', 'valuenum': 43.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '63', 'valuenum': 63.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.26', 'valuenum': 4.26, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '44.8', 'valuenum': 44.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '70', 'valuenum': 70.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.43', 'valuenum': 4.43, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 87.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Gen: Awake and alert\nCV: RRR\nResp: CTAB\nAbd: Soft, nontender, nondistended\nIncision: Clean/dry/intact with clean dressing in place\nJP: serosanguinous\nExtremities: Warm and well perfused', 'diagnoses': [{'icd_code': '2910', 'desc': 'Alcohol withdrawal delirium'}, {'icd_code': 'V6284', 'desc': 'Suicidal ideation'}, {'icd_code': '30301', 'desc': 'Acute alcoholic intoxication in alcoholism, continuous'}, {'icd_code': '3331', 'desc': 'Essential and other specified forms of tremor'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': 'V1047', 'desc': 'Personal history of malignant neoplasm of testis'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': '28749', 'desc': 'Other secondary thrombocytopenia'}, {'icd_code': 'V1551', 'desc': 'Personal history of traumatic fracture'}, {'icd_code': 'V8741', 'desc': 'Personal history of antineoplastic chemotherapy'}, {'icd_code': '28989', 'desc': 'Other specified diseases of blood and blood-forming organs'}, {'icd_code': '7904', 'desc': 'Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]'}], 'summary': "___ 05:16AM BLOOD WBC-8.6 RBC-2.79* Hgb-9.3* Hct-29.1* \nMCV-104* MCH-33.3* MCHC-32.0 RDW-13.4 RDWSD-51.0* Plt ___\n___ 12:20PM BLOOD WBC-8.5# RBC-2.82# Hgb-9.5 Hct-28.7* \nMCV-102* MCH-33.7* MCHC-33.1 RDW-13.2 RDWSD-49.6* Plt ___\n___ 05:16AM BLOOD Glucose-111* UreaN-11 Creat-0.6 Na-136 \nK-4.4 Cl-99 HCO3-30 AnGap-11\n___ 12:20PM BLOOD Glucose-144* UreaN-12 Creat-0.7 Na-137 \nK-4.1 Cl-102 HCO3-26 AnGap-13\n___ 05:16AM BLOOD Calcium-8.3* Phos-3.2 Mg-2.1\nMs. ___ is a ___ year-old female with s/p RNY gastric bypass \n___ recurrent panniculitis and a ___ hernia. \nThe patient presented to pre-op ___ was evaluated by \nanaesthesia and taken to the operating room where she underwent \na panniculectomy and incisional hernia repair with mesh. There \nwere no adverse events in the operating room; please see the \noperative note for details. Pt was extubated, taken to the PACU \nuntil stable, then transferred to the ward for observation. \nNeuro: The patient was alert and oriented throughout \nhospitalization; pain was initially managed with a \nhydromorphone/bupivacaine containing thoracic epidural and then \ntransitioned to oral oxycodone once tolerating a diet. \nCV: The patient triggered for hypotension (SBP ___ on POD1, \nwhich was responsive to a fluid bolus and reduced epidural \ninfusion rate. She remained stable from a cardiovascular \nstandpoint for the remainder of her hospitalization; vital signs \nwere routinely monitored.\nPulmonary: The patient remained stable from a pulmonary \nstandpoint; vital signs were routinely monitored. Good pulmonary \ntoilet, early ambulation and incentive spirometry were \nencouraged throughout hospitalization. \nGI/GU/FEN: The patient was initially on a clear liquid diet, \nwhich was advanced sequentially to a bariatric stage V diet, \nwhich was well tolerated. Patient's intake and output were \nclosely monitored\nID: The patient's fever curves were closely watched for signs of \ninfection, of which there were none.\nHEME: The patient's blood counts were closely watched for signs \nof bleeding, of which there were none.\nProphylaxis: The patient received subcutaneous heparin and ___ \ndyne boots were used during this stay and was encouraged to get \nup and ambulate as early as possible.\nAt the time of discharge, the patient was doing well, afebrile \nand hemodynamically stable. The patient was tolerating a diet, \nambulating, voiding without assistance, and pain was well \ncontrolled. The patient received discharge teaching and \nfollow-up instructions with understanding verbalized and \nagreement with the discharge plan."}}	{'final_diagnoses': ['Panniculitis', 'Periumbilical hernia'], 'procedures': ['Panniculectomy', 'Incisional hernia repair with mesh underlay'], 'visit_summary': "Ms. ___ is a ___ year-old female with s/p RNY gastric bypass \n___ recurrent panniculitis and a ___ hernia. \nThe patient presented to pre-op ___ was evaluated by \nanaesthesia and taken to the operating room where she underwent \na panniculectomy and incisional hernia repair with mesh. There \nwere no adverse events in the operating room; please see the \noperative note for details. Pt was extubated, taken to the PACU \nuntil stable, then transferred to the ward for observation. \nNeuro: The patient was alert and oriented throughout \nhospitalization; pain was initially managed with a \nhydromorphone/bupivacaine containing thoracic epidural and then \ntransitioned to oral oxycodone once tolerating a diet. \nCV: The patient triggered for hypotension (SBP ___ on POD1, \nwhich was responsive to a fluid bolus and reduced epidural \ninfusion rate. She remained stable from a cardiovascular \nstandpoint for the remainder of her hospitalization; vital signs \nwere routinely monitored.\nPulmonary: The patient remained stable from a pulmonary \nstandpoint; vital signs were routinely monitored. Good pulmonary \ntoilet, early ambulation and incentive spirometry were \nencouraged throughout hospitalization. \nGI/GU/FEN: The patient was initially on a clear liquid diet, \nwhich was advanced sequentially to a bariatric stage V diet, \nwhich was well tolerated. Patient's intake and output were \nclosely monitored\nID: The patient's fever curves were closely watched for signs of \ninfection, of which there were none.\nHEME: The patient's blood counts were closely watched for signs \nof bleeding, of which there were none.\nProphylaxis: The patient received subcutaneous heparin and ___ \ndyne boots were used during this stay and was encouraged to get \nup and ambulate as early as possible.\nAt the time of discharge, the patient was doing well, afebrile \nand hemodynamically stable. The patient was tolerating a diet, \nambulating, voiding without assistance, and pain was well \ncontrolled. The patient received discharge teaching and \nfollow-up instructions with understanding verbalized and \nagreement with the discharge plan.", 'medications_prescribed': ['Atorvastatin 20 mg PO QPM', 'Chlorthalidone 12.5 mg PO DAILY', 'RisperiDONE 1.5 mg PO QHS', 'Venlafaxine XR 150 mg PO DAILY', 'amLODIPine 5 mg PO DAILY', 'Calcium 500 + D (D3) (calcium carbonate-vitamin D3) 500 \nmg(1,250mg) -125 unit oral DAILY', 'Centrum Silver \n(multivit-min-FA-lycopen-lutein;<br>mv-min-folic acid-lutein) \n0.4-300-250 mg-mcg-mcg oral DAILY', 'Cyanocobalamin 1000 mcg PO DAILY', 'Thiamine 100 mg PO DAILY', 'Nystatin Cream 1 Appl TP BID:PRN as directed', 'Acetaminophen 1000 mg PO Q8H \nRX acetaminophen 500 mg 2 tablet(s) by mouth every 8 hours Disp \n#30 Tablet Refills:0', 'Docusate Sodium 100 mg PO BID \nTake this while you are taking oxycodone \nRX docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice \ndaily Disp #60 Capsule Refills:0', 'OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN pain \nRX oxycodone 5 mg ___ tablet(s) by mouth every 4 hours Disp \n#30 Tablet Refills:*0']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 49, 'gender': 'F', 'symptoms': 'Diarhea, Acute Renal Failure, Dehydration', 'medical_history': ['GERD preventing use of Bisphosphonates', 'Osteoporosis', 'hiatal hernia', 'gastritis', 'HTN', 'HLD', 'Cholecystectomy', 'Knee surgery'], 'family_history': 'Father with peptic ulcer disease. Mother with gallstones. Both \nparents with CAD.', 'present_illness': "This is a ___ yo F with recent hospitalization for chronic \ndiarhea found to have blunting of duodenal villi on EGD \nconsistent with celiac disease who presents again to the \nemergency room with continued diarrhea, nausea, vomiting, and \nweakness. Since discharge on ___, the patient has continued to \nhave ___ loose, watery stools per day. The pathology results \nconsistent with Celiac was only recently obtained, so the \npatient has not been following a gluten free diet. Also, the \npatient's recent diet has included a lot of dairy products. The \npatient notes loose, non-bloody stools without abdominal pain. \nShe endorses mild flatus, nausea, and occassional nausea. The \npatient has been taking Loperamide and Zofran at home with only \nmild effect. With her symptoms, the patient has had difficulty \nstaying hydrated and, on the morning of admission, she noted \nweakness, fatigue, dry mouth, and mild lightheadedness. \n\nThe patient presented to the ED and was found to have mild \nhyponatremia, hypochloremia, and acute kidney injury. She was \nafebrile. The patient was transfered to the floor for further \nworkup.", 'medications': [{'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Meclizine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CarBAMazepine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fexofenadine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Erythromycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Domperidone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Tenofovir Disoproxil (Viread)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Domperidone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lithium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.6,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 305.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '0.51', 'valuenum': 0.51, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '36.9', 'valuenum': 36.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '92.8', 'valuenum': 92.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '223', 'valuenum': 223.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.93', 'valuenum': 3.93, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.04', 'valuenum': 0.04, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.01', 'valuenum': 0.01, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.29', 'valuenum': 0.29, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.47', 'valuenum': 11.47, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.1', 'valuenum': 41.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'SM .'}, 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'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '219', 'valuenum': 219.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.47', 'valuenum': 3.47, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40.4', 'valuenum': 40.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 136.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.5', 'valuenum': 35.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '209', 'valuenum': 209.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.87', 'valuenum': 3.87, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.3', 'valuenum': 6.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39.5', 'valuenum': 39.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 279.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.5', 'valuenum': 36.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '241', 'valuenum': 241.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.98', 'valuenum': 3.98, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40.1', 'valuenum': 40.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 241.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37.0', 'valuenum': 37.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '207', 'valuenum': 207.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.00', 'valuenum': 4.0, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '40.8', 'valuenum': 40.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.5,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 314.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37.8', 'valuenum': 37.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED.'}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.72', 'valuenum': 3.72, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '45.2', 'valuenum': 45.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'ug/mL', 'ref_range_lower': 4.0, 'ref_range_upper': 12.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 52.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 139.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1559', 'valuenum': 1559.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED.'}, {'value': '202', 'valuenum': 202.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.55', 'valuenum': 3.55, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '41.4', 'valuenum': 41.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 142.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '213', 'valuenum': 213.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.52', 'valuenum': 3.52, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44.4', 'valuenum': 44.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ROS:\nGEN: - fevers, - Chills, - Weight Loss, + Lightheaded\nEYES: - Photophobia, - Visual Changes\nHEENT: - Oral/Gum bleeding\nCARDIAC: - Chest Pain, - Palpitations, - Edema\nGI: - Nausea, - Vomitting, + Diarhea, - Abdominal Pain, - \nConstipation, - Hematochezia\nPULM: - Dyspnea, - Cough, - Hemoptysis\nHEME: - Bleeding, - Lymphadenopathy\nGU: - Dysuria, - hematuria, - Incontinence\nSKIN: - Rash\nENDO: - Heat/Cold Intolerance\nMSK: - Myalgia, - Arthralgia, - Back Pain\nNEURO: - Numbness, - Weakness, - Vertigo, - Headache\n \nPHYSICAL EXAM:\nVSS: 98, 122/69, 67, 18, 100%\nGEN: NAD\nPain: ___\nHEENT: EOMI, MMM, - OP Lesions\nPUL: CTA B/L\nCOR: RRR, S1/S2, - MRG\nABD: NT/ND, +BS, - CVAT\nEXT: - CCE\nNEURO: CAOx3, Non-Focal\n.\nDISCHARGE PHYSICAL EXAM: \nVS - Temp 98.6F, BP 134/80, HR 72, R 18, O2-sat 97% RA \nGENERAL - pleasant, comfortable-appearing, NAD \nHEENT - EOMI, MMM\nNECK - supple, no thyromegaly, no JVD, no carotid bruits\nLUNGS - CTA bilat, no r/rh/wh \nHEART - PMI non-displaced, RRR, no MRG, nl S1-S2 \nABDOMEN - NABS, soft/NT/ND, no masses or HSM, no \nrebound/guarding \nEXTREMITIES - WWP, no edema, 2+ peripheral pulses (radials, DPs) \n \nSKIN - no rashes or lesions \nNEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength \n___ throughout, sensation grossly intact throughout, DTRs 2+ and \nsymmetric, cerebellar exam intact, steady gait', 'diagnoses': [{'icd_code': 'E1043', 'desc': 'Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy'}, {'icd_code': 'E873', 'desc': 'Alkalosis'}, {'icd_code': 'E1021', 'desc': 'Type 1 diabetes mellitus with diabetic nephropathy'}, {'icd_code': 'B1910', 'desc': 'Unspecified viral hepatitis B without hepatic coma'}, {'icd_code': 'E871', 'desc': 'Hypo-osmolality and hyponatremia'}, {'icd_code': 'E1065', 'desc': 'Type 1 diabetes mellitus with hyperglycemia'}, {'icd_code': 'K3184', 'desc': 'Gastroparesis'}, {'icd_code': 'E10319', 'desc': 'Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema'}, {'icd_code': 'H5509', 'desc': 'Other forms of nystagmus'}, {'icd_code': 'F319', 'desc': 'Bipolar disorder, unspecified'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'T450X6A', 'desc': 'Underdosing of antiallergic and antiemetic drugs, initial encounter'}, {'icd_code': 'E860', 'desc': 'Dehydration'}, {'icd_code': 'F419', 'desc': 'Anxiety disorder, unspecified'}, {'icd_code': 'Z23', 'desc': 'Encounter for immunization'}, {'icd_code': 'Z91120', 'desc': "Patient's intentional underdosing of medication regimen due to financial hardship"}, {'icd_code': 'Y92009', 'desc': 'Unspecified place in unspecified non-institutional (private) residence as the place of occurrence of the external cause'}, {'icd_code': 'R42', 'desc': 'Dizziness and giddiness'}, {'icd_code': 'G40909', 'desc': 'Epilepsy, unspecified, not intractable, without status epilepticus'}, {'icd_code': 'D72829', 'desc': 'Elevated white blood cell count, unspecified'}, {'icd_code': 'K5900', 'desc': 'Constipation, unspecified'}, {'icd_code': 'E8342', 'desc': 'Hypomagnesemia'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}], 'summary': "___ 10:15AM BLOOD WBC-4.9 RBC-3.73* Hgb-11.3* Hct-33.6* \nMCV-90 MCH-30.2 MCHC-33.6 RDW-13.2 Plt ___\n___ 10:15AM BLOOD Neuts-64.6 ___ Monos-4.6 Eos-0.7 \nBaso-0.5\n___ 10:15AM BLOOD Glucose-84 UreaN-17 Creat-1.6* Na-128* \nK-5.0 Cl-95* HCO3-17* AnGap-21\n___ 03:21PM URINE Hours-RANDOM Creat-34 Na-13 K-9 Cl-19\n___ 03:21PM URINE Osmolal-135\n.\n___\nGastrointestinal mucosal biopsies, seven: \nA. Upper esophagus: Squamous epithelium within normal limits. \nB. Mid esophagus: Squamous epithelium within normal limits. \nC. Lower esophagus: Squamous epithelium within normal limits, no \nglandular tissue present. \nD. Duodenum: Villi are present but focally shortened. \nIntraepithelial lymphocytes are focally increased. A few \nneutrophils are also present in the epithelium and lamina \npropria. The findings are not specific. The differential \ndiagnoses includes infection, drug reaction, mild celiac \ndisease, etc. Clinical correlation is needed. \nE. Duodenal bulb: Villi are present but focally shortened. \nIntraepithelial lymphocytes are focally increased. A few \nneutrophils are also present in the epithelium and lamina \npropria. The findings are not specific. The differential \ndiagnoses includes infection, drug reaction, mild celiac \ndisease, etc. Clinical correlation is needed. \n.\n___ 10:16 am STOOL CONSISTENCY: NOT APPLICABLE\n Source: Stool. \n\n Cryptosporidium/Giardia (DFA) (Pending): \n\n.\nDISCHARGE LABS:\n___ 07:55AM BLOOD WBC-4.2 RBC-3.16 Hgb-9.5* Hct-28.2* \nMCV-89 MCH-30.1 MCHC-33.8 RDW-13.6 Plt ___\n___ 07:55AM BLOOD Glucose-79 UreaN-6 Creat-0.6 Na-139 K-3.4 \nCl-103 HCO3-29 AnGap-___\nwith history of HTN, HLD, with recent admission for \ndiarhea during which she had a GI w/u with EGD and cscopy, \npresents with persistent diarrhea and occasional emesis, \nadmitted for ___ and hyponatremia. The ___ and hyponatremia \nquickly resolved with IVF after admission. However, the \naetiology of her diarrhea remains unclear despite w/u to date, \nalthough it may have had an osmotic component given its \nimprovement after being kept NPO for a time. Her diarrhea had \nresolved for over 2 days prior to her d/c home, and she was \nd/c'd home with outpt GI f/u. See below under TRANSITIONS for \nas-yet pending studies.\n.\nACTIVE ISSUES:\n.\n# Chronic Diarrhea: The patient had recent workup and admission \nfor her diarrhea of about 3 wks duration; at that time, EGD and \ncscopy showed villous blunting and shortening, possibly c/w \nceliac disease although she had a negative TTG. The remaining \nDDx for this pathological finding includes bacterial overgrowth, \ngiardia, eosinophilic gastroenteritis, Peptic duodenitis, \ntropical sprue, and autoimmune enteropathy. Pt denies having \nused any laxatives whatsoever in past few yrs at least. Quant \nimmunoglobulins were unremarkable. Pt was maintained on Lomotil \nPRN, loperamide PRN, and zofran PRN as she had emesis several \ntimes during admission. The aetiology of her diarrhea remains \nunclear, although it may have an osmotic component. The pt was \nkept NPO during admission per GI recs, and her diarrea appeared \nto have slowed down diarrhea somewhat, suggesting possible \nosmotic type diarrhea. The pt was maintained on a Gluten and \nlactose-free diet. Further GI recs were for no further inpt w/u \nbut rather for f/u as outpt and to continue empiric gluten and \nlactose free diet. At time of d/c, pt was comfortable, \nambulatory, maintaining PO, without continuing diarrhea, and \nwith nl vitals and labs. Pt was advised to maintain strong PO \nintake with gatorade and other electrolyte-containing beverages \nrather than free water. At time of d/c, pending studies include \nstool elastase (for pancreatic insufficiency) and stool alpha-1 \nantitrypsin.\n.\n# Anemia: Stabilized around Hct of 30. Fe studies were \nunremarkable other than high ferritin, suggesting chronic dz. \nPt's EGD and cscopy did not show any particular abnlties \nmorphologically. Pt reports that she had a nl mammogram in \n___ and is due for her next one soon; had nl pap smear \nabout ___ ago and had ___ normal paps prior to that one. Pt \nwill need f/u CBC to monitor anaemia.\n.\nRESOLVED OR CHRONIC ISSUES:\n.\n# ___: Currently resolved, with Cr of 0.7. Creatinine on \nadmission was elevated to 1.6 with a baseline around 0.6, in the \nsetting of diarrhea, nausea, vomiting and poor PO intake. Given \ndry mouth on exam and flat neck veins, this was most likely \nprerenal azotemia that should improve with IVFs. Her Cr quickly \nimproved to 0.7 after IVF. \n.\n# Hyponatremia: Currently resolved after IVF repletion. Likely \nwas hypovolemic hyponatremia in the setting of GI illness and \nfluid losses.\n.\n# Hypertension: The patient has h/o HTN. She was kept on home \nmetoprolol and losartan (home olmesartan is non-formulary).\n.\n# Osteoporosis: The patient is on Calcitonin to prevent further \nbone loss. Continued Calcitonin 200u intranasally."}}	{'final_diagnoses': ['Chronic diarrhea', 'Gastroesophageal reflux disease', 'Gastritis', 'Hypertension'], 'procedures': ['None'], 'visit_summary': "with history of HTN, HLD, with recent admission for \ndiarhea during which she had a GI w/u with EGD and cscopy, \npresents with persistent diarrhea and occasional emesis, \nadmitted for ___ and hyponatremia. The ___ and hyponatremia \nquickly resolved with IVF after admission. However, the \naetiology of her diarrhea remains unclear despite w/u to date, \nalthough it may have had an osmotic component given its \nimprovement after being kept NPO for a time. Her diarrhea had \nresolved for over 2 days prior to her d/c home, and she was \nd/c'd home with outpt GI f/u. See below under TRANSITIONS for \nas-yet pending studies.\n.\nACTIVE ISSUES:\n.\n# Chronic Diarrhea: The patient had recent workup and admission \nfor her diarrhea of about 3 wks duration; at that time, EGD and \ncscopy showed villous blunting and shortening, possibly c/w \nceliac disease although she had a negative TTG. The remaining \nDDx for this pathological finding includes bacterial overgrowth, \ngiardia, eosinophilic gastroenteritis, Peptic duodenitis, \ntropical sprue, and autoimmune enteropathy. Pt denies having \nused any laxatives whatsoever in past few yrs at least. Quant \nimmunoglobulins were unremarkable. Pt was maintained on Lomotil \nPRN, loperamide PRN, and zofran PRN as she had emesis several \ntimes during admission. The aetiology of her diarrhea remains \nunclear, although it may have an osmotic component. The pt was \nkept NPO during admission per GI recs, and her diarrea appeared \nto have slowed down diarrhea somewhat, suggesting possible \nosmotic type diarrhea. The pt was maintained on a Gluten and \nlactose-free diet. Further GI recs were for no further inpt w/u \nbut rather for f/u as outpt and to continue empiric gluten and \nlactose free diet. At time of d/c, pt was comfortable, \nambulatory, maintaining PO, without continuing diarrhea, and \nwith nl vitals and labs. Pt was advised to maintain strong PO \nintake with gatorade and other electrolyte-containing beverages \nrather than free water. At time of d/c, pending studies include \nstool elastase (for pancreatic insufficiency) and stool alpha-1 \nantitrypsin.\n.\n# Anemia: Stabilized around Hct of 30. Fe studies were \nunremarkable other than high ferritin, suggesting chronic dz. \nPt's EGD and cscopy did not show any particular abnlties \nmorphologically. Pt reports that she had a nl mammogram in \n___ and is due for her next one soon; had nl pap smear \nabout ___ ago and had ___ normal paps prior to that one. Pt \nwill need f/u CBC to monitor anaemia.\n.\nRESOLVED OR CHRONIC ISSUES:\n.\n# ___: Currently resolved, with Cr of 0.7. Creatinine on \nadmission was elevated to 1.6 with a baseline around 0.6, in the \nsetting of diarrhea, nausea, vomiting and poor PO intake. Given \ndry mouth on exam and flat neck veins, this was most likely \nprerenal azotemia that should improve with IVFs. Her Cr quickly \nimproved to 0.7 after IVF. \n.\n# Hyponatremia: Currently resolved after IVF repletion. Likely \nwas hypovolemic hyponatremia in the setting of GI illness and \nfluid losses.\n.\n# Hypertension: The patient has h/o HTN. She was kept on home \nmetoprolol and losartan (home olmesartan is non-formulary).\n.\n# Osteoporosis: The patient is on Calcitonin to prevent further \nbone loss. Continued Calcitonin 200u intranasally.", 'medications_prescribed': ['Aspirin 81 mg PO DAILY', 'Atenolol 50 mg PO BID', 'Calcitonin Salmon 200 UNIT NAS DAILY', 'NexIUM NF (esomeprazole magnesium) 40 mg ORAL DAILY', 'Ondansetron 4 mg PO Q8H:PRN nausea \nRX ondansetron 4 mg every eight (8) hours Disp #30 Tablet \nRefills:1', 'Calcium 600 + D(3) NF* (calcium carbonate-vitamin D3) 600 mg \ncalcium- 200 unit Oral DAILY', 'Multivitamins 1 TAB PO DAILY', 'olmesartan NF 20 mg Oral DAILY', 'Loperamide 2 mg PO TID:PRN loose stool \nRX Anti-Diarrhea 2 mg three times a day Disp #30 Tablet \nRefills:1', 'Diphenoxylate-Atropine 2 TAB PO Q6H:PRN diarrhea \nRX diphenoxylate-atropine 2.5 mg-0.025 mg every six (6) hours \nDisp #30 Tablet Refills:1']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 69, 'gender': 'F', 'symptoms': 'Worsening right sided weakness and slurred speech', 'medical_history': ['Hypertension-no longer on anti-hypertensive meds because they\n"bottomed out his pressure."', 'Hyperlipidemia on statin', 'Diabetes Mellitus on metformin', 'Macular degeneration', 'CAD - ETT-Mibi positive for moderate sized area of mild ischemia\nof the lateral wall of L ventricle ___', 'Stroke ___ in the setting of a peptic ulcer (right hemiparesis\nand difficulties with speech, recovered with 2 months of rehab)\nand on no therapy given GI bleed'], 'family_history': 'Strokes in both parents when they were in their ___. Paternal grandfather with stroke at age ___.', 'present_illness': '___ right-handed man with a history of\nhypertension, hyperlipidemia, diabetes, prior infarct in ___\nnow\npresenting with 5 days of fluctuating right face, arm, leg\nweakness and slurred speech. On ___, family noticed that\nhis sentence were trailing off and that his speech seemed "off."\n\nOvernight, he awoke to use the bathroom and feel after his right\nleg gave out from under him. By morning of ___ his speech was\nmarkedly slurred, had right facial droo, had difficulty raising\nhis right arm above his head and continued to have right leg\nweakness. \n\nHe went to ___ and was eventually admitted from\n___. Head CT showed subcortical white matter hypodense foci\non the left, likely chronic microangiopathic disease. No acute\nhemorrhage or infarcts. He had a brain MRI/MRA on ___ showing a\nmoderate amount of subcortical and periventricular white matter\ndisease, some peripendicular to the ventricles. The MRA showed\ncalcification of the cavernous cartoid arteries. He was \nfollowed\nby neurology and the working diagnosis was an internal capsule\ninfarct, although this was not visible on MRI. His statin was\nincreased and he was supposed to transition from ASA to Plavix.\nHe left against medical advice prior to having a repeat brain \nMRI\nwith contrast to further evaluate his white matter lesions. At\ntime of discharge his weakness was improving and he was\nfrustrated with the overnight noise preventing him from \nsleeping.\n\nHe was stable yesterday at home and the plan was for an\noutpatient MRI with contrast today to further evaluate the white\nmatter lesions. This morning awoke around 7am and noticed that\nhis symptoms were worsening. He was unable to move the right \narm\nat all and his right leg was weaker than the prior night. His\nspeech was more slurred and his facial droop more prominent. He\nwas unable to dress himself. Saw his PCP at ___ \nwho\nreferred him to ___ ED for further evaluation.\n\nIn our ED, he was hypertensive (220\'s/90\'s) and noticed to have \na\nright hemiparesis. A code stroke was called. \n\nOn neuro ROS, the pt denies blurred vision, diplopia,\ndysphagia, lightheadedness, vertigo, tinnitus or hearing\ndifficulty. Dysarthria as above. Denies difficulties producing\nor comprehending speech. Weakness as above, no numbness, no\nparasthesiae. No bowel or bladder incontinence or retention.\nReports difficulty walking secondary to leg weakness.\n\nOn general review of systems, the pt denies recent fever or\nchills. No night sweats or recent weight loss or gain. Denies\ncough, shortness of breath. Denies chest pain or tightness,\npalpitations. Denies nausea, vomiting, diarrhea, constipation \nor\nabdominal pain. No recent change in bowel or bladder habits. \nNo\ndysuria. Denies arthralgias or myalgias. Denies rash.', 'medications': [{'medication': 'Cefpodoxime Proxetil', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'NEB', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NEB', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ipratropium-Albuterol Inhalation Spray', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'FLUoxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'NEB', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 41.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'WARMED UP TO 37C.'}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '373', 'valuenum': 373.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.99', 'valuenum': 4.99, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '42.5', 'valuenum': 42.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 174.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 131.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.6', 'valuenum': 35.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '389', 'valuenum': 389.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.0', 'valuenum': 16.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.94', 'valuenum': 3.94, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '44.2', 'valuenum': 44.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Admission examination:\nPHYSICAL EXAM:\nVitals: P-69, BP-186/77, R-12, O2-100% on RA\nGeneral Appearance: Comfortable, no apparent distress.\nHEENT: NC, OP clear, MMM.\nNeck: Supple. No bruits.\nLungs: CTA bilaterally.\nCardiac: RRR. Normal S1/S2. No M/R/G.\nAbdominal: Soft, NT, BS+\nExtremities: Warm and well-perfused. Peripheral pulses 2+.\n\nNeurologic:\n-Mental Status: Alert, oriented x 3. Able to relate history\nwithout difficulty. Attentive, able to name ___ backward \nwithout\ndifficulty. Language is fluent with intact repetition and\ncomprehension. Normal prosody. There were no paraphasic \nerrors.\nPt. was able to name both high and low frequency objects. \nSpeech\nwas mildly dysarthric. Able to follow both midline and\nappendicular\ncommands. Pt. was able to register 3 objects and recall ___ at 5\nminutes. The pt. had good knowledge of current events. There\nwas no evidence of apraxia or neglect.\n\n-Cranial Nerves:\nI: Olfaction not tested.\nII: PERRL 3 to 2mm and brisk. Visual fields full to\nconfrontation.\nIII, IV, VI: EOMI without nystagmus. Normal saccades.\nV: Facial sensation intact to light touch, pinprick and cold\nthroughout.\nVII: Mild right facial droop and right nasolabial fold\nflattening\nVIII: Hearing intact to finger-rub bilaterally.\nIX, X: Palate elevates symmetrically.\nXI: ___ strength in left trapezii and SCM bilaterally.\nXII: Tongue protrudes in midline.\n\n-Motor: Normal bulk, tone throughout. Right pronator drift.\nNo tremor. No asterixis noted. Right hand held in a clasped\nposition. Slowed finger tapping on right hand.\n Delt Bic Tri WrE FFl FE IO IP Quad Ham TA ___\nL 5 ___ ___ 5 5 5 5 5 5 5\nR 4+ ___ ___ 4+ 4+ 4+ 3 3 3 3\n\n-Sensory: Decreased vibration, pinprick and cold at bilateral\nlower extremities (ankles down), otherwise sensation intact. No\nextinction to DSS.\n\n-DTRs:\n Bi Tri ___ Pat Ach\nL 2 2 2 2 1\nR 3 3 3 2+ 1\nPlantar response was flexor on left, mute on right.\n\n-Coordination: No intention tremor, mild dysmetria on right FNF\nbut but likely secondary to weakness rather than ataxia.\n\n-Gait: not assessed.\n.\n.\nDischarge examination:\nA+Ox3. No sensory deficits. Right mild facial weakness with no \nother CN deficits and mild dysarthria.\nRight pupil smaller and unreactive ___ cataract 2.5 vs 3.25 \n(left reactive). Right hemiparesis arm>leg.\n Delt Bic Tri WrE WrF FFl FE IO IP Quad Ham TA ___\nL 5 ___ ___ ___ 5 5 5 5 5\nR 2 ___ 3 0 0 0 4+ 4+ 4- 0 0 3 1', 'diagnoses': [{'icd_code': 'J189', 'desc': 'Pneumonia, unspecified organism'}, {'icd_code': 'J9601', 'desc': 'Acute respiratory failure with hypoxia'}, {'icd_code': 'J45909', 'desc': 'Unspecified asthma, uncomplicated'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'D72829', 'desc': 'Elevated white blood cell count, unspecified'}, {'icd_code': 'T380X5A', 'desc': 'Adverse effect of glucocorticoids and synthetic analogues, initial encounter'}, {'icd_code': 'Y929', 'desc': 'Unspecified place or not applicable'}, {'icd_code': 'Z853', 'desc': 'Personal history of malignant neoplasm of breast'}], 'summary': 'Laboratory investigations:\nAdmission labs:\n___ 10:15AM BLOOD WBC-8.3 RBC-4.38* Hgb-13.1* Hct-39.4* \nMCV-90 MCH-29.8 MCHC-33.1 RDW-13.1 Plt ___\n___ 10:15AM BLOOD Neuts-68.4 ___ Monos-6.9 Eos-3.5 \nBaso-0.7\n___ 10:15AM BLOOD ___ PTT-32.2 ___\n___ 10:15AM BLOOD UreaN-32\n___ 10:28AM BLOOD Creat-1.7\n___ 10:33AM BLOOD Glucose-142* Na-142 K-4.8 Cl-101 \ncalHCO3-26\n.\nStroke risk factors:\n___ 12:01PM BLOOD %HbA1c-PND\n___ 04:25AM BLOOD Calcium-8.7 Phos-4.3 Mg-2.2 Cholest-168\n___ 04:25AM BLOOD Triglyc-204* HDL-37 CHOL/HD-4.5 \nLDLcalc-90\n___ 10:15AM BLOOD ALT-21 AST-24 LD(LDH)-196 AlkPhos-65 \nTotBili-0.5\n.\nCEs:\n___ 10:15AM BLOOD CK-MB-4\n___ 10:15AM BLOOD cTropnT-<0.01\n___ 04:25AM BLOOD CK-MB-2 cTropnT-<0.01\n.\nDischarge:\n___ 05:20AM BLOOD WBC-8.5 RBC-3.94* Hgb-11.9* Hct-35.2* \nMCV-89 MCH-30.2 MCHC-33.8 RDW-13.6 Plt ___\n___ 05:20AM BLOOD Glucose-118* UreaN-30* Creat-1.5* Na-141 \nK-4.4 Cl-107 HCO3-24 AnGap-14\n___ 05:20AM BLOOD Calcium-9.2 Phos-4.8* Mg-2.2\n.\n.\nUrine:\n___ 12:30PM URINE Color-Straw Appear-Clear Sp ___\n___ 12:30PM URINE Blood-NEG Nitrite-NEG Protein-30 \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG\n___ 12:30PM URINE RBC-0 WBC-0 Bacteri-NONE Yeast-NONE Epi-0\n.\n.\nRadiology:\nCT HEAD W/O CONTRAST Study Date of ___ 10:18 AM \nFINDINGS: There are no signs of intracranial hemorrhage, mass \neffect, edema, \nor shift of normally midline structures. Within the left \nsemicentrum ovale as \nwell as within the periventricular white matter, there are \nseveral \nhypodensities suggestive of chronic microvascular infarction. \nAdditional focal \nhypodensity in the region of the left anterior medulla is noted. \nVentricles \nand sulci are mildly prominent, compatible with the patient\'s \nage. No acute \nfractures are seen. The mastoid air cells and paranasal sinuses \nappear well \naerated. There is calcification of the carotid siphons. \n \nIMPRESSION: \n1. No evidence of intracranial hemorrhage. \n2. Hypodensities within the left semicentrum ovale, left \nperiventricular \nwhite matter, and left anterior medulla may represent chronic \nmicrovascular \ninfarction, though, acute/subacute infarct cannot be ruled out. \nMRI is a more \nsensitive exam to assess for areas of acute infarction. \n.\nCHEST (PORTABLE AP) Study Date of ___ 12:16 ___\nSEMI-UPRIGHT AP VIEW OF THE CHEST: The heart size is normal. The \nmediastinal \nand hilar contours are unremarkable. The lungs are clear and the \npulmonary \nvascularity is normal. No pleural effusion or pneumothorax is \nseen. There \nare no acute osseous abnormalities. \n \nIMPRESSION: No acute cardiopulmonary process. \n.\nMRI/A HEAD AND NECK W/O CONTRAST Study Date of ___ 12:44 ___\n\nFINDINGS: \n \nMRI BRAIN: There is focally restricted diffusion in the left \npontomedullary \njunction in the pyramid (7, 306) consistent with acute infarct. \nAlso note is \nfaintly T2/FLAIR hyperintense area in the pons which has \nassociated blooming \nfelt to represent a capillary telangiectasia, less likely \nsubacute infarct (6, \n7). \n \nIn the supratentorial brain, there are no definite acute \ninfarcts. There are \nareas of periventricular white matter signal abnormality, some \npunctate, some \nconfluent, which could represent a combination of small vessel \nischemic \ndisease and probable subacute infarcts on the left, as supported \nby slight ex \nvacuo configuration of the left lateral ventricle. Ventricles \nand sulci are \noverall slightly prominent, consistent with age-related \ninvolution. There is \nno susceptibility abnormality. \n \nParanasal sinuses and mastoid air cells are well aerated. Globes \nand soft \ntissues are unremarkable. Cervicocranial junction appears within \nnormal \nlimits. \n \nMRA: Allowing for moderate diffuse atherosclerotic disease, the \nACAs, MCAs, \nand PCAs are patent without flow-limiting stenosis, large \naneurysm, or \ndissection. The basilar artery remains patent. Note that \nassessment for \nsmall branching vessels is limited by motion degradation. There \nis \nirregularity along the baislar and bilateral vertebral arteries. \nThe mid \nbasilar artery is also narrowed but patent. There is plaque in \nthe proximal \nright ICA and in the left carotid bifurcation, without \nhemodynamically \nsignificant narrowing. \n \nIMPRESSION: \n1. Findings consistent with left pontomedullary junction acute \ninfarct. \n2. Left pontine possible capillary telangiectasia, less likely \nsubacute \ninfarct. \n3. Patent anterior and posterior circulation and vertebrobasilar \nvessels. \nModerate diffuse atherosclerotic disease. \n.\nCardiology:\nECG Study Date of ___ 11:03:24 AM \n \n \nSinus rhythm. T wave changes in the lateral leads may be \nnon-specific but \nraise the possibility of ischemia. Clinical correlation is \nsuggested. No \nprevious tracing available for comparison. \nTRACING #1 \n \n \nRead by: ___. \n \n Intervals Axes \nRate PR QRS QT/QTc P QRS T \n76 176 86 372/400 39 45 122 \n.\nECG Study Date of ___ 8:20:56 AM \n \n \nSinus rhythm. Minor ST segment changes and T wave inversion in \nthe lateral \nleads raises the possibility of ischemia. Clinical correlation \nis suggested. \nCompared to the previous tracing of ___ the lateral T wave \nchanges are \nslightly more pronounced. \nTRACING #2 \n \n \nRead by: ___. \n \n ___ Axes \nRate PR QRS QT/QTc P QRS T \n67 168 88 ___\nyear old male with a history of hypertension, hyperlipidemia, \ndiabetes and prior stroke in ___ presented with 5 days of \nfluctuating right face/arm/leg weakness and incoordination with \nassociated dysarthria. Initial CT showed a left pontine \nhypodensity and MRI showed a left ponto-medullary infarct with \ndiffuse atherosclerosis on MRA. Patient had initially \nfluctuating symptoms and then becam persistent representing a \ncompleted infarct with a likely aetiology of atherosclerosis. \nPatient had a high Cr 1.7 and metformin is being held and will \nbe re-addressed post-discharge. Risk factors were addressed. \nPatient was admitted to ___ stroke service on ___ and \ndischarged on ___ to rehab. He has neuroloy follow-up and \nhis PCP ___ diabetes follow-up.\n.\n.\nNeurology:\nPatient had a previous stroke in ___ with right hemiparesis \nwith no residual deficits and given concomitant GI bleed was not \non any antiplatelet therapy. The patient\'s symptoms began on \n___ with incoordination on the right side and dysarthria \nand his wife noted that the right side of his face was droopy. \nHe was admitted to ___ and there reportedly, brain MRI/MRA did \nnot show infarcts and raised the possibility of "demyelination". \nHe improved while in the hospital and was discharged home on \nclopidogrel. However, he was never back to his baseline. The \npatient had previously stopped lisinopril due to BP \nfluctuations. On the morning of admission, he noticed profound \nweakness of the right arm upon waking and presented to ___. \nHis weakness had improved on initial assessment by neurology and \nlatterly fluctuated and then had persistent significant right \nhemiparesis arm>leg.\n\nAdmission neurological exam was significant for right \nhemiparesis (arm>leg), mild facial asymmetry, mildly dysarthric \nspeech and right sided hyperreflexia with possible ataxic \nhemiparesis limited by weakness. \n\nHead CT showed a left pontine hypodensity. MRI confirmed a left \nponto-medullary infarct and MRA showed patent anterior and \nposterior circulation and vertebrobasilar vessels (irregularity \nalong the basilar and bilateral vertebral arteries and mid \nbasilar artery narrowed) with moderate diffuse atherosclerotic \ndisease. \n\nStroke risk factors were assessed and patient was monitored on \ntelemetry with no arrhythmias seen. HbA1c is pending at time of \nwriting. Lipid profile revealed Chol 168 TGCs 204 LDL 90. LFTs \nwere normal. CXR was unremarkable. UA was negative save \nproteinuria. Echocardiography was deferred given a recent echo \non ___ which showed mild asymmetric septal hypertrophy \nwith normal LV function and estimated LVEF 65-70% with no \nhemodynamically significant valvular disease and no evidence of \nshunt by color Doppler.\n\nHis eamination worsened on ___ with dense right arm paresis and \nless so right leg and this persisted despite IVF suggesting that \nhe completed his infarct. His statin was increased to \npravastatin 80mg qd. Aspirin was changed to clopidogrel and \ninitially BP was allowed to autoregulate and was given IVF and \nlisinopril was started on the day of discharge.\n\nThe aetiology of his stroke is likely atherosclerotic given \nextensive disease.\n\nExam remained stable in house and he was assessed by ___ and \ndeemed to require rehab. He was able to ambulate short distances \non discharge. He was discharged to rehab on ___ and has \nneurology follow-up.\n.\n___: \nPatient has a history of HTN, HLD and T2DM. He was moitored on \ntelemetry and this revealed no arrhythmias. CEs were negative. \nHis BP was initially allowed to autoregulate and the goal is now \nnormotension. We started lisinopril 2.5mg qd on the day of \ndischarge for SBPs up to 150s. Echocardiography was deferred \ngiven a recent echo on ___ which showed mild asymmetric \nseptal hypertrophy with normal LV function and estimated LVEF \n65-70% with no hemodynamically significant valvular disease and \nno evidence of shunt by color Doppler.\n.\nRenal: \nCr was 1.7 on admission with baseline 1.3-1.5 on recent \nmeasurements. He has ahistory of proteinuria and this was also \nfound on our UA. We trended Cr in house and remained stable at \nroughly 1.5 and was 1.5 on discharge. Metformin was held whilst \nhe was in house and is currently contraindicated given his \ncurent creatinine and should be readdressed with repeat Cr post \ndischarge. He was hydrated with IVF.\n.\nENDO: \nWe hld metformin on admission and patient was managed with a \nHISS. Given discharge creatinine of 1.5 metformin is \ncontraindicated (should be </=1.3) and we consulted \nendocrinology who recommended inpatient HISS and discharge on no \npo DM medications and he should have follow-up labs in 2 weeks \npost discharge and based on this to restart either metformin or \nan alternative po oral hypoglucemic. We discussed with his PCP \nwho will organise DM follow-up.HbA1c pending at time of writing.'}}	{'final_diagnoses': ['Left ponto-medullary infarct likely secondary to diffuse atherosclerosis', 'Type 2 Diabetes Mellitus', 'Chronic Renal Failure'], 'procedures': ['None'], 'visit_summary': 'year old male with a history of hypertension, hyperlipidemia, \ndiabetes and prior stroke in ___ presented with 5 days of \nfluctuating right face/arm/leg weakness and incoordination with \nassociated dysarthria. Initial CT showed a left pontine \nhypodensity and MRI showed a left ponto-medullary infarct with \ndiffuse atherosclerosis on MRA. Patient had initially \nfluctuating symptoms and then becam persistent representing a \ncompleted infarct with a likely aetiology of atherosclerosis. \nPatient had a high Cr 1.7 and metformin is being held and will \nbe re-addressed post-discharge. Risk factors were addressed. \nPatient was admitted to ___ stroke service on ___ and \ndischarged on ___ to rehab. He has neuroloy follow-up and \nhis PCP ___ diabetes follow-up.\n.\n.\nNeurology:\nPatient had a previous stroke in ___ with right hemiparesis \nwith no residual deficits and given concomitant GI bleed was not \non any antiplatelet therapy. The patient\'s symptoms began on \n___ with incoordination on the right side and dysarthria \nand his wife noted that the right side of his face was droopy. \nHe was admitted to ___ and there reportedly, brain MRI/MRA did \nnot show infarcts and raised the possibility of "demyelination". \nHe improved while in the hospital and was discharged home on \nclopidogrel. However, he was never back to his baseline. The \npatient had previously stopped lisinopril due to BP \nfluctuations. On the morning of admission, he noticed profound \nweakness of the right arm upon waking and presented to ___. \nHis weakness had improved on initial assessment by neurology and \nlatterly fluctuated and then had persistent significant right \nhemiparesis arm>leg.\n\nAdmission neurological exam was significant for right \nhemiparesis (arm>leg), mild facial asymmetry, mildly dysarthric \nspeech and right sided hyperreflexia with possible ataxic \nhemiparesis limited by weakness. \n\nHead CT showed a left pontine hypodensity. MRI confirmed a left \nponto-medullary infarct and MRA showed patent anterior and \nposterior circulation and vertebrobasilar vessels (irregularity \nalong the basilar and bilateral vertebral arteries and mid \nbasilar artery narrowed) with moderate diffuse atherosclerotic \ndisease. \n\nStroke risk factors were assessed and patient was monitored on \ntelemetry with no arrhythmias seen. HbA1c is pending at time of \nwriting. Lipid profile revealed Chol 168 TGCs 204 LDL 90. LFTs \nwere normal. CXR was unremarkable. UA was negative save \nproteinuria. Echocardiography was deferred given a recent echo \non ___ which showed mild asymmetric septal hypertrophy \nwith normal LV function and estimated LVEF 65-70% with no \nhemodynamically significant valvular disease and no evidence of \nshunt by color Doppler.\n\nHis eamination worsened on ___ with dense right arm paresis and \nless so right leg and this persisted despite IVF suggesting that \nhe completed his infarct. His statin was increased to \npravastatin 80mg qd. Aspirin was changed to clopidogrel and \ninitially BP was allowed to autoregulate and was given IVF and \nlisinopril was started on the day of discharge.\n\nThe aetiology of his stroke is likely atherosclerotic given \nextensive disease.\n\nExam remained stable in house and he was assessed by ___ and \ndeemed to require rehab. He was able to ambulate short distances \non discharge. He was discharged to rehab on ___ and has \nneurology follow-up.\n.\n___: \nPatient has a history of HTN, HLD and T2DM. He was moitored on \ntelemetry and this revealed no arrhythmias. CEs were negative. \nHis BP was initially allowed to autoregulate and the goal is now \nnormotension. We started lisinopril 2.5mg qd on the day of \ndischarge for SBPs up to 150s. Echocardiography was deferred \ngiven a recent echo on ___ which showed mild asymmetric \nseptal hypertrophy with normal LV function and estimated LVEF \n65-70% with no hemodynamically significant valvular disease and \nno evidence of shunt by color Doppler.\n.\nRenal: \nCr was 1.7 on admission with baseline 1.3-1.5 on recent \nmeasurements. He has ahistory of proteinuria and this was also \nfound on our UA. We trended Cr in house and remained stable at \nroughly 1.5 and was 1.5 on discharge. Metformin was held whilst \nhe was in house and is currently contraindicated given his \ncurent creatinine and should be readdressed with repeat Cr post \ndischarge. He was hydrated with IVF.\n.\nENDO: \nWe hld metformin on admission and patient was managed with a \nHISS. Given discharge creatinine of 1.5 metformin is \ncontraindicated (should be </=1.3) and we consulted \nendocrinology who recommended inpatient HISS and discharge on no \npo DM medications and he should have follow-up labs in 2 weeks \npost discharge and based on this to restart either metformin or \nan alternative po oral hypoglucemic. We discussed with his PCP \nwho will organise DM follow-up.HbA1c pending at time of writing.', 'medications_prescribed': ['senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a\nday) as needed for constipation.', 'docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2\ntimes a day).', 'insulin regular human 100 unit/mL Solution Sig: As per\nsliding scale Injection ASDIR (AS DIRECTED).', 'heparin (porcine) 5,000 unit/mL Solution Sig: One (1) \nInjection TID (3 times a day).', 'acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every\n6 hours) as needed for pain, temp > 100.4.', 'clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY\n(Daily).', 'lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily): Hod\nfor SBP<110.', 'pravastatin 80 mg Tablet Sig: One (1) Tablet PO at bedtime.', 'Outpatient Lab Work\nPlease repeat Chem 7 in 2 weeks and fax to PCP Dr ___ on ___']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 81, 'gender': 'F', 'symptoms': 'loss of consciousness', 'medical_history': ['-CORONARY ARTERY DISEASE ___ s/p CABGx5 ___ complicated \nby CVA/Lt hemimonymous hemianopsia, ___ Stress Mibi-mod \nperfusion abnormality inf/lat wall, partially rev. ___ \n___. EF 64%.', '-HYPERTENSION', 'Echo ___: ___ EF 50%, AK/HK basal to mid inf wall, mild \nMR', 'ECHO ___ EF 35%', '-DIABETES TYPE II', '-diabetic nephropathy', '-HYPERCHOLESTEROLEMIA', '-CHRONIC CONSTIPATION', '-SEIZURE DISORDER ___', '-Hx stroke.', '-ANXIETY DISORDER - Onset after 5-vessel bypass. Improved on low \n\ndose klonapin, however has some concommitant cognitive deficits. \n\nAttempting to wean to SSRI and eval for residual cognitive \neffects thereafter.', '-CERVICAL SPONDYLOSIS ___', '-COLONIC POLYPS ___', '-GASTROESOPHAGEAL REFLUX EGD ___: Mild gastritis, ?', '-SENSORINEURAL HEARING LOSS', '-LACTOSE INTOLERANCE ___', '-PSORIASIS ___'], 'family_history': 'Non-contributory', 'present_illness': 'Mr. ___ is a ___ with a PMHx significant for CAD s/p CABG, \nCVA, HTN, HLD, DM2 (last A1c 6.8, ___, and anxiety who \npresents 1 day s/p unwitness fall in the bathroom with LOC. \nEarlier that day, pt had been outside in the heat with his \nfamily. His daughter gave him water and food. Per family, he \nwent to the bathroom to rinse out his mouth and his family heard \na thud. He was apparentlty on the floor against a wall. She \nendorses LOC, gray ashy color, momentary absence of breath \ndue to positioning. He regained consciousness within seconds and was \naware of incident and preceeding events. No evidence of \ndiaphoresis, bowel or bladder incontinence, jerking motion. He \nwas not on the toilet when during event. EMS was called, finger \nstick 226, no EKG findings. He was not taken to the hospital. \nAfter the incident his family increased his water intake above \nbaseline to ___ (above 30cc baseline). That night he had \nincreased urinary frequency, up to 10x during the night. The \nmorning of admission he had 4 episodes of non bloody, non \nbilious vomit. \n\nIn the ED, he was noted to have an abrasion over his posterior \nneck. \n\nOf note, he was recently admitted in ___ for hyponatremia \nthought to be secondary to SIADH as well as drug-induced \n(paxil). He responded well when his diuretics were held and he \nwas fluid restricted to 16cc water, 2 cups of coffee, and 1 cup \nof tea a day. Baseline low 130s-128. \n\nThe daughter concerned about UTI which he has had in past. No \nfevers, chills. Current c/o mild headache, neck pain, R shoulder \npain. Denies CP, cough, abd pain, ___ pain, numbness, weakness. \nHas been able to ambulate since fall and per daughter and wife \nis currently at baseline. \n\nIn the ED, his initial VS were 97.4 79 160/99 18 100%. His labs \nwere notable for leukocytosis to 11.3, hyponatremia with Na 125, \nhyperglcyemic with glucose 228. His INR was 1.2 and his lactate \nwas 2.2. He has a UA notable for proteinuria, glucosuria and \nketonuria but no evidence of a UTI. His Cr was 0.8. He had a CT \nHead and CXR which were both unremarkable. He developed a fever \nto 100.6 at 10:30 this morning. Given concern for occult PNA, he \nwas given a dose of Levofloxacin and was admitted to medicine. \nHe was fluid restricted as well. \n\nOn the floor his vitals were stable. He was alert and oriented \nx2-3. Per his daughter, he is at his baseline. He has no \ncomplaints at this time.', 'medications': [{'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sertraline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Isosorbide Mononitrate (Extended Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Dabigatran Etexilate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Mirtazapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Cephalexin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Oxycodone SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Cephalexin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '36.8', 'valuenum': 36.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '324', 'valuenum': 324.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.98', 'valuenum': 3.98, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 179.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY ELEVATES CK.. NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '___', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY ELEVATES MG..'}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY ELEVATES K..'}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.06, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '38.2', 'valuenum': 38.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ON ADMISSION:\n\nVitals: T 99.1, BP 130/58, P 74, RR 18, 98% RA\nGeneral: Alert, oriented x2-3 (not year), no acute distress \nHEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL \nNeck: Supple, JVP not elevated, no LAD \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi \nAbdomen: Soft, non-tender, non-distended, bowel sounds present, \nno organomegaly, no rebound or guarding, bladder not palpable\nGU: No foley \nExt: Warm, well perfused, no clubbing, cyanosis or edema \nNeuro: CNII-XII intact, ___ strength upper/lower extremities, \ngrossly normal sensation, 2+ reflexes bilaterally, gait \ndeferred. \n\n=\n=\n=\n=\n=\n=\n=\n=\n=\n=\n=\n=\n=\n================================================================\nON DISCHARGE:\n\nVS: Tc 98.2, Tm 100.3 (yesterday), HR 68, BP 123/55 lying and \n90/46 standing, RR 18, O2 sat \nGeneral: Alert, oriented x2-3 (not year), no acute distress \nHEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL \nNeck: Supple, JVP not elevated, no LAD \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi \nAbdomen: Soft, non-tender, non-distended, bowel sounds present, \nno organomegaly, no rebound or guarding, bladder not palpable\nGU: No foley \nExt: Warm, well perfused, no clubbing, cyanosis or edema \nNeuro: CNII-XII intact, ___ strength upper/lower extremities, \ngrossly normal sensation.', 'diagnoses': [{'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '4239', 'desc': 'Unspecified disease of pericardium'}, {'icd_code': '514', 'desc': 'Pulmonary congestion and hypostasis'}, {'icd_code': '1830', 'desc': 'Malignant neoplasm of ovary'}, {'icd_code': '1970', 'desc': 'Secondary malignant neoplasm of lung'}, {'icd_code': '1976', 'desc': 'Secondary malignant neoplasm of retroperitoneum and peritoneum'}, {'icd_code': '1962', 'desc': 'Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes'}, {'icd_code': '1977', 'desc': 'Malignant neoplasm of liver, secondary'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '04149', 'desc': 'Other and unspecified Escherichia coli [E. coli]'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': 'V8741', 'desc': 'Personal history of antineoplastic chemotherapy'}, {'icd_code': 'V4501', 'desc': 'Cardiac pacemaker in situ'}, {'icd_code': 'V4364'}, {'icd_code': 'V1251', 'desc': 'Personal history of venous thrombosis and embolism'}], 'summary': 'ADMISSION LABS:\n\n___ 09:35AM BLOOD WBC-11.3# RBC-4.29 Hgb-12.7* Hct-38.3* \nMCV-89 MCH-29.7 MCHC-33.3 RDW-13.4 Plt ___\n___ 09:35AM BLOOD Neuts-86.9* Lymphs-7.1* Monos-5.1 Eos-0.5 \nBaso-0.4\n___ 09:35AM BLOOD Glucose-228* UreaN-13 Creat-0.8 Na-125* \nK-4.1 Cl-82* HCO3-27 AnGap-20\n___ 09:35AM BLOOD Osmolal-265\n___ 09:49AM BLOOD Lactate-2.2\n\n===============================================================\n\nDISCHARGE LABS:\n\n___ 06:40AM BLOOD WBC-5.6 RBC-3.69* Hgb-10.7* Hct-32.4* \nMCV-88 MCH-29.0 MCHC-32.9 RDW-13.0 Plt ___\n___ 06:40AM BLOOD Plt ___\n___ 05:40PM BLOOD Glucose-221* UreaN-11 Creat-0.8 Na-127* \nK-4.2 Cl-88* HCO3-31 AnGap-12\n___ 06:40AM BLOOD Glucose-151* UreaN-11 Creat-0.9 Na-129* \nK-4.1 Cl-90* HCO3-32 AnGap-11\n___ 05:40PM BLOOD Calcium-8.9 Phos-4.2 Mg-2.5\n___ with a PMHx significant for CAD s/p CABG, CVA, HTN, HLD, DM2 \n(last A1c 6.8, ___, and anxiety who presents 1 day s/p \nunwitness fall in the bathroom with loss of consciousness and \nfound to be hyponatremic to 125, lactate 2.2, wbc 11.3.\n\n# syncope- According to the family, syncopal episode was sudden, \nhe had a gray-ashen color, and regained consciousness quickly, \nhe remembered the event. There was no bowel or bladder \nincontinence. EKG was within normal limits. Given symptoms most \nlikely vasovagal. However, he had an episode of orthostatic \nhypotenstion in the hospital and had been fluid restricting \nhimself on the day of syncope. Renal was consulted to advise on \nmanaging orthostatic hypotension given the hyponatremia. Family \nwas hesitant to give fluids since hyponatremia was improving. \nPhysical therapy evaluated the patient and recommended home ___, \nbut the family declined. He was advised to increase protein and \nsodium intake and continue to restrict water. \n\n# SIRS (Fever, leukocytosis) w/elevated lactate- Mr. ___ \npresented wtih elevated temperature, elevated wbc, elevated \nlactate. He had a remote history of cough and was started on \nlevofloxacin in the ED. UA clear, CXR clear, lung exam clear. \nNo meningeal manifestations. Per family, he is at baseline. \nClinically, no source of infection can be identified. \nLevofloxacin was stopped on the floor given low clinical \nsuspicion of pneumonia. However, given low grade fevers \nthroughout admission, infection cannot be ruled out. Patient was \ninstructed to return if fevers persisted or there were any \nconcerns. \n\n# Hyponatremia- patient has longstanding and documented history \nof hyponatremia with baseline sodium in high 120s to low 130s, \nlikely due to Paxil and SIADH. He has been followed by PCP and \nthey have decided to keep pt on Paxil 20mg daily to help mood \nstability. At home he fluid restricts to 16 ounces of water, 2 \ncups of coffee, and 1 cup of tea a day. On admission sodium was \n125, which was likely due to increased water intake after \nepisode of syncope. After water was restricted in the hospital \nand food intake improved, his sodium improved to 128. \n \nCHRONIC ISSUES:\n# DM2- on metformin at home. Last A1c 6.8. Well controlled. FSBG \n228 after syncope. \n\n# anxiety/depression- on paxil 20mg daily and valium ___ daily \nfor anxiety and depression. Even though paxil likely medication \ncausing hyponatremia, benefit of mood stability outweights risk.'}}	{'final_diagnoses': ['syncope', 'hyponatremia', 'Coronary Artery Disease', 'Hypertension', 'Diabetes Type II', 'Hypercholesterolemia', 'Chronic Constipation'], 'procedures': ['none'], 'visit_summary': '___ with a PMHx significant for CAD s/p CABG, CVA, HTN, HLD, DM2 \n(last A1c 6.8, ___, and anxiety who presents 1 day s/p \nunwitness fall in the bathroom with loss of consciousness and \nfound to be hyponatremic to 125, lactate 2.2, wbc 11.3.\n\n# syncope- According to the family, syncopal episode was sudden, \nhe had a gray-ashen color, and regained consciousness quickly, \nhe remembered the event. There was no bowel or bladder \nincontinence. EKG was within normal limits. Given symptoms most \nlikely vasovagal. However, he had an episode of orthostatic \nhypotenstion in the hospital and had been fluid restricting \nhimself on the day of syncope. Renal was consulted to advise on \nmanaging orthostatic hypotension given the hyponatremia. Family \nwas hesitant to give fluids since hyponatremia was improving. \nPhysical therapy evaluated the patient and recommended home ___, \nbut the family declined. He was advised to increase protein and \nsodium intake and continue to restrict water. \n\n# SIRS (Fever, leukocytosis) w/elevated lactate- Mr. ___ \npresented wtih elevated temperature, elevated wbc, elevated \nlactate. He had a remote history of cough and was started on \nlevofloxacin in the ED. UA clear, CXR clear, lung exam clear. \nNo meningeal manifestations. Per family, he is at baseline. \nClinically, no source of infection can be identified. \nLevofloxacin was stopped on the floor given low clinical \nsuspicion of pneumonia. However, given low grade fevers \nthroughout admission, infection cannot be ruled out. Patient was \ninstructed to return if fevers persisted or there were any \nconcerns. \n\n# Hyponatremia- patient has longstanding and documented history \nof hyponatremia with baseline sodium in high 120s to low 130s, \nlikely due to Paxil and SIADH. He has been followed by PCP and \nthey have decided to keep pt on Paxil 20mg daily to help mood \nstability. At home he fluid restricts to 16 ounces of water, 2 \ncups of coffee, and 1 cup of tea a day. On admission sodium was \n125, which was likely due to increased water intake after \nepisode of syncope. After water was restricted in the hospital \nand food intake improved, his sodium improved to 128. \n \nCHRONIC ISSUES:\n# DM2- on metformin at home. Last A1c 6.8. Well controlled. FSBG \n228 after syncope. \n\n# anxiety/depression- on paxil 20mg daily and valium ___ daily \nfor anxiety and depression. Even though paxil likely medication \ncausing hyponatremia, benefit of mood stability outweights risk.', 'medications_prescribed': ['1. Atorvastatin 20 mg PO HS', '2. Diazepam 1 mg PO DAILY anxiety', '3. Lisinopril 30 mg PO DAILY', '4. Metoprolol Succinate XL 25 mg PO DAILY', '5. Omeprazole 20 mg PO DAILY', '6. Paroxetine 20 mg PO DAILY', '7. Tamsulosin 0.4 mg PO DAILY', '8. Aspirin 162 mg PO DAILY', '9. Betamethasone Dipro 0.05% Cream 1 Appl TP BID:PRN skin \nirritation', '10. cod liver oil 1,250-135 unit oral daily', '11. MetFORMIN XR (Glucophage XR) ___ mg PO DAILY', '12. Multivitamins 1 TAB PO DAILY', '13. Psyllium Wafer 1 WAF PO DAILY']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 80, 'gender': 'F', 'symptoms': 'GERD', 'medical_history': ['Colitis', 'Pneumonia', 's/p gastric bypass ___ years ago', 's/p cholecystectomy', 's/p tonsil/adenoidectomy', 's/p Hysterectomy', '___ (porthacath for Iron infusion)'], 'family_history': 'Mother\nFather- lung cancer\nSiblings\nOffspring\nOther- aunt x 2: breast cancer, mat grandmother: breast cancer', 'present_illness': 'Ms. ___ is a ___ yo female, current\nsmoker s/p gastric bypass with a history of Asthma, GERD. BRAVO\nshowed showed significant reflux with ___ score 41.4\nReferred for surgical consideration of LINX/antireflux surgery.\n\nToday she reports hx of reflux on and off but significant reflux\n___ years ago with recurrent aspiration pneumonia with visit to ER\nwith respiratory failure. She has been treated on and off for\naspiration pna, last ___. She reports dysphagia to\nliquids, even will regurgitate water standing up. Sx include:\nnausea, vomiting, cough, hoarseness, acid reflux per rectum,\ndehydration required IVF repletion ( portacath in place).', 'medications': [{'medication': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Nitroglycerin Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '30', 'valuenum': 30.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NotDone. CK-MB NOT PERFORMED, TOTAL CK < 100.'}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '37.1', 'valuenum': 37.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.02', 'valuenum': 4.02, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NotDone. CK-MB NOT PERFORMED, TOTAL CK < 100.'}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.1', 'valuenum': 25.1, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37.0', 'valuenum': 37.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Initial:\nVS 98.1; 99/70; 71; 16; 98% RA. wt 202.6lbs\n\nGen: well nourished female in NAD\nChest: CTAB with palpable port in the right upper chest with a\nwell-healed overlying incision\nCor: RRR without any pathologic heart sounds\nAbd: abdomen soft, mildly tender on the right, well-healed\nmidline incision and lap port sites. no epigastric\npain/tenderness\nExtrem: warm\n\nDischarge:\n24 HR Data (last updated ___ @ 832)\n Temp: 98.3 (Tm 98.3), BP: 105/73 (105-124/72-85), HR: 75\n(72-81), RR: 18 (___), O2 sat: 92% (91-92), O2 delivery: Ra\n___: BMI: 33.1\nFluid Balance (last updated ___ @ 849)\n Last 8 hours Total cumulative 625ml\n IN: Total 625ml, PO amount 180ml, IV amount infused 445ml\n OUT: Total 0ml, Urine amount 0ml\n Last 24 hours Total cumulative 2905ml\n IN: Total 4965ml, PO amount 180ml, IV amount infused \n4785ml\n OUT: Total 2060ml, Urine amount 2060ml\n\nGen: [x] NAD, [x] AAOx3\nCV: [x] RRR, [] murmur\nResp: [x] breaths unlabored, [x] CTAB, [] wheezing, [] rales\nAbdomen: [x] soft, [] distended, [x] tender, [] rebound/guarding\nWound: [x] incisions clean, dry, intact\nExt: [x] warm, [] tender, [] edema', 'diagnoses': [{'icd_code': '78079', 'desc': 'Other malaise and fatigue'}, {'icd_code': '7231', 'desc': 'Cervicalgia'}, {'icd_code': '7245', 'desc': 'Backache, unspecified'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '412', 'desc': 'Old myocardial infarction'}, {'icd_code': 'V4582', 'desc': 'Percutaneous transluminal coronary angioplasty status'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '30000', 'desc': 'Anxiety state, unspecified'}], 'summary': 'CXR ___\nIMPRESSION: \nNo comparison. Lung volumes are low. Right pectoral \nPort-A-Cath in situ. \nNormal size of the heart. Free air in the left and right \nsupraclavicular soft\ntissues. Free air is also present bilaterally in the chest \nwall, seen on both\nthe frontal and the lateral radiograph. Volumes are very low \nand areas of\natelectasis are visualized both at the left and the right lung \nbases, in\naddition, the lateral radiograph shows a relatively large \natelectasis at the\nleft lung basis. No pneumothorax. Normal size of the heart. \nNo pleural\neffusions.\n\n___ 01:20PM BLOOD WBC-7.4 RBC-3.81* Hgb-10.8* Hct-34.0 \nMCV-89 MCH-28.3 MCHC-31.8* RDW-13.1 RDWSD-42.8 Plt ___\n\n___ 03:59AM BLOOD Glucose-84 UreaN-5* Creat-0.4 Na-141 \nK-3.7 Cl-106 HCO3-25 AnGap-10\n___ 03:59AM BLOOD Calcium-7.6* Phos-2.6* Mg-1.8\nPatient underwent laparoscopic LINX procedure on ___. \nPostoperatively, she had significant pain that was difficult to \ncontrol. This was thought to be secondary to chronic Suboxone \nuse (held 48 hours prior to surgery). The morning of ___, \nshe continued to have difficulty with pain control and she was \nplaced on scheduled Tylenol and her oxycodone was switched to \nDilaudid with a higher than equivalent dose. She was also \nstarted on Toradol. She felt that she was able to start \nambulating and moving around on the new pain regimen. Since the \nprocedure, she was unable to void spontaneously and she required \nmultiple straight catheterizations for her urinary retention. \nShe endorsed a history of over 1 month of retention symptoms at \nhome prior to admission for surgery\x96she had never been worked up \nfor these complaints. After failing multiple voiding trials, a \nFoley was inserted and urology follow-up was arranged. Patient \nwas discharged home with her pain well controlled, breathing \ncomfortably on room air and ambulating without difficulty, and \nwith a Foley catheter in place. She will follow-up with Dr. \n___ in clinic in 2 weeks. She will follow-up with her \noutpatient pain/addiction doctor on ___ to manage her \ntransition back to Suboxone (she was given a prescription for 4 \ndays of opiates to carry her through the weekend). She will \nfollow-up with the outpatient ___ clinic for a voiding trial \nat the middle of next week.'}}	{'final_diagnoses': ['Gastroesophageal reflux'], 'procedures': ['___ Laparoscopic LINX Procedure'], 'visit_summary': 'Patient underwent laparoscopic LINX procedure on ___. \nPostoperatively, she had significant pain that was difficult to \ncontrol. This was thought to be secondary to chronic Suboxone \nuse (held 48 hours prior to surgery). The morning of ___, \nshe continued to have difficulty with pain control and she was \nplaced on scheduled Tylenol and her oxycodone was switched to \nDilaudid with a higher than equivalent dose. She was also \nstarted on Toradol. She felt that she was able to start \nambulating and moving around on the new pain regimen. Since the \nprocedure, she was unable to void spontaneously and she required \nmultiple straight catheterizations for her urinary retention. \nShe endorsed a history of over 1 month of retention symptoms at \nhome prior to admission for surgery\x96she had never been worked up \nfor these complaints. After failing multiple voiding trials, a \nFoley was inserted and urology follow-up was arranged. Patient \nwas discharged home with her pain well controlled, breathing \ncomfortably on room air and ambulating without difficulty, and \nwith a Foley catheter in place. She will follow-up with Dr. \n___ in clinic in 2 weeks. She will follow-up with her \noutpatient pain/addiction doctor on ___ to manage her \ntransition back to Suboxone (she was given a prescription for 4 \ndays of opiates to carry her through the weekend). She will \nfollow-up with the outpatient ___ clinic for a voiding trial \nat the middle of next week.', 'medications_prescribed': ['Acetaminophen 1000 mg PO Q8H', 'HYDROmorphone (Dilaudid) 4 mg PO Q4H:PRN Pain - Moderate \n Reason for PRN duplicate override: .\nRX hydromorphone 4 mg 1 tablet(s) by mouth every 6 hours Disp \n#20 Tablet Refills:*0', 'Omeprazole 20 mg PO DAILY', 'Baclofen 10 mg PO QID', 'Citalopram 40 mg PO DAILY', 'Estrogens Conjugated 0.9 mg PO DAILY', 'Fluticasone-Salmeterol Diskus (100/50) 1 INH IH QD', 'Gabapentin 300 mg PO BID', 'HydrOXYzine 10 mg PO QID', 'Nystatin Cream 1 Appl TP BID', 'Ranitidine 300 mg PO BID', 'Sucralfate 1 gm PO QID', 'Topiramate (Topamax) 75 mg PO QHS', 'HELD- Buprenorphine-Naloxone (8mg-2mg) 1 TAB SL TID This \nmedication was held. Do not restart Buprenorphine-Naloxone \n(8mg-2mg) until you follow up with your pain/addiction doctor']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 76, 'gender': 'F', 'symptoms': 'Left leg ischemia', 'medical_history': ['-CHF unknown EF', '-Afib on coumadin', '-HTN', '-Ligation and division of left femoral to anterior tibial\nbypass graft', '-Evacuation of left thigh hematoma', '-Left femoral to anterior tibial bypass with non\nreverse greater saphenous vein, angioscopy, multiple segment\nof vein with splicing together', '-Balloon angioplasty of left popliteal artery.', '-Balloon angioplasty of left posterior tibial artery.', '-numerous debridements to his left foot'], 'family_history': 'N/C', 'present_illness': 'This is a ___ male with a history of SFA and popliteal \nangioplasty who healed his ulcers, but then developed new ulcers \nand an angiogram showing a complete popliteal occlusion with \ninability to pass the occlusion a second time. The patient was \nthen deemed a candidate for bypass surgery. He was noted to have \na large varicosity of his vein as well as a large segment of the \nvein near the saphenofemoral junction and the decision was made \nto attempt\nwith this vein but use right arm vein if necessary.', 'medications': [{'medication': 'OxycoDONE Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate (Oral Solution) 2 mg/mL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'MethylPHENIDATE (Ritalin)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Morphine Sulfate IR', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (100 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'PARoxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'MethylPHENIDATE (Ritalin)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Erythromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sucralfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'Q72H', 'doses_per_24_hrs': 0.0}]}, 'clinical_findings': {'labs': [{'value': '12', 'valuenum': 12.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': '<0.2.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.1', 'valuenum': 24.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '351', 'valuenum': 351.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.69', 'valuenum': 2.69, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '47.8', 'valuenum': 47.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.4, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': 'GREEN TOP.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '54', 'valuenum': 54.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'LG.'}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.025', 'valuenum': 1.025, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Hazy.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '50', 'valuenum': 50.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'HOLD. SPECIMEN TO BE HELD 48 HOURS AND DISCARDED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}], 'exams': 'Alert and oriented x3\nCTA\nRRR\n+BS\nPedal pulses dopperable bilaterally\nLLE staples intact. \nLeft thigh small hematoma stable\nTwo open left foot ulcers without signs of infection', 'diagnoses': [{'icd_code': 'R109', 'desc': 'Unspecified abdominal pain'}, {'icd_code': 'C257', 'desc': 'Malignant neoplasm of other parts of pancreas'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'G8918', 'desc': 'Other acute postprocedural pain'}, {'icd_code': 'R197', 'desc': 'Diarrhea, unspecified'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}], 'summary': '___ 08:20PM GLUCOSE-114* UREA N-20 CREAT-1.1 SODIUM-139 \nPOTASSIUM-5.3* CHLORIDE-107 TOTAL CO2-25 ANION GAP-12\n___ 08:20PM estGFR-Using this\n___ 08:20PM ALT(SGPT)-19 AST(SGOT)-28 ALK PHOS-58\n___ 08:20PM CK-MB-3 cTropnT-<0.01\n___ 08:20PM CALCIUM-8.1* PHOSPHATE-3.4 MAGNESIUM-1.7\n___ 08:20PM HGB-11.0* HCT-34.0\n___ 08:20PM PLT COUNT-268\n___ 08:20PM ___ PTT-29.4 ___\n___ 06:18PM TYPE-ART RATES-10/ TIDAL VOL-700 O2-41 \nPO2-179 PCO2-43 PH-7.40 TOTAL CO2-28 BASE XS-1 \nINTUBATED-INTUBATED VENT-CONTROLLED\n___ 06:18PM GLUCOSE-102 LACTATE-1.3 NA+-140 K+-4.5 \nCL--105\n___ 06:18PM HGB-12.1* calcHCT-36\n___ 06:18PM freeCa-1.12\n___ 04:07PM TYPE-ART TEMP-36.0 RATES-10/ TIDAL VOL-670 \nO2-41 PO2-182* PCO2-42 PH-7.41 TOTAL CO2-28 BASE XS-2 \nINTUBATED-INTUBATED VENT-CONTROLLED\n___ 04:07PM GLUCOSE-107* LACTATE-1.3 NA+-140 K+-4.6 \nCL--104\n___ 04:07PM HGB-12.5* calcHCT-38\n___ 04:07PM freeCa-1.14\n___ 02:11PM TYPE-ART TIDAL VOL-700 O2-50 PO2-206* \nPCO2-48* PH-7.38 TOTAL CO2-29 BASE XS-2 INTUBATED-INTUBATED \nVENT-CONTROLLED\n___ 02:11PM GLUCOSE-126* LACTATE-1.5 NA+-139 K+-4.6 \nCL--104\n___ 02:11PM HGB-12.8* calcHCT-38\n___ 02:11PM freeCa-1.14\nPatient underwent an uneventful left femoral to anterior tibial \nbypass with nonreversed greater saphenous vein by Dr. ___. He \nwas stable post-op and followed the lower extremity clinical \npathway. He ambulated with ___ and was cleared for home. He went \nhome with ___ for continued wound care. He was discharged on \n___'}}	{'final_diagnoses': ['PMH: HTN, ^chol, CHF, AF (onCoumadin); OSA, CRI (1.6)', 'PSH: L pop/tib angioplasty ___ s/p LLE angio ___'], 'procedures': ['___ Left femoral to anterior tibial bypass with non\nreverse greater saphenous vein, angioscopy, multiple segment\nof vein with splicing together.', '___ Left femoral to anterior tibial bypass with non\nreverse greater saphenous vein, angioscopy, multiple segment\nof vein with splicing together.'], 'visit_summary': 'Patient underwent an uneventful left femoral to anterior tibial \nbypass with nonreversed greater saphenous vein by Dr. ___. He \nwas stable post-op and followed the lower extremity clinical \npathway. He ambulated with ___ and was cleared for home. He went \nhome with ___ for continued wound care. He was discharged on \n___', 'medications_prescribed': ['1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '2. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). ', '3. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 \nhours): refill from ___. ___. \nDisp:60 Tablet(s) Refills:0', '4. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '5. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO TID \n(3 times a day): refill from ___. ___. \nDisp:180 Tablet(s) Refills:0', '6. Warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 \n___. ', '7. Oxycodone-Acetaminophen ___ mg Tablet Sig: ___ Tablets PO \nevery six (6) hours as needed for pain.\nDisp:40 Tablet(s) Refills:0', '8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day) as needed for constipation. ', '9. Simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day. ']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 64, 'gender': 'F', 'symptoms': 'Scheduled chemotherapy', 'medical_history': ['PAST ONCOLOGIC HISTORY:', '- Approximately ___: Lymphoma treated at CHA. Details not\navailable.', '- ___: Developed poor balanced, dysarthria, dysphagia, and\nconfusion', '- ___ - ___: Transferred to ___ from OSH after imaging \nshowed large right thalamic lesion ganglion lesion.', '- ___ - Right sided image guided biopsy - Non-diagnostic', '- ___: Repeat image guided brain biopsy - DLBCL', '- ___: C1D1 HD-MTX at 4.8g/m2', '- ___: C2D1 HD-MTX', '- ___ - C3D1 HD MTX - 6.0 grams/m2 ', '- ___ - C4D1 - HDMTX', '- ___ C5 Methotrexate', '- ___ Cycle ___ MTX', '- ___ C7 HD-MTX', '- ___ C8 HD-MTX with desensitization protocol', '- ___ C9 HD-MTX with desensitization protocol', '- ___ C10 HD-MTX with desensitization protocol', '- ___: C11 HD-MTX with desensitization protocol', '- ___: C12 HD-MTX with desensitization protocol', 'OTHER PAST MEDICAL HISTORY: ', '- Non-Hodgkins lymphoma treated at ___ ___', '- Hypothyroidism', '- PE/DVT. Not currently on anticoagulation', '- MTX induced liver injury', '- Esophageal stricture'], 'family_history': 'Has two healthy sons. Has a sister and two brothers, all are\nhealthy. No known family history of cancer', 'present_illness': '___ yo female with a history of CNS Lymphoma who is admitted for\nscheduled chemotherapy with cycle 13 HD-MTX with desensitization\nprotocol due to prior severe transaminitis.\n\nPatient underwent C12 HD-MTX ___. She tolerated treatment\nwell aside from her typical transaminitis (ALT/AST peaded at\n598/917 on ___ with quick resolution. She returns today for \nher\nscheduled 4 month HD-MTX.\n\nOn arrival, she has no acute complaints, and feels well. No FC.\nNo CP, SOB or cough. No N/V/D. No abdominal pain. No dysuria. No\nnew leg pain or swelling. She does note intermittent dysphagia \nto\nsolids and had an EGD with esophageal dilation. She also\ndecreased her keppra to 250mg q12 hours back in ___.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'DULoxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Mouth Care Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'potassium chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': '1', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'ED', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Methadone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Cyclobenzaprine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q5MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Methadone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CeFAZolin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Nitrofurantoin Monohyd (MacroBID)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Pregabalin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ON CALL TO OR', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Methylnaltrexone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SUBCUT', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': 0.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'OxyCODONE--Acetaminophen (5mg-325mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '38.4', 'valuenum': 38.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '274', 'valuenum': 274.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.95', 'valuenum': 2.95, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.9', 'valuenum': 6.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43.8', 'valuenum': 43.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.5, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.02', 'valuenum': 1.02, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '127', 'valuenum': 127.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '49', 'valuenum': 49.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.36', 'valuenum': 7.36, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 28.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 135.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '46', 'valuenum': 46.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LABEL VERIFIED.'}, {'value': '155', 'valuenum': 155.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.51', 'valuenum': 3.51, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '50.1', 'valuenum': 50.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.2', 'valuenum': 26.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '163', 'valuenum': 163.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.7', 'valuenum': 16.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.93', 'valuenum': 2.93, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '54.5', 'valuenum': 54.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 109.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'TR.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'LG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'POS.'}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.014', 'valuenum': 1.014, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Hazy.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '165', 'valuenum': 165.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM: \nT 98.0 BP 106/71 HR 74 RR 18 O2 95%RA\nGENERAL: Very pleasant, sitting up in bedside chair in NAD\nEYES: Anicteric sclerea, PERLL, EOMI; \nENT: Oropharynx clear without lesion, JVD not elevated \nCARDIOVASCULAR: Regular rate and rhythm, no murmurs, rubs, or\ngallops; 2+ radial pulses\nRESPIRATORY: Appears in no respiratory distress, clear to\nauscultation bilaterally, no crackles, wheezes, or rhonchi\nGASTROINTESTINAL: Normal bowel sounds; nondistended; soft,\nnontender without rebound or guarding; no hepatomegaly\nMUSKULOSKELATAL: Warm, well perfused extremities without lower\nextremity edema; Normal bulk \nNEURO: Alert, oriented, CN III-XII intact, motor and sensory\nfunction grossly intact\nSKIN: No significant rashes\nLYMPHATIC: No cervical, supraclavicular, submandibular\nlymphadenopathy. No significant ecchymoses\n\nDISCHARGE PHYSICAL EXAM:\nT 97.8 BP 107/73 HR 97 RR 18 O2 98%RA\nGENERAL: Very pleasant, sitting up in bed reading a book\nEYES: Anicteric sclerea, PERLL, EOMI; \nENT: Oropharynx clear without lesion, JVD not elevated \nCARDIOVASCULAR: Regular rate and rhythm, no murmurs, rubs, or\ngallops; 2+ radial pulses\nRESPIRATORY: Appears in no respiratory distress, clear to\nauscultation bilaterally, no crackles, wheezes, or rhonchi\nGASTROINTESTINAL: Normal bowel sounds; nondistended; soft,\nnontender without rebound or guarding; no hepatomegaly\nMUSKULOSKELATAL: Warm, well perfused extremities without lower\nextremity edema; Normal bulk \nNEURO: Alert, oriented, PERLL and EOMI, motor and sensory\nfunction grossly intact\nSKIN: No significant rashes\nLYMPHATIC: No cervical, supraclavicular, submandibular\nlymphadenopathy. No significant ecchymoses', 'diagnoses': [{'icd_code': 'M48062', 'desc': 'Spinal stenosis, lumbar region with neurogenic claudication'}, {'icd_code': 'G9731', 'desc': 'Intraoperative hemorrhage and hematoma of a nervous system organ or structure complicating a nervous system procedure'}, {'icd_code': 'M419', 'desc': 'Scoliosis, unspecified'}, {'icd_code': 'G834', 'desc': 'Cauda equina syndrome'}, {'icd_code': 'J9811', 'desc': 'Atelectasis'}, {'icd_code': 'J9589', 'desc': 'Other postprocedural complications and disorders of respiratory system, not elsewhere classified'}, {'icd_code': 'M4316', 'desc': 'Spondylolisthesis, lumbar region'}, {'icd_code': 'M5136', 'desc': 'Other intervertebral disc degeneration, lumbar region'}, {'icd_code': 'M5126', 'desc': 'Other intervertebral disc displacement, lumbar region'}, {'icd_code': 'M810', 'desc': 'Age-related osteoporosis without current pathological fracture'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'Y831', 'desc': 'Surgical operation with implant of artificial internal device as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure'}, {'icd_code': 'Y92234', 'desc': 'Operating room of hospital as the place of occurrence of the external cause'}, {'icd_code': 'Z8673', 'desc': 'Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'Z96653', 'desc': 'Presence of artificial knee joint, bilateral'}], 'summary': "ADMISSION LABS:\n===============\n\n___ 12:00PM BLOOD WBC-5.7 RBC-4.19 Hgb-10.8* Hct-34.0 \nMCV-81* MCH-25.8* MCHC-31.8* RDW-14.6 RDWSD-42.9 Plt ___\n___ 12:00PM BLOOD Glucose-93 UreaN-10 Creat-0.7 Na-142 \nK-4.2 Cl-105 HCO3-26 AnGap-11\n___ 12:00PM BLOOD ALT-8 AST-12 LD(LDH)-261* AlkPhos-98 \nTotBili-0.3\n___ 12:00PM BLOOD Calcium-9.5 Phos-3.4 Mg-2.2\n\nDISCHARGE LABS:\n===============\n\n___ 05:09AM BLOOD WBC-4.1 RBC-4.05 Hgb-10.4* Hct-33.0* \nMCV-82 MCH-25.7* MCHC-31.5* RDW-14.8 RDWSD-44.4 Plt ___\n___ 05:09AM BLOOD Glucose-89 UreaN-5* Creat-0.7 Na-146 \nK-3.9 Cl-103 HCO3-32 AnGap-11\n___ 05:09AM BLOOD ALT-264* AST-91* LD(LDH)-294* AlkPhos-102 \nTotBili-0.4\n___ 05:09AM BLOOD Calcium-9.3 Phos-3.2 Mg-1.9\n\nIMAGING: \n========\n___ Imaging CHEST (PORTABLE AP) \nLungs are clear. Right-sided Port-A-Cath tip projects to the \n___. Cardiomediastinal silhouette is stable. There is no \npleural effusion. No pneumothorax is seen. \n\n___ Imaging MR HEAD W & W/O CONTRAS \n1. Unchanged nonenhancing FLAIR hyperintensity within the right \nfrontal and parietal lobe white matter, likely post treatment \nrelated. \n2. Stable changes status post right frontal craniotomy and \nbiopsy with cystic encephalomalacia centered within the right \nbasal ganglia. \n3. No new or enhancing lesions are identified. \n4. Scattered white matter chronic small vessel ischemic disease. \n\n5. Generalized parenchymal volume loss, likely age related.\nPRINCIPLE REASON FOR ADMISSION:\n___ yo female with a history of CNS Lymphoma who is admitted for \nscheduled chemotherapy with cycle 13 HD-MTX with desensitization \nprotocol due to prior severe transaminitis.\n\n# CNS lymphoma: Most recent imaging shows persistent remission. \nShe was admitted on ___ for a full day of urinary \nalkalanization and underwent MTX infusion per desens protocol on \n___. She was maintained on an MTX diet (no organic acids). \nLeucovorin rescue was initiated 12 hours after infusion at 100mg \ndue to prior transaminitis. Her LFT's bumped significantly, but \nsimilar to prior admissions. LFT's were downtrending \nappropriately upon discharge and she was asymptomatic. Her MTX \nlevel was monitored q 24 hours until 0.1. She will follow up \nwith Dr. ___ repeat MRI in four months prior to her next \nHD-MTX treatment, scheduled for ___. \n\n# MTX related liver injury: Has history of markedly elevated \ntransaminitis with MTX. Is followed by liver clinic without any \nspecific changes necessary at this time. LFT's elevated after \ninfusion in line with prior admissions, and were downtrending \nappropriately prior to discharge. She was asymptomatic.\n\n# Hypokalemia: Repleted aggressively per sliding scales. \n\n# Dysphagia: Patient reports marked esophageal dysphagia \nsymptoms. She reports she has had prior EGD at OSH, and she is \nnot losing weight. She was adamantly opposed to a soft diet and \nwas not interested in GI consultation this admission. I \ncounseled her on safe eating practices and strongly encouraged \nher to follow up with her gastroenterologists.\n\n# DVT/PE: No longer on anticoagulation as of ___. No \ncurrent symptoms.\n\n# Hypothyroidism: Continued home levothyroxine. \n\n# Billing: >30 minutes spend coordinating and executing this \ndischarge plan"}}	{'final_diagnoses': ['# CNS Lymphoma'], 'procedures': ['None'], 'visit_summary': "PRINCIPLE REASON FOR ADMISSION:\n___ yo female with a history of CNS Lymphoma who is admitted for \nscheduled chemotherapy with cycle 13 HD-MTX with desensitization \nprotocol due to prior severe transaminitis.\n\n# CNS lymphoma: Most recent imaging shows persistent remission. \nShe was admitted on ___ for a full day of urinary \nalkalanization and underwent MTX infusion per desens protocol on \n___. She was maintained on an MTX diet (no organic acids). \nLeucovorin rescue was initiated 12 hours after infusion at 100mg \ndue to prior transaminitis. Her LFT's bumped significantly, but \nsimilar to prior admissions. LFT's were downtrending \nappropriately upon discharge and she was asymptomatic. Her MTX \nlevel was monitored q 24 hours until 0.1. She will follow up \nwith Dr. ___ repeat MRI in four months prior to her next \nHD-MTX treatment, scheduled for ___. \n\n# MTX related liver injury: Has history of markedly elevated \ntransaminitis with MTX. Is followed by liver clinic without any \nspecific changes necessary at this time. LFT's elevated after \ninfusion in line with prior admissions, and were downtrending \nappropriately prior to discharge. She was asymptomatic.\n\n# Hypokalemia: Repleted aggressively per sliding scales. \n\n# Dysphagia: Patient reports marked esophageal dysphagia \nsymptoms. She reports she has had prior EGD at OSH, and she is \nnot losing weight. She was adamantly opposed to a soft diet and \nwas not interested in GI consultation this admission. I \ncounseled her on safe eating practices and strongly encouraged \nher to follow up with her gastroenterologists.\n\n# DVT/PE: No longer on anticoagulation as of ___. No \ncurrent symptoms.\n\n# Hypothyroidism: Continued home levothyroxine. \n\n# Billing: >30 minutes spend coordinating and executing this \ndischarge plan", 'medications_prescribed': ['LevETIRAcetam 250 mg PO BID', 'Levothyroxine Sodium 100 mcg PO 2X/WEEK (___)', 'Levothyroxine Sodium 88 mcg PO 5X/WEEK (___)']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 69, 'gender': 'F', 'symptoms': 'right iliac pseudoaneurysm', 'medical_history': ['HTN', 'Afib', 'GIB'], 'family_history': 'NC', 'present_illness': '___ M w/ hx of right ___ transferred from OSH \nwith right groin discomfort and possible infected vs ruptured \npseudoanerysm. Pt has a surgical history that began in ___ when \nhe developed a right common iliac pseudoanerysm after a cardiac \ncatheterization. This pseudoaneurym later became infected and in \n___ he underwent a left to right fem fem bypass and a\npseudoaneurysm resection. The pseudoaneurysm later recurred and \nin ___ he underwent another resection of the pseudoaneurysm \nwith Dr ___. In ___ he developed another infection and \nunderwent an I&D of a right iliac artery abscess, ligation of a \nfeeding ecternal iliac vessel, and resection of a right iliac \npseudoaneurysm. This was c/b by a DVT and he underwent IVC \nfilter placement at that time. He has been doing well until he \nstarted noting fevers and right groin discomfort.', 'medications': [{'medication': 'LaMOTrigine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Gentamicin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22.0', 'valuenum': 22.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.3', 'valuenum': 41.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '88.0', 'valuenum': 88.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '218', 'valuenum': 218.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.81', 'valuenum': 4.81, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '223', 'valuenum': 223.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 126.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '223', 'valuenum': 223.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '420', 'valuenum': 420.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '177', 'valuenum': 177.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.98', 'valuenum': 3.98, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '167', 'valuenum': 167.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.01', 'valuenum': 4.01, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '312', 'valuenum': 312.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '303', 'valuenum': 303.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '293', 'valuenum': 293.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': '98.5 65 117/58 18 93RA\nGEN: NAD, AAOx3\nCV: RRR S1S2\nPULM: CTAB\nAB: soft, NT, ND\nBACK: right flank dressing c/d/i\nEXT: warm well perfused, right groin incision c/d/i, pulses R: \nd/d L: d/d', 'diagnoses': [{'icd_code': '5761', 'desc': 'Cholangitis'}, {'icd_code': '5762', 'desc': 'Obstruction of bile duct'}, {'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '34590', 'desc': 'Epilepsy, unspecified, without mention of intractable epilepsy'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}], 'summary': '___ 07:20AM BLOOD WBC-6.0 RBC-4.37* Hgb-11.5* Hct-36.6* \nMCV-84 MCH-26.3* MCHC-31.4 RDW-14.9 Plt ___\n___ 07:20AM BLOOD Glucose-123* UreaN-34* Creat-1.9* Na-131* \nK-4.2 Cl-99 HCO3-25 AnGap-11\n___ 07:20AM BLOOD Calcium-8.3* Phos-2.4* Mg-1.9\nThe patient is an ___ year old male who was admitted to the \nVascular Surgery service after undergoing embolization of the \nright iliac pseudoaneurysm on ___. Please see procedure \nnote for more details. He was transferred to the floor for \nfurther care. Six hours after surgery, he was started on a \nregular diet, which he tolerated well. He was restarted on all \nof his home medications, including fondaparinux. His foley was \nremoved at midnight on ___, and he failed to void. The \nfoley was replaced, and he was given a dose of flomax. The \nfoley was removed the following morning, and he voided without \ndifficulty. He also had adequate output from his nephrostomy \ntube, which was placed during a prior admission. He was \nfollowed by urology who recommended clamping the nephrostomy \ntube. On ___, he underwent a nephrostogram which showed no \nobstruction, and the nephrostomy tube was removed in ___. At the \ntime of discharge on ___, he was in stable condition. He \nwas given a prescription for oxycodone, and he was advised to \nfollow up with Dr. ___. He was further advised to follow \nup with Dr. ___ in urology in 1 month.'}}	{'final_diagnoses': ['right iliac pseudoaneurysm'], 'procedures': ['___: Venous access, R hypo and PSA coiling'], 'visit_summary': 'The patient is an ___ year old male who was admitted to the \nVascular Surgery service after undergoing embolization of the \nright iliac pseudoaneurysm on ___. Please see procedure \nnote for more details. He was transferred to the floor for \nfurther care. Six hours after surgery, he was started on a \nregular diet, which he tolerated well. He was restarted on all \nof his home medications, including fondaparinux. His foley was \nremoved at midnight on ___, and he failed to void. The \nfoley was replaced, and he was given a dose of flomax. The \nfoley was removed the following morning, and he voided without \ndifficulty. He also had adequate output from his nephrostomy \ntube, which was placed during a prior admission. He was \nfollowed by urology who recommended clamping the nephrostomy \ntube. On ___, he underwent a nephrostogram which showed no \nobstruction, and the nephrostomy tube was removed in ___. At the \ntime of discharge on ___, he was in stable condition. He \nwas given a prescription for oxycodone, and he was advised to \nfollow up with Dr. ___. He was further advised to follow \nup with Dr. ___ in urology in 1 month.', 'medications_prescribed': ['1. Atenolol 50 mg PO DAILY ', '2. Disopyramide Phosphate 100 mg PO BID ', '3. Fondaparinux 2.5 mg SC DAILY ', '4. Hydrochlorothiazide 25 mg PO DAILY ', '5. Losartan Potassium 50 mg PO DAILY ', '6. Mesalamine 1000 mg PO BID ', '7. NIFEdipine CR 90 mg PO DAILY ', '8. Omeprazole 20 mg PO DAILY ', '9. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain \nRX oxycodone 5 mg 1 tablet(s) by mouth every ___ hours Disp \n#30 Tablet Refills:*0']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 85, 'gender': 'M', 'symptoms': 'amaurosis fugax', 'medical_history': ['mitral valve prolapse', 'depression/anxiety'], 'family_history': 'N/A', 'present_illness': 'The patient is a young female, who was noted to\nhave episodes of amaurosis fugax in the summer. She did not\nnotify a physician or seek care. When she saw her primary\ncare physician recently, she mentioned a carotid ultrasound\nwas obtained, which showed greater than 80% right carotid\nstenosis. She was referred after starting full-dose aspirin\nand maximum statin for urgent endarterectomy. She understood\nthe risks, including need for additional surgery, stroke,\ncranial nerve injury, bleeding.', 'medications': [{'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'CefTAZidime', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q48H', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 651.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference interval as of ___:. Upper limit (97.5th %ile) varies with ancestry and gender (male/female). whites 322/201 blacks 801/414 asians 641/313..'}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 230.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '16', 'valuenum': 16.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '60', 'valuenum': 60.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 7.2, 'valueuom': '%', 'ref_range_lower': 4.0, 'ref_range_upper': 6.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'ADA recommendations:. <7% goal of therapy. >8% warrants therapeutic action.'}, {'value': '___', 'valuenum': 160.0, 'valueuom': 'mg/dL', 'ref_range_lower': 68.0, 'ref_range_upper': 126.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '39.4', 'valuenum': 39.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '156', 'valuenum': 156.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.32', 'valuenum': 4.32, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.4', 'valuenum': 24.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '47.8', 'valuenum': 47.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.71', 'valuenum': 3.71, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.8', 'valuenum': 23.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '48.0', 'valuenum': 48.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 168.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '57', 'valuenum': 57.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '-6', 'valuenum': -6.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.33', 'valuenum': 7.33, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 38.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.78', 'valuenum': 3.78, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.5', 'valuenum': 25.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '46.9', 'valuenum': 46.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 243.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '57', 'valuenum': 57.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 73.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 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'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 118.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.8', 'valuenum': 26.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '204', 'valuenum': 204.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.33', 'valuenum': 3.33, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '46.5', 'valuenum': 46.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 127.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'At discharge: \nvitals: 98.4/98.0 66 116/54 16 95%RA\nAAOx3, no acute distress\nRRR\nCTA b/l \nAbdomen soft, non distended, non tender\nCNII-XII intact, following all commands, equal and good strength \nbilaterally, facial movements symmetric', 'diagnoses': [{'icd_code': 'S32391A', 'desc': 'Other fracture of right ilium, initial encounter for closed fracture'}, {'icd_code': 'T794XXA', 'desc': 'Traumatic shock, initial encounter'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'E1122', 'desc': 'Type 2 diabetes mellitus with diabetic chronic kidney disease'}, {'icd_code': 'I959', 'desc': 'Hypotension, unspecified'}, {'icd_code': 'D62', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': 'E872', 'desc': 'Acidosis'}, {'icd_code': 'E1165', 'desc': 'Type 2 diabetes mellitus with hyperglycemia'}, {'icd_code': 'D472', 'desc': 'Monoclonal gammopathy'}, {'icd_code': 'E875', 'desc': 'Hyperkalemia'}, {'icd_code': 'W108XXA', 'desc': 'Fall (on) (from) other stairs and steps, initial encounter'}, {'icd_code': 'Y92018', 'desc': 'Other place in single-family (private) house as the place of occurrence of the external cause'}, {'icd_code': 'D751', 'desc': 'Secondary polycythemia'}, {'icd_code': 'I129', 'desc': 'Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'N183', 'desc': 'Chronic kidney disease, stage 3 (moderate)'}, {'icd_code': 'Z79890', 'desc': 'Hormone replacement therapy'}], 'summary': 'CT Head ___: There is no evidence of acute intracranial \nprocess, specifically, there is no evidence of intracranial \nhemorrhage.\nMs. ___ was admitted for symptomatic right carotid artery \nstenosis. She underwent a R CEA on ___. The procedure went \nwithout any complications. Please see operative note for further \ndetails. During her post-operative period, she was complaining \nof a frontal headache. CT head was negative for any intracranial \npathology. Her headache slowly began to resolve. She was \npersistently hypertensive and on a maximum dose of a nitro drip. \nShe was transferred to the ICU for blood pressure control. Upon \ntransfer, her SBP remained lower than 140 without requiring any \ndrips. By ___, her headache was controlled, her neuro exam was \nintact and stable, and her SBP was well controlled without any \nIV medications. She was stable for discharge to home with ___ \nfor blood pressure checks.'}}	{'final_diagnoses': ['symptomatic right carotid stenosis'], 'procedures': ['Right carotid endarterectomy'], 'visit_summary': 'Ms. ___ was admitted for symptomatic right carotid artery \nstenosis. She underwent a R CEA on ___. The procedure went \nwithout any complications. Please see operative note for further \ndetails. During her post-operative period, she was complaining \nof a frontal headache. CT head was negative for any intracranial \npathology. Her headache slowly began to resolve. She was \npersistently hypertensive and on a maximum dose of a nitro drip. \nShe was transferred to the ICU for blood pressure control. Upon \ntransfer, her SBP remained lower than 140 without requiring any \ndrips. By ___, her headache was controlled, her neuro exam was \nintact and stable, and her SBP was well controlled without any \nIV medications. She was stable for discharge to home with ___ \nfor blood pressure checks.', 'medications_prescribed': ['1. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN pain \nRX oxycodone 5 mg 1 capsule(s) by mouth every six (6) hours \nDisp #20 Capsule Refills:*0', '2. Aspirin 81 mg PO DAILY', '3. Atorvastatin 80 mg PO QPM']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 62, 'gender': 'F', 'symptoms': '"I just got brought in because my wound got reopened..got into \nan\nargument with my girlfriend last night."', 'medical_history': ['PSYCHIATRIC HISTORY (INCLUDE PRIOR HOSPITALIZATIONS, OUTPATIENT\nTREATMENTS, MEDICATION/ECT HISTORY, RESPONSE TO TREATMENT,\nHISTORY OF HOMICIDAL/SUICIDAL/ASSAULTIVE BEHAVIOR):\n* ___ ___ s/p cutting arm with razor after an arguement \nwith\n his g.f.', '* ___ ___ weeks ago as he was having a "nervous \n breakdown " but did not feel that he wanted to continue\n treatment there', '* ___ @ ___ is no linger in treatment with him', '* ___ @ ___ Counseling ___ x1 for \n psychopharm.', 'PAST MEDICAL HISTORY (INCLUDE HISTORY OF HEAD TRAUMA, SEIZURES,\nOR OTHER NEUROLOGIC ILLNESS):\n* MVA last year resulting in bilateral fractures of both feet', '* wrist cutting ___ surgical repair of the laceration that\n severed several tendons and the muscle bellies'], 'family_history': '* sister with depression/anxiety and is on medications\n* father with anger issues{would throw glassware} but has never\n harmed the children', 'present_illness': 'The patient is a ___ yo cauc. male with his of depression, \nanxiety\nand alcohol and THC abuse who was biba that he called after an\naltercation with his g.f this morning.The patient and his g.f \ngot\ninto an argument last noc and he reports that he cut himself\nwith a piece of glass not to kill himself "but to feel pain."\nHe said this morning they continued to argue and " she beat me \nup\ngrabbed my hair and was hitting my head on concrete."During that\naltercation this morning his lac from last noc re-opened\nrequiring stitches in the ED. The patient said that he called \nthe\npolice this morning on his g.f and they saw his open wound\nbrought him to the ED while she ran out the back door.He said\nthat his g.f. wants to move back to ___ but despite their\nongoing problems he would prefer that they remain together.\nThe patient reports that he has been more depressed and anxious\nsince he was discharged from ___ in ___ when he had been\nadmitted after a similar incident and had cut himself on his L\nforearm deeply enough to require surgical repair.He is denying \nSI\ntoday but said that he goes home he will most likely cut himself\nagain.\nThe patient also reports that he has not seen his outpatient\ntreaters in over ___ weeks as he has lost his health insurance\nand cannot afford the co-pay but said he is in the process of\napplying for ___. \nHe also reports that several weeks ago he was went to\n___ as he was having a "nervous breakdown"\nbut he did not feel that they were helpful.\nIn speaking with his therapist ___ who\nreports that he has only seen the patient twice and that the\npatient did not continue with him as he couldn\'t afford the\nco-pay and had also lost his health insurance.He said the \npatient\nalso met with ___ on ___ and told them at that\nappointment that he had met with a psychiatrsit @ ___. \n___ the day before but did not plan to continue treatment there.', 'medications': [{'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Estradiol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ondansetron ODT', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '-6', 'valuenum': -6.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 10.3, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.33', 'valuenum': 7.33, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '280', 'valuenum': 280.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}], 'exams': 'PHYSICAL EXAMINATION:\nVS: BP: 120/72 HR: 109 temp: 98.8 resp: 18 O2 sat: 100%RA \nheight: 66in weight: 71.7lbs\n\nMENTAL STATUS EXAM:\n--appearance: ___ y/o M, appears stated age, dressed casually \nwith\nmultiple piercings and dyed hair, fair grooming with good eye\ncontact.\n--behavior/attitude: Cooperative, no PMR/PMA\n--speech: Somewhat loud, pressured but interruptible, normal\nprosody\n--mood (in patient\'s words): "I\'m great, I don\'t need to be \nhere"\n\n--affect: elevated, reactive, pt laughs inappropriately\n--thought content: Pt is perseverative on wanting to leave,\nwanting to know when he\'s going to leave, who he needs to talk \nto\nto leave, when his 3 day notice will be up, and getting his pain\nmedications. No delusions, paranoia.\n--thought process: Linear, logical, goal-directed\n--perception: Denies AVH\n--SI/HI: no SI/HI, maintains that his cutting was not an attempt\nto kill himself\n--insight: poor \n--judgment: poor\n--cognition: grossly intact\n\nPE:\nGeneral: Well-nourished, in no distress.\nHEENT: Normocephalic. PERRL, EOMI. Oropharynx clear.\nNeck: Supple, trachea midline. No adenopathy or thyromegaly.\nLungs: Clear to auscultation; no crackles or wheezes.\nCV: Tachycardia, regular rhythm; no murmurs/rubs/gallops; 2+\npedal pulses\nAbdomen: Soft, nontender, nondistended; no masses or\norganomegaly.\nExtremities: No clubbing, cyanosis, or edema.\nSkin: Warm and dry, no rash. 2 large scars on R forearm that\nappear to be healing well with no evidence of erythema or pus.\nNeurological:\n *Cranial Nerves-\n I: Not tested\n II: Pupils equally round and reactive to light\nbilaterally. Visual fields are full to confrontation.\n III, IV, VI: Extraocular movements intact bilaterally\nwithout nystagmus.\n V, VII: Facial strength and sensation intact and \nsymmetric.\n VIII: Hearing intact to voice.\n IX, X: Palatal elevation symmetrical.\n XI: Sternocleidomastoid and trapezius normal bilaterally.\n XII: Tongue midline without fasciculations.\n No gross focal motor or sensory deficits, normal gait.', 'diagnoses': [{'icd_code': '7837', 'desc': 'Adult failure to thrive'}, {'icd_code': '2989', 'desc': 'Unspecified psychosis'}, {'icd_code': 'V4987', 'desc': 'Physical restraints status'}, {'icd_code': '30500', 'desc': 'Alcohol abuse, unspecified'}, {'icd_code': '71945', 'desc': 'Pain in joint, pelvic region and thigh'}, {'icd_code': '2875', 'desc': 'Thrombocytopenia, unspecified'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '4275', 'desc': 'Cardiac arrest'}], 'summary': "___ 11:20AM GLUCOSE-91 UREA N-12 CREAT-0.9 SODIUM-142 \nPOTASSIUM-3.3 CHLORIDE-100 TOTAL CO2-27 ANION GAP-18\n___ 11:20AM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG \nbnzodzpn-NEG barbitrt-NEG tricyclic-NEG\n___ 11:20AM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG \ncocaine-NEG amphetmn-NEG mthdone-NEG\n___ 11:20AM WBC-9.2 RBC-5.53 HGB-16.3 HCT-47.3 MCV-86 \nMCH-29.4 MCHC-34.4 RDW-13.4\n___ 11:20AM NEUTS-66.4 ___ MONOS-4.5 EOS-1.4 \nBASOS-1.1\n___ 11:20AM PLT COUNT-270\n___ 11:20AM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 11:20AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 \nLEUK-NEG\nPsychiatric: Mr. ___ was admitted to the inpatient \npsychiatric unit at ___ on ___. He signed a CV on \nadmission. He was quite anxious on arrival, and felt that he did \nnot require an admission. He met with his care team and was \ncooperative with all interviews. He consistently denied any \nthoughts, plan, or intention of harming himself or anyone else. \nThe team elected to discontinue his wellbutrin, as this may have \nbeen activating him and thus worsening his impulsive behavior. \nThe team requested recent records from ___ \n___. He provided further history that a recent neck \nlaceration had occured during an altercation with police after \nhe had threatened to cut himself durign a fight with his \ngirlfriend. The patient did psychological testing, which showed \nhigh anxiety and borderline traits. These findings stemmed in \nparticular from difficulties interpersonal relationships, and \nwith his relationship with his girlfriend specifically. On ___, \nhe insisted on discharge from the inpatient unit, and the team \ndid not feel that he met criteria for ___. The team felt \nthat his anxiety would benefit from long term treatment with an \nSSRI, and recommended celexa in particular. His was given an \nappointment with an NP at his PCP's office for the week \nfollowing discharge. The team was unable to make contact with \nher to discuss whether she would feel comfortable continuing his \npsychopharm management, and so elected to discharge him without \na prescription, but with the recommendation that this would be \nan appropriate medication for him to start, should his PCP agree \nwith this plan and feel comfortable prescribing. He was unable \nto follow further at ___, as he had previously been unable to \nafford their co-pay, and his chart there had been closed. He \nshould be able to get a psychiatry and therapy referral through \nhis PCP at his next appointment. He continues to be at chronic \nrisk for suicide given his impulsivity, tendency toward \nself-harm, and ongoing housing with his girlfriend. However, he \nvoiced multiple coping strategies he would employ if he began to \nhave thoughts of hurting himself, including calling his mother \nand leaving the house. He also felt that his roommates would be \nable to provide emotional support. \n\nPsychosocial: He was quite social on the unit, frequently \nattending groups and speaking with other patients in the milieu. \n\n\nLegal: ___\nSafety: He remained in good behavioral control throughout the \nadmission. He was maintained on q 15 min checks and was housed \nin a 4 person room without difficulty."}}	{'final_diagnoses': ['Multi-Axial Diagnosis', 'Axis I - anxiety disorder NOS', 'Axis II - cluster B traits', 'Axis III - recent arm lacerations', 'Axis IV - relationship troubles, academic stress', 'Axis V - 55'], 'procedures': ['None'], 'visit_summary': "Psychiatric: Mr. ___ was admitted to the inpatient \npsychiatric unit at ___ on ___. He signed a CV on \nadmission. He was quite anxious on arrival, and felt that he did \nnot require an admission. He met with his care team and was \ncooperative with all interviews. He consistently denied any \nthoughts, plan, or intention of harming himself or anyone else. \nThe team elected to discontinue his wellbutrin, as this may have \nbeen activating him and thus worsening his impulsive behavior. \nThe team requested recent records from ___ \n___. He provided further history that a recent neck \nlaceration had occured during an altercation with police after \nhe had threatened to cut himself durign a fight with his \ngirlfriend. The patient did psychological testing, which showed \nhigh anxiety and borderline traits. These findings stemmed in \nparticular from difficulties interpersonal relationships, and \nwith his relationship with his girlfriend specifically. On ___, \nhe insisted on discharge from the inpatient unit, and the team \ndid not feel that he met criteria for ___. The team felt \nthat his anxiety would benefit from long term treatment with an \nSSRI, and recommended celexa in particular. His was given an \nappointment with an NP at his PCP's office for the week \nfollowing discharge. The team was unable to make contact with \nher to discuss whether she would feel comfortable continuing his \npsychopharm management, and so elected to discharge him without \na prescription, but with the recommendation that this would be \nan appropriate medication for him to start, should his PCP agree \nwith this plan and feel comfortable prescribing. He was unable \nto follow further at ___, as he had previously been unable to \nafford their co-pay, and his chart there had been closed. He \nshould be able to get a psychiatry and therapy referral through \nhis PCP at his next appointment. He continues to be at chronic \nrisk for suicide given his impulsivity, tendency toward \nself-harm, and ongoing housing with his girlfriend. However, he \nvoiced multiple coping strategies he would employ if he began to \nhave thoughts of hurting himself, including calling his mother \nand leaving the house. He also felt that his roommates would be \nable to provide emotional support. \n\nPsychosocial: He was quite social on the unit, frequently \nattending groups and speaking with other patients in the milieu. \n\n\nLegal: ___\nSafety: He remained in good behavioral control throughout the \nadmission. He was maintained on q 15 min checks and was housed \nin a 4 person room without difficulty.", 'medications_prescribed': ['none']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 38, 'gender': 'F', 'symptoms': 'DKA, GI Bleed', 'medical_history': ['- Hepatitis C x ___ years (presumed to have been contracted \nthrough intranasal cocaine use); c/b portal hypertension, \nvarices, refractory ascites, SBP. ', '- s/p liver transplant ___ ', '- DM on insulin ', '- ___ s/p RFA in ___ '], 'family_history': 'N/C', 'present_illness': 'Mr. ___ is a ___ h/o HCC/HCV cirrhosis s/p liver transplant \n___ on cyclosporine, CKD ___ immunosuppression, DM, HTN who \npresented in transfer to the ED with melena x24 hours. \nReportedly the patient was recently placed on indomethacin for a \ngout exacerbation and steroids, but over the last 24 hours he \ndeveloped melenic stool and light-headedness. He presented to \nOSH where he was found to have Hct 20; he was transfused 1u pRBC \nand transferred to ___ as his liver ___. \n\nOf note, patient is followed his for his liver transplant. He \nwas last seen in ___ by Dr. ___, at which time he had \nno acute complaints. \n\n In ED initial VS: 98.9, Hr 83, 155/78, RR 16, 98% RA\n Exam: guaiac positive stool at OSH, anicteric, no fluid wave,\n Labs notable for: WBC:15.8, Hgb:9.1, Plt:421. Lactate 1.3\n131\| 96\|137 AGap=24 \n-------------<346\n4.7\| 16\|3.3 \n___: 11.2 PTT: 26.7 INR: 1.0 \nlactate 1.3\nVBG: pH 7.34/ pCO2 33/ pO2 66/ HCO3 19 \nALT: <5 AP: 73 Tbili: 0.2 Alb: 3.5 \nAST: 6 \n Imaging notable for: CXR WNL\n Patient was given: 1u pRBC, IV Octreotide Acetate 50 mcg + gtt \nordered, 80 mg iv pantoprazole, 40 mEq KCl, 1g ceftriaxone\n Consults: GI/Hepatology and transplant surgery\n VS prior to transfer: HR 84, 148/80, RR 16, 97%RA\n\nOn arrival to the MICU, patient reports that he was doing well \nuntil 2 weeks ago when he developed knee pain and was diagnosed \nwith gout. His PCP started him on indomethacin 50 mg TID, which \nthe patient started taking, but had nausea and vomiting from the \nmedication, as well as abdominal discomfort. He was switched to \nprednisone 20 mg, but reports that after starting the prednisone \nhis blood glucose became hard to control, and it reached the \nmaximum on his glucometer, which prompted him to present to ___ \n___. He had also had some fatigue over the last few \ndays and lightheadedness. He reports 2 melenic stools in total, \nlast at noon on ___. No fevers, chills, no further vomiting \n(last 2 days ago), no changes in urination, no abdominal pain.\n', 'medications': [{'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ascorbic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'ZIPRASidone Hydrochloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Zonisamide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Cepastat (Phenol) Lozenge', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Hydrocortisone Cream 1%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.9', 'valuenum': 37.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '241', 'valuenum': 241.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.18', 'valuenum': 4.18, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM: \n========================\nVITALS: T 98.1 HR 95, 149/95, RR14, 98% RA\nGENERAL: Alert, oriented, no acute distress \nHEENT: Sclera anicteric, MMM, oropharynx clear, PERRL, EOMI \nNECK: supple, JVP not elevated, no LAD \nLUNGS: Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi \nCV: Regular rate and rhythm, normal S1 S2, no murmurs, rubs, \ngallops \nABD: soft, non-tender, non-distended, bowel sounds present, no \nrebound tenderness or guarding, no organomegaly \nEXT: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nSKIN: stasis dermatitis bilaterally\nNEURO: CN II-XII intact, strength ___ symmetric in upper and \nlower extremities, sensation grossly intact\n\nDISCHARGE EXAM\n==============\nVITALS: 98.7 ___ 82-114 ___ 94-98RA\nI/O: ___\nGENERAL: Alert, oriented, no acute distress, sitting in bed \nHEENT: Sclera anicteric, MMM, oropharynx clear \nNECK: supple\nLUNGS: Clear to auscultation bilaterally, no wheezes, \nCV: tachycardia, regular rhythm normal S1 S2, no murmurs\nABD: soft, non-tender, non-distended, bowel sounds present, no\nrebound tenderness or guarding\nEXT: Warm, well perfused, no edema, right knee with no\nsignificant effusion, slightly warm but no erythema, point\ntenderness along medial/lateral joint lines of R knee\nNEURO: CN II-XII intact, grossly normal strength and sensation', 'diagnoses': [{'icd_code': '2230', 'desc': 'Benign neoplasm of kidney, except pelvis'}, {'icd_code': '7595', 'desc': 'Tuberous sclerosis'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '34590', 'desc': 'Epilepsy, unspecified, without mention of intractable epilepsy'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '6264', 'desc': 'Irregular menstrual cycle'}], 'summary': '___ 04:05AM BLOOD WBC-15.8* RBC-2.78# Hgb-9.1# Hct-25.7# \nMCV-92 MCH-32.7 MCHC-35.4 RDW-12.2 RDWSD-41.4 Plt ___\n___ 04:05AM BLOOD Neuts-78* Bands-1 Lymphs-10* Monos-6 \nEos-1 Baso-0 ___ Metas-2* Myelos-2* AbsNeut-12.48* \nAbsLymp-1.58 AbsMono-0.95* AbsEos-0.16 AbsBaso-0.00\n___ 04:05AM BLOOD Hypochr-NORMAL Anisocy-NORMAL Poiklo-1+ \nMacrocy-NORMAL Microcy-NORMAL Polychr-NORMAL Burr-1+\n___ 04:05AM BLOOD Plt Smr-NORMAL Plt ___\n___ 04:55AM BLOOD ___ PTT-26.7 ___\n___ 04:05AM BLOOD Glucose-346 UreaN-137* Creat-3.3* \nNa-131* K-4.7 Cl-96 HCO3-16* AnGap-24\n___ 04:05AM BLOOD ALT-<5 AST-6 AlkPhos-73 TotBili-0.2\n___ 04:05AM BLOOD Albumin-3.5\n___ 07:46AM BLOOD Calcium-8.3 Phos-4.2 Mg-2.2\n___ 07:46AM BLOOD %HbA1c-7.8* eAG-177\n___ 07:46AM BLOOD Cyclspr-38\n___ 04:17AM BLOOD pO2-66* pCO2-33* pH-7.34* calTCO2-19* \nBase XS--6 Comment-GREEN\n___ 04:17AM BLOOD Lactate-1.3\n___ 09:17PM BLOOD Glucose-170\n___ 09:17PM BLOOD Hgb-9.2 calcHCT-28\n___ 09:33AM URINE Color-Straw Appear-Clear Sp ___\n___ 09:33AM URINE Blood-NEG Nitrite-NEG Protein-30 \nGlucose-300 Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG\n___ 09:33AM URINE RBC-0 WBC-0 Bacteri-NONE Yeast-NONE Epi-0\n\nPERTINENT LABS\n=============\n___ 04:34AM BLOOD WBC-10.0 RBC-3.04* Hgb-9.5* Hct-27.8* \nMCV-91 MCH-31.3 MCHC-34.2 RDW-14.2 RDWSD-46.5* Plt ___\n___ 04:34AM BLOOD Glucose-148* UreaN-49* Creat-2.7* Na-140 \nK-4.7 Cl-107 HCO3-23 AnGap-15\n___ 07:46AM BLOOD %HbA1c-7.8* eAG-177\n___ 07:46AM BLOOD Cyclspr-38\n___ 04:53AM BLOOD Cyclspr-91\n___ 04:34AM BLOOD Cyclspr-142\n\nDISCHARGE LABS\n=============\n___ 04:34AM BLOOD WBC-10.0 RBC-3.04 Hgb-9.5* Hct-27.8* \nMCV-91 MCH-31.3 MCHC-34.2 RDW-14.2 RDWSD-46.5* Plt ___\n___ 04:34AM BLOOD Plt ___\n___ 04:34AM BLOOD Glucose-148* UreaN-49* Creat-2.7* Na-140 \nK-4.7 Cl-107 HCO3-23 AnGap-15\n___ 04:34AM BLOOD Calcium-8.8 Phos-4.6* Mg-2.0\n___ 04:34AM BLOOD Cyclspr-142\n\nMICRO\n=====\n___ 5:10 am BLOOD CULTURE\n\n Blood Culture, Routine (Pending): \n\n___ 5:05 am BLOOD CULTURE\n\n Blood Culture, Routine (Pending):\n\n___ 9:33 am URINE Source: ___. \n\n FINAL REPORT ___\n\n URINE CULTURE (Final ___: NO GROWTH. \nMr. ___ is a ___ h/o HCC/HCV cirrhosis s/p liver transplant \n___ on cyclosporine, CKD ___ immunosuppression, DM, HTN who \npresented with melena x24hrs and hyperglycemia.\n\n# Melena\n# Anemia\n# Upper gastrointestinal bleeding - Patient presented with \nmelenic stools. He was found to have a substantial, symptomatic \nhematocrit drop from 9.9 to 5.5 in 15 hours. Patient had an \nelevated BUN and recent history of indomethacin and prednisone \nuse for gout, strongly suggesting UGIB etiology. Patient was \ntransferred to the MICU for close monitoring. EGD was performed \nand showed diffuse ulceration with no active bleeding in the \nstomach and duodenum. Patient was transfused with an increase in \nhis hemoglobin from 5.5 - 9.7 with two units implying likely \ndilutional component given aggressive fluid hydration due to DKA \n(see below). GI recommended BID pantoprazole 40mg BID x12weeks \nand then 40mg x3 months. Patient should resume a PPI should he \never take steroids again in the future. Hb 9.5 on day of \ndischarge. \n\n# Type 2 Diabetes Mellitus\n# Diabetic Ketoacidosis - Elevated blood glucose to 346 on \nadmission in this T2DM patient who was taking NPH/Humalog ISS at \nhome, likely in the setting of missed inuslin dose in ED and \nrecent steroids. Blood glucose on BMP subsequently rose to \n>1000. Mild acidosis on VBG, suggestive of symptomatic \nhyperglycemia. ___ was consulted. Patient was placed on an \ninsulin drip, received aggressive fluid hydration with NS, \ntransitioned to ___ NS when patient became hypernatremic. \nPatient transitioned to Lantus/Humalog with sliding scale. On \ndischarge, ___ recommended continuation of Lantus/Humalog \nwith consideration of starting Victoza as an outpatient. ___ \nat time of discharge ranging 155-222. HbA1C during this \nadmission was 7.8. \n- Insulin regimen at time of discharge:\n* Lantus 18U at bedtime with sliding scale\n\n# Acute on chronic kidney disease - Baseline Cr 2.3-2.6 in ___ \ndue to calcineurin inhibitors, with Cr 3.3 in setting of GIB and \nindomethacin administration. Patient was given fluid hydration \nas above after which his creatinine improved to 2.5-2.7.\n\n# Leukocytosis - Most likely hemoconcentrated on admission iso \nDKA, WBC 15.8k. White count subsequently downtrended to ___, \nthen increased to ___ at time of discharge. Suspect reactive \nprocess from bleed, infectious workup including blood and urine \ncultures was negative. No evolving signs of localizing infection \nthroughout admission, knee pain iso of gout as below. ___ count \n10k on day of discharge.\n\n# Gout - Indomethacin and prednisone were not continued as \nabove. After management of acute bleed and DKA, patient remained \nwith significant pain in R knee (tenderness along medial/lateral \njoint lines), though joint was not swollen or erythematous (it \nwas slightly warm). No palpable effusion. Pain seemed to improve \nwith APAP and lidocaine patch. Patient was cleared by ___ prior \nto discharge. Decision was made not to restart prednisone given \nrecent bleed and DKA and no recurrence of joint swelling. \nPatient may benefit from an intraarticular steroid injection as \nan outpatient if his pain continues. \n\n# Liver transplant ___ to ___ in ___ \n- Continued cyclosporine 100mg BID, goal (goal 75-110), levels \nwere 38 (___) and 91 (___\n\n# HTN - BP elevated after volume resuscitation. Home amlodipine, \nwhich had been held given bleed, was restarted after call out to \nthe floor. home metoprolol was restarted on day of discharge, \npatient normotensive.\n\n# ___ edema - Unclear etiology, patient was taking furosemide at \nhome. No evidence of edema on exam. Furosemide was not restarted \nat time of discharge. \n\n#Osteopenia \n- Continued vitamin D 5000 u/day \n- Continued Ca carbonate \n\n# Hx of HSV meningitis\n- Continued home acyclovir 400 mg BID \n\n# Hyperlipidemia/hypertriglyceridemia\n- Restarted gemfibrozil 600 mg BID at time of discharge'}}	{'final_diagnoses': ['Acute blood loss anemia', 'Gastric and duodenal ulcers', 'Type 2 diabetes mellitus', 'Diabetic ketoacidosis', 'Gout', 'HCV/HCC s/p liver transplant ', 'Hypertension'], 'procedures': ['EGD'], 'visit_summary': 'Mr. ___ is a ___ h/o HCC/HCV cirrhosis s/p liver transplant \n___ on cyclosporine, CKD ___ immunosuppression, DM, HTN who \npresented with melena x24hrs and hyperglycemia.\n\n# Melena\n# Anemia\n# Upper gastrointestinal bleeding - Patient presented with \nmelenic stools. He was found to have a substantial, symptomatic \nhematocrit drop from 9.9 to 5.5 in 15 hours. Patient had an \nelevated BUN and recent history of indomethacin and prednisone \nuse for gout, strongly suggesting UGIB etiology. Patient was \ntransferred to the MICU for close monitoring. EGD was performed \nand showed diffuse ulceration with no active bleeding in the \nstomach and duodenum. Patient was transfused with an increase in \nhis hemoglobin from 5.5 - 9.7 with two units implying likely \ndilutional component given aggressive fluid hydration due to DKA \n(see below). GI recommended BID pantoprazole 40mg BID x12weeks \nand then 40mg x3 months. Patient should resume a PPI should he \never take steroids again in the future. Hb 9.5 on day of \ndischarge. \n\n# Type 2 Diabetes Mellitus\n# Diabetic Ketoacidosis - Elevated blood glucose to 346 on \nadmission in this T2DM patient who was taking NPH/Humalog ISS at \nhome, likely in the setting of missed inuslin dose in ED and \nrecent steroids. Blood glucose on BMP subsequently rose to \n>1000. Mild acidosis on VBG, suggestive of symptomatic \nhyperglycemia. ___ was consulted. Patient was placed on an \ninsulin drip, received aggressive fluid hydration with NS, \ntransitioned to ___ NS when patient became hypernatremic. \nPatient transitioned to Lantus/Humalog with sliding scale. On \ndischarge, ___ recommended continuation of Lantus/Humalog \nwith consideration of starting Victoza as an outpatient. ___ \nat time of discharge ranging 155-222. HbA1C during this \nadmission was 7.8. \n- Insulin regimen at time of discharge:\n*** Lantus 18U at bedtime with sliding scale\n\n# Acute on chronic kidney disease - Baseline Cr 2.3-2.6 in ___ \ndue to calcineurin inhibitors, with Cr 3.3 in setting of GIB and \nindomethacin administration. Patient was given fluid hydration \nas above after which his creatinine improved to 2.5-2.7.\n\n# Leukocytosis - Most likely hemoconcentrated on admission iso \nDKA, WBC 15.8k. White count subsequently downtrended to ___, \nthen increased to ___ at time of discharge. Suspect reactive \nprocess from bleed, infectious workup including blood and urine \ncultures was negative. No evolving signs of localizing infection \nthroughout admission, knee pain iso of gout as below. ___ count \n10k on day of discharge.\n\n# Gout - Indomethacin and prednisone were not continued as \nabove. After management of acute bleed and DKA, patient remained \nwith significant pain in R knee (tenderness along medial/lateral \njoint lines), though joint was not swollen or erythematous (it \nwas slightly warm). No palpable effusion. Pain seemed to improve \nwith APAP and lidocaine patch. Patient was cleared by ___ prior \nto discharge. Decision was made not to restart prednisone given \nrecent bleed and DKA and no recurrence of joint swelling. \nPatient may benefit from an intraarticular steroid injection as \nan outpatient if his pain continues. \n\n# Liver transplant ___ to ___ in ___ \n- Continued cyclosporine 100mg BID, goal (goal 75-110), levels \nwere 38 (___) and 91 (___\n\n# HTN - BP elevated after volume resuscitation. Home amlodipine, \nwhich had been held given bleed, was restarted after call out to \nthe floor. home metoprolol was restarted on day of discharge, \npatient normotensive.\n\n# ___ edema - Unclear etiology, patient was taking furosemide at \nhome. No evidence of edema on exam. Furosemide was not restarted \nat time of discharge. \n\n#Osteopenia \n- Continued vitamin D 5000 u/day \n- Continued Ca carbonate \n\n# Hx of HSV meningitis\n- Continued home acyclovir 400 mg BID \n\n# Hyperlipidemia/hypertriglyceridemia\n- Restarted gemfibrozil 600 mg BID at time of discharge', 'medications_prescribed': ['Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild \nRX acetaminophen 500 mg 2 capsule(s) by mouth three times a day \nDisp #42 Capsule Refills:0 ', 'Lidocaine 5% Patch 1 PTCH TD DAILY knee pain \nRX lidocaine [Lidoderm] 5 % Please place over R knee once daily \nafter removing old patch Disp #1 Package Refills:0 ', 'Pantoprazole 40 mg PO Q12H \nRX pantoprazole 40 mg 1 tablet(s) by mouth twice a day Disp \n#180 Tablet Refills:0 ', 'Pen Needle (pen needle, diabetic) 31 gauge x ___ \nmiscellaneous up to 4x daily \nRX pen needle, diabetic 31 gauge x ___ Please use with \ninsulin pens to inject insulin Up to 4x daily as directed Disp \n#1 Package Refills:3 ', 'Glargine 18 Units Breakfast\nGlargine 0 Units Bedtime\nInsulin SC Sliding Scale using HUM Insulin\nRX insulin glargine [Lantus Solostar] 100 unit/mL (3 mL) AS DIR \n18 Units before BKFT; 0 Units before BED; Disp #1 Package \nRefills:3\nRX insulin lispro [Humalog KwikPen] 100 unit/mL AS DIR Up to 13 \nUnits QID per sliding scale Disp #1 Package Refills:3 ', 'Acyclovir 400 mg PO Q12H ', 'amLODIPine 10 mg PO DAILY ', 'Calcium Carbonate 500 mg PO DAILY ', 'CycloSPORINE (Neoral) MODIFIED 100 mg PO Q12H ', 'Furosemide 40 mg PO DAILY ', 'Gemfibrozil 600 mg PO BID ', 'Metoprolol Tartrate 50 mg PO BID ', 'Vitamin D 5000 UNIT PO DAILY ']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 81, 'gender': 'F', 'symptoms': 'Increased confusion, somnolence, poor PO intake', 'medical_history': ['Progressive cognitive impairment and gait difficulty with onset \nin her ___ requiring nursing home placement.', 'Chronic hypercarbic respiratory failure (baseline pCO2 ___', 'OSA', 'Obesity, with possible obesity hypoventilation', 'Asthma', 'Presumed dysphagia (daughter says she has coughed when eating \nfor a long time)', 'DM', 'HTN', 'HLD', 'GERD ', 'Generalized abdominal pain ', 'Depression'], 'family_history': 'Pt unable to relate', 'present_illness': '___ w/ DM2, OSA, recurrent hypercarbic respiratory failure \n(baseline pCO2 ___, and chronic decline in strength and \ncognition over ___ years requiring SNF placement, who presented \nwith several days of encephalopathy, somnolence, poor PO intake. \n\nIn the ED, RR was 44, BP 88/47, and temp was ___. she was found \nhave pCO2 of 112, suggesting acute-on-chronic hyeprcarbia as a \ncause of her encephalopathy and subacute decline. Na was 159, \npresumably from resultant poor PO fluid intake.\n\nShe was intubated, given 2L LR, transiently started on levophed \n(although BP was very fluid responsive), and was admitted to the \nFICU. \n\nCXR looked bad enough to be diagnostically nonspecific, but \nessentially showed multifocal infiltrates. She was initially \ntreated for possible multifocal pneumonia, but on review of her \nhistory, suspicion increased for this being cause by a \nprogression/exacerbation of her chronic problems. \n\nIn addition to OSA and obesity hypoventilation, it is suspected \nthat she has an as of yet undiagnosed progressive neurological \ncondition causing respiratory failure due to muscle weakness and \nalso chronic aspiration. After extubation, she was confirmed by \nspeech and swallow eval to have severe aspiration, and was made \nstrict NPO with placement of Dobbhoff for tube feeds. \nTransferred to the floor on nasal cannula O2 and nocturnal CPAP.', 'medications': [{'medication': 'Oxybutynin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Hydrocodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Methocarbamol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Alendronate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QSAT', 'doses_per_24_hrs': 0.0}, {'medication': 'Hydroxychloroquine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Methotrexate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': '1X/WEEK', 'doses_per_24_hrs': 0.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sulfasalazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '29.3', 'valuenum': 29.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '283', 'valuenum': 283.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.31', 'valuenum': 3.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '258', 'valuenum': 258.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'EXAM ON TRANSFER TO FLOOR:\nVITALS: 99.2, 65, 117/49, 16, 98% on 2L NC\nGENERAL: Alert and in no apparent distress, obese\nEYES: Anicteric, no conjunctival injection, pupils equally round\nCV: Heart regular, no appreciable murmur, no S3, no S4.\nRESP: Anterior auscultation with coarse breath sounds \nthroughout,\nbut good air movement bilaterally. On the left, there are coarse\ncrackles. She is not in overt respiratory distress.\nGI: Abdomen soft, obese, non-distended in all quadrants,\nnon-tender to palpation. No rebound or guarding.\nEXT: Warm and well perfused. No ___ edema.\nNEURO: Alert, oriented, face symmetric, gaze conjugate with \nEOMI,\nspeech fluent but her voice is soft and hoarse\nPSYCH: pleasant, appropriate mood and affect\n\nDISCHARGE EXAM:\n\nVITALS:\n\nPO 131 / 55 Lying 76 18 92 2L NC \nGEN: NAD\nChest: Patient wearing nasal canula, but speaking in complete \nsentences, with breath sounds throughout.\nABD: S/NT/ND +BS', 'diagnoses': [{'icd_code': '7140', 'desc': 'Rheumatoid arthritis'}, {'icd_code': 'V1588', 'desc': 'History of fall'}, {'icd_code': '7812', 'desc': 'Abnormality of gait'}, {'icd_code': '2768', 'desc': 'Hypopotassemia'}, {'icd_code': '72888', 'desc': 'Rhabdomyolysis'}, {'icd_code': '71590', 'desc': 'Osteoarthrosis, unspecified whether generalized or localized, site unspecified'}, {'icd_code': '3384', 'desc': 'Chronic pain syndrome'}, {'icd_code': '73300', 'desc': 'Osteoporosis, unspecified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}], 'summary': "VENOUS US LUE\n1. Acute thrombosis of the superficial vein of the left basilic \nvein.\n2. No evidence of deep vein thrombosis in the left upper \nextremity.\n\nMR BRAIN ___\n1. Small subacute infarct in the right cerebellum, similar \ncompared with ___.\n2. 1.0 cm mass foramen of magendie, exerting mild mass effect on \nthe posterior medulla, stable since ___, most likely \nsubependymoma. Meningioma is unlikely. Findings not consistent \nwith aneurysm. No hydrocephalus.\n\nMRI C-SPINE ___\n1. Markedly degraded study due to motion artifact.\n2. Mild asymmetry, hyperemia left lateral nasopharyngeal recess, \nmay be an artifact, it is indeterminate.\n3. Enlarged right thyroid lobe containing a 1.7 cm nodule, \nrecommend\nultrasound in further evaluation.\n4. Bilateral pulmonary opacities, consider pneumonia, refer to \nrecent chest x-rays and CT or further evaluation with chest \nx-ray if clinically\nappropriate.\n5. Advanced degenerative changes cervical spine, with multilevel \nmoderate to severe central canal narrowing, cord flattening.\n___ w/ DM2, OSA, recurrent hypercarbic respiratory failure \n(baseline pCO2 ___, and chronic decline in strength and \ncognition over ___ years requiring SNF placement, who presented \nwith encephalopathy and hypercarbic respiratory failure \nrequiring intubation. In addition to OSA and obesity \nhypoventilation, it is suspected that she has an as of yet \nundiagnosed progressive neurological condition causing \nrespiratory failure due to muscle weakness and also chronic \naspiration. She also had hypernatremia requiring free water \nrepletion, as well as dysphagia requiring tube feedings. After \ntransfer to the floor, neurology performed an EMG and sent off \nlab studies for myasthenia ___. However, a goals of care \nconference was held on ___ and the family decided that \n___ wishes would be to not receive tube feedings or a \ntracheostomy. She discharged to hospice, but will follow up with \nneurology in regards to her test results.\n\n#Hypotension w initial c/f sepsis\nInitially treated for possible multifocal pneumonia and possible \nseptic shock, but BP was extremely fluid responsive and - as \ncollateral was obtained - history was more suggestive of \nprogression of a chronic issue. \nShe had been treated for pneumonia at her nursing home. Fever to \n103 in the ED with leukocytosis initially to 14.6 and CXR read w \nc/f multifocal pneumonia. Given previous positive MRSA swab and \nESBL E. coli culture data with risk for aspiration, broad \nspectrum coverage with vancomycin and meropenem was started on \n___ but stopped the following day as suspicion for PNA \ndecreased, and she was extubated without complication on ___. \nUrine, blood, sputum cultures, urine legionella and strep pneumo \nantigens were negative. \n\n#Dysphagia \n#Goals of care conference\nSpeech and swallow evaluated and felt patient was unsafe for any\nPO intake. ___ placed on ___ by ___ team and she was \nstarted on tube feedings. Her dysphagia did not improve. As it \nbecame clear that her dysphagia was progressive rather than \nacute from her hospitalization, a goals of care conference was \nheld on ___. Her daughter and HCP ___, as well as many other \nfamily members, reported that ___ had on many occasions said \nshe would never want a feeding tube or a tracheostomy and \nventilator. Therefore, it was decided to remove the tube and let \nher eat and drink. She was discharged on hospice, and a MOLST \nwas completed stating DNR/DNI. However, she will still follow up \nwith neurology as below, as a diagnosis of myasthenia ___ \ncould potentially change her prognosis, and her neurologic \ndiagnosis is otherwise obscure.\n\n#Question of underlying neurological disorder\n#Acute and chronic hypercarbic respiratory failure\nAfter extubation, it became clear patient has had a steady \ndecline in muscle strength over the past ___ years, without good \nexplanation. SLP felt patient was not safe to swallow, and \nlikely had been aspirating for some time. Neurology saw patient \nand recommended further workup with MRI imaging at the time of \ntransfer to the floor. Combination of chronic aspiration and \nneuromuscular weakness likely causing her pulmonary disease. MRI \ndid not show any obvious explanation -- it showed an old stroke, \nand cervical cord compression, which would explain her upper \nextremity weakness. An EMG was obtained, as well as antibody \nstudies for myasthenia ___. She will follow up with neurology \nas an outpatient, as this could potentially change her \nprognosis.\n\nUnfortunately, the patient's mental status limited her ability \nto cooperate with CPAP, which she needs to prevent hypercarbia. \nThe decision to not proceed with a trach is discussed above.\n\n#Hypernatremia \nNa noted to be 159 upon arrival to ___. Likely due to poor PO \nintake and/or mobility issues limiting access to free water. She \nwas given IVF however Na was difficult to control. Eventually \ndecided to give D5W drip instead of boluses, and patient was \ntransferred to the floor on this. Na normalized on D5W and was \nremained stale on enteral free water flushes.\n\n#C Diff. Patient was noted to have diarrhea on the floor. C Diff \nwas positive, and she was started on PO vancomycin for recurrent \nC Diff. She will receive 9 more days.\n\n#VENOUS THROMBOSIS\nThe patient was found to have a provoked basilic vein thrombus \nat the site of her prior LUE PICC line. Technically it is not a \nDVT because it was only in the superficial portion of the \nbasilic vein prior to entry into the deep fascial compartment. \nShe was started on lovenox, but, given unclear risk benefit \nprofile, low threshold to discontinue if she has any bleeding \ncomplications. She will finish three months -- the last day on \n___. \n\n#H/o ESBL E. Coli UTI \nOn treatment course with ertapenem for E. Coli UTI at nursing \nhome (was on day 8 of 10 day course upon presentation). UA here \nbland and abx were discontinued at completion of predetermined \nten-day course. \n\nTRANSITIONAL ISSUES:\n- complete 9 additional days of PO vancomycin\n- complete 3 months of enoxaparin 120 mg SC BID (last day ___"}}	{'final_diagnoses': ['Hypercarbic respiratory failure, multifactorial', 'Dysphagia'], 'procedures': ['EMG -- ___'], 'visit_summary': "___ w/ DM2, OSA, recurrent hypercarbic respiratory failure \n(baseline pCO2 ___, and chronic decline in strength and \ncognition over ___ years requiring SNF placement, who presented \nwith encephalopathy and hypercarbic respiratory failure \nrequiring intubation. In addition to OSA and obesity \nhypoventilation, it is suspected that she has an as of yet \nundiagnosed progressive neurological condition causing \nrespiratory failure due to muscle weakness and also chronic \naspiration. She also had hypernatremia requiring free water \nrepletion, as well as dysphagia requiring tube feedings. After \ntransfer to the floor, neurology performed an EMG and sent off \nlab studies for myasthenia ___. However, a goals of care \nconference was held on ___ and the family decided that \n___ wishes would be to not receive tube feedings or a \ntracheostomy. She discharged to hospice, but will follow up with \nneurology in regards to her test results.\n\n#Hypotension w initial c/f sepsis\nInitially treated for possible multifocal pneumonia and possible \nseptic shock, but BP was extremely fluid responsive and - as \ncollateral was obtained - history was more suggestive of \nprogression of a chronic issue. \nShe had been treated for pneumonia at her nursing home. Fever to \n103 in the ED with leukocytosis initially to 14.6 and CXR read w \nc/f multifocal pneumonia. Given previous positive MRSA swab and \nESBL E. coli culture data with risk for aspiration, broad \nspectrum coverage with vancomycin and meropenem was started on \n___ but stopped the following day as suspicion for PNA \ndecreased, and she was extubated without complication on ___. \nUrine, blood, sputum cultures, urine legionella and strep pneumo \nantigens were negative. \n\n#Dysphagia \n#Goals of care conference\nSpeech and swallow evaluated and felt patient was unsafe for any\nPO intake. ___ placed on ___ by ___ team and she was \nstarted on tube feedings. Her dysphagia did not improve. As it \nbecame clear that her dysphagia was progressive rather than \nacute from her hospitalization, a goals of care conference was \nheld on ___. Her daughter and HCP ___, as well as many other \nfamily members, reported that ___ had on many occasions said \nshe would never want a feeding tube or a tracheostomy and \nventilator. Therefore, it was decided to remove the tube and let \nher eat and drink. She was discharged on hospice, and a MOLST \nwas completed stating DNR/DNI. However, she will still follow up \nwith neurology as below, as a diagnosis of myasthenia ___ \ncould potentially change her prognosis, and her neurologic \ndiagnosis is otherwise obscure.\n\n#Question of underlying neurological disorder\n#Acute and chronic hypercarbic respiratory failure\nAfter extubation, it became clear patient has had a steady \ndecline in muscle strength over the past ___ years, without good \nexplanation. SLP felt patient was not safe to swallow, and \nlikely had been aspirating for some time. Neurology saw patient \nand recommended further workup with MRI imaging at the time of \ntransfer to the floor. Combination of chronic aspiration and \nneuromuscular weakness likely causing her pulmonary disease. MRI \ndid not show any obvious explanation -- it showed an old stroke, \nand cervical cord compression, which would explain her upper \nextremity weakness. An EMG was obtained, as well as antibody \nstudies for myasthenia ___. She will follow up with neurology \nas an outpatient, as this could potentially change her \nprognosis.\n\nUnfortunately, the patient's mental status limited her ability \nto cooperate with CPAP, which she needs to prevent hypercarbia. \nThe decision to not proceed with a trach is discussed above.\n\n#Hypernatremia \nNa noted to be 159 upon arrival to ___. Likely due to poor PO \nintake and/or mobility issues limiting access to free water. She \nwas given IVF however Na was difficult to control. Eventually \ndecided to give D5W drip instead of boluses, and patient was \ntransferred to the floor on this. Na normalized on D5W and was \nremained stale on enteral free water flushes.\n\n#C Diff. Patient was noted to have diarrhea on the floor. C Diff \nwas positive, and she was started on PO vancomycin for recurrent \nC Diff. She will receive 9 more days.\n\n#VENOUS THROMBOSIS\nThe patient was found to have a provoked basilic vein thrombus \nat the site of her prior LUE PICC line. Technically it is not a \nDVT because it was only in the superficial portion of the \nbasilic vein prior to entry into the deep fascial compartment. \nShe was started on lovenox, but, given unclear risk benefit \nprofile, low threshold to discontinue if she has any bleeding \ncomplications. She will finish three months -- the last day on \n___. \n\n#H/o ESBL E. Coli UTI \nOn treatment course with ertapenem for E. Coli UTI at nursing \nhome (was on day 8 of 10 day course upon presentation). UA here \nbland and abx were discontinued at completion of predetermined \nten-day course. \n\nTRANSITIONAL ISSUES:\n- complete 9 additional days of PO vancomycin\n- complete 3 months of enoxaparin 120 mg SC BID (last day ___", 'medications_prescribed': ['Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild ', 'Enoxaparin Sodium 120 mg SC Q12H \nStart: Today - ___, First Dose: Next Routine Administration \nTime ', 'Guaifenesin-Dextromethorphan ___ mL PO Q4H:PRN cough ', 'Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY ', 'Vancomycin Oral Liquid ___ mg PO Q6H ', 'Bisacodyl 10 mg PO BID ', 'Docusate Sodium 100 mg PO BID ', 'Fluticasone-Salmeterol Diskus (100/50) 1 INH IH BID ', 'Ipratropium Bromide MDI 1 PUFF IH QID ', 'Ipratropium-Albuterol Neb 1 NEB NEB Q6H ', 'Senna 17.2 mg PO QHS ', 'Sertraline 200 mg PO DAILY ']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 67, 'gender': 'F', 'symptoms': 'Right Hip Fracture s/p Fall Out Of Scooter', 'medical_history': ['CAD s/p MI in ___', 'CHF (normal EF)', 'OSA (refuses BiPAP)', 'Type 2 DM c/b neuropathy, ?nephropathy', 'Benign Hypertension', 'Hyperlipidemia', 'Gout', 'Anxiety', 'Psoriasis", c/b RLE ulcers.', 'CKD baseline Cr 1.5'], 'family_history': 'Mother had MI in her sleep at age ___, father died of old age.', 'present_illness': 'This is a ___ year-old woman who presents with a R \nintertrochanteric femur fracture after a mechanical fall from \nher scooter. She was initially admitted to the ICU in the \nsetting of apneic/hypoxic episodes presumed to be from narcotics \n(she apparently received 3mg IV hydromorphone at OSH ED and 1mg \nadditional at ___ ED).\n\nOn ___, she was electively intubated and went to the OR for \nintramedullary rod fixation of the right hip fracture. She was \nkept intubated overnight and extubated this am without event. \nFor hct drop, she was transfused 1 unit pRBCs this am, with \nsubsequent stable hct. In the ICU, her SBP has been persistently \nin the ___, although she remains asymptomatic with good UOP. \n\nOn arrival to the floor, she noted ___ hip pain, but denied \nfever, chills, night sweats, chest pain, shortness of breath, \ncough, wheeze, abdominal pain, nausea, vomiting, diarrhea, \nconstipation, dysuria, black or bloody stools, lightheadedness \nor dizziness. This morning she reports good control of her \npain.', 'medications': [{'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Hydrocodone-Acetaminophen (5mg-325mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'ClonazePAM', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Loratadine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Readi-Cat 2 (Barium Sulfate 2% Suspension)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'ClonazePAM', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Fluticasone Propionate NASAL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NU', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39.0', 'valuenum': 39.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '209', 'valuenum': 209.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.41', 'valuenum': 4.41, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 129.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 135.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 23.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'NO CLOT.'}, {'value': '39.7', 'valuenum': 39.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '248', 'valuenum': 248.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.46', 'valuenum': 4.46, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 122.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '213', 'valuenum': 213.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.02', 'valuenum': 4.02, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 23.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 144.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39.2', 'valuenum': 39.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '237', 'valuenum': 237.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.47', 'valuenum': 4.47, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'VITAL SIGNS: 99.2 105/43 96 24 93%2L \nGENERAL: Obese female in NAD \nHEENT: MMM \nCV: RRR, II/VI systolic murmur at LUSB \nLUNGS: Clear to auscultation bilaterally with mild crackles at \nbases, has wet cough \nABD: Soft, obese, NT, ND, no masses or organomegaly, BS+ \nEXT: WWP, mild ankle edema. RLE wrapped with bandage. Wiggles \ntoes bilaterally, <2 sec cap refill, sensation in toes intact to \nlight touch. Has multiple lower extremity healing ulcerations.', 'diagnoses': [{'icd_code': '2396', 'desc': 'Neoplasm of unspecified nature of brain'}, {'icd_code': '3485', 'desc': 'Cerebral edema'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '4739', 'desc': 'Unspecified sinusitis (chronic)'}, {'icd_code': '30001', 'desc': 'Panic disorder without agoraphobia'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '73300', 'desc': 'Osteoporosis, unspecified'}, {'icd_code': 'V4365', 'desc': 'Knee joint replacement'}, {'icd_code': 'V4364'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}], 'summary': "Admission Labs:\n___ 11:15PM WBC-15.0* RBC-3.98* HGB-11.5* HCT-36.1 MCV-91 \nMCH-28.8 MCHC-31.8 RDW-15.7\n___ 11:15PM PLT COUNT-267\n___ 11:15PM NEUTS-82 BANDS-0 LYMPHS-12* MONOS-4 EOS-2 \nBASOS-0 ___ MYELOS-0\n___ 11:15PM ___ PTT-23.0 ___\n___ 11:15PM GLUCOSE-203* UREA N-43* CREAT-1.5* SODIUM-142 \nPOTASSIUM-5.4* CHLORIDE-109* TOTAL CO2-25 ANION GAP-13\n___ 11:15PM CALCIUM-8.8 PHOSPHATE-4.9* MAGNESIUM-1.5\n___ 11:15PM CK-MB-3\n___ 11:15PM cTropnT-0.01\n\nOther Pertinent Labs:\n___ 12:17PM GLUCOSE-206 LACTATE-2.1* NA+-143 K+-6.3* \nCL--107\n___ 02:23PM TYPE-ART PO2-65* PCO2-69* PH-7.13* TOTAL \nCO2-24 BASE XS--7 INTUBATED-NOT INTUBA\n\nDischarge Labs:\n___ 06:30AM BLOOD WBC-8.1 RBC-2.80* Hgb-7.9* Hct-25.4* \nMCV-91 MCH-28.3 MCHC-31.2 RDW-15.6* Plt ___\n___ 06:30AM BLOOD Glucose-137* UreaN-29* Creat-1.3* Na-144 \nK-4.2 Cl-110* HCO3-27 AnGap-11\n___ 06:30AM BLOOD Calcium-7.4* Phos-2.3* Mg-2.2\n\nStudies:\n\n___ ECG: Sinus rhythm. Non-specific ST-T wave changes in the \nlateral leads. No previous tracing available for comparison. \n\n___ Chest Xray: Single portable chest radiograph is reviewed. \nThe lung volumes are low. Cardiac silhouette appears enlarged, \nthough abundantly exaggerated by technique. There is increased \nopacity at the left base, increased from one day prior. This may \nreflect atelectasis, although evolving pneumonia is not \nexcluded. It appears to be a mild degree of volume overload, \nwithout large effusion. There is no pneumothorax. Marked \ndegenerative changes are identified in the visualized thoracic \nspine. \n\n___ Right femur xray: Eight intraoperative radiographs were \nperformed in the operating room for operative assistance without \na radiologist present. These demonstrate an intratrochanteric \nright proximal femoral fracture, which appears comminuted. There \nis evidence of placement of a gamma nail fixation with a long \nfemoral intramedullary rod. Pre-existing right total knee \narthroplasty is evident. For full details, please consult the \noperative report. \n\n___ Chest Xray (preliminary read): S/p removal of ET tube, no \nother significant change.\n___ year old female with CAD s/p MI, chronic diastolic CHF and \npsoriasis who presented after a scooter accident with right hip \nfracture now s/p repair. \n\n#. Closed femur fracture with acute blood loss anemia:\nShe presented with right hip fracture and underwent surgical \nrepair on ___ without complication. She was given 1 unit of \npacked red cells post-operatively for a small hematocrit drop \nand her hematocrit subsequently remained stable. She was \nstarted on SC heparin instead of Lovenox given her acute renal \nfailure for DVT prophylaxis. She is weight bearing as tolerated \non both lower extremities. She was seen by the physical therapy \nteam who recommended rehab placement. Her pain was controlled \npost-operatively with standing Tylenol and oxycodone.\n\n#. Hypoxia:\nShe was mildly hypoxic post-operatively felt to be due to a \ncombination of CO2 retention in the setting of OSA, atelectasis, \nand narcotic use for pain. She refused to wear CPAP during this \nadmission and her oxygen requirements decreased \npost-operatively. At discharge she was still requiring 2L O2. \nIt is important for her to continue incentive spirometry after \ndischarge.\n\n#. Acute on chronic kidney disease Stage III:\nHer creatinine increased to 1.9 during this admission from a \npresumed baseline of 1.3-1.5 of stage III CKD. We were unable \nto validate her baseline creatinine and her kidney function \nshould be followed after discharge. Her creatinine improved to \n1.3 with IV fluid hydration post-operatively and it was felt \nthat she had prerenal azotemia in the setting of her hip \nfracture. Her outpatient ___ was restarted prior to discharge \nbut held during most of her stay.\n\n#. Type 2 Diabetes Mellitus Uncontrolled with Complications:\nShe was managed with her home insulin regimen post-operatively. \nActos and glimeprimide were held during her stay but restarted \nat discharge.\n\n#. CAD s/p MI:\nShe would likely benefit from aspirin treatment as an outpatient \nbut this was deferred to her PCP.\n\n#. Chronic diastolic CHF:\nHer home Lasix dose was initially held due to acute renal \nfailure but was restarted prior to discharge. She may need \nbetter heart rate control to optimize her CHF treatment.\n\n#. Benign Hypertension:\nHer blood pressure was slightly elevated on admission and \npost-operatively and her antihypertensives were restarted prior \nto discharge.\n\n#. Hyperlipidemia: She was continued on her statin and her \nfenofibrate was held during this admission. \n \n#. Gout: Continued on allopurinol.\n \n#. Psoriasis c/b RLE ulcers: She receives methotrexate weekly \nwhich she was not due for during this hospitalization. It \nshould be resumed at discharge although her dose could not be \nconfirmed during her stay as her primary care doctor's office \nwas closed.\n \n#. Prior cellulitis:\nShe reported recent antibiotic use on admission for a possible \ncellulitis although had no signs of cellulitis on physical exam. \n She was given antibiotics perioperatively and then was not \ncontinued on them"}}	{'final_diagnoses': ['Right subtrochanteric femur fracture', 'Type 2 Diabetes Mellitus', 'Obstructive Sleep Apnea', 'Hypertension'], 'procedures': ['Intramedullary rod fixation of right peritrochanteric hip fracture.'], 'visit_summary': "___ year old female with CAD s/p MI, chronic diastolic CHF and \npsoriasis who presented after a scooter accident with right hip \nfracture now s/p repair. \n\n#. Closed femur fracture with acute blood loss anemia:\nShe presented with right hip fracture and underwent surgical \nrepair on ___ without complication. She was given 1 unit of \npacked red cells post-operatively for a small hematocrit drop \nand her hematocrit subsequently remained stable. She was \nstarted on SC heparin instead of Lovenox given her acute renal \nfailure for DVT prophylaxis. She is weight bearing as tolerated \non both lower extremities. She was seen by the physical therapy \nteam who recommended rehab placement. Her pain was controlled \npost-operatively with standing Tylenol and oxycodone.\n\n#. Hypoxia:\nShe was mildly hypoxic post-operatively felt to be due to a \ncombination of CO2 retention in the setting of OSA, atelectasis, \nand narcotic use for pain. She refused to wear CPAP during this \nadmission and her oxygen requirements decreased \npost-operatively. At discharge she was still requiring 2L O2. \nIt is important for her to continue incentive spirometry after \ndischarge.\n\n#. Acute on chronic kidney disease Stage III:\nHer creatinine increased to 1.9 during this admission from a \npresumed baseline of 1.3-1.5 of stage III CKD. We were unable \nto validate her baseline creatinine and her kidney function \nshould be followed after discharge. Her creatinine improved to \n1.3 with IV fluid hydration post-operatively and it was felt \nthat she had prerenal azotemia in the setting of her hip \nfracture. Her outpatient ___ was restarted prior to discharge \nbut held during most of her stay.\n\n#. Type 2 Diabetes Mellitus Uncontrolled with Complications:\nShe was managed with her home insulin regimen post-operatively. \nActos and glimeprimide were held during her stay but restarted \nat discharge.\n\n#. CAD s/p MI:\nShe would likely benefit from aspirin treatment as an outpatient \nbut this was deferred to her PCP.\n\n#. Chronic diastolic CHF:\nHer home Lasix dose was initially held due to acute renal \nfailure but was restarted prior to discharge. She may need \nbetter heart rate control to optimize her CHF treatment.\n\n#. Benign Hypertension:\nHer blood pressure was slightly elevated on admission and \npost-operatively and her antihypertensives were restarted prior \nto discharge.\n\n#. Hyperlipidemia: She was continued on her statin and her \nfenofibrate was held during this admission. \n \n#. Gout: Continued on allopurinol.\n \n#. Psoriasis c/b RLE ulcers: She receives methotrexate weekly \nwhich she was not due for during this hospitalization. It \nshould be resumed at discharge although her dose could not be \nconfirmed during her stay as her primary care doctor's office \nwas closed.\n \n#. Prior cellulitis:\nShe reported recent antibiotic use on admission for a possible \ncellulitis although had no signs of cellulitis on physical exam. \n She was given antibiotics perioperatively and then was not \ncontinued on them", 'medications_prescribed': ['1. Allopurinol ___ mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '2. Atacand 32 mg Tablet Sig: One (1) Tablet PO once a day.', '3. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO twice a day as \nneeded for anxiety.', '4. Fenofibrate 160 mg Tablet Sig: One (1) Tablet PO once a day.', '5. Tenoretic 50 50-25 mg Tablet Sig: One (1) Tablet PO once a \nday.', '6. Methotrexate Sodium 2.5 mg Tablet Sig: Unknown dose - please \nconfirm with PCP who is open on ___ Tablet PO once \na week: On ___.', '7. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '8. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO once a day.', '9. Humalog Mix ___ 100 unit/mL (75-25) Suspension Sig: Thirty \nTwo (32) units Subcutaneous twice a day.', '10. Actos 15 mg Tablet Sig: One (1) Tablet PO once a day.', '11. Amaryl 4 mg Tablet Sig: One (1) Tablet PO twice a day.', '12. Lipitor 40 mg Tablet Sig: One (1) Tablet PO once a day.', '13. Acetaminophen 650 mg Tablet Sig: One (1) Tablet PO every six \n(6) hours.', '14. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) \nTablet, Chewable PO three times a day.', '15. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2) \nTablet PO DAILY (Daily).', '16. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO twice \na day.', '17. Senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day as \nneeded for constipation.', '18. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical QID \n(4 times a day) as needed for rash.', '19. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 \nhours) as needed for pain.']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 52, 'gender': 'M', 'symptoms': 'shortness of breath', 'medical_history': ['COPD, severe with baseline O2 requirement of ___', '-Never intubated. Frequent hospitalizations', 'CAD s/p 2V CABG in ___ (LIMA to LAD and Radial artery graft to \nMid circumflex).', 'Mitral valve mechanical replacement ___ rheumatic mitral \nstenosis', '-chronic anticoagulation with goal INR 3.0 (range 2.5-3.5)', 'Aortic Insufficiency ___ rheumatic heart disease', 'history of multiple sternal wound infections -- ___', "Stress Cardiomypathy (Takatsubo's)", "history of coronary vasospasm (Prinzmetal's Angina)", 'Atypical chest pain with chronic chest pain syndrome', 'Depression/anxiety/panic disorder', 'Hypothyroidism', 'Hyperlipidemia', 's/p cholecystectomy', 'Psoriasis', 'Non-bleeding gastropathy', 'GERD', 'Hemorrhoids'], 'family_history': 'Mother: Died colon cancer ___\nFather: Died MI ___\n___: 1 Sister died of AIDS, 4 other siblings alive and well', 'present_illness': "___ year old woman with PMH Rheumatic mitral stenosis s/p St \nJudes MVR ___, ___, ___ on \n\nwarfarin, complicated by Staph sternal wound infection and \nchronic chest pain, CABG at time of MVR (LIMA-LAD, radial-LCx) \nwith \nsubsequent normal cors on repeat cath, h/o stress cardiomyopathy \n\n___, moderate PHTN, severe COPD on 3L home O2, aortic \ninsufficiency, hypothyroidism, psoriasis, presenting as a direct \nadmission for worsening shortness of breath.\n\nStates that starting about a week ago she feels like she has \ngained weight. Over this time period notes worsening shortness \nof breath with exertion. States at baseline can walk around 50ft \nbefore having to rest but currently it's about 25ft. Cannot walk \nup a flight of stairs. Has paroxysmal nocturnal dyspnea and \northopnea. Sleeps on 3 pillows and sometimes upright. Notes a \nslightly worsening productive cough and occasional wheezing. \nUses albuterol inhaler about ___. States that over the \nholidays her diet was a little more liberal with salt intake. \nFeels like she's been feeling more thirsty and lightheaded and \nfelt near syncope 2 days ago: felt hot & sweaty with darkening \nof vision but resolved with sitting down. \n\nEndorses chest pain that has been present for years since \ncomplications of her CABG. Pain is worse with inspiration and \nmovement. Pain is controlled with oxycodone pain medication. \nDenies palpitations, n/v, constipation, fevers, chills, swollen \nankles. Endorses abdominal pain below right and left ribcage \nthat is crampy and tender and lasts few minutes at a time but is \ntender to palpation. Not worsened or relieved by anything. \n\nOf note, recently admitted with CP and had a LHC showing \ninsignificant CAD w/ atretic bypass grafts LIMA to LAD and \nradial SVG to OMB. \n\nROS: On review of systems, denies any prior history of stroke, \nTIA, deep venous thrombosis, pulmonary embolism, bleeding at the \ntime of surgery, myalgias, joint pains,, hemoptysis, black \nstools or red stools. Denies recent fevers, chills or rigors. \nDenies exertional buttock or calf pain. All of the other review \nof systems were negative.", 'medications': [{'medication': 'MoviPrep', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '30.8', 'valuenum': 30.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '210', 'valuenum': 210.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.61', 'valuenum': 3.61, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 78.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.1', 'valuenum': 36.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '280', 'valuenum': 280.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.96', 'valuenum': 3.96, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.8', 'valuenum': 6.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM:\n=======================\nVS: 98.8 103 105/62 18 97% 3L\nAdmission weight: 77kg. Last discharge wt: 77.8kg\nGENERAL: WDWN female in NAD. Oriented x3. Mood, affect \nappropriate.\nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa. No xanthelasma.\nNECK: Supple with no JVD at 90deg.\nCARDIAC: PMI located in ___ intercostal space, midclavicular \nline. RR, normal S2. S1 w/ mechanical click c/w MVR. Precordial \ndiastolic murmur. No thrills, lifts.\nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp \nwere unlabored, no accessory muscle use. Diffuse bilateral \nwheezes.\nCHEST: tender to palpation anteriorly and along R & L inferior \nrib cage\nABDOMEN: Soft, NTND. No HSM or tenderness.\nEXTREMITIES: No cyanosis, clubbing. Trace pedal edema.\nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. Mild \nsilver scaly pink eruption on chest.\nPULSES: Distal pulses palpable and symmetric\n\nDISCHARGE PHYSICAL EXAM:\n=======================\nVS 98.5 90/46 66 20 100% 3L NC\nWt: 79kg \nGENERAL: WDWN female in NAD. Oriented x3. Mood, affect \nappropriate.\nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa. No xanthelasma.\nNECK: Supple with JVD mid neck at 90deg.\nCARDIAC: RR, normal S2. S1 w/ mechanical click c/w MVR. No \nthrills, lifts. Soft systolic murmur.\nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp \nwere unlabored, no accessory muscle use. Mild bilateral wheezes.\nCHEST: tender to palpation anteriorly and along R & L inferior \nrib cage\nABDOMEN: Soft, NTND. No HSM or tenderness.\nEXTREMITIES: No cyanosis, clubbing. Trace pedal edema.\nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. Mild \nsilver scaly pink eruption on chest.\nPULSES: Distal pulses palpable and symmetric', 'diagnoses': [{'icd_code': '5789', 'desc': 'Hemorrhage of gastrointestinal tract, unspecified'}, {'icd_code': '2851', 'desc': 'Acute posthemorrhagic anemia'}], 'summary': "ADMISSION LABS:\n==============\n___ 06:40PM BLOOD WBC-9.0 RBC-3.61* Hgb-11.1* Hct-33.4* \nMCV-93 MCH-30.7 MCHC-33.2 RDW-12.2 RDWSD-40.5 Plt ___\n___ 01:40PM BLOOD ___\n___ 01:40PM BLOOD UreaN-19 Creat-1.1 Na-137 K-2.5* Cl-82* \nHCO3-40* AnGap-18\n___ 06:13PM BLOOD ALT-15 AST-18 AlkPhos-87 TotBili-0.2\n___ 01:41PM BLOOD ___ pO2-33* pCO2-76* pH-7.34* \ncalTCO2-43* Base XS-10 Comment-GREEN TOP\n___ 06:29PM BLOOD Hgb-9.4* calcHCT-28 O2 Sat-70\n\nDISCHARGE AND PERTINENT LABS\n==========================\n___ 08:00AM BLOOD WBC-8.8 RBC-3.22* Hgb-9.6* Hct-31.2* \nMCV-97 MCH-29.8 MCHC-30.8* RDW-14.1 RDWSD-50.4* Plt ___\n___ 08:00AM BLOOD ___ PTT-39.7* ___\n___ 08:00AM BLOOD Glucose-123* UreaN-20 Creat-1.1 Na-142 \nK-3.8 Cl-98 HCO3-34* AnGap-14\n___ 01:00AM BLOOD CK(CPK)-43\n___ 03:00PM BLOOD CK-MB-4 cTropnT-0.07\n___ 08:00AM BLOOD Calcium-9.5 Phos-4.7 Mg-2.1\n___ 07:00AM BLOOD VitB12-311 Folate-7.3\n___ 01:41PM BLOOD ___ pO2-33* pCO2-76* pH-7.34* \ncalTCO2-43* Base XS-10 Comment-GREEN TOP\n___ 05:37PM BLOOD Type-ART pO2-115* pCO2-52* pH-7.35 \ncalTCO2-30 Base XS-2\n___ 01:41PM BLOOD Lactate-2.8*\n___ 03:39PM BLOOD Lactate-0.7\n\nIMAGING/STUDIES:\n==============\nCXR ___\nIn comparison with the study of ___, the patient \nhas taken a \nbetter inspiration. The cardiac silhouette is within normal \nlimits with \nevidence of a prosthetic mitral valve an intact midline sternal \nwires. No \ndefinite vascular congestion or pleural effusion at this time. \nNo acute focal pneumonia. No evidence of displacement of the \ntrachea to suggest thyroid mass. \n\nRight CARDIAC CATH ___\n- upper normal right heart pressures PCW 11mmHg, PA 35/15, \nnormal cardiac index 2.6 \n\nTTE ___\nThe left atrium is elongated. There is mild symmetric left \nventricular hypertrophy with normal cavity size and global \nsystolic function (LVEF>55%). Due to suboptimal technical \nquality, a focal wall motion abnormality cannot be fully \nexcluded. Tissue Doppler imaging suggests an increased left \nventricular filling pressure (PCWP>18mmHg). Right ventricular \nchamber size and free wall motion are normal. The diameters of \naorta at the sinus, ascending and arch levels are normal. A \n___ aortic valve bioprosthesis is present. The transaortic \ngradient is normal for this prosthesis. The aortic valve VTI = \n45 cm. Trace aortic regurgitation is seen. A bileaflet mitral \nvalve prosthesis is present. The mitral prosthesis appears well \nseated, with normal leaflet/disc motion and transvalvular \ngradients. Physiologic mitral regurgitation is seen (within \nnormal limits). Moderate to severe [3+] tricuspid regurgitation \nis seen. There is mild pulmonary artery systolic hypertension. \nThere is no pericardial effusion. \nIMPRESSION: Suboptimal image quality. Well-seated, normally \nfunctioning aortic ___ with trace aortic insufficiency. \nModerate to severe tricuspid regurgitation. Mild pulmonary \nartery systolic hypertension.\nCompared with the prior study (images reviewed) of ___, \nthere has been interval placement of an aortic ___ \nprosthesis. The severity of aortic regurgitation has decreased. \nThe severity of tricuspid regurgitation has increased. \n\nMICROBIOLOGY:\n=============\n___ 10:40 pm Staph aureus Screen\n Source: Nasal swab NARES AXILLA. \n\n Staph aureus Screen (Preliminary): \n STAPH AUREUS COAG +.\nBrief Hospital Course:\nPatient is a ___ yo Woman with a hx. of mitral stenosis s/p MVR \non Coumadin with 3V CABG in ___, recent history of stress \ncardiomyopathy, aortic regurgitation, and COPD on home oxygen \nwho presented with worsening shortness of breath, chest pain, \nand nausea. \n\nFloor course ___\n#SOB: Worsening over the last week with a mild cough with green \nsputum and occasional wheezing. Patient states subjectively \ngaining weight but stable since last discharge. Most likely \ncause was mild COPD exacerbation given increased cough, \nwheezing. Patient was continued on home 3L O2\n\n#Hypotension: Patient was hypotensive with systolics in the \n___. Lactate was elevated to 2.8. Appeared dry given \nincreased diuresis prior to admission, although did have \nelevated JVP, but most likely due to tricuspid regurgitation. \nHome nifedipine was discontinued. Decision was made for a right \nheart cath with continuous motoring in the intensive care unit \nto assess cardiac function. Patient was transferred to the \ncardiac ICU for further monitoring. \n\n#Valvular disease: Aortic Insufficiency/AS, Mechanical MVR: Plan \nfor TAVR on ___. Home warfarin was discontinued and heparin \ndrip was started in anticipation of procedure. \n\n#Congestive heart failure with preserved ejection fraction: \nDiuresis was held given low blood pressures.\n\n#COPD - has hx of severe COPD (FEV1 23%). Continued on home 3L \nof O2, albuterol and ipratropium nebs and \nfluticasone-salmeterol. Transferred to Cardiac ICU for further \ntreatment. \n\n#Hypokalemia - had increased diuresis day prior to admission \nwith IV lasix 80mg on top of home lasix 80QAM and 40QPM and \npossibly didn't take her K supplements as scheduled. Was \nswitched to torsemide 60mg day prior admission in clinic. \n\n#Chest pain: Chronic issue and tender to palpation, controlled \nwith home oxycodone.\n\nCCU COURSE ___: \nThe patient was transferred to the ICU for hypotension of \nunknown etiology and received a right heart catheterization to \nhelp guide management. She was given 1L of IVF with resolution \nof her hypotension, which was thought to be secondary to poor PO \nintake and increased diuresis. Her shortness of breath was \nsimilar to her symptoms on the floor, however Pulmonary was \nconsulted for optimization prior to TAVR for aortic \ninsufficiency. They recommended treatment for COPD exacerbation \nwith a prednisone taper: (60mg x 7 days total and then taper\nas follows: 40mg x 3 days, 20 mg x 2 days, 10mg x 2 days for a \ntotal duration of 2 weeks) and azithromycin. In addition dental \nand vascular surgery were consulted for TAVR clearance/access \noptions respectively.\n\nFloor Course ___ to ___\nPatient transferred back to floor to await TAVR procedure on \n___. Diuresis with torsemide 40mg was attempted with \nnegative 2L in fluids and patient became slightly hypotensive to \nsystolic in the ___ and received small fluid boluses with \nresolution of hypotension. Patient had a dental extraction of \nher remaining teeth on ___ in anticipation of the TAVR \nprocedure. Went for TAVR procedure on ___ and transferred to \nthe cardiac ICU afterward. \n\nCCU COURSE ___\nThe patient was transferred to the CCU after TAVR on ___ \nwith 26 mm ___ Evolut-R via transfemoral approach. The \npatient was noted to have trace-mild paravalvular leak following \nthe procedure. The patient was continued on aspirin and Plavix \nafter the procedure. Repeat echocardiogram ___ hours after \nprocedure showed aortic ___ prosthesis in place, the \nseverity of aortic regurgitation had decreased while the \nseverity of tricuspid regurgitation had increased. Her final \ntreatment consisted of aspirin 81 mg daily and warfarin with \nheparin drip (due to concomitant MVR s/p mechanical valve). \n\nFloor Course (___)\nPatient was transferred back to the floor from the cardiac ICU \non ___. Noted improved SOB. Was continued on prednisone taper \nwith 20mg to be taken on ___ then 10mg the next 2 days to \ncomplete a 14 day course. Patient clinically appeared to be \nretaining fluids and was restarted on torsemide 40mg daily (down \nfrom home dose of 60mg). Heparin drip was discontinued once \ntherapeutic INR was reached. On day of discharge INR was 3.5 and \nwarfarin dose was decreased to 3.5mg. INR should be rechecked on \n___ and warfarin adjusted as needed. Patient was evaluated by \nphysical therapy and discharged to rehab."}}	{'final_diagnoses': ['Transcatheter aortic valve replacement', 'Aortic insufficiency', 'Acute on chronic congestive heart failure with preserved \nejection fraction', 'COPD Exacerbation', 'History of rheumatic heart disease with mechanical mitral valve \nreplacement', 'Hypotension', 'Chronic Pain'], 'procedures': ['Right Cardiac Cath', 'Transcatheter Aortic Valve Replacement'], 'visit_summary': "Brief Hospital Course:\nPatient is a ___ yo Woman with a hx. of mitral stenosis s/p MVR \non Coumadin with 3V CABG in ___, recent history of stress \ncardiomyopathy, aortic regurgitation, and COPD on home oxygen \nwho presented with worsening shortness of breath, chest pain, \nand nausea. \n\nFloor course ___\n#SOB: Worsening over the last week with a mild cough with green \nsputum and occasional wheezing. Patient states subjectively \ngaining weight but stable since last discharge. Most likely \ncause was mild COPD exacerbation given increased cough, \nwheezing. Patient was continued on home 3L O2\n\n#Hypotension: Patient was hypotensive with systolics in the \n___. Lactate was elevated to 2.8. Appeared dry given \nincreased diuresis prior to admission, although did have \nelevated JVP, but most likely due to tricuspid regurgitation. \nHome nifedipine was discontinued. Decision was made for a right \nheart cath with continuous motoring in the intensive care unit \nto assess cardiac function. Patient was transferred to the \ncardiac ICU for further monitoring. \n\n#Valvular disease: Aortic Insufficiency/AS, Mechanical MVR: Plan \nfor TAVR on ___. Home warfarin was discontinued and heparin \ndrip was started in anticipation of procedure. \n\n#Congestive heart failure with preserved ejection fraction: \nDiuresis was held given low blood pressures.\n\n#COPD - has hx of severe COPD (FEV1 23%). Continued on home 3L \nof O2, albuterol and ipratropium nebs and \nfluticasone-salmeterol. Transferred to Cardiac ICU for further \ntreatment. \n\n#Hypokalemia - had increased diuresis day prior to admission \nwith IV lasix 80mg on top of home lasix 80QAM and 40QPM and \npossibly didn't take her K supplements as scheduled. Was \nswitched to torsemide 60mg day prior admission in clinic. \n\n#Chest pain: Chronic issue and tender to palpation, controlled \nwith home oxycodone.\n\nCCU COURSE ___: \nThe patient was transferred to the ICU for hypotension of \nunknown etiology and received a right heart catheterization to \nhelp guide management. She was given 1L of IVF with resolution \nof her hypotension, which was thought to be secondary to poor PO \nintake and increased diuresis. Her shortness of breath was \nsimilar to her symptoms on the floor, however Pulmonary was \nconsulted for optimization prior to TAVR for aortic \ninsufficiency. They recommended treatment for COPD exacerbation \nwith a prednisone taper: (60mg x 7 days total and then taper\nas follows: 40mg x 3 days, 20 mg x 2 days, 10mg x 2 days for a \ntotal duration of 2 weeks) and azithromycin. In addition dental \nand vascular surgery were consulted for TAVR clearance/access \noptions respectively.\n\nFloor Course ___ to ___\nPatient transferred back to floor to await TAVR procedure on \n___. Diuresis with torsemide 40mg was attempted with \nnegative 2L in fluids and patient became slightly hypotensive to \nsystolic in the ___ and received small fluid boluses with \nresolution of hypotension. Patient had a dental extraction of \nher remaining teeth on ___ in anticipation of the TAVR \nprocedure. Went for TAVR procedure on ___ and transferred to \nthe cardiac ICU afterward. \n\nCCU COURSE ___\nThe patient was transferred to the CCU after TAVR on ___ \nwith 26 mm ___ Evolut-R via transfemoral approach. The \npatient was noted to have trace-mild paravalvular leak following \nthe procedure. The patient was continued on aspirin and Plavix \nafter the procedure. Repeat echocardiogram ___ hours after \nprocedure showed aortic ___ prosthesis in place, the \nseverity of aortic regurgitation had decreased while the \nseverity of tricuspid regurgitation had increased. Her final \ntreatment consisted of aspirin 81 mg daily and warfarin with \nheparin drip (due to concomitant MVR s/p mechanical valve). \n\nFloor Course (___)\nPatient was transferred back to the floor from the cardiac ICU \non ___. Noted improved SOB. Was continued on prednisone taper \nwith 20mg to be taken on ___ then 10mg the next 2 days to \ncomplete a 14 day course. Patient clinically appeared to be \nretaining fluids and was restarted on torsemide 40mg daily (down \nfrom home dose of 60mg). Heparin drip was discontinued once \ntherapeutic INR was reached. On day of discharge INR was 3.5 and \nwarfarin dose was decreased to 3.5mg. INR should be rechecked on \n___ and warfarin adjusted as needed. Patient was evaluated by \nphysical therapy and discharged to rehab.", 'medications_prescribed': ['Aquaphor Ointment 1 Appl TP BID', 'Aspirin 81 mg PO DAILY', 'Clobetasol Propionate 0.05% Ointment 1 Appl TP DAILY:PRN \npsoriasis', 'Diazepam 10 mg PO Q12H:PRN Anxiety \nRX diazepam 10 mg 1 tablet by mouth Q12H:PRN Disp #12 Tablet \nRefills:0', 'Ferrous Sulfate 325 mg PO WITH LUNCH AND DINNER', 'Levothyroxine Sodium 100 mcg PO DAILY', 'Mirtazapine 15 mg PO QHS:PRN insomnia', 'OxycoDONE (Immediate Release) 10 mg PO Q4H:PRN pain \nRX oxycodone 10 mg 1 tablet(s) by mouth every four (4) hours \nPRN Disp #30 Tablet Refills:0', 'Benzonatate 100 mg PO TID cough', 'Polyethylene Glycol 17 g PO DAILY', 'PredniSONE 20 mg PO DAILY Duration: 2 Doses \nThis is dose # 2 of 3 tapered doses\nRX prednisone 10 mg 1 tablet(s) by mouth once a day Disp #4 \nTablet Refills:*0', 'Senna 8.6 mg PO BID:PRN constipation', 'Torsemide 40 mg PO DAILY', 'DiphenhydrAMINE 50 mg PO Q4H:PRN itching', 'fluocinolone 0.01 % topical BID', 'Hydrocortisone (Rectal) 2.5% Cream ___AILY', 'Ipratropium-Albuterol Neb 1 NEB NEB Q6H:PRN shortness of \nbreath', 'NexIUM (esomeprazole magnesium) 40 mg oral BID', 'Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation \ninhalation BID', 'Tiotropium Bromide 1 CAP IH DAILY', 'PredniSONE 10 mg PO DAILY Duration: 2 Doses \nThis is dose # 3 of 3 tapered doses', 'Warfarin 3.5 mg PO DAILY16']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 78, 'gender': 'F', 'symptoms': 'Ureteral stricture', 'medical_history': ['ESRD secondary to possible streptococcal glomerulonephritis \n( ) on hemodialysis since , then underwent \nliving-related renal transplant from her daughter in (at \n) but kidney thrombosed and was removed within 24 \nhours. S/p renal transplant on , post op course \ncomplicated by retroperitoneal bleeding with washout x2, \npulmonary edema requiring intubation and CVVH, many blood \ntransfusions, UTI/pan-resistant E.coli, removal of ureteral \nstent was removed, vaginal bleeding likely secondary to \nperitoneal hematoma.', 'Exploratory laparotomy with lysis of adhesions,\nextensive ureteral mobilization of right ureter with\nureteropyelostomy to transplanted kidney.', 'with bilateral stent placement. Open \nureterotomy with stent placement. Ureteral pyelostomy', 'Elevated factor VIII levels/high fibrinogen levels: on coumadin', 'Hypertension - well controlled on metoprolol', 'Gout - on allopurinol', 'DM - on glipizide'], 'family_history': '-mother alive at age with HTN and DM2 \n-father alive at age with TBI and vision loss\n-four siblings, all healthy \n-children all healthy', 'present_illness': 'y.o. F with h/o hypercoagulable disorder (elevated \nfactor VIII). She developed ESRD strep glomerulonephritis, \ns/p LRRT with subsequent nephrectomy for acute thrombus,\nre-transplanted c/b hematoma requiring \nevacuation/washout.\nPost transplant course further complicated by multiple \nUTIs (VRE,MDR E.coli), ureteral stricture, hydronephrosis and\nrenal insufficiency. On , she underwent aborted\nuretero-ureterostomy secondary to excessive bleeding with\nretention of nephrostomy tube. Now presents for re-attempt at\nrevision of transplant ureter tomorrow. Last UTI (E.coli) \ntreated with Imipenem until . \n\nNephrostomy tube study scheduled for today in and OR \nscheduled\ntomorrow for uretero-ureterostomy. Last dose of coumadin was . However, has been taking aspirin daily. \n\nROS: Has been feeling well. Appetite good. Sleeping well, but\ndoes have trouble falling asleep (takes a couple hours to fall\nasleep). Denies fever, chills, nausea, vomiting, sob, cp,\nindigestion, diarrhea, constipation, dysuria. Did have scant\namout of blood in urine when she voided yesterday. Voids small\namount once daily. No futher bleeding. No longer menstrates. \nNephrostomy tube output has been great without hematuria or\ncloudy urine. Insertion site without s/o infection', 'medications': [{'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'ALPRAZolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Guaifenesin ER', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Doxycycline Hyclate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Cepacol (Sore Throat Lozenge)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Vitamin B Complex', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aluminum-Magnesium Hydrox.-Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'ALPRAZolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Guaifenesin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '1.65', 'valuenum': 1.65, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.8', 'valuenum': 25.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21.7', 'valuenum': 21.7, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '70.0', 'valuenum': 70.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '384', 'valuenum': 384.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.93', 'valuenum': 2.93, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.06', 'valuenum': 0.06, 'valueuom': 'm/uL', 'ref_range_lower': 0.02, 'ref_range_upper': 0.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': '%', 'ref_range_lower': 0.4, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.04', 'valuenum': 0.04, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.04', 'valuenum': 0.04, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.53', 'valuenum': 0.53, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.34', 'valuenum': 5.34, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '46.1', 'valuenum': 46.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '67', 'valuenum': 67.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '67', 'valuenum': 67.0, 'valueuom': 'ng/mL', 'ref_range_lower': 13.0, 'ref_range_upper': 150.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': 'ng/mL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'ug/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 160.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '293', 'valuenum': 293.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '151', 'valuenum': 151.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '225', 'valuenum': 225.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '735', 'valuenum': 735.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.9', 'valuenum': 26.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '416', 'valuenum': 416.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.04', 'valuenum': 3.04, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46.5', 'valuenum': 46.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 109.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.0', 'valuenum': 28.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '432', 'valuenum': 432.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.29', 'valuenum': 3.29, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46.9', 'valuenum': 46.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'VS:96.8 HR 72 106/63 RR 14 97% RA wt 84kg, height inc\nGen: A&O, NAD, appears well. Husband present\n: , sys murmur\nPulm: clear bilat\nAbd: non-distended, non-tender, soft, +bowel sounds, well healed\nincisions, LLQ nephrostomy tube site without redness/drainage,\nclear yellow urine in NT bag\next: no edema\n\nLabs: Creatinine 2.0. INR 2.0', 'diagnoses': [{'icd_code': 'J14', 'desc': 'Pneumonia due to Hemophilus influenzae'}, {'icd_code': 'J918', 'desc': 'Pleural effusion in other conditions classified elsewhere'}, {'icd_code': 'E46', 'desc': 'Unspecified protein-calorie malnutrition'}, {'icd_code': 'R64', 'desc': 'Cachexia'}, {'icd_code': 'D649', 'desc': 'Anemia, unspecified'}, {'icd_code': 'E8809', 'desc': 'Other disorders of plasma-protein metabolism, not elsewhere classified'}, {'icd_code': 'Z681', 'desc': 'Body mass index [BMI] 19.9 or less, adult'}, {'icd_code': 'J479', 'desc': 'Bronchiectasis, uncomplicated'}, {'icd_code': 'M810', 'desc': 'Age-related osteoporosis without current pathological fracture'}, {'icd_code': 'Z85828', 'desc': 'Personal history of other malignant neoplasm of skin'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'E781', 'desc': 'Pure hyperglyceridemia'}, {'icd_code': 'F410', 'desc': 'Panic disorder [episodic paroxysmal anxiety]'}, {'icd_code': 'R600', 'desc': 'Localized edema'}, {'icd_code': 'Z9181', 'desc': 'History of falling'}], 'summary': '03:10PM BLOOD WBC-6.3 RBC-4.05* Hgb-12.1 Hct-35.5* \nMCV-88 MCH-29.9 MCHC-34.1 RDW-15.8* Plt \n02:30AM BLOOD Hct-24.2\n06:00AM BLOOD PTT-25.5 \n03:10PM BLOOD Glucose-79 UreaN-45 Creat-2.0* Na-139 \nK-4.7 Cl-105 HCO3-25 AnGap-14\n06:00AM BLOOD Glucose-128* UreaN-38* Creat-2.2* Na-135 \nK-4.1 Cl-100 HCO3-27 AnGap-12\nShe was admitted the day prior to surgery for a nephrostomy tube \nstudy that demonstrated moderated hydronephrosis with complete \nobstruction of ureter as previously noted.\n\nOn , she underwent exploratory laparotomy with lysis of \nadhesions,extensive ureteral mobilization of right ureter with \nureteropyelostomy to transplanted kidney. Surgeon was Dr. \n. Dr. performed cystoscopy with bilateral \nstent placement, open ureterotomy with stent placement and \nureteral pyelostomy. Please refer to operative notes for further \ndetails. \n\nPostop, she experienced hyperkalemia for which she required \ndialysis. She was transferred to the SICU for management. She \ndid well. Vital signs remained stable with good urine output via \nthe nephrostomy tube. Creatinine decreased to 1.6 likely \nsecondary to the dialysis. She was extubated on without \nincident with stable vital signs. She was transferred out of the \nSICU on . \n\nTemporary dialysis line was removed as potassium remained in the \nnormal range. Creatinine ranged between 1.6-2.2. Urine output \nwas primarily draining via the nephrostomy tube. Minimal urine \nwas draining via the foley. Foley output was bloody. The JP \noutput was sanguinous and minimal ()\n\nHeparin drip was started given h/o elevated factor V and \nfibrinogen levels. HCT dropped on to 24 from 29. Heparin \nwas stopped and she was given 2 units of PRBC without incident. \nPost transfusion remained stable. Coumadin 3mg was initiated on \nand continued until discharge to home. INR was 1.5 on . \n\n\nDiet was advanced slowly due to nausea related to ileus that \nresolved. She was finally able to tolerated regular food and was \npassing BMs at time of discharge to home. \n\nPhysical therapy declared her safe for home. She was independent \nin drain/foley care and felt that she did not require \nservices. She will have and chem 7/trough prograf level \non . \n\nFollow up with Dr. will be determined at time of follow \nup with Dr. on . Of note, she does have ureteral stent.'}}	{'final_diagnoses': ['Ureteral stricture', 'Ureteral necrosis'], 'procedures': ['Exploratory laparotomy with lysis of adhesions,\nextensive ureteral mobilization of right ureter with\nureteropyelostomy to transplanted kidney.', '1. Cystoscopy with bilateral stent placement.', '2. Open ureterotomy with stent placement.', '3. Ureteral pyelostomy'], 'visit_summary': 'She was admitted the day prior to surgery for a nephrostomy tube \nstudy that demonstrated moderated hydronephrosis with complete \nobstruction of ureter as previously noted.\n\nOn , she underwent exploratory laparotomy with lysis of \nadhesions,extensive ureteral mobilization of right ureter with \nureteropyelostomy to transplanted kidney. Surgeon was Dr. \n. Dr. performed cystoscopy with bilateral \nstent placement, open ureterotomy with stent placement and \nureteral pyelostomy. Please refer to operative notes for further \ndetails. \n\nPostop, she experienced hyperkalemia for which she required \ndialysis. She was transferred to the SICU for management. She \ndid well. Vital signs remained stable with good urine output via \nthe nephrostomy tube. Creatinine decreased to 1.6 likely \nsecondary to the dialysis. She was extubated on without \nincident with stable vital signs. She was transferred out of the \nSICU on . \n\nTemporary dialysis line was removed as potassium remained in the \nnormal range. Creatinine ranged between 1.6-2.2. Urine output \nwas primarily draining via the nephrostomy tube. Minimal urine \nwas draining via the foley. Foley output was bloody. The JP \noutput was sanguinous and minimal ()\n\nHeparin drip was started given h/o elevated factor V and \nfibrinogen levels. HCT dropped on to 24 from 29. Heparin \nwas stopped and she was given 2 units of PRBC without incident. \nPost transfusion remained stable. Coumadin 3mg was initiated on \nand continued until discharge to home. INR was 1.5 on . \n\n\nDiet was advanced slowly due to nausea related to ileus that \nresolved. She was finally able to tolerated regular food and was \npassing BMs at time of discharge to home. \n\nPhysical therapy declared her safe for home. She was independent \nin drain/foley care and felt that she did not require \nservices. She will have and chem 7/trough prograf level \non . \n\nFollow up with Dr. will be determined at time of follow \nup with Dr. on . Of note, she does have ureteral stent.', 'medications_prescribed': ['1. metoprolol succinate 100 mg Tablet Extended Release 24 hr \nSig: One (1) Tablet Extended Release 24 hr PO DAILY (Daily).\nDisp:30 Tablet Extended Release 24 hr(s) Refills:2', '2. mycophenolate sodium 180 mg Tablet, Delayed Release (E.C.) \nSig: One (1) Tablet, Delayed Release (E.C.) PO BID (2 times a \nday).\nDisp:60 Tablet, Delayed Release (E.C.)(s) Refills:2', '3. oxycodone-acetaminophen mg Tablet Sig: Tablets PO \nQ4H (every 4 hours) as needed for pain.\nDisp:60 Tablet(s) Refills:0', '4. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2) \nCapsule, Delayed Release(E.C.) PO DAILY (Daily).\nDisp:60 Capsule, Delayed Release(E.C.)(s) Refills:2', '5. allopurinol mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '6. gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3 \ntimes a day).', '7. sulfamethoxazole-trimethoprim 400-80 mg Tablet Sig: One (1) \nTablet PO DAILY (Daily).', '8. pravastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '9. glipizide 5 mg Tablet Sig: One (1) Tablet PO once a day.', '10. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '11. warfarin 1 mg Tablet Sig: Three (3) Tablet PO once a day.', '12. Outpatient Lab Work\n: stat', '13. tacrolimus 1 mg Capsule Sig: Two (2) Capsule PO Q12H (every \n12 hours).', '14. tacrolimus 0.5 mg Capsule Sig: One (1) Capsule PO twice a \nday.', '15. Outpatient Lab Work\n: \nchem 7 and trough prograf level\nfax to attention RN', '16. senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day.', '17. multivitamin Tablet Sig: One (1) Tablet PO once a day.']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 75, 'gender': 'F', 'symptoms': 'abdominal pain', 'medical_history': ['hypertension', 'hyperlipidemia', 'anxiety'], 'family_history': 'noncontributory', 'present_illness': '___. female p/w nausea/vomiting for past 24 hours. Initially\nseen at ___. Vomited 250 mL, then NGT placed, drained\n500 mL feculent fluid. Denies fever, pain', 'medications': [{'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'CefTAZidime', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'MetroNIDAZOLE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '1.21', 'valuenum': 1.21, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37.3', 'valuenum': 37.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.3', 'valuenum': 25.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '84.0', 'valuenum': 84.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '645', 'valuenum': 645.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.63', 'valuenum': 4.63, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.03', 'valuenum': 0.03, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.06', 'valuenum': 0.06, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.56', 'valuenum': 0.56, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.93', 'valuenum': 9.93, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '43.9', 'valuenum': 43.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '150', 'valuenum': 150.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.6, . Estimated GFR = >75 if non African-American (mL/min/1.73 m2) . Estimated GFR = >75 if African-American (mL/min/1.73 m2) . For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2) . GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 113.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': 'GREEN TOP TUBE.'}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.5', 'valuenum': 35.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '121', 'valuenum': 121.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 82.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '130', 'valuenum': 130.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.1', 'valuenum': 25.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '624', 'valuenum': 624.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.23', 'valuenum': 4.23, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '45.5', 'valuenum': 45.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.043', 'valuenum': 1.043, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.3', 'valuenum': 25.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '567', 'valuenum': 567.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.84', 'valuenum': 3.84, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '43.9', 'valuenum': 43.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 82.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 80.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.0', 'valuenum': 25.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '615', 'valuenum': 615.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.96', 'valuenum': 3.96, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '44.1', 'valuenum': 44.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.1', 'valuenum': 25.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '597', 'valuenum': 597.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.74', 'valuenum': 3.74, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44.8', 'valuenum': 44.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 78.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'T: 97.6 P: 101 BP: 156/56 RR: 16 O2sat: 97% on RA\nGeneral: awake, alert, NAD\nHEENT: NCAT, EOMI, anicteric, NGT in place\nHeart: RRR, paced\nLungs: normal excursion, no respiratory distress, CTAB\nChest: non-tender, no deformities\nBack: no vertebral tenderness, no CVAT, kyphosis\nAbdomen: soft, NT, ND, no mass, no hernia\nExtremities: WWP, no CCE, no tenderness, 2+ B radial pulses\nVascular Pulse Exam: palpable bilateral DP pulses\nSkin: no rashes, ulcers on medial aspects of bilateral ___ MT\nhead\nPsychiatric: diminished memory', 'diagnoses': [{'icd_code': 'C181', 'desc': 'Malignant neoplasm of appendix'}, {'icd_code': 'C786', 'desc': 'Secondary malignant neoplasm of retroperitoneum and peritoneum'}, {'icd_code': 'R180', 'desc': 'Malignant ascites'}, {'icd_code': 'K5669', 'desc': 'Other intestinal obstruction'}, {'icd_code': 'I959', 'desc': 'Hypotension, unspecified'}, {'icd_code': 'K632', 'desc': 'Fistula of intestine'}, {'icd_code': 'Z66', 'desc': 'Do not resuscitate'}, {'icd_code': 'Z515', 'desc': 'Encounter for palliative care'}, {'icd_code': 'M810', 'desc': 'Age-related osteoporosis without current pathological fracture'}, {'icd_code': 'D473', 'desc': 'Essential (hemorrhagic) thrombocythemia'}], 'summary': '___ 07:25PM ___ PTT-29.4 ___\n___ 07:25PM PLT COUNT-192\n___ 07:25PM NEUTS-86.1* LYMPHS-8.6* MONOS-5.0 EOS-0.1 \nBASOS-0.2\n___ 07:25PM WBC-13.0* RBC-3.75* HGB-10.8* HCT-32.6* \nMCV-87 MCH-28.7 MCHC-33.0 RDW-13.5\n___ 07:25PM estGFR-Using this\n___ 07:25PM GLUCOSE-123* UREA N-39* CREAT-1.4* SODIUM-144 \nPOTASSIUM-3.6 CHLORIDE-101 TOTAL CO2-33* ANION GAP-14\n___ 07:40PM LACTATE-1.0\n___ 08:30PM URINE WBCCLUMP-FEW\n___ 08:30PM URINE RBC-60* WBC->182* BACTERIA-FEW \nYEAST-NONE EPI-0\n___ 08:30PM URINE BLOOD-MOD NITRITE-NEG PROTEIN-100 \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-0.2 PH-7.5 \nLEUK-LG\n___ 08:30PM URINE COLOR-Yellow APPEAR-Cloudy SP\n___ admitted for gastric volvulus and hiatal hernia for which \nshe underwent a Hill repair of acute gastric volvulus with \ngastropexy and closure of the hiatus, placement ___ \ngastrostomy tube. She tolerated the procedure well and was \ntransferred to the PACU in stable condition. She did well there \nand went to the floors. Overnight she was kept nil per os. On \n___, her diet was advanced to clears, which shse tolerated \nwell. Once she began to have flatus, her diet was advanced to \nregulars. Pain was controlled with a hydromorphone PCA, which \nwas transitioned to PO pain meds as her diet was advanced. She \nwas discharged to rehab in stable condition on ___ once \ntolerating regular diet and on PO pain meds.'}}	{'final_diagnoses': ['hiatal hernia / gastric volvulus'], 'procedures': ['___ - ___ repair', 'gastropexy', 'gastrostomy tube'], 'visit_summary': '___ admitted for gastric volvulus and hiatal hernia for which \nshe underwent a Hill repair of acute gastric volvulus with \ngastropexy and closure of the hiatus, placement ___ \ngastrostomy tube. She tolerated the procedure well and was \ntransferred to the PACU in stable condition. She did well there \nand went to the floors. Overnight she was kept nil per os. On \n___, her diet was advanced to clears, which shse tolerated \nwell. Once she began to have flatus, her diet was advanced to \nregulars. Pain was controlled with a hydromorphone PCA, which \nwas transitioned to PO pain meds as her diet was advanced. She \nwas discharged to rehab in stable condition on ___ once \ntolerating regular diet and on PO pain meds.', 'medications_prescribed': ['1. Levothyroxine Sodium 100 mcg PO DAILY', '2. Omeprazole 20 mg PO DAILY', '3. Vitamin D 400 UNIT PO DAILY', '4. Simvastatin 20 mg PO DAILY', '5. Multivitamins 1 TAB PO DAILY', '6. Mirtazapine 45 mg PO HS', '7. Acetaminophen 650 mg PO TID', '8. OxycoDONE (Immediate Release) 2.5 mg PO Q4H:PRN pain', '9. Citracal + D NF (calcium phosphate-vitamin D3) 250 mg \ncalcium- 250 unit Oral BID', '10. Estrogens Conjugated 1 gm VG DAILY Duration: 3 Weeks']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 45, 'gender': 'F', 'symptoms': 'hyperkalemia, ___ on outpatient labs', 'medical_history': ['-Hypertension', '-Diabetes', '-Hypothyroidism', '-NASH cirrhosis', '-h/o SDH ___ s/p fall ', '-Grade I Esophageal Varices ___: Multi-drug resistant E. coli urinary tract infection'], 'family_history': 'Sister - DM \nBrother - ?stomach or liver cancer ', 'present_illness': '___ yo female with history of NASH cirrhosis c/b Grade I \nesophageal varices (___), HTN, DM, hypothyroidism, h/o SDH \n(___) who presents due to hyperkalemia and ___ noted on \noutpatient routine labs. Patient was noted to be hyperkalemic to \n5.6 with a creatinine of 1.5 from a baseline of 1. Patient and \ndaughter state that she has been feeling generally weak for \nabout 1 month. Patient endorses anorexia and poor po intake. She \ndenies f/c, n/v, diarrhea, CP, SOB, ___ edema, abdominal pain. \nShe has been taking her medications as prescribed. Daughter \nreports that her mental status is at baseline.\n\nIn the ED, initial VS were T 98.1 HR 82 BP 102/37 RR 16 100% RA \n\nExam notable for oriented, no ABD tenderness, mild asterixis\nLabs showed K+ 5.3, H/H 9.7/28.7 (up from baseline), Cr 1.2. \nALT: 30 AP: 176 Tbili: 0.9 Alb: 3.6 \nAST: 42 LDH: Dbili: 0.3 Lip: 103 \nUA with pyuria, few bacteria, 6 epis\n\nImaging showed CXR with a worsened focal opacity in RUL that is \nsuggested to have CT chest follow up (seen ___. Interval \nimprovement in previously noted patchy opacities in LUL and LLL. \n\n\nECG NSR @ 80, NANI, precordial TW hyperacuity vs baseline/\n\nReceived calcium gluconate and 50g albumin 25%\n\nTransfer VS were T 98.3 HR 81 BP 114/53 RR 18 100% RA \n\nHepatology was consulted.\n\nDecision was made to admit to medicine for further management. \nOn arrival to the floor, patient reports feeling generally weak \nbut better since her ED stay. \n\nREVIEW OF SYSTEMS: \nDenies fever, chills, night sweats, headache, vision changes, \nrhinorrhea, congestion, sore throat, cough, shortness of breath, \nchest pain, abdominal pain, nausea, vomiting, diarrhea, \nconstipation, BRBPR, melena, hematochezia, dysuria, hematuria. ', 'medications': [{'medication': 'Fluticasone-Salmeterol Diskus (250/50) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fluconazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Aluminum-Magnesium Hydrox.-Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '37.1', 'valuenum': 37.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '156', 'valuenum': 156.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.90', 'valuenum': 3.9, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 113.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1000', 'valuenum': 1000.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.049', 'valuenum': 1.049, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'OCC.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Admission exam:\nVS - T 98.7 HR 81 BP 114/53 RR 18 100% RA\nGENERAL: NAD, AAOx ___ "___" and name.\n___, PERRL, anicteric sclera, pink conjunctiva, MMM, \npoor dentition\nNECK: nontender supple neck, no LAD, no JVD \nCARDIAC: RRR, holosystolic murmur heard best at ___, without \nradiation to carotids. Normal S1, S2, no rubs or gallops \nLUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably \nwithout use of accessory muscles \nABDOMEN: no appreciable ascites fluid wave, nontender to \npalpation, no HSM, nondistended\nEXTREMITIES: wwp, no edema\nPULSES: 2+ DP pulses bilaterally \nNEURO: CN II-XII intact \n\nDischarge exam:\nVS - T 98.5 HR 85 BP 109/45 RR 16 100% RA. WEIGHT 52 kg\nGENERAL: NAD, AAOx2 "hospital" and name.\n___, PERRL, anicteric sclera, pink conjunctiva, MMM, \npoor dentition\nNECK: nontender supple neck, no LAD, no JVD \nCARDIAC: RRR, holosystolic murmur heard best at ___, without \nradiation to carotids. Normal S1, S2, no rubs or gallops \nLUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably \nwithout use of accessory muscles \nABDOMEN: no appreciable ascites fluid wave, nontender to \npalpation, no HSM, nondistended\nEXTREMITIES: wwp, no edema\nPULSES: 2+ DP pulses bilaterally \nNEURO: no asterixis, following commands appropriately ', 'diagnoses': [{'icd_code': '0088', 'desc': 'Intestinal infection due to other organism, not elsewhere classified'}, {'icd_code': '1121', 'desc': 'Candidiasis of vulva and vagina'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': 'V5867', 'desc': 'Long-term (current) use of insulin'}, {'icd_code': '49390', 'desc': 'Asthma, unspecified type, unspecified'}], 'summary': 'Admission Labs:\n___ 01:30PM ___\n___ 01:30PM WBC-4.5 RBC-2.78* HGB-9.5* HCT-28.3* MCV-102* \nMCH-34.2* MCHC-33.6 RDW-13.7 RDWSD-50.9\n___ 01:30PM ALBUMIN-3.7\n___ 01:30PM ALT(SGPT)-32 AST(SGOT)-38 ALK PHOS-170 TOT \nBILI-0.9 DIR BILI-0.3 INDIR BIL-0.6\n___ 01:30PM UREA N-37* CREAT-1.5* SODIUM-133 \nPOTASSIUM-5.5* CHLORIDE-103 TOTAL CO2-19* ANION GAP-17\n___ 10:09AM WBC-4.6 RBC-2.92* HGB-9.7* HCT-28.7* MCV-98 \nMCH-33.2* MCHC-33.8 RDW-13.6 RDWSD-48.8\n___ 10:09AM ALBUMIN-3.6 CALCIUM-9.9 PHOSPHATE-3.6 \nMAGNESIUM-2.1\n___ 10:09AM LIPASE-103\n___ 11:39AM LACTATE-1.9\n___ 03:20PM URINE RBC-2 WBC-5 BACTERIA-FEW YEAST-NONE \nEPI-6 TRANS EPI-1\n___ 09:31PM K+-5.1\n\nDischarge labs:\n___ 03:30PM BLOOD WBC-3.7* RBC-2.62* Hgb-8.7* Hct-26.7* \nMCV-102* MCH-33.2* MCHC-32.6 RDW-13.5 RDWSD-50.1* Plt Ct-80\n___ 06:03AM BLOOD Glucose-93 UreaN-25 Creat-0.8 Na-137 \nK-5.0 Cl-111* HCO3-16* AnGap-15\n___ 06:03AM BLOOD ALT-23 AST-33 LD(LDH)-150 AlkPhos-132* \nTotBili-0.9\n___ 09:31PM BLOOD K-5.1\n\nImaging:\nCXR ___\nFINDINGS: \nHeart size is normal. Mediastinal and hilar contours are \nunremarkable. \nPulmonary vasculature is normal. Linear opacities are re- \ndemonstrated within\nthe mid lung fields bilaterally, with slight interval \nimprovement in\npreviously noted patchy opacities in the left upper and lower \nlung fields. \nMore focal opacity is noted within the right upper lobe, which \nappears more\nconspicuous than on the previous radiograph. No new focal \nconsolidation,\npleural effusion or pneumothorax is present. Pulmonary \nvasculature is normal.\nModerate multilevel degenerative changes are again seen.\nIMPRESSION:\n1. More conspicuous focal opacity within the right upper lobe \nwhich has been\npresent since ___. As suggested on the prior chest \nradiograph, CT is\nrecommended for further assessment.\n2. Interval improvement in previously noted patchy opacities in \nthe left upper\nand lower lung fields.\n___ yo female with HTN, DM, hypothyroidism, and NASH cirrhosis \nc/b grade I esophageal varices who presents after outpatient \nlabs revealed ___ and hyperkalemia\n\n#Hyperkalemia: noted to be 5.6 on outpatient labs. EKG in the ED \nwas not concerning for hyperkalemia, although she did receive \ncalcium gluconate x1 in the ED. Her potassium improved with home \nlactulose. Her hyperkalemia was felt to be due to ARF vs poor \nlactulose compliance vs poor nutrition, for which nutrition was \nconsulted. It was recommended that she start glucerna \nsupplements TID. \n\n#ARF: Creatinine of 1.5 noted in outpatient setting from \nbaseline of 1. On admission, Cr improved to 1.2 but given \nconcern for intravascular depletion, she received albumin \nchallenge in the ED. ARF was felt to be likely prerenal in s/o \nESLD. Infectious work up, including UA, CXR, and blood cultures \nwere negative. Her home lasix, spironolactone, and lisinopril \nwere held initially but started on discharge. Her lasix dose was \nhalved to 20 mg daily on discharge. \n\n#gross hematuria: patient noted 1x episode of gross hematuria on \nthe day of discharge without other symptoms. Her H/H was stable \nat baseline, her INR was normal, and her UA was normal as well. \nAs such, no further inpatient work up was pursued. However, \nurology outpatient office number was provided for patient to \nfollow up if symptoms persist. Patient and daughter were aware \nof the need for urology follow-up and vocalized this \nunderstanding.\n\n#macrocytic anemia: most likely ACD given macrocytosis. She was \nnoted to be slightly below her baseline H/H of around \n___ during the admission with H/H of ___. This was \nfelt to be dilutional with WBC and platelets low and resolved \nspontaneously to baseline. \n\n#RUL lung mass: concerning for malignancy. This had been noted \non prior admissions and discharge documentation. Patient and \ndaughter were aware of the mass and the need to follow up with \nCT chest. This was communicated via email and fax to PCP during \nthis admission as with prior discharges. \n\n#NASH cirrhosis: Patient had no significant ascites for \nparacentesis and had no abdominal pain. She was continued on \nprotonix, rifaximin, and lactulose. Her home spironolactone was \nheld initially but restarted upon discharge. Lasix was also held \ninitially but restarted on discharge at half the dose.\n\n#Hypertension: home lisinopril held initially but started on \ndischarge\n\n#Diabetes: SSI while inpatient \n\n#Hypothyroidism: continued home levothyroxine'}}	{'final_diagnoses': ['ARF', 'Hyperkalemia', 'NASH cirrhosis', 'poor nutrition', 'HTN', 'hypothyroidism', 'DM'], 'procedures': ['None'], 'visit_summary': '___ yo female with HTN, DM, hypothyroidism, and NASH cirrhosis \nc/b grade I esophageal varices who presents after outpatient \nlabs revealed ___ and hyperkalemia\n\n#Hyperkalemia: noted to be 5.6 on outpatient labs. EKG in the ED \nwas not concerning for hyperkalemia, although she did receive \ncalcium gluconate x1 in the ED. Her potassium improved with home \nlactulose. Her hyperkalemia was felt to be due to ARF vs poor \nlactulose compliance vs poor nutrition, for which nutrition was \nconsulted. It was recommended that she start glucerna \nsupplements TID. \n\n#ARF: Creatinine of 1.5 noted in outpatient setting from \nbaseline of 1. On admission, Cr improved to 1.2 but given \nconcern for intravascular depletion, she received albumin \nchallenge in the ED. ARF was felt to be likely prerenal in s/o \nESLD. Infectious work up, including UA, CXR, and blood cultures \nwere negative. Her home lasix, spironolactone, and lisinopril \nwere held initially but started on discharge. Her lasix dose was \nhalved to 20 mg daily on discharge. \n\n#gross hematuria: patient noted 1x episode of gross hematuria on \nthe day of discharge without other symptoms. Her H/H was stable \nat baseline, her INR was normal, and her UA was normal as well. \nAs such, no further inpatient work up was pursued. However, \nurology outpatient office number was provided for patient to \nfollow up if symptoms persist. Patient and daughter were aware \nof the need for urology follow-up and vocalized this \nunderstanding.\n\n#macrocytic anemia: most likely ACD given macrocytosis. She was \nnoted to be slightly below her baseline H/H of around \n___ during the admission with H/H of ___. This was \nfelt to be dilutional with WBC and platelets low and resolved \nspontaneously to baseline. \n\n#RUL lung mass: concerning for malignancy. This had been noted \non prior admissions and discharge documentation. Patient and \ndaughter were aware of the mass and the need to follow up with \nCT chest. This was communicated via email and fax to PCP during \nthis admission as with prior discharges. \n\n#NASH cirrhosis: Patient had no significant ascites for \nparacentesis and had no abdominal pain. She was continued on \nprotonix, rifaximin, and lactulose. Her home spironolactone was \nheld initially but restarted upon discharge. Lasix was also held \ninitially but restarted on discharge at half the dose.\n\n#Hypertension: home lisinopril held initially but started on \ndischarge\n\n#Diabetes: SSI while inpatient \n\n#Hypothyroidism: continued home levothyroxine', 'medications_prescribed': ['1. Clobetasol Propionate 0.05% Ointment 1 Appl TP BID ', '2. Clobetasol Propionate 0.05% Soln 1 Appl TP QHS ', '3. FoLIC Acid 1 mg PO DAILY ', '4. Hydrocortisone Cream 2.5% 1 Appl TP BID ', '5. Lactulose 30 mL PO TID \nRX lactulose 10 gram/15 mL (15 mL) ___ by mouth three times \na day Refills:0', '6. Levothyroxine Sodium 50 mcg PO DAILY ', '7. Pantoprazole 40 mg PO Q24H ', '8. Rifaximin 550 mg PO BID ', '9. calcium carbonate-vitamin D3 500 mg(1,250mg) -125 unit oral \nDAILY ', '10. econazole 1 % topical DAILY ', '11. Lisinopril 5 mg PO DAILY ', '12. Spironolactone 100 mg PO DAILY ', '13. Furosemide 20 mg PO DAILY ']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 63, 'gender': 'M', 'symptoms': 'Palpitations', 'medical_history': ['Atrial Flutter', 'Carotid Artery Stenosis', 'Cerebrovascular Accident', 'Chronic Kidney Disease', 'Colon Adenocarcinoma, Stage I', 'Coronary Artery Disease', 'Diabetes Mellitus Type II', 'Gastroesophageal Reflux Disease', 'Glossopharyngeal Neuralgia - resolved', 'Hyperlipidemia', 'Hypertension', 'Obstructive Sleep Apnea, does not use CPAP', 'Transient Ischemic Attack'], 'family_history': 'No Premature coronary artery disease\nbrother died ___ MI, uncle died ___ MI. mom died lung CA', 'present_illness': 'Mr. ___ is an ___ year old man with a history of atrial \nflutter, cerebrovascular accident, chronic kidney disease, \ndiabetes mellitus, hyperlipidemia, hypertension, and obstructive \nsleep apnea. Over the last month he has felt unwell but denied \nchest pain or dyspnea. These feeling occurred at rest and was \nassociated with palpitations and diaphoresis. His symptoms \nlasted up to 90 minutes. He was seen by Dr. ___ 3 recent \nepisodes and was referred for stress test ___. In Dr. \n___, had episode & EKG showed 3mm ST elevation & Q \nwave in III, avF, resolved after 3 sublingual nitroglycerin. He \nwas transferred to ___ where he was aymptomatic and had \na stable EKG. His troponin peaked at 6.42. A cardiac \ncatheterization demonstrated multivessel disease. He was \ntransferred to ___ for revascularization evaluation.', 'medications': [{'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxybutynin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Flecainide Acetate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Sulfameth/Trimethoprim DS', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Flecainide Acetate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.38', 'valuenum': 3.38, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '48.2', 'valuenum': 48.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.37', 'valuenum': 3.37, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '48.0', 'valuenum': 48.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 88.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Admission Physical Exam:\n\nPulse: 66, SR. BP: 135/68. RR: 16. O2 sat: 94% on RA.\nHeight: 67" Weight: 197lbs\n\nGeneral: obese, NAD, pleasant elderly man\nSkin: Dry [x] intact--RLQ yeast breakdown in ABD folds & less so\nbilat groins L>R []\nHEENT: PERRLA [x] EOMI [x], teeth in good repair\nNeck: Supple [x] Full ROM [x], well healed L neck scar\nChest: Lungs clear w/few bibasilar crackles [x]\nHeart: RRR [x] Irregular [] Murmur [x] grade II/VI heard best \nat ___\nAbdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds \n+[x], well healed RLQ/midline scar[x]foley in place with clear\nyellow urine\nExtremities: Warm [x], well-perfused [x] R fem dressing c/d/I, \nno tenderness\nEdema: trace BLE [x] \nVaricosities: None [x]\nNeuro: Grossly intact [x]\nPulses:\nFemoral Right:2 Left:2\nDP Right:2 Left:2\n___ Right:2 Left:2\nRadial Right:2 Left:2\n\nCarotid Bruit Right: yes Left: yes', 'diagnoses': [{'icd_code': 'R319', 'desc': 'Hematuria, unspecified'}, {'icd_code': 'Z8546', 'desc': 'Personal history of malignant neoplasm of prostate'}, {'icd_code': 'Z85038', 'desc': 'Personal history of other malignant neoplasm of large intestine'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'I4891', 'desc': 'Unspecified atrial fibrillation'}], 'summary': 'Transesophageal Echocardiogram ___\nPRE-BYPASS: The left atrium is dilated. No spontaneous echo \ncontrast or thrombus is seen in the body of the left atrium/left \natrial appendage or the body of the right atrium/right atrial \nappendage. No atrial septal defect is seen by 2D or color \nDoppler. Left ventricular wall thicknesses are normal. The left \nventricular cavity size is normal. There is mild regional left \nventricular systolic dysfunction with focalities on the mid and \nbasal inferior wall. Overall left ventricular systolic function \nis mildly depressed (LVEF= 45 %). Right ventricular chamber size \nand free wall motion are normal. There are simple atheroma in \nthe aortic arch. There are complex (>4mm) atheroma in the \ndescending thoracic aorta. There are three aortic valve \nleaflets. The aortic valve leaflets are moderately thickened. \nThere is no aortic valve stenosis. No aortic regurgitation is \nseen. The mitral valve leaflets are mildly thickened. Mild (1+) \nmitral regurgitation is seen. There is no pericardial effusion. \nDr. ___ was notified in person of the results before surgical \nincision.\n\nPOST-BYPASS:\nNormal RV systolic funtion. LVEF 50%. Intact thoracic aorta. No \nother new findings. \n\nTransthoracic Echocardiogram ___\nThe left atrium is mildly dilated. The right atrium is \nmoderately dilated. No atrial septal defect is seen by 2D or \ncolor Doppler. There is mild symmetric left ventricular \nhypertrophy with normal cavity size. Due to suboptimal technical \nquality, a focal wall motion abnormality cannot be fully \nexcluded. Overall left ventricular systolic function is low \nnormal (LVEF 50-55%). There is no ventricular septal defect. The \nright ventricular cavity is mildly dilated with normal free wall \ncontractility. The ascending aorta is mildly dilated. The number \nof aortic valve leaflets cannot be determined. The aortic valve \nleaflets are moderately thickened. There is mild aortic valve \nstenosis (valve area 1.2-1.9cm2). No aortic regurgitation is \nseen. The mitral valve leaflets are mildly thickened. There is \nno mitral valve prolapse. Trivial mitral regurgitation is seen. \nThe tricuspid valve leaflets are mildly thickened. There is \nmoderate pulmonary artery systolic hypertension. There is no \npericardial effusion. \n\nIMPRESSION: Mild symmetric left ventricular hypertrophy with \npreserved right and borderline left ventricular systolic \nfunction. Mild calcific aortic stenosis. Moderate pulmonary \nhypertension. Left pleural effusion and ascites noted.\nThe patient was admitted to the hospital and brought to the \noperating room on ___ where the patient underwent CABGx4 \nLIMA-LAD, SVG-Ramus, sequential SVG-OM1-OM2. Overall the patient \ntolerated the procedure well and post-operatively was \ntransferred to the CVICU in stable condition for recovery and \ninvasive monitoring. POD 1 found the patient extubated, alert \nand oriented and breathing comfortably. He was hypoxic \npost-extubation and required hi-flow oxygenation and aggressive \ndiuresis for several days. The patient was neurologically intact \nand hemodynamically stable on no inotropic or vasopressor \nsupport. Beta blocker was initiated. He has history of aflutter \nand developed post-operative afib and was started on amiodarone \nbut developed bradycardia and it was promptly discontinued. He \nremained in rate controlled afib and Lopressor was adjusted. He \nwas started on Coumadin therapy for anticoagulation. He \nremained very deconditioned and hypoxic requiring aggressive \npulmonary hygiene. Chest tubes and pacing wires were \ndiscontinued without complication. He required aggressive \ndiuresis post-operatively and developed acute-on-chronic kidney \ninjury requiring hemodialysis. With his volume overload he had \nprogressive increasing work of breathing requiring reintubation \non ___. He developed a pneumonia and was treated with \nVancomycin and cefepime. On ___ a trach and PEG were \nperformed. \n\nThroughout his complicated course Mr. ___ was frustrated and \ndiscouraged. He repeated to family members and staff that he \nwanted cessation of care. Palliative care was consulted and met \nwith Mr. ___ and his family. He began to refuse dialysis and \nhis potassium, BUN, and creatinine rose. Mr. ___ and his \nfamily decided to change his code status to Do Not Resuscitate. \nBy post-operative day 26, his family had gathered at his bedside \nand a decision was made to begin comfort measures with a goal of \nwithdrawing care. A fentanyl infusion was initiated and the \nventilator was discontinued. He was declared deceased at 22:40. \nCase was declined by medical examiner and family declined an \nautopsy.'}}	{'final_diagnoses': ['Coronary artery disease.'], 'procedures': ['___ - Coronary artery bypass grafting x4 with the left \ninternal mammary artery to the left anterior descending artery \nand reverse saphenous vein graft to the ramus intermedius artery \nand sequential reverse saphenous vein graft to the ___ and ___ \nobtuse marginal arteries.'], 'visit_summary': 'The patient was admitted to the hospital and brought to the \noperating room on ___ where the patient underwent CABGx4 \nLIMA-LAD, SVG-Ramus, sequential SVG-OM1-OM2. Overall the patient \ntolerated the procedure well and post-operatively was \ntransferred to the CVICU in stable condition for recovery and \ninvasive monitoring. POD 1 found the patient extubated, alert \nand oriented and breathing comfortably. He was hypoxic \npost-extubation and required hi-flow oxygenation and aggressive \ndiuresis for several days. The patient was neurologically intact \nand hemodynamically stable on no inotropic or vasopressor \nsupport. Beta blocker was initiated. He has history of aflutter \nand developed post-operative afib and was started on amiodarone \nbut developed bradycardia and it was promptly discontinued. He \nremained in rate controlled afib and Lopressor was adjusted. He \nwas started on Coumadin therapy for anticoagulation. He \nremained very deconditioned and hypoxic requiring aggressive \npulmonary hygiene. Chest tubes and pacing wires were \ndiscontinued without complication. He required aggressive \ndiuresis post-operatively and developed acute-on-chronic kidney \ninjury requiring hemodialysis. With his volume overload he had \nprogressive increasing work of breathing requiring reintubation \non ___. He developed a pneumonia and was treated with \nVancomycin and cefepime. On ___ a trach and PEG were \nperformed. \n\nThroughout his complicated course Mr. ___ was frustrated and \ndiscouraged. He repeated to family members and staff that he \nwanted cessation of care. Palliative care was consulted and met \nwith Mr. ___ and his family. He began to refuse dialysis and \nhis potassium, BUN, and creatinine rose. Mr. ___ and his \nfamily decided to change his code status to Do Not Resuscitate. \nBy post-operative day 26, his family had gathered at his bedside \nand a decision was made to begin comfort measures with a goal of \nwithdrawing care. A fentanyl infusion was initiated and the \nventilator was discontinued. He was declared deceased at 22:40. \nCase was declined by medical examiner and family declined an \nautopsy.', 'medications_prescribed': ['none']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 51, 'gender': 'M', 'symptoms': 'SOB', 'medical_history': ['diabetes', 'hypothyroidism', 'hypertension', 'obesity', 'arthritis, chronic pain', '-s/p:', 'bilateral TKRs', 'hernia repair x5', 'cholecystectomy'], 'family_history': 'Family history of arthritis', 'present_illness': 'This patient is a ___ year old female who complains of headache \nfollowing a fall at a casino three days ago, injuring the left \nside of her face. She has poor recall of the circumstances and \nsince has had left sided headaches and facial pain. She reports \nthree weeks of dyspnea and non-productive cough for which she \nsaw her PCP one week ago.', 'medications': [{'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Meropenem', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Clindamycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Nicotine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Clindamycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '34.6', 'valuenum': 34.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.5', 'valuenum': 35.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '156', 'valuenum': 156.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.91', 'valuenum': 3.91, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.5', 'valuenum': 16.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.2', 'valuenum': 27.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 10.0, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'ADA RECOMMENDATIONS:; <7% GOAL OF THERAPY; >8% WARRANTS THERAPEUTIC ACTION.'}, {'value': '___', 'valuenum': 240.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 230.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 108.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '___', 'valuenum': 77.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.6', 'valuenum': 35.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '82.7', 'valuenum': 82.7, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '183', 'valuenum': 183.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.99', 'valuenum': 3.99, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': '300', 'valuenum': 300.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': '1.031', 'valuenum': 1.031, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': '>12.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 150.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.4', 'valuenum': 41.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '325', 'valuenum': 325.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.73', 'valuenum': 4.73, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.1', 'valuenum': 25.1, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': "On Admission:\nPHYSICAL EXAMINATION\n\nTemp: 98.9 HR: 72 BP: 153/69 Resp: 16 O(2)Sat: 99 Normal\n\nConstitutional: Comfortable\nHEENT: abrasion over her left zygoma, Pupils equal, round\nand reactive to light, Extraocular muscles intact\ndiffuse C-spine tenderness\nChest: Clear to auscultation\nCardiovascular: Regular Rate and Rhythm\nAbdominal: Soft, Nontender\nExtr/Back: No cyanosis, clubbing or edema\nSkin: Warm and dry\nNeuro: Speech fluent\nPsych: Normal mentation\n___: No petechiae\n\nECG\n\n Heart Rate: 70\n Rhythm: Sinus\n Ischemia: None\n ECG Axis: Normal\n Intervals: Normal\n Comparison to prior results: Same\n\nAt Discharge:\nVS: T 98 HR 70 RR 18 BP 138/78 97% RA\ntele: SR 70-90's\nGeneral: no c/o discomfort currently, asking why her BP was so \nhigh post procedure and her severe headache cause\nHEENT: no JVP appreciated. supple, thick neck, no masses\nCHEST: CTAB\nCV: RRR no m/r/g\nABD: Soft, obese, NT, +BS\nSkin: Warm and dry, R radial access site with gauze and Tegaderm \nc/d/I, no erythema or excess warmth\nNeuro: Grossly N/V/I, moving all 4 extremities, thoughts linear, \ncrosses hemispheres, answering questions appropriately", 'diagnoses': [{'icd_code': '25072', 'desc': 'Diabetes with peripheral circulatory disorders, type II or unspecified type, uncontrolled'}, {'icd_code': '0400', 'desc': 'Gas gangrene'}, {'icd_code': '6827', 'desc': 'Cellulitis and abscess of foot, except toes'}, {'icd_code': '04109', 'desc': 'Streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus'}, {'icd_code': 'V1581', 'desc': 'Personal history of noncompliance with medical treatment, presenting hazards to health'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}], 'summary': "LABS ON ADMISSION:\n\n___ 09:30AM BLOOD WBC-6.3 RBC-3.96 Hgb-11.9 Hct-36.9 MCV-93 \nMCH-30.1 MCHC-32.2 RDW-13.2 RDWSD-45.1 Plt ___\n___ 09:30AM BLOOD Neuts-59.3 ___ Monos-8.1 Eos-2.2 \nBaso-1.0 Im ___ AbsNeut-3.71 AbsLymp-1.79 AbsMono-0.51 \nAbsEos-0.14 AbsBaso-0.06\n___ 09:30AM BLOOD ___ PTT-34.3 ___\n___ 09:30AM BLOOD Glucose-169* UreaN-10 Creat-0.7 Na-139 \nK-3.6 Cl-100 HCO3-23 AnGap-20\n___ 09:30AM BLOOD cTropnT-<0.01\n___ 04:30PM BLOOD cTropnT-<0.01\n___ 09:30AM BLOOD proBNP-111\n___ 09:30AM BLOOD Calcium-8.8 Phos-3.1 Mg-1.6\n\nLABS AT DISCHARGE:\n\n___ 06:00AM BLOOD WBC-10.6* RBC-3.78* Hgb-11.9 Hct-35.1 \nMCV-93 MCH-31.5 MCHC-33.9 RDW-13.5 RDWSD-46.5* Plt ___\n___ 06:00AM BLOOD ___ PTT-33.3 ___\n___ 06:00AM BLOOD Glucose-209* UreaN-12 Creat-0.8 Na-136 \nK-4.4 Cl-98 HCO3-19* AnGap-23\n___ 06:00AM BLOOD Calcium-9.1 Phos-3.8 Mg-1.7\n\nCATHETERIZATIN REPORT ___:\nCoronary Anatomy\nDominance: Right\n Left Main Coronary Artery\nThe LMCA is.free of significant disease.\n* Left Anterior Descending\nThe LAD has mid 40% stenosis.\n* Circumflex\nThe Circumflex has orign 40% stenosis.\nThe ___ Marginal has oirigin 50% stenosis.\n* Right Coronary Artery\nThe RCA is very difficult to engage. Non-selective angiography \nshows mid ___ stenosis.\nThe Right PDA is a small vessel and the distal RCA is possibly \noccluded before a small RPL branch.\nImpressions:\n1. Moderate 3 vessel CAD with possible branch occlusion of \ndistal RCA. There are no good targets for PCI or surgery.\nRecommendations\n1. Medical therapy,\n\nCARDIAC PERFUSION STUDY ___:\nSUMMARY FROM THE EXERCISE LAB: \nFor pharmacologic stress dipyridamole was infused intravenously \nfor \napproximately 4 minutes at a dose of 0.142 \nmilligram/kilogram/min. 1 to 2 \nminutes after the cessation of infusion, the stress dose of the \nradiotracer was injected. She had no anginal symptoms or \nischemic ECG changes. \n \nTECHNIQUE: \nISOTOPE DATA: (___) 31.9 mCi Tc-99m Sestamibi Stress; DRUG \nDATA: (Non-NM admin) Dipyridamole; Following intravenous \ninfusion of the pharmacologic agent, Tc-99m sestamibi was \nadministered intravenously. Stress images were obtained \napproximately 30 minutes following tracer injection. \n \nResting perfusion images were obtained on a subsequent day with \nTc-99m \nsestamibi. Tracer was injected approximately 45 minutes prior to \nobtaining the resting images. \n \nImaging protocol: Gated SPECT. \n \nThis study was interpreted using the 17-segment myocardial \nperfusion model. \n \nFINDINGS: \n \nThe image quality is adequate but limited due to soft tissue and \nbreast \nattenuation. \n \nLeft ventricular cavity size is normal. \n \nRest and stress perfusion images reveal a reversible, mild \nreduction in photon \ncounts involving the entire inferior wall. \n \nGated images reveal normal wall motion. \n \nThe calculated left ventricular ejection fraction is 57% with an \nEDV of 77 ml. \n \n \nIMPRESSION: \n \n1. Reversible, medium sized, mild perfusion defect involving the \nRCA territory. \n \n2. Normal left ventricular cavity size and systolic function. \n \nCT HEAD w/o CONTRAST ___:\nCOMPARISON: CT head without contrast ___\n \nFINDINGS: \n \nThere is no evidence of infarction, hemorrhage, edema, or mass. \nThere is \nprominence of the ventricles and sulci suggestive of \ninvolutional changes. \n \nThere is no evidence of fracture. Small mucous retention cyst \nis noted in the right anterior ethmoid sinus. The visualized \nportion of the orbits are unremarkable. \n \nIMPRESSION: \n \n1. No acute intracranial process. \n \nCT C-SPINE w/o CONTRAST ___:\nFINDINGS: \n \nAlignment is normal. No fractures are identified. There is no \nprevertebral \nsoft tissue swelling. Degenerative changes notable for disc \nbulges and \nthickening of the ligamentum flavum. Disc protrusion at C2-3 \nand C3-4 effaces the ventral CSF and may contact the ventral \naspect of the cord. \n \nThyroid is small but grossly unremarkable. Lung apices are \nnotable for a 3 mm right apical nodule (3:70), unchanged from \nprior. \n \nIMPRESSION: \n \nNo acute fracture or malalignment of the cervical spine. \nA 3 mm right apical pulmonary nodule unchanged since prior ___. \n \nRECOMMENDATION(S): If patient has risk factors such as smoking \nor malignancy, ___ year followup suggested for followup of a 3 mm \nright apical pulmonary nodule. Otherwise no additional imaging \nnecessary. \n\nCT SINUS ___:\nFINDINGS: \n \nThere is no facial bone fracture. Pterygoid plates are intact. \nThere is no mandibular fracture and the temporomandibular joints \nare anatomically aligned. The orbits are intact. The globes and \nextra-ocular muscles are unremarkable. \nThere is no orbital hematoma. \n \nIncluded paranasal sinuses are clear besides a mucous retention \ncyst in the right maxillary sinus. Included extracranial soft \ntissues are unremarkable. \n \nIMPRESSION: \n \nNo fracture. \n\nCXR PA & LATERAL ___:\nFINDINGS: \n \nSlightly lower lung volumes on the current exam. Lungs remain \nclear without consolidation, effusion, or edema. \nCardiomediastinal silhouette is stable. Atherosclerotic \ncalcifications seen at the aortic arch. No acute osseous \nabnormalities, hypertrophic changes again noted in the spine. \n \nIMPRESSION: \n \nNo acute cardiopulmonary process.\nThe patient presented to the ED complaining of a headache, SOB \nand facial pain following a fall at a casino several days \nearlier. She reports no significant headaches in the past and \nwhen quizzed regarding her blood pressure control states she \nchecks her pressure at home and it typically runs in the 120's \nsystolic. She was subsequently transferred to the ___ for \nfurther observation until she underwent numerous studies include \na pharmacological stress test indicating a mild perfusion \ndefect. It was suspected given her history that she could have \ncoronary artery disease. She underwent catheterization on \n___ and had three vessel moderate disease not obstructive or \namenable to PCI or surgery and to continue/enhance medical \nmanagement, particularly in light of her other co-morbidities \nincluding obesity and diabetes. She was expected to discharge \nhome following the catheterization but reported a severe \nheadache and had a high blood pressure running to 230/97. She \nwas subsequently triggered and had vomiting. She was given \nZofran, Hydralazine and persistently hypertensive. A nitro drip \nwas started and she was given Ativan to help with her anxiety \nand her nausea, which subsequently resolved. She was started on \nAtorvastatin and Metoprolol. Her blood pressure normalized by \nthe early morning hours on ___ and her nitro drip was \ndiscontinued. At the time of discharge, her blood pressure was \nranging in the 130's systolic. She had no further headache, was \ntolerating her diet and voiding without difficulty. She was \ncounseled regarding lifestyle changes, management of blood \npressure and close follow up with her physicians. Her headache \nwas felt to be multi-factorial, including her NPO status until \nher late day catheterization, and her high blood pressures, \nwhich likely exist at home."}}	{'final_diagnoses': ['NEW:', 'Abnormal stress test:', 'Cardiac Cath: multivessel moderate disease, no obstructive CAD \nw/o good targets for PCI or surgery - manage medically', 'PRIOR:', 'DM Type 2', 'Hypertension', 'Hyperlipidemia'], 'procedures': ['Diagnostic coronary angiogram'], 'visit_summary': "The patient presented to the ED complaining of a headache, SOB \nand facial pain following a fall at a casino several days \nearlier. She reports no significant headaches in the past and \nwhen quizzed regarding her blood pressure control states she \nchecks her pressure at home and it typically runs in the 120's \nsystolic. She was subsequently transferred to the ___ for \nfurther observation until she underwent numerous studies include \na pharmacological stress test indicating a mild perfusion \ndefect. It was suspected given her history that she could have \ncoronary artery disease. She underwent catheterization on \n___ and had three vessel moderate disease not obstructive or \namenable to PCI or surgery and to continue/enhance medical \nmanagement, particularly in light of her other co-morbidities \nincluding obesity and diabetes. She was expected to discharge \nhome following the catheterization but reported a severe \nheadache and had a high blood pressure running to 230/97. She \nwas subsequently triggered and had vomiting. She was given \nZofran, Hydralazine and persistently hypertensive. A nitro drip \nwas started and she was given Ativan to help with her anxiety \nand her nausea, which subsequently resolved. She was started on \nAtorvastatin and Metoprolol. Her blood pressure normalized by \nthe early morning hours on ___ and her nitro drip was \ndiscontinued. At the time of discharge, her blood pressure was \nranging in the 130's systolic. She had no further headache, was \ntolerating her diet and voiding without difficulty. She was \ncounseled regarding lifestyle changes, management of blood \npressure and close follow up with her physicians. Her headache \nwas felt to be multi-factorial, including her NPO status until \nher late day catheterization, and her high blood pressures, \nwhich likely exist at home.", 'medications_prescribed': ['Aspirin 81 mg PO DAILY', 'Atorvastatin 80 mg PO QPM', 'Metoprolol Tartrate 25 mg PO BID', 'Cyanocobalamin 1000 mcg PO DAILY', 'GlipiZIDE 5 mg PO DAILY', 'Levothyroxine Sodium 125 mcg PO DAILY', 'Losartan Potassium 100 mg PO DAILY', 'Sucralfate 1 gm PO QID']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 62, 'gender': 'M', 'symptoms': 'Trauma: Fall from tree', 'medical_history': ['IVDU'], 'family_history': 'Non-contributory', 'present_illness': 'Pt is ___ male with hx of substance abuse who fell 6 \nfeet out of a tree. No LOC. Pt transferred from OSH where he had \na CT head and C-spine negative for bleed or fracture. Patient \nunderwent a CT of the torso which showed a 30% pneumothorax. \nChest tube was placed and the patient was transferred here for \nevaluation. Complaining of sharp pain in the left chest worse \nwith movement. Pt with neg tox, +opiates at ___, no tox from \nOSH.', 'medications': [{'medication': 'Verapamil SR', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Desonide 0.05% Cream', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Verapamil SR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Verapamil SR', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Flecainide Acetate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '45.1', 'valuenum': 45.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '253', 'valuenum': 253.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.02', 'valuenum': 5.02, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'GEN: AAOx3, in mild distress\nVS: WNL\nHEENT: ecchymosis around left eye, EMOI, PERRLA, nares patent, \nmoist mucous membrances, no blood in nasopharynx or oropharynx\nHEART: RRR S1S2\nLUNGS: CTAB, TTP on left chest wall, saturated bandage over CT \nremoval site\nAB: soft, NT, ND, normal bowel sounds\nEXT: peripheral pulses intact bilaterally\nNEURO: CN ___ intact, oriented to person, place, and time', 'diagnoses': [{'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '4589', 'desc': 'Hypotension, unspecified'}, {'icd_code': '7802', 'desc': 'Syncope and collapse'}, {'icd_code': '42789', 'desc': 'Other specified cardiac dysrhythmias'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': 'V5866', 'desc': 'Long-term (current) use of aspirin'}], 'summary': '___ 06:45PM BLOOD WBC-8.6 RBC-4.62 Hgb-14.0 Hct-39.8* \nMCV-86 MCH-30.2 MCHC-35.2* RDW-12.3 Plt ___\n___ 06:45PM BLOOD ___ PTT-29.8 ___\n___ 06:45PM BLOOD Glucose-94 UreaN-14 Creat-0.8 Na-140 \nK-4.2 Cl-107 HCO3-23 AnGap-14\n___ 06:45PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nBnzodzp-NEG Barbitr-NEG Tricycl-NEG\n\n___ 10:00PM URINE bnzodzp-NEG barbitr-NEG opiates-POS \ncocaine-NEG amphetm-NEG mthdone-NEG\n\nPortable CXR ___\n1. No definite pneumothorax seen on this single semi upright AP \nview. Left \nchest tube in place with a small amount of subcutaneous \nemphysema in the left \nlateral chest wall. \n \n2. Low lung volumes with bibasilar airspace opacities, likely \natelectasis, but \ninfection is difficult to exclude. Small left pleural effusion. \n\n \nPA/LAT AM ___\n\nIMPRESSION: \n1. No appreciable pneumothorax after chest tube removal. \n \n2. Left lower lobe volume loss. \n\nPA/LAT ___ ___\n\nFINDINGS: PA and lateral chest radiographs. Left basilar \natelectasis \npersists. However, there is no visible pneumothorax. The \ncardiomediastinal \nsilhouette is stable. \n \nIMPRESSION: No pneumothorax. \nThe patient was admitted to the Acute Care Surgery Service on \n___ a fall from a tree. The patient was evaluated at an \nOSH, and found to have a left pneumothorax of CT chest. A chest \ntube was placed, and he was transferred here for further care. \nHis hospital course was uneventful, and he was discharged to \nhome. \n\nHospital Course by Systems:\nNeuro: Pain was well controlled on oral regimen. \n\nCardiovascular: Remained hemodynamically stable.\n\nPulmonary: Portable CXR on HD1 showed no PTX with CT in place on \nleft. CT dislodged by patient overnight, and removed HD2 AM. \nPA/LAT CXR on HD2 AM showed no PTX, chest tube removed. PA/LAT \nCXR on HD2 ___ confirmed no PTX.\n\nGI: Diet was advanced as tolerated. Bowel regimen was given prn.\n\nGU: Patient was able to void independently.\n\nHeme: Received heparin subcutaneously and pneumatic compression \nboots for DVT prophylaxis.\n \nThe patient was discharged to home in stable condition, \nambulating, and voiding independently, and with adequate pain \ncontrol. The patient was given instructions to follow-up in the \n___ clinic in ___ weeks. The patient was also given detailed \ndischarge instructions outlining activity, diet, follow up, and \nmedication scripts.'}}	{'final_diagnoses': ['trauma: fall from tree'], 'procedures': ['CT placement at OSH'], 'visit_summary': 'The patient was admitted to the Acute Care Surgery Service on \n___ a fall from a tree. The patient was evaluated at an \nOSH, and found to have a left pneumothorax of CT chest. A chest \ntube was placed, and he was transferred here for further care. \nHis hospital course was uneventful, and he was discharged to \nhome. \n\nHospital Course by Systems:\nNeuro: Pain was well controlled on oral regimen. \n\nCardiovascular: Remained hemodynamically stable.\n\nPulmonary: Portable CXR on HD1 showed no PTX with CT in place on \nleft. CT dislodged by patient overnight, and removed HD2 AM. \nPA/LAT CXR on HD2 AM showed no PTX, chest tube removed. PA/LAT \nCXR on HD2 ___ confirmed no PTX.\n\nGI: Diet was advanced as tolerated. Bowel regimen was given prn.\n\nGU: Patient was able to void independently.\n\nHeme: Received heparin subcutaneously and pneumatic compression \nboots for DVT prophylaxis.\n \nThe patient was discharged to home in stable condition, \nambulating, and voiding independently, and with adequate pain \ncontrol. The patient was given instructions to follow-up in the \n___ clinic in ___ weeks. The patient was also given detailed \ndischarge instructions outlining activity, diet, follow up, and \nmedication scripts.', 'medications_prescribed': ['Acetaminophen 650 mg PO Q4H ', 'HYDROmorphone (Dilaudid) ___ mg PO Q3H:PRN pain \nRX hydromorphone [Dilaudid] 2 mg ___ tablet(s) by mouth every \n___ hours Disp #30 Tablet Refills:0', 'Cyclobenzaprine 10 mg PO TID:PRN pain \nRX cyclobenzaprine 10 mg 1 tablet(s) by mouth three times a day \nDisp #30 Tablet Refills:0']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 85, 'gender': 'F', 'symptoms': 'Wound drainage', 'medical_history': ['Asthma', 'anxiety', 'sleep apnea', 'vitamin D deficiency', 'anemia'], 'family_history': 'Non-contributory', 'present_illness': 'Ms. ___ is well known to our service. She is a ___ y/o\nfemale who underwent a spinal cord stimulator by Dr. ___ on ___\nand came back to the hospital for concerns of wound drainage and\ninfection on ___ she received a few days of Vancomycin and at\nher request was transitioned to PO antibiotics and was\ndischarged home on ___. She states that she went home that ___ and was feeling well,\nbut having some discomfort with dressing changes and was \nnoticing\nthat her wound which was draining yellow fluid had started to\ndischarge thicker yellow/white fluid that was different than\nbefore. She went to ___ in ___ and was\nadmitted. There her wound was cultured and the medial portion\nclosed with steri strips. She was transferred here for further\ncare and evaluation by Dr. ___.', 'medications': [{'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Diltiazem Extended-Release', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Miconazole Powder 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Miconazole 2% Cream', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem Extended-Release', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acyclovir', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acyclovir', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Alendronate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QSUN', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem Extended-Release', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem Extended-Release', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}]}, 'clinical_findings': {'labs': [{'value': '1.7', 'valuenum': 1.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.9', 'valuenum': 18.9, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 55.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': 'NotDone. CK-MB NOT PERFORMED, TOTAL CK < 100.'}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.9,. Estimated GFR = 60 if non African-American (mL/min/1.73 m2). Estimated GFR = 72 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 129.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '___', 'valuenum': 5.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES K.'}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.0', 'valuenum': 17.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '77.1', 'valuenum': 77.1, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '389', 'valuenum': 389.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18.2', 'valuenum': 18.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.62', 'valuenum': 3.62, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.8', 'valuenum': 18.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 22.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': 'NotDone. CK-MB NOT PERFORMED, TOTAL CK < 100.'}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '340', 'valuenum': 340.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18.2', 'valuenum': 18.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.13', 'valuenum': 3.13, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 18.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY REPLICATE ANALYSIS. NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': 'NotDone. CK-MB NOT PERFORMED, TOTAL CK < 100.'}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19.0', 'valuenum': 19.0, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '361', 'valuenum': 361.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.4', 'valuenum': 18.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.09', 'valuenum': 3.09, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': '%', 'ref_range_lower': 1.2, 'ref_range_upper': 3.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '333', 'valuenum': 333.0, 'valueuom': 'ng/mL', 'ref_range_lower': 13.0, 'ref_range_upper': 150.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.6', 'valuenum': 16.6, 'valueuom': 'ng/mL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'ug/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 160.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '304', 'valuenum': 304.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '234', 'valuenum': 234.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '593', 'valuenum': 593.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'MOD', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'SM', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'LG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11-20', 'valuenum': None, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21-50', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.019', 'valuenum': 1.019, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Clear', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Yellow', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '330', 'valuenum': 330.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.0', 'valuenum': 18.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.08', 'valuenum': 3.08, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 89.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19.7', 'valuenum': 19.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.005', 'valuenum': 1.005, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20.2', 'valuenum': 20.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 86.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '330', 'valuenum': 330.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.1', 'valuenum': 18.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.34', 'valuenum': 3.34, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 86.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '308', 'valuenum': 308.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.1', 'valuenum': 17.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.35', 'valuenum': 3.35, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.8,. Estimated GFR = 68 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 84.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'On admission:\n\nT: 98.3 BP:132 /88 HR: 74 R O2Sats 94\nGen: WD/WN, comfortable, NAD.\n\nLungs: CTA bilaterally.\nCardiac: RRR. S1/S2.\nAbd: Soft, NT, BS+\nExtrem: Warm and well-perfused.\nNeuro:\nMental status: Awake and alert, cooperative with exam, normal\naffect.\n\nCranial Nerves:\nI: Not tested\nII: Pupils equally round and reactive to light, 5 to 4\nmm bilaterally. Visual fields are full to confrontation.\nIII, IV, VI: Extraocular movements intact bilaterally without\nnystagmus.\nV, VII: Facial strength and sensation intact and symmetric.\nVIII: Hearing intact to voice.\nIX, X: Palatal elevation symmetrical.\nXI: Sternocleidomastoid and trapezius normal bilaterally.\nXII: Tongue midline without fasciculations.\n\nMotor: Normal bulk and tone bilaterally. No abnormal movements,\ntremors. Strength full power ___ throughout. No pronator drift\n\nSensation: Intact to light touch\n\nWOUND: Right flank, irritated and red, no active discharge \nnoted.\nsteri strips over medial part of wound. No tenderness with\npalpation\n\nOn discharge:\n\nAAO x 3. Strength full throughout.\n\nWound: Right flank slightly reddened. No drainage from wound \nnoted. Most medial portion of wound closed with sutures. CDI.\nNo tenderness with palpation.', 'diagnoses': [{'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '42833', 'desc': 'Acute on chronic diastolic heart failure'}, {'icd_code': '0538', 'desc': 'Herpes zoster with unspecified complication'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '4589', 'desc': 'Hypotension, unspecified'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}, {'icd_code': '3940', 'desc': 'Mitral stenosis'}, {'icd_code': '56409', 'desc': 'Other constipation'}, {'icd_code': '71536', 'desc': 'Osteoarthrosis, localized, not specified whether primary or secondary, lower leg'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': 'V422'}, {'icd_code': 'V4582', 'desc': 'Percutaneous transluminal coronary angioplasty status'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}], 'summary': '___ 05:08AM BLOOD WBC-4.0 RBC-3.71* Hgb-9.6* Hct-30.7\nMCV-83 MCH-26.0 MCHC-31.4 RDW-20.5* Plt ___\n___ 05:08AM BLOOD Plt ___\n___ 05:08AM BLOOD ESR-75\n___ 05:08AM BLOOD Glucose-82 UreaN-5 Creat-0.5 Na-142\nK-3.7 Cl-104 HCO3-27 AnGap-15\n___ 05:08AM BLOOD CRP-7.6*\nMrs ___ was admitted to the Neurosurgery service for\nfurther assessment of her wound, clinical status and laboratory\nassay evaluation. She had no fever or leukocytosis. ESR and\nCRP were slightly elevated. In the ED, she was started on\nvancomycin q 8 hours IV. She was admitted to the neurosurgical\nfloor overnight.\n\nOn the following day, Mrs. ___ wound was assessed by the\nNeurosurgery team, as well as the Attending. Because there was\nno observable drainage and looked much improved from prior, she\nwas given her two scheduled doses of IV vancomycin and\ndischarged home on oral levaquin. The patient was requesting to\ngo home, so this plan was agreed upon by all members of the\nteam, including the patient.\n\nMrs. ___ was instructed to call Dr. ___ office on ___\nto schedule a follow-up appointment within one week. In the\nmeantime, she was given a prescription for levaquin for a total\nof 14 days. If she had any questions, concerns or seemingly\nworsening of her wound, she was instructed to go to the nearest\nemergency department.'}}	{'final_diagnoses': ['Right buttock cellulitis'], 'procedures': ['None'], 'visit_summary': 'Mrs ___ was admitted to the Neurosurgery service for\nfurther assessment of her wound, clinical status and laboratory\nassay evaluation. She had no fever or leukocytosis. ESR and\nCRP were slightly elevated. In the ED, she was started on\nvancomycin q 8 hours IV. She was admitted to the neurosurgical\nfloor overnight.\n\nOn the following day, Mrs. ___ wound was assessed by the\nNeurosurgery team, as well as the Attending. Because there was\nno observable drainage and looked much improved from prior, she\nwas given her two scheduled doses of IV vancomycin and\ndischarged home on oral levaquin. The patient was requesting to\ngo home, so this plan was agreed upon by all members of the\nteam, including the patient.\n\nMrs. ___ was instructed to call Dr. ___ office on ___\nto schedule a follow-up appointment within one week. In the\nmeantime, she was given a prescription for levaquin for a total\nof 14 days. If she had any questions, concerns or seemingly\nworsening of her wound, she was instructed to go to the nearest\nemergency department.', 'medications_prescribed': ['1. Albuterol Inhaler 2 PUFF IH Q6H:PRN sob', '2. Baclofen 10 mg PO QID', '3. Chlordiazepoxide HCl 25 mg PO TID', '4. Nicotine Patch 21 mg TD DAILY', '5. Docusate Sodium 100 mg PO BID', '6. OxyCODONE SR (OxyconTIN) 80 mg PO Q8H', '7. Venlafaxine XR 37.5 mg PO DAILY', '8. Zolpidem Tartrate 5 mg PO HS:PRN insomnia', '9. Levofloxacin 750 mg PO Q24H Duration: 14 Days \nRX levofloxacin 750 mg 1 tablet(s) by mouth daily Disp #14 \nTablet Refills:*0']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 52, 'gender': 'M', 'symptoms': 'Right distal clavicle fracture', 'medical_history': ['None signficant'], 'family_history': 'Not contributory', 'present_illness': '___ is a ___ year-old with a right distal clavicle \nfracture now almost 8 weeks out of non-operative treatment. \nUnfortunately, she was still having daily pain and limitations \nin her activities from discomfort.', 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metolazone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'NIFEdipine CR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': 260.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '42.1', 'valuenum': 42.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23.7', 'valuenum': 23.7, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '63.0', 'valuenum': 63.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '196', 'valuenum': 196.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.38', 'valuenum': 4.38, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 249.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '175', 'valuenum': 175.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 206.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 135.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LDL(CALC) INVALID IF TRIG>400 OR NON-FASTING SAMPLE.'}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'RARE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'TR', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.015', 'valuenum': 1.015, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Clear', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Yellow', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 134.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '49.3', 'valuenum': 49.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.3', 'valuenum': 16.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '207', 'valuenum': 207.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.10', 'valuenum': 5.1, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 127.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '___', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY ELEVATES Mg.'}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY ELEVATES K.'}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 122.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '49.7', 'valuenum': 49.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.6', 'valuenum': 16.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '262', 'valuenum': 262.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.16', 'valuenum': 5.16, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.5', 'valuenum': 16.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Vitals: ___ ___ Temp: 97.8 PO BP: 91/63 L Lying HR: 64 RR:\n18 O2 sat: 98% O2 delivery: Ra \nGeneral: Well-appearing, breathing comfortably\nMSK:\nShoulder in sling\nRight upper extremity:\n- In sling, bandage c/d/i\n- No deformity, erythema, edema, induration or ecchymosis \n- Soft, non-tender arm and forearm\n- Full, painless AROM/PROM of elbow, wrist, and digits\n- EPL/FPL/DIO (index) fire\n- SILT axillary/radial/median/ulnar nerve distributions\n- 2+ radial pulse', 'diagnoses': [{'icd_code': '42823', 'desc': 'Acute on chronic systolic heart failure'}, {'icd_code': 'V854'}, {'icd_code': '78659', 'desc': 'Other chest pain'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '25080', 'desc': 'Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '27801', 'desc': 'Morbid obesity'}, {'icd_code': '7823', 'desc': 'Edema'}, {'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': '3004', 'desc': 'Dysthymic disorder'}, {'icd_code': 'V5866', 'desc': 'Long-term (current) use of aspirin'}], 'summary': "See OMR for all lab and imaging results.\nThe patient presented as a same day admission for surgery. The \npatient was taken to the operating room on ___ for open \nreduction internal fixation of right distal clavicle fracture, \nwhich the patient tolerated well. For full details of the \nprocedure please see the separately dictated operative report. \nThe patient was taken from the OR to the PACU in stable \ncondition and after satisfactory recovery from anesthesia was \ntransferred to the floor. The patient was initially given IV \nfluids and IV pain medications, and progressed to a regular diet \nand oral medications by POD#1. The patient was given \n___ antibiotics and anticoagulation per routine. The \npatient's home medications were continued throughout this \nhospitalization. The patient worked with ___ who determined that \ndischarge to home was appropriate. The ___ hospital course \nwas otherwise unremarkable.\n\nAt the time of discharge the patient's pain was well controlled \nwith oral medications, incisions were clean/dry/intact, and the \npatient was voiding/moving bowels spontaneously. The patient is \nnon-weight bearing in the right upper extremity, and will be \ndischarged on aspirin 325mg daily (if not mobilizing well \notherwise none) for DVT prophylaxis. The patient will follow up \nwith Dr. ___ routine. A thorough discussion was had with \nthe patient regarding the diagnosis and expected post-discharge \ncourse including reasons to call the office or return to the \nhospital, and all questions were answered. The patient was also \ngiven written instructions concerning precautionary instructions \nand the appropriate follow-up care. The patient expressed \nreadiness for discharge."}}	{'final_diagnoses': ['Right distal clavicle fracture'], 'procedures': ['Open reduction internal fixation right distal clavicle fracture'], 'visit_summary': "The patient presented as a same day admission for surgery. The \npatient was taken to the operating room on ___ for open \nreduction internal fixation of right distal clavicle fracture, \nwhich the patient tolerated well. For full details of the \nprocedure please see the separately dictated operative report. \nThe patient was taken from the OR to the PACU in stable \ncondition and after satisfactory recovery from anesthesia was \ntransferred to the floor. The patient was initially given IV \nfluids and IV pain medications, and progressed to a regular diet \nand oral medications by POD#1. The patient was given \n___ antibiotics and anticoagulation per routine. The \npatient's home medications were continued throughout this \nhospitalization. The patient worked with ___ who determined that \ndischarge to home was appropriate. The ___ hospital course \nwas otherwise unremarkable.\n\nAt the time of discharge the patient's pain was well controlled \nwith oral medications, incisions were clean/dry/intact, and the \npatient was voiding/moving bowels spontaneously. The patient is \nnon-weight bearing in the right upper extremity, and will be \ndischarged on aspirin 325mg daily (if not mobilizing well \notherwise none) for DVT prophylaxis. The patient will follow up \nwith Dr. ___ routine. A thorough discussion was had with \nthe patient regarding the diagnosis and expected post-discharge \ncourse including reasons to call the office or return to the \nhospital, and all questions were answered. The patient was also \ngiven written instructions concerning precautionary instructions \nand the appropriate follow-up care. The patient expressed \nreadiness for discharge.", 'medications_prescribed': ['Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild', 'HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN Pain - Moderate', 'Ondansetron 4 mg PO Q8H:PRN nausea']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 69, 'gender': 'M', 'symptoms': 'lethargy', 'medical_history': ['AFib s/p ICD ___', '___ Successful PTCA of the LCX/OM/Left PDA', '___ 1. Three vessel coronary artery disease. 2. Successful \nPTCA and stenting of the L PDA with a bare metal stent. 3. \nSuccessful PTCA and stenting of the mid and proximal CX with \nthree drug eluting stents. ', 'Chronic systolic CHF with EF ___ in ___, ICD ___', 'Hypertension', 'Type II Diabetes x ___ years, with peripheral neuropathy', 'Chronic renal insufficiency with baseline Cr 1.3-1.5', '___ syndrome (warm autoimmune hemolytic anemia and \nthrombocytopenia) on prednisone', 'Peripheral vascular disease s/p recent angioplasty, amputation \nof ___ toe', 'Osteoporosis', 'GERD/Barretts esophagus (dx on EGD, per daughter and pt)', '___', 'hx of squamous cell carcinoma of the ear (excised)'], 'family_history': '- Mother: ___ in her ___, died of MI at age ___. \n- Father: ___ in his ___. \n- Sister: CAD and DM. ', 'present_illness': "___ y/o male with IDDM, CAD, sCHF (EF 25%) s/p ICD, HTN, CKD, \nAfib, PVD, hypothyroidism, ___ syndrome, h/o c. diff infection \nwho presented to the ED with weakness, now with hospital course \nc/b recurrent NSVT and altered mental status. Please see \nmedicine nightfloat note for full details, but in brief, patient \nhad URI type symptoms (rhinorrhea, dry cough, myalgias, nausea, \nlethargy and decreased appetite for four days prior to admission \non ___. Tmax at home 100.0F. Also had elevated BG to 500 at \nhome. Of note, had Cdiff diagnosed on ___ and had left \nsecond toe amputated on ___ for osteomyelitis. \n\nIn the ED intial vitals were: 8 99.7 95 92/46 20 99%RA. Labs \nwere significant for Na 129, BUN 116, creat 2.2 (baseline \n1.4's), Trop 0.12, CKMB 3, proBNP: 2933, H/H 8.___.7, PLT 79. \nLactate 1.4. Glucose 162. UA negative with the exception of \nglucose 300. INR 1.1. Blood and urine cultures sent. ECG showed \npaced rhythm, rate 85. CXR showed AICD in place, No acute \ncardiopulmonary process. Patient was given NS at 200cc/hr and \noseltamivir. Patient was admitted for hydration given ___ and \nsymptom control. \n\nThus far during admission, patient was given resuscitation with \nso far a total of 3.5L, and getting another liter on transport \nto ICU. Initially was not started on abx given more suspicion \nfor viral process and no clear source, but overnight patient \ndecompensated with altered mental status, had new fever to 100.7 \nthis morning and was started on vancomycin, cefepime, and \nflagyl. Noncon CT head o/n was negative for acute intracranial \nprocess. There is suspicion for uremia as cause of AMS given \nrise in BUN from CXR was pending at time of transfer. Admission \nhas also been complicated by many episodes of NSVT, for which \nthe patient has not actually been shocked by his ICD but has had \nseveral episodes of overdrive pacing. EP was called today who \ninterrogated pacer, and felt that his VT is most likely due to \nanother underlying (possibly infectious) process, and \nrecommended starting amiodarone.\n\nOn arrival, patient is lethargic but following commands and can \nstate name, month/year, and location. ", 'medications': [{'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Neostigmine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ezetimibe', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Phenylephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Phenylephrine', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Citrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Protamine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ezetimibe', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'ChlorproMAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Paroxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Glycopyrrolate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 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None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.15', 'valuenum': 1.15, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '164', 'valuenum': 164.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': 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'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.67', 'valuenum': 3.67, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 13.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED.'}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.12', 'valuenum': 1.12, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.47', 'valuenum': 7.47, 'valueuom': 'units', 'ref_range_lower': 7.35, 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{'value': '40', 'valuenum': 40.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.45', 'valuenum': 7.45, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '246', 'valuenum': 246.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 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'flag': None, 'priority': None, 'comments': '___'}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '195', 'valuenum': 195.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.24', 'valuenum': 3.24, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.11', 'valuenum': 1.11, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.38', 'valuenum': 7.38, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '27.5', 'valuenum': 27.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '175', 'valuenum': 175.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.05', 'valuenum': 3.05, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.7', 'valuenum': 16.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.9,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 116.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 123.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.0', 'valuenum': 24.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '164', 'valuenum': 164.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.71', 'valuenum': 2.71, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '176', 'valuenum': 176.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.25', 'valuenum': 3.25, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '240', 'valuenum': 240.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.31', 'valuenum': 3.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION EXAM:\n======================================\nVitals: 98.3 126/55 101 22 97% RA \nGeneral: lethargic but responds to questions, follows commands, \nno acute distress\nHEENT: Sclera anicteric, MM dry \nNeck: supple, JVP to ear but could be more EJ \nLungs: Rales bilateral bases, no wheezing\nCV: Tachycardic, difficult to hear heart sounds\nAbdomen: soft, non-tender, non-distended, bowel sounds present, \nno rebound tenderness or guarding, no organomegaly \nGU: foley in place\nExt: warm, dry skin. left ___ toe with dry gangrene, no drainage \nor pus \n\nDISCHARGE EXAM:\n======================================\nTm98.2, BP105-131/44-83, P59-64, R18-19, O299-100RA\nWeight: 74.5 -< 74.9 <- 75.2 <-73.3 kg <- 71.7 kg <-71.7kg \nGENERAL: NAD, alert, interactive \nHEENT: NC/AT, sclerae anicteric \nNECK: soft, no LAD \nLUNGS: Clear w/ exception of faint bibasilar crackles, no incr \nWOB, comfortable on RA\nHEART: systolic murmur at apex, regular rate and rhythm \nABDOMEN: +BS, soft, NT/ND \nEXTREMITIES: L foot wrapped w/ amputated ___ digit, 1+ edema to \nknees b/l \nNEURO: awake, A&Ox3', 'diagnoses': [{'icd_code': '41092', 'desc': 'Acute myocardial infarction of unspecified site, subsequent episode of care'}, {'icd_code': '5121', 'desc': 'Iatrogenic pneumothorax'}, {'icd_code': '2761', 'desc': 'Hyposmolality and/or hyponatremia'}, {'icd_code': '79001', 'desc': 'Precipitous drop in hematocrit'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': 'V4582', 'desc': 'Percutaneous transluminal coronary angioplasty status'}, {'icd_code': 'E8782', 'desc': 'Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}, {'icd_code': '412', 'desc': 'Old myocardial infarction'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}], 'summary': "___ 09:45PM WBC-7.2# RBC-3.18* Hgb-8.9* Hct-26.7* MCV-84 \nMCH-27.8 MCHC-33.2 RDW-17.4* Plt Ct-79\n___ 09:45PM Neuts-73.5 Lymphs-11.6* Monos-14.3* Eos-0.5 \nBaso-0.1\n___ 09:45PM Hypochr-1+ Anisocy-2+ Poiklo-2+ Macrocy-1+ \nMicrocy-1+ Polychr-NORMAL Ovalocy-2+ Schisto-OCCASIONAL \nPencil-1+ Acantho-OCCASIONAL\n___ 09:45PM ___ PTT-27.2 ___\n___ 09:45PM Glucose-162* UreaN-116* Creat-2.2* Na-129* \nK-4.1 Cl-90* HCO3-23 AnGap-20\n___ 09:45PM CK-MB-3 proBNP-2933\n___ 09:45PM cTropnT-0.12\n\nPERTINENT LABS:\n======================================\n___ 06:08AM CK-MB-3 cTropnT-0.14\n___ 12:00PM CK-MB-3 cTropnT-0.30\n___ 06:08AM Hapto-229\n___ 06:15AM Hapto-275\n___ 04:33AM Hapto-243\n___ 06:08AM Osmolal-315\n___ 06:15AM Osmolal-309\n___ 12:25AM Lactate-1.4\n___ 03:03PM Lactate-3.8\n___ 06:08AM Lactate-2.6\n___ 12:24PM Lactate-3.3\n___ 12:19PM ___ Temp-36.6 pO2-129 pCO2-34* pH-7.39 \ncalTCO2-21 Base XS--3\n___ 03:03PM ___ Temp-36.6 pO2-19* pCO2-31* pH-7.39 \ncalTCO2-19* Base XS--5\n___ 06:08PM ___ pO2-196* pCO2-23* pH-7.46* calTCO2-17* \nBase XS--4 Comment-GREEN TOP\n___ 12:24PM ___ Temp-37.0 pO2-239* pCO2-32* pH-7.38 \ncalTCO2-20* Base XS--4 Comment-GREEN TOP\n___ 06:15AM ALT-18 AST-31 LD(___)-214 AlkPhos-66 \nTotBili-0.4\n___ 04:33AM LD(___)-686* TotBili-0.7\n\nDISCHARGE LABS:\n=====================================\n___ 05:52AM BLOOD WBC-9.4 RBC-2.61* Hgb-7.2* Hct-23.7* \nMCV-91 MCH-27.7 MCHC-30.5* RDW-21.2* Plt Ct-UNABLE TO \n___ 06:37AM BLOOD Neuts-85.8* Lymphs-7.8* Monos-5.8 Eos-0.4 \nBaso-0.2\n___ 05:52AM BLOOD ___ PTT-68.6* ___\n___ 05:52AM BLOOD Glucose-153* UreaN-81* Creat-2.2* Na-136 \nK-4.4 Cl-109* HCO3-19* AnGap-12\n___ 05:52AM BLOOD ALT-7 AST-75* AlkPhos-83 TotBili-0.7\n___ 05:52AM BLOOD Albumin-3.0* Calcium-7.7* Phos-3.6 Mg-2.6\n\nPERTINENT MICRO:\n====================================\nBlood Culture, Routine (Final ___: NO GROWTH.\nURINE CULTURE (Final ___: NO GROWTH. \nBlood Culture, Routine (Final ___: NO GROWTH. \n Respiratory Viral Antigen Screen (Final ___: \n Negative for Respiratory Viral Antigen. \n Specimen screened for: Adeno, Parainfluenza 1, 2, 3, \nInfluenza A, B,\n and RSV by immunofluorescence. \n Refer to respiratory viral culture for further \ninformation. \n\n Respiratory Viral Culture (Final ___: \n No respiratory viruses isolated. \n Culture screened for Adenovirus, Influenza A & B, \nParainfluenza type\n 1,2 & 3, and Respiratory Syncytial Virus.. \n Detection of viruses other than those listed above will \nonly be\n performed on specific request. Please call Virology at \n___\n within 1 week if additional testing is needed.\n\n Blood Culture, Routine (Final ___: \n STAPH AUREUS COAG +. \n Consultations with ID are recommended for all blood \ncultures\n positive for Staphylococcus aureus, yeast or other \nfungi. \n FINAL SENSITIVITIES. \n Staphylococcus species may develop resistance during \nprolonged\n therapy with quinolones. Therefore, isolates that are \ninitially\n susceptible may become resistant within three to four \ndays after\n initiation of therapy. Testing of repeat isolates may \nbe\n warranted. \n\n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n STAPH AUREUS COAG +\n \| \nCLINDAMYCIN-----------<=0.25 S\nERYTHROMYCIN----------<=0.25 S\nGENTAMICIN------------ <=0.5 S\nLEVOFLOXACIN----------<=0.12 S\nOXACILLIN-------------<=0.25 S\nTRIMETHOPRIM/SULFA---- <=0.5 S\n\n Anaerobic Bottle Gram Stain (Final ___: \n GRAM POSITIVE COCCI IN CLUSTERS. \n Reported to and read back by ___ (___) \n1:05AM\n ___. \n\n Aerobic Bottle Gram Stain (Final ___: \n GRAM POSITIVE COCCI IN CLUSTERS.\n\n URINE CULTURE (Final ___: NO GROWTH.\n MRSA SCREEN (Final ___: No MRSA isolated.\n Blood Culture, Routine (Final ___: NO GROWTH.\n Blood Culture, Routine (Final ___: NO GROWTH\n C. difficile DNA amplification assay (Final ___: \n Reported to and read back by ___ ___ @1408 ___ \n___. \n CLOSTRIDIUM DIFFICILE. \n Positive for toxigenic C. difficile by the Illumigene \nDNA\n amplification. (Reference Range-Negative). \n URINE CULTURE (Final ___: NO GROWTH. \n Blood Culture, Routine (Final ___: NO GROWTH. \n Blood Culture, Routine (Final ___: NO GROWTH.\n\n GRAM STAIN (Final ___: \n NO POLYMORPHONUCLEAR LEUKOCYTES SEEN. \n 4+ (>10 per 1000X FIELD): GRAM POSITIVE COCCI. \n ___ AND IN PAIRS. \n SMEAR REVIEWED; RESULTS CONFIRMED. \n\n WOUND CULTURE (Final ___: \n STAPH AUREUS COAG +. HEAVY GROWTH. \n Staphylococcus species may develop resistance during \nprolonged\n therapy with quinolones. Therefore, isolates that are \ninitially\n susceptible may become resistant within three to four \ndays after\n initiation of therapy. Testing of repeat isolates may \nbe\n warranted. \n\n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n STAPH AUREUS COAG +\n \| \nCLINDAMYCIN-----------<=0.25 S\nERYTHROMYCIN----------<=0.25 S\nGENTAMICIN------------ <=0.5 S\nLEVOFLOXACIN---------- 0.25 S\nOXACILLIN-------------<=0.25 S\nTETRACYCLINE---------- <=1 S\nTRIMETHOPRIM/SULFA---- <=0.5 S\n\n ANAEROBIC CULTURE (Final ___: NO ANAEROBES ISOLATED. \n\n\n___ 3:17 pm TISSUE Site: BONE\n PIECES OF BONE, LEFT FOOT, ___ DIGIT. \n\n GRAM STAIN (Final ___: \n NO POLYMORPHONUCLEAR LEUKOCYTES SEEN. \n NO MICROORGANISMS SEEN. \n\n TISSUE (Final ___: \n STAPH AUREUS COAG +. SPARSE GROWTH. \n SENSITIVITIES PERFORMED ON CULTURE # ___ ___. \n\n\n ANAEROBIC CULTURE (Preliminary): NO ANAEROBES ISOLATED. \nBRIEF HOSPITAL COURSE:\n==================================\n___ y/o male with PMH including IDDM, CAD, sCHF (EF 25%) s/p ICD, \nHTN, CKD, Afib, PVD, ___ syndrome, h/o c. diff infection who \npresents with weakness found to have sepsis / MSSA bacteremia \nfrom L foot infection, w/ hosp course c/b CDiff, ATN, \ntransaminitis, ventricular tachycardia who is now s/p LLE \nangioplasty and amputation of L ___ toe\n\n#Sepsis / MSSA Bacteremia: \nThe patient presented with weakness but developed encephalopathy \nand SIRS criteria early during the hospitalization. He was \nstarted on vancomycin, cefepime and flagyl empirically and was \nlater narrowed to Nafcillin after blood cultures grew MSSA. Last \nblood positive culture on ___. The likely source is left second \ntoe infection / steomyelitis (s/p partial ___ toe amputation on \n___. He underwent successful angioplasty of L tibial artery \non this admission followed by full amputation of the toe by \npodiatry on ___. TEE did not show valvular or pacer wire \ninfection. He was switched from nafcillin to cefazolin after \ndeveloping ATN and transaminitis. Cefazolin dosing was switched \nto q8h dosing by time of discharge based on improving renal fxn. \nPathology report is pending at the time of discharge. He will \nhave OPAT monitoring and ID ___ in 2 wks to determine length \nof treatment. \n\n#) Osteomyelitis of L ___ toe: \nPatient underwent partial ___ toe amputation on ___, then \nsuccessful angioplasty of L tibial artery on this admission, and \nfinally full amputation on ___ as the toe was felt to be the \nsource of his MSSA bacteremia.\n\n#ATN on CKD: \nThought to be nafcillin-related vs. ATN in the setting of \nrelative hypoperfusion. Urine Eosinophils negative. Baseline \n1.7, Cr preaked at 3.1, but trending down to 2.2 on day of \ndischarge. BUN continued to improve by time of discharge. Pt was \ndischarged w/ outpatient renal ___. Abx were adjusted to renal \nfunction. Spironolactone and Lisinopril were held given \nresolving ATN, and will need to be restarted on outpatient basis \nat cardiology's discretion. \n\n# C Diff: \nToxin PCR positive on ___. Diarrheal frequency improved \nthroughout admission and leukocytosis resolved. Abd exam \ncontinued to remain benign. Previously on IV Flagyl and PO \nvancomycin but flagyl dc'ed given improvement in symptoms. Pt \ndischarged on PO vancomycin w/ instructions to continue until \noutpatient ID ___ appointment to determine total treatment \ncourse. \n\n#Splenic lesion: He was found to have a 1.7 cm hypoechoic \nsplenic lesion on RUQ U/S of unclear etiology. Would recommend \nrepeat imaging to evaluate for interval change. \n\n# Acute Decompensated sCHF: \nPt known to have severely depressed EF. Given ATN had to have \ndiuretics held initially. Later in hosp course, pt was \nhypervolemic w/ sacral edema, w/ subsequent CXR showing volume \noverload. Accordingly, he recieved IV lasix, then was started on \nhome dose torsemide (40mg daily). Spironolactone and Lisinopril \nwere held given resolving ATN, and will need to be restarted on \noutpatient basis at cardiology's discretion. \n\n# ___ syndrome (autoimmune hemolytic anemia and ITP): His \nhematocrit trended down during hospital course and after \nconsultation with his hematologist he was transfused the day \nprior to discharge. The lower than baseline hematocrit was \nthought to be due to phlebotomy and marrow suppression in the \nsetting of acute illness. Labs for hemolysis were negative. \nDischarge Hgb was 7.2. \n \n# Transaminitis: \nInitial elevation in transaminase thought to be secondary to \nnafcillin toxicity. The transaminitis nearly resolved after \nswitching to cefazolin. Recent RUQ echo showing small volume \nascites. Enzymes continued to downtrend and INR continued to \ndecrease suggestive of improved synthetic function. Would \nrepeat LFT at outpatient appointment. \n\n# CAD: \nPt was continued on ASA, atorvastatin, clopidogrel \n\n#) Ventricular Tachycardia: \nPatient developed VT, requiring ATP, in the setting of acute \ninfection. As per cardiology, pt was started on Amiodarone and \nresponded well. With treatment of infection and maintenance w/ \namiodarone, pt did not have further episodes of VTach. EP \ninterrogated pacer and found that it was functioning properly.\n\n#) DM:\nPt was continued on home insulin regimen.\n\n#) Hypothyroidism:\nWas continued on home dose levothyroxine"}}	{'final_diagnoses': ['Osteomyelitis', 'Bacteremia without endocarditis', 'Ventricular Tachycardia', 'ATN', 'CDiff Infection', 'Anemia ___ ___'], 'procedures': ['Angioplasty of L tibial artery', 'Surgical Amputation of L ___ toe', 'PICC placement'], 'visit_summary': "BRIEF HOSPITAL COURSE:\n==================================\n___ y/o male with PMH including IDDM, CAD, sCHF (EF 25%) s/p ICD, \nHTN, CKD, Afib, PVD, ___ syndrome, h/o c. diff infection who \npresents with weakness found to have sepsis / MSSA bacteremia \nfrom L foot infection, w/ hosp course c/b CDiff, ATN, \ntransaminitis, ventricular tachycardia who is now s/p LLE \nangioplasty and amputation of L ___ toe\n\n#Sepsis / MSSA Bacteremia: \nThe patient presented with weakness but developed encephalopathy \nand SIRS criteria early during the hospitalization. He was \nstarted on vancomycin, cefepime and flagyl empirically and was \nlater narrowed to Nafcillin after blood cultures grew MSSA. Last \nblood positive culture on ___. The likely source is left second \ntoe infection / steomyelitis (s/p partial ___ toe amputation on \n___. He underwent successful angioplasty of L tibial artery \non this admission followed by full amputation of the toe by \npodiatry on ___. TEE did not show valvular or pacer wire \ninfection. He was switched from nafcillin to cefazolin after \ndeveloping ATN and transaminitis. Cefazolin dosing was switched \nto q8h dosing by time of discharge based on improving renal fxn. \nPathology report is pending at the time of discharge. He will \nhave OPAT monitoring and ID ___ in 2 wks to determine length \nof treatment. \n\n#) Osteomyelitis of L ___ toe: \nPatient underwent partial ___ toe amputation on ___, then \nsuccessful angioplasty of L tibial artery on this admission, and \nfinally full amputation on ___ as the toe was felt to be the \nsource of his MSSA bacteremia.\n\n#ATN on CKD: \nThought to be nafcillin-related vs. ATN in the setting of \nrelative hypoperfusion. Urine Eosinophils negative. Baseline \n1.7, Cr preaked at 3.1, but trending down to 2.2 on day of \ndischarge. BUN continued to improve by time of discharge. Pt was \ndischarged w/ outpatient renal ___. Abx were adjusted to renal \nfunction. Spironolactone and Lisinopril were held given \nresolving ATN, and will need to be restarted on outpatient basis \nat cardiology's discretion. \n\n# C Diff: \nToxin PCR positive on ___. Diarrheal frequency improved \nthroughout admission and leukocytosis resolved. Abd exam \ncontinued to remain benign. Previously on IV Flagyl and PO \nvancomycin but flagyl dc'ed given improvement in symptoms. Pt \ndischarged on PO vancomycin w/ instructions to continue until \noutpatient ID ___ appointment to determine total treatment \ncourse. \n\n#Splenic lesion: He was found to have a 1.7 cm hypoechoic \nsplenic lesion on RUQ U/S of unclear etiology. Would recommend \nrepeat imaging to evaluate for interval change. \n\n# Acute Decompensated sCHF: \nPt known to have severely depressed EF. Given ATN had to have \ndiuretics held initially. Later in hosp course, pt was \nhypervolemic w/ sacral edema, w/ subsequent CXR showing volume \noverload. Accordingly, he recieved IV lasix, then was started on \nhome dose torsemide (40mg daily). Spironolactone and Lisinopril \nwere held given resolving ATN, and will need to be restarted on \noutpatient basis at cardiology's discretion. \n\n# ___ syndrome (autoimmune hemolytic anemia and ITP): His \nhematocrit trended down during hospital course and after \nconsultation with his hematologist he was transfused the day \nprior to discharge. The lower than baseline hematocrit was \nthought to be due to phlebotomy and marrow suppression in the \nsetting of acute illness. Labs for hemolysis were negative. \nDischarge Hgb was 7.2. \n \n# Transaminitis: \nInitial elevation in transaminase thought to be secondary to \nnafcillin toxicity. The transaminitis nearly resolved after \nswitching to cefazolin. Recent RUQ echo showing small volume \nascites. Enzymes continued to downtrend and INR continued to \ndecrease suggestive of improved synthetic function. Would \nrepeat LFT at outpatient appointment. \n\n# CAD: \nPt was continued on ASA, atorvastatin, clopidogrel \n\n#) Ventricular Tachycardia: \nPatient developed VT, requiring ATP, in the setting of acute \ninfection. As per cardiology, pt was started on Amiodarone and \nresponded well. With treatment of infection and maintenance w/ \namiodarone, pt did not have further episodes of VTach. EP \ninterrogated pacer and found that it was functioning properly.\n\n#) DM:\nPt was continued on home insulin regimen.\n\n#) Hypothyroidism:\nWas continued on home dose levothyroxine", 'medications_prescribed': ['Vancomycin Oral Liquid ___ mg PO Q6H \nMust be continued for 2 weeks post-discharge \nRX vancomycin 125 mg 1 capsule(s) by mouth every 6 hours as \nneeded Disp #56 Capsule Refills:0', 'Aspirin 325 mg PO DAILY \nRX aspirin 325 mg 1 tablet(s) by mouth daily Disp #30 Tablet \nRefills:2', 'Atorvastatin 80 mg PO DAILY ', 'Clopidogrel 75 mg PO DAILY ', 'FoLIC Acid 5 mg PO DAILY ', 'Levothyroxine Sodium 25 mcg PO DAILY ', 'Multivitamins 1 TAB PO DAILY ', 'Omeprazole 40 mg PO BID ', 'Torsemide 40 mg PO DAILY ', 'Amiodarone 200 mg PO DAILY \nRX amiodarone 200 mg 1 tablet(s) by mouth daily Disp #30 \nTablet Refills:2', 'Metoprolol Succinate XL 25 mg PO DAILY ', 'Nitroglycerin SL 0.4 mg SL PRN CP ', 'Lidocaine 5% Patch 1 PTCH TD DAILY \nRX lidocaine 5 % (700 mg/patch) 1 Patch applied to neck daily \nDisp #30 Each Refills:0', 'PredniSONE 7.5 mg PO EVERY OTHER DAY ', 'Glargine 10 Units Bedtime\nNPH 4 Units Breakfast\nInsulin SC Sliding Scale using HUM Insulin', 'Outpatient Lab Work\nICD-9 790.7\nPt will need his labs checked 3 days after discharge and weekly \nthereafter. Necessary labs include CBC w/ differential, BUN/Cr, \nAST/ALT/Alk Phos/TBili, CPK, and ESR/CRP. Results should be \nfaxed to ___ R.N.s at ___. Antibiotic \ndosing will depend on such labs', 'CefazoLIN 2 g IV Q8H \nRX cefazolin in dextrose (iso-os) 2 gram/50 mL 2 g IV every 8 \nhours Disp #42 Each Refills:*0', 'Outpatient Lab Work\nICD9 428.2\nPt will need a CHEM7 checked (Na/K/Cl/HCO3/BUN/Cr/Glc) 3 days \npost-discharge at ___, and the results will \nbe interpreted by his primary care doctor ___, \nMD)']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 91, 'gender': 'M', 'symptoms': 'increasing headaches, nausea, back of neck pain, difficulties \nwith fine motor, skills, loss of balance and difficulty with \nambulation and also', 'medical_history': ['Her past medical history is notable for reflux and a history of\nobesity.'], 'family_history': 'Notable for family history of cancer, diabetes, heart disease, \nlung disease, GI problems and rheumatological problems.', 'present_illness': '___ is a ___ female who had previously \nundergone anterior cervical discectomy and fusion from C4 \nthrough C7. She developed adjacent segment disease, however, \nhas central stenosis and spinal cord compression, and\nmyelopathic symptoms which are progressive. In this setting, she \nelected to undergo surgical decompression with the goal of \nhalting the progression of her spinal cord symptomatology.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Olanzapine (Disintegrating Tablet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IM', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IM', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Olanzapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IM', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': 'POS', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': 'I/E', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Intra/ExtraCellular.'}, {'value': 'MOD', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'OTHER', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'TR', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.015', 'valuenum': 1.015, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'Clear', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'Yellow', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': 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'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '336', 'valuenum': 336.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.80', 'valuenum': 3.8, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.6', 'valuenum': 5.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': "NAE's overnight. Pain well controlled. Complains of occipital\nheadache this morning that she has at baseline. She denies any\nother radicular pain. Hand paresthesias are improving. HVAC\n20cc;removed. Ambulating independently in room. \n \nPE: \nVS 98.4 PO 143 / 88 R Lying 72 16 96 Ra \n\nNAD, A&Ox4\nnl resp effort\nRRR\nIncision c/d/I. HVAC 20cc; removed\n \nSensory:\nUE \n C5 C6 C7 C8 T1\n (lat arm) (thumb) (mid fing) (sm finger) (med arm)\nR SILT SILT SILT SILT SILT\nL SILT SILT SILT SILT SILT\n\nMotor:\nUE Dlt(C5) Bic(C6) WE(C6) Tri(C7) WF(C7) FF(C8)FinAbd(T1)\nR 5 5 5 5 5 5 5\nL 5 5 5 5 5 5 5\n\n___ Flex(L1) Add(L2) Quad(L3) TA(L4) ___ ___\nR 5 5 5 5 5 5 5 \nL 5 5 5 5 5 5 5\n\n \n___: Negative", 'diagnoses': [{'icd_code': '27549', 'desc': 'Other disorders of calcium metabolism'}, {'icd_code': '71223', 'desc': 'Chondrocalcinosis, due to pyrophosphate crystals, forearm'}, {'icd_code': '2948', 'desc': 'Other persistent mental disorders due to conditions classified elsewhere'}, {'icd_code': '28529', 'desc': 'Anemia of other chronic disease'}, {'icd_code': '40390', 'desc': 'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}, {'icd_code': '5859', 'desc': 'Chronic kidney disease, unspecified'}, {'icd_code': '8730', 'desc': 'Open wound of scalp, without mention of complication'}, {'icd_code': 'E8859', 'desc': 'Fall from other slipping, tripping, or stumbling'}, {'icd_code': '71906', 'desc': 'Effusion of joint, lower leg'}, {'icd_code': '71536', 'desc': 'Osteoarthrosis, localized, not specified whether primary or secondary, lower leg'}, {'icd_code': 'V1251', 'desc': 'Personal history of venous thrombosis and embolism'}], 'summary': "___ 08:18AM BLOOD WBC-17.1* RBC-4.17 Hgb-11.6 Hct-37.2 \nMCV-89 MCH-27.8 MCHC-31.2* RDW-14.3 RDWSD-46.4* Plt ___\nPatient was admitted to the ___ Spine Surgery Service and \ntaken to the Operating Room for the above procedure.Refer to the \ndictated operative note for further details.The surgery was \nwithout complication and the patient was transferred to the PACU \nin a stable ___ were used for postoperative \nDVT prophylaxis.Intravenous antibiotics were continued for 24hrs \npostop per standard protocol.Initial postop pain was controlled \nwith oral and IV pain medication.Diet was advanced as \ntolerated.Voiding independently. Physical therapy and \nOccupational therapy were consulted for mobilization OOB to \nambulate and ADL's.Hospital course was otherwise unremarkable.On \nthe day of discharge the patient was afebrile with stable vital \nsigns, comfortable on oral pain control and tolerating a regular \ndiet."}}	{'final_diagnoses': ['Prior cervical discectomy and fusion, C4 through C7.', 'C3-C4 adjacent segment disease with spinal cord\ncompression.', 'Cervical myelopathy.'], 'procedures': ['C3-4 ACDF and ___ C4-7'], 'visit_summary': "Patient was admitted to the ___ Spine Surgery Service and \ntaken to the Operating Room for the above procedure.Refer to the \ndictated operative note for further details.The surgery was \nwithout complication and the patient was transferred to the PACU \nin a stable ___ were used for postoperative \nDVT prophylaxis.Intravenous antibiotics were continued for 24hrs \npostop per standard protocol.Initial postop pain was controlled \nwith oral and IV pain medication.Diet was advanced as \ntolerated.Voiding independently. Physical therapy and \nOccupational therapy were consulted for mobilization OOB to \nambulate and ADL's.Hospital course was otherwise unremarkable.On \nthe day of discharge the patient was afebrile with stable vital \nsigns, comfortable on oral pain control and tolerating a regular \ndiet.", 'medications_prescribed': ['Acetaminophen 1000 mg PO Q8H \nmay take over the counter', 'Docusate Sodium 100 mg PO BID \nplease take while taking pain medications \nRX docusate sodium 100 mg 1 capsule(s) by mouth twice a day \nDisp #14 Tablet Refills:0', 'OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - \nModerate \nplease do not operate heavy machinery, drink alcohol or drive \nRX oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours \nDisp #45 Tablet Refills:0', 'Citalopram 10 mg PO DAILY', 'Gabapentin 300 mg PO QHS', 'Multivitamins 1 TAB PO DAILY', 'Ranitidine 150 mg PO BID']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 24, 'gender': 'M', 'symptoms': 'Vertigo/Headaches', 'medical_history': ['hypertension', 'low back pain', 'diverticulitis', 'Headache'], 'family_history': 'Brother with seizures. Denies family history of aneurysms', 'present_illness': '___ year old female hx of hypertension presents with headache and \nvertigo. She reports onset of vertigo, room spinning at earlier \ntoday at 0600 which was associated with nausea, vomiting \ndiarrhea. She states vertigo worsens with turning of her head. \nShe reports she had similar symptoms about a year ago and had \nmaneuvers done which had helped with her vertigo. She c/o \nheadache that has been ongoing for the past year, that is \nsomewhat relieved with Tylenol. She went to ___ \n___ for and work up CTA head revealed a 6mm Right\nparaclinoid aneurysm and 3mm right MCA bifurcation aneurysm. She \nwas transferred to neurosurgery for further evaluation.', 'medications': [{'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'HOLD. SPECIMEN TO BE HELD 48 HOURS AND DISCARDED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.028', 'valuenum': 1.028, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 82.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '150', 'valuenum': 150.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40.5', 'valuenum': 40.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '200', 'valuenum': 200.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.62', 'valuenum': 4.62, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'On Admission: ___\n=====================\nPHYSICAL EXAM:\n\nPatient is ___ speaking, exam obtained with interpreter \n\nT:97.7 BP:137/95 HR:80 RR:13 O2Sats:96%RA \n\nGen: WD/WN, comfortable, NAD.\nHEENT: Pupils: 3-2mm bil EOMs: Full \nExtrem: Warm and well-perfused.\n\nNeuro:\nMental status: Awake and alert, cooperative with exam, normal\naffect.\nOrientation: Oriented to person, place, and date.\nLanguage: Speech fluent with good comprehension.\nNo dysarthria or paraphasic errors.\n\nCranial Nerves:\nI: Not tested\nII: Pupils equally round and reactive to light,3 to 2mm\nbilaterally. Visual fields are full to confrontation.\nIII, IV, VI: Extraocular movements intact bilaterally without\nnystagmus.\nV, VII: Facial strength and sensation intact and symmetric.\nVIII: Hearing intact to voice.\nIX, X: Palatal elevation symmetrical.\nXI: Sternocleidomastoid and trapezius normal bilaterally.\nXII: Tongue midline without fasciculations.\n\nMotor: Normal bulk and tone bilaterally. No abnormal movements,\ntremors. Strength full power ___ throughout. No pronator drift\n\nSensation: Intact to light touch\n\nCoordination: normal on finger-nose-finger\n\nON DISCHARGE: ___\n======================\nGeneral:\n[X]AVSS \nT:98, HR: 72, BP: 137/87, RR: 18, O2: 98% room air\n\nExam:\n- Assessment and exam performed with in person ___\ninterpreter\nOpens eyes: [X]spontaneous [ ]to voice [ ]to noxious\n\nOrientation: [X]Person [X]Place [X]Time\n\nFollows commands: [ ]Simple [X]Complex [ ]None\n\nPupils: Right: ___ brisk Left: ___ brisk\n\nEOM: [X]Full [ ]Restricted\n\nFace Symmetric: [X]Yes [ ]NoTongue Midline: [X]Yes [ ]No\n\nPronator Drift [ ]Yes [X]No Speech Fluent: [X]Yes [ ]No\n\nComprehension intact [X]Yes [ ]No\n\nMotor:\nTrapDeltoidBicepTricepGrip\n\nIPQuadHamATEHLGast\n\n[X]Sensation intact to light touch\n\n[X]Angiogram site:\n - Dressing CDI. No active drainage. No hematoma.', 'diagnoses': [{'icd_code': '78039', 'desc': 'Other convulsions'}, {'icd_code': '2762', 'desc': 'Acidosis'}, {'icd_code': '30001', 'desc': 'Panic disorder without agoraphobia'}, {'icd_code': '87364', 'desc': 'Open wound of tongue and floor of mouth, without mention of complication'}, {'icd_code': 'E8160', 'desc': 'Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle'}], 'summary': 'Please see OMR for pertinent lab and imaging data.\nNilva Lopes was transferred from OSH with complaints of vertigo \nand headaches with CTA positive for right MCA aneurysm and ICA \naneurysm. Patient was admitted to the neurosurgery service for \nfurther workup. Patient underwent a diagnostic angiogram on ___ \nwhich revealed a Right MCA aneurysm and a small right cavernous \naneurysm. Patient tolerated the procedure well. Her right groin \nwas intact without signs of a hematoma. Patient remained \nneurologically stable post-procedure. Patient was discharged on \n___ to home. Patient to follow up with Dr. ___ on ___ for \nan elective right craniotomy for clipping of right MCA aneurysm.'}}	{'final_diagnoses': ['Right MCA aneurysm', 'Small right cavernous aneurysm'], 'procedures': ['___: Diagnostic cerebral angiogram'], 'visit_summary': 'Nilva Lopes was transferred from OSH with complaints of vertigo \nand headaches with CTA positive for right MCA aneurysm and ICA \naneurysm. Patient was admitted to the neurosurgery service for \nfurther workup. Patient underwent a diagnostic angiogram on ___ \nwhich revealed a Right MCA aneurysm and a small right cavernous \naneurysm. Patient tolerated the procedure well. Her right groin \nwas intact without signs of a hematoma. Patient remained \nneurologically stable post-procedure. Patient was discharged on \n___ to home. Patient to follow up with Dr. ___ on ___ for \nan elective right craniotomy for clipping of right MCA aneurysm.', 'medications_prescribed': ['Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever \nDo not exceed more than 4G/day', 'Lisinopril 30 mg PO DAILY']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 59, 'gender': 'F', 'symptoms': 'r/o seizures', 'medical_history': ['chronic Lyme? disease', 'Bipolar?', 'trigeminal neuralgia?', 'celiac disease?', 'asthma', 'hypertension'], 'family_history': 'Non-contributory', 'present_illness': '___ is a ___ year old right handed female with a\npast medical history of ?chronic Lyme disease, celiac disease,\nviral meningitis ___ or ___, ADHD/dyslexia, "nerve pain,"\nand remote etoh/cocaine use presenting for elective LTM\nadmission. Since childhood, patient endorses a feeling of\ndifficulty moving and feeling stuck. She says she has a history\nof chronic Lyme disease since childhood as her mother took her \nto\nsee many doctors for difficulty remembering words. \nShe had an episode of meningitis in late ___. ___ years ago she\nhad the worse headache of her life with the worst nausea and\nvomiting with an unremarkable LP. About ___ years ago, she had a\nlong hospitalization for a bacterial pneumonia complicated by\nsepsis. She says they tried ___ antibiotics without \nimprovement.\nLP at the time was + for Lyme IgM, per patient. She was started\non clarithromycin and bactrim, which she has been taking on and\noff for the last ___ years. Whenever she tries to stop, she \nsuffers\nfrom difficulty swallowing, stammering, disorientation,\nconfusion, clenching of all muscles, and feeling of "a struggle\nfor forward motion". She does endorse that she has stopped these\nantibiotics for the past week and has been ok. \nHer history is notable for many medications. She takes Lithium\nfor bipolar since age ___ when she was diagnosed. But recently \nshe\nsays 3 different psychiatrists saw her and all said she does not\nhave bipolar disorder. She has been on vicodin for ___ years for\nback pain/spasms and trigeminal neuralgia, which she also takes\ngabapentin for. Clobazepam she says is for anxiety and she says\nshe does not take it all the time. \n\nShe also mentions prior episodes with fits of rage with \nincreased\nstrength enough to flip tables when she is usually not that\nstrong. She would have no memory of these episodes and also\ninexplicably be crying afterwards. She states these episodes \nhave\ndecreased since being together with her current boyfriend who is\nmore supportive. \n\nSeizure semiology:\n1. waking up with both arms shaking which can last half a day,\nand includes confusion\n2. brown outs as above which can last several days\n3. periods of sudden confusion/memory loss\n4. light behind both eyes, yellowish?\n5. episodes for days at a time where she stares, doesn\'t feel\nlike herself, sometimes with occasional arm jerks.', 'medications': [{'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Carbamazepine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'dexlansoprazole (Dexilant)', 'proc_type': 'Non-Formulary', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Carbamazepine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Promethazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'NiCARdipine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dexilant', 'proc_type': 'Non-Formulary', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'DAILY', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aluminum-Magnesium Hydrox.-Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Carbamazepine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.0', 'valuenum': 27.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.5,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 217.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.6', 'valuenum': 35.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '288', 'valuenum': 288.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.88', 'valuenum': 3.88, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.8', 'valuenum': 25.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '270', 'valuenum': 270.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.63', 'valuenum': 3.63, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 159.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': '24 HR Data (last updated ___ @ 808)\n Temp: 97.8 (Tm 98.8), BP: 136/98 (136-158/90-104), HR: 79\n(75-106), RR: 18, O2 sat: 97% (97-100), O2 delivery: RA \n\nGeneral: middle aged woman lying in bed, appears tired\nHEENT: NC/AT, EEG leads in place\nPulmonary: breathing comfortably on RA\nSkin: no rashes or lesions noted. \nNeurologic: \n-MS: Awake, alert, oriented x 3. Able to relate history without\ndifficulty. Speech is fluent with full sentences, intact\nrepetition, and intact verbal comprehension. Naming intact. No\nparaphasias. No dysarthria. Normal prosody.\n-CN: PERRL 5-3mm b/l. EOMI, no nystagmus. Sensation intact to\nlight touch in V1, V2, V3 distributions. No facial droop. Tongue\nmidline, symmetric palate elevation. \n-Motor - no pronator drift. \n-Sensory: Deferred\n-Reflexes: Deferred\n-Coordination: intact FNF. \n-Gait: Deferred', 'diagnoses': [{'icd_code': '3501', 'desc': 'Trigeminal neuralgia'}, {'icd_code': '5533', 'desc': 'Diaphragmatic hernia without mention of obstruction or gangrene'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '49390', 'desc': 'Asthma, unspecified type, unspecified'}, {'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}], 'summary': '___ 04:00AM BLOOD WBC-6.9 RBC-3.47* Hgb-11.0* Hct-33.4* \nMCV-96 MCH-31.7 MCHC-32.9 RDW-13.2 RDWSD-46.5* Plt ___\n___ 04:15AM BLOOD Glucose-83 UreaN-8 Creat-0.8 Na-136 K-3.9 \nCl-103 HCO3-24 AnGap-9*\n___ 04:15AM BLOOD Calcium-9.6 Phos-3.8 Mg-1.9\n___ is a ___ year old right handed female with a \npast medical history of ?chronic Lyme disease, celiac disease, \nviral meningitis ___ or ___, ADHD/dyslexia, "nerve pain," \nand remote etoh/cocaine use presenting for elective LTM \nadmission. She has unclear history of episodes of confusion, \nmemory problems, brownouts with memory loss, bilateral arm \nshaking. Unclear if these episodes could be focal seizures, so \npatient admitted for LTM with cvEEG. Most of her symptoms have \nbeen captured with no EEG correlates. Patient also experienced \nmigraine while inpatient. Patient was treated with toradol, with \nimprovement of her symptoms. The leading diagnosis was felt to \nbe cortical depression from under treated migraines. Her home \nnortriptyline was restarted and ultimately increased. There was \nalso a cervicogenic component, and therefore she was referred \nfor physical therapy, soft cervical collar at night, with \npotential for muscle relaxants.'}}	{'final_diagnoses': ['r/o seizure disorder'], 'procedures': ['None'], 'visit_summary': '___ is a ___ year old right handed female with a \npast medical history of ?chronic Lyme disease, celiac disease, \nviral meningitis ___ or ___, ADHD/dyslexia, "nerve pain," \nand remote etoh/cocaine use presenting for elective LTM \nadmission. She has unclear history of episodes of confusion, \nmemory problems, brownouts with memory loss, bilateral arm \nshaking. Unclear if these episodes could be focal seizures, so \npatient admitted for LTM with cvEEG. Most of her symptoms have \nbeen captured with no EEG correlates. Patient also experienced \nmigraine while inpatient. Patient was treated with toradol, with \nimprovement of her symptoms. The leading diagnosis was felt to \nbe cortical depression from under treated migraines. Her home \nnortriptyline was restarted and ultimately increased. There was \nalso a cervicogenic component, and therefore she was referred \nfor physical therapy, soft cervical collar at night, with \npotential for muscle relaxants.', 'medications_prescribed': ['Nortriptyline 40 mg PO QHS \nRX nortriptyline 10 mg 4 tablets by mouth at bedtime Disp #120 \nCapsule Refills:*1', 'Albuterol Inhaler 1 PUFF IH Q4H:PRN SOB', 'ClonazePAM 1 mg PO BID:PRN anxiety', 'FLUoxetine 20 mg PO DAILY', 'Gabapentin 900 mg PO QHS', 'HYDROcodone-Acetaminophen (5mg-325mg) 1 TAB PO BID:PRN Pain \n- Moderate', 'Lithium Carbonate SR (Lithobid) 900 mg PO QPM \nLithobid SR']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 83, 'gender': 'F', 'symptoms': 'chest pain', 'medical_history': ['# Multiple angioectasias - She has had 6 scopes in ___.', '# Iron defiency anemia - TTG negative, EGD in ___ at OSH with ? \nbarretts, duodenitis with some ulcers or erosions in the \nbulb, ___ negative. Repeat EGD ___ with mild erosions in \nantrum and duodenum', '# CAD with 80% RCA stenosis, s/p DES in ___', '# COPD (diagnosed ___.', '# Congenital pulmonic stenosis', '# Chronic low back pain', '# R Breast cancer, s/p lumpectomy and XRT ___ with no chemo', '# Hypertension', '# Hyperlipidemia', '# DM2', '# Cholecystectomy', '# ORIF for right ankle fracture with hardware placement/removal', '# Basal cell cancer on face', '# Palpitations', '# Excision of urachel cyst'], 'family_history': 'MGF with GB cancer, PUncle with colon cancer in ___. Mother died \nat age ___ of an MI. Father also had CAD.', 'present_illness': '___ with h/o CAD s/p DES ___, with h/o GIB ___ AVM. She \ndiscontinued aspirin in ___ and plavix 1.5 weeks ago in \nanticipation of GI intervention for her AVM, and with though \nthat decrased antiplatelet agents might allow her own bone \nmarrow to reconstitute her HCT. \n. \nAt baseline, she describes symptoms of chest discomfort ___ \nweekly, substernal chest burning, not associated with exertion, \nworse with food, and improved with antacids. She has used her SL \nNTG Q3-4 months over past year. \n. \nWhile driving today, she notes onset of band like chest pain \nbegining suddenly at rest, with radiation to left arm. No \ndiaphoresis, palpitations, +n, mild dyspnea. Symptoms persisted \nfor 1 hour, no change with exertion, or food. Moderate \nimprovement with 1 SL NTG, though sx recurred after 20 minutes, \nprompting presentation to OSH ED. \n. \nAt OSH, EKG felt to reflect STD in V4-6, and pt started on \naspirin 325, heparin gtt, nitro gtt and transferred to ___. In \n___ ED, VS 97.9 68 106/52 16 98%RA. EKG not felt to be acutely \nchanged, and after discussion with cardiology attending, she was \ngiven plavix 75mg x 1, with plan for catheterization.', 'medications': [{'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Dexamethasone Ophthalmic Soln 0.1%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'RIGHT EAR', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Dexamethasone Ophthalmic Soln 0.1%', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'RIGHT EAR', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ciprofloxacin 0.3% Ophth Soln', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'RIGHT EAR', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin 0.3% Ophth Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'RIGHT EAR', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Morphine Sulfate IR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate IR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.4', 'valuenum': 41.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '250', 'valuenum': 250.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.25', 'valuenum': 4.25, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42.7', 'valuenum': 42.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '240', 'valuenum': 240.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.38', 'valuenum': 4.38, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 84.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'VS: 97.6 106/62 63 18 98%2L FSBS 166 \nGENERAL: WDWN female in NAD. Oriented x3. Mood, affect \nappropriate. \nHEENT: NCAT. Sclera anicteric. EOMI. Conjunctiva were pink. MMM. \n \nNECK: Supple without LAD. \nCARDIAC: RRR, normal S1, S2. distant heart sounds, No m/r/g. \nLUNGS: Resp were unlabored, no accessory muscle use. CTAB, no \ncrackles, wheezes or rhonchi. \nABDOMEN: Normoactive BS, soft, NTND. \nEXTREMITIES: No c/c/e. 2+ DP pulses bilaterally.', 'diagnoses': [{'icd_code': '38010', 'desc': 'Infective otitis externa, unspecified'}, {'icd_code': '3829', 'desc': 'Unspecified otitis media'}, {'icd_code': '56400', 'desc': 'Constipation, unspecified'}, {'icd_code': '2761', 'desc': 'Hyposmolality and/or hyponatremia'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '78701', 'desc': 'Nausea with vomiting'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '7840', 'desc': 'Headache'}, {'icd_code': '38630', 'desc': 'Labyrinthitis, unspecified'}], 'summary': "___ 12:00AM \n___ PTT-34.7 ___\nPLT COUNT-326\nNEUTS-71.2* ___ MONOS-4.5 EOS-2.2 BASOS-0.8\nWBC-7.5 RBC-3.31* HGB-9.9* HCT-29.3* MCV-89 MCH-30.0 MCHC-33.8 \nRDW-15.3\ncTropnT-<0.01\nCK(CPK)-77\nGLUCOSE-154* UREA N-20 CREAT-0.8 SODIUM-141 POTASSIUM-3.7 \nCHLORIDE-109* TOTAL CO2-25 ANION GAP-11\n\n___ 09:10AM cTropnT-<0.01\n___ 09:10AM CK(CPK)-71\nThe patient is a ___ year old woman with a history of small bowel \nAVMs, coronary artery disease status post drug eluding stent \nplacement in ___ who was transferred from ___ with \nchest pain in the setting of recent discontinuation of Plavix \nand aspirin. \n. \n# Chest Pain - The patient had a long history of chest pain, \nwith both reflux and anxiety related symptoms. She was admitted \nfor a change in chest pain (radiation down left arm, nausea, \nmild SOB) and a question of ST depressions in the lateral leads. \n Repeat EKGs showed no change and all EKGs were similar to her \npreviously documented exams. However, given her associated \nsymptoms, history if CAD as well as improvement with \nnitroglycerin, the patient underwent cardiac catheterization. \nCath was without evidence of blockage or restent thrombosis. \nAll troponins were flat and throughout her hospitalization, \nthere was no evidence of cardiac ischemia. The patient's \nsymptoms resolved without further intervention. She was \nscheduled for follow up with her cardiologist (Dr. ___ on \n___. \n. \n# Anemia/GI Bleed - The patient has a history of iron deficiency \nanemia as well as gastrointestinal bleeding from known AVMs in \nthe small bowel. Her hematocrit on admission was noted to be \n29, down from her baseline of 33 approximately 2 weeks prior. \nThis was felt to be dilutional in the setting of IV fluids. \nEven on a heparin drip, the patient had no evidence of bleeding. \nExamination of the celiac arteries was performed during her \ncardiac catherization, but these results were not available at \nthe time of discharge. Overall, the patient's hematocrit \nimproved to ~32 during this hospitalization. It was recommended \nthat she continue PPI therapy. In addition, it was suggested \nthat she not resume her use of Plavix. She was instructed to \ncontinue aspirin (81mg) until instructed otherwise by her \nphysicians. \n. \n# Abdominal Pain: The patient reported a history of abdominal \npain as well as intermittant episodes of diarrhea and \nconstipation. She initially denied any abdominal symptoms, but \nhad one episode of nausea and vomiting the morning of discharge. \n Her symptoms resolved rapidly with zofran/simethicone and the \npatient felt this was due to over eating. She had no associated \nsymptoms except for mild fatigue. She was instructed to contact \nher physician if her symptoms continued or changed.\n.\n# COPD: Advair and ipratropium inhalers were continued.\n. \n# Hypertension: Antihypertensives were initially held in the \n. \n# Type II Diabetes: The patient's home regimen of metformin was \nheld given the need for IV contrast. She was placed on an \ninsulin sliding scale during her hospitalization. Blood sugars \nranged from the 120's-230s. She was restarted on metformin \nprior to discharge. \n. \n# Right Breast cancer: The patient was continued on Arimidex. \n. \n# Depression: Venlafaxine and Ativan were continued.\n. \n# Hyperlipidemia: Statin therapy was continued."}}	{'final_diagnoses': ['Chest Pain NOS', 'Coronary Artery Disease', 'Gastrointestinal bleeding', 'Anemia', 'Type II diabetes', 'Chronic obstructive pulmonary disease', 'Chronic low back pain', 'Right Breast cancer', 'Hypertension', 'Hyperlipidemia'], 'procedures': ['Cardiac catheterization'], 'visit_summary': "The patient is a ___ year old woman with a history of small bowel \nAVMs, coronary artery disease status post drug eluding stent \nplacement in ___ who was transferred from ___ with \nchest pain in the setting of recent discontinuation of Plavix \nand aspirin. \n. \n# Chest Pain - The patient had a long history of chest pain, \nwith both reflux and anxiety related symptoms. She was admitted \nfor a change in chest pain (radiation down left arm, nausea, \nmild SOB) and a question of ST depressions in the lateral leads. \n Repeat EKGs showed no change and all EKGs were similar to her \npreviously documented exams. However, given her associated \nsymptoms, history if CAD as well as improvement with \nnitroglycerin, the patient underwent cardiac catheterization. \nCath was without evidence of blockage or restent thrombosis. \nAll troponins were flat and throughout her hospitalization, \nthere was no evidence of cardiac ischemia. The patient's \nsymptoms resolved without further intervention. She was \nscheduled for follow up with her cardiologist (Dr. ___ on \n___. \n. \n# Anemia/GI Bleed - The patient has a history of iron deficiency \nanemia as well as gastrointestinal bleeding from known AVMs in \nthe small bowel. Her hematocrit on admission was noted to be \n29, down from her baseline of 33 approximately 2 weeks prior. \nThis was felt to be dilutional in the setting of IV fluids. \nEven on a heparin drip, the patient had no evidence of bleeding. \nExamination of the celiac arteries was performed during her \ncardiac catherization, but these results were not available at \nthe time of discharge. Overall, the patient's hematocrit \nimproved to ~32 during this hospitalization. It was recommended \nthat she continue PPI therapy. In addition, it was suggested \nthat she not resume her use of Plavix. She was instructed to \ncontinue aspirin (81mg) until instructed otherwise by her \nphysicians. \n. \n# Abdominal Pain: The patient reported a history of abdominal \npain as well as intermittant episodes of diarrhea and \nconstipation. She initially denied any abdominal symptoms, but \nhad one episode of nausea and vomiting the morning of discharge. \n Her symptoms resolved rapidly with zofran/simethicone and the \npatient felt this was due to over eating. She had no associated \nsymptoms except for mild fatigue. She was instructed to contact \nher physician if her symptoms continued or changed.\n.\n# COPD: Advair and ipratropium inhalers were continued.\n. \n# Hypertension: Antihypertensives were initially held in the \n. \n# Type II Diabetes: The patient's home regimen of metformin was \nheld given the need for IV contrast. She was placed on an \ninsulin sliding scale during her hospitalization. Blood sugars \nranged from the 120's-230s. She was restarted on metformin \nprior to discharge. \n. \n# Right Breast cancer: The patient was continued on Arimidex. \n. \n# Depression: Venlafaxine and Ativan were continued.\n. \n# Hyperlipidemia: Statin therapy was continued.", 'medications_prescribed': ['1. Anastrozole 1 mg Tablet Sig: One (1) Tablet PO QDAILY ().', '2. Atenolol 100 mg Tablet Sig: One (1) Tablet PO once a day.', '3. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig: \nOne (1) Disk with Device Inhalation BID (2 times a day).', '4. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: Two (2) \nPuff Inhalation QID (4 times a day).', '5. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '6. Misoprostol 100 mcg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day).', '7. Venlafaxine 75 mg Capsule, Sust. Release 24 hr Sig: Two (2) \nCapsule, Sust. Release 24 hr PO DAILY (Daily).', '8. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO QDAILY ().', '9. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY \n(Daily).', '10. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).', '11. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) \nTablet PO TID (3 times a day).', '12. Zolpidem 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime) \nas needed for insomnia.', '13. Colace 100 mg Capsule Sig: One (1) Capsule PO once a day as \nneeded for constipation.', '14. Metformin 500 mg Tablet Sig: ___ Tablets PO twice a day.', '15. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily).']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 67, 'gender': 'M', 'symptoms': 'Right Hip Pain', 'medical_history': ['pacemaker', 'history of DVT'], 'family_history': 'Non-Contributory', 'present_illness': '___ presents with dislocated right prosethetic hip. The patient \nhad hip surgery at ___ on ___ for arthritis/pain. \nPost-operative course was uneventful. Patient states that she \nwas transferring to a chair lift when she felt like she landed \noddly. She then tried to get up and was unable to. Patient was \nfound to have hip dislocation at ___. Patient was \nreferred here for further management. At present, patient \ndenies weakness / numbness. She is on coumadin for h/o DVT.', 'medications': [{'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'amLODIPine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'amLODIPine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'RisperiDONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': None}, {'medication': 'CarBAMazepine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Carbamazepine (Extended-Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Valsartan', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Latanoprost 0.005% Ophth. Soln.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Valsartan', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CarBAMazepine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Pravastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'RisperiDONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG. Benzodiazepine immunoassay screen does not detect some drugs,. including Lorazepam, Clonazepam, and Flunitrazepam.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RANDOM.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG. Methadone assay detects Methadone (not other Opiates/Opioids). Quetiapine (Seroquel) may cause a false positive result.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG. Opiate assay does not reliably detect synthetic opioids. such as Methadone, Oxycodone, Fentanyl, Buprenorphine, Tramadol,. Naloxone, Meperidine. See online Lab Manual for details.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '-332', 'valuenum': -332.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '-644', 'valuenum': -644.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '-444', 'valuenum': -444.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '-306', 'valuenum': -306.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '-65', 'valuenum': -65.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '-383', 'valuenum': -383.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.4, 'valueuom': '%', 'ref_range_lower': 4.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'ADA recommendations:. <7% goal of therapy. >8% warrants therapeutic action.'}, {'value': '___', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 68.0, 'ref_range_upper': 126.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '___', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG. Benzodiazepine immunoassay screen does not reliably detect some drugs,. including Lorazepam, Clonazepam, and Flunitrazepam.'}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'ug/mL', 'ref_range_lower': 4.0, 'ref_range_upper': 12.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG. 80 (these units) = 0.08 (% by weight).'}, {'value': '___', 'valuenum': 103.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '___', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG. Positive Tricyclic results represent potentially toxic levels. Therapeutic Tricyclic levels will typically have Negative results.'}, {'value': '___', 'valuenum': 0.03, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '-38', 'valuenum': -38.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '-76', 'valuenum': -76.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '-54', 'valuenum': -54.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '202', 'valuenum': 202.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.88', 'valuenum': 3.88, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43.0', 'valuenum': 43.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 290.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference interval as of ___:. Upper limit (97.5th %ile) varies with ancestry and gender (male/female). whites 322/201 blacks 801/414 asians 641/313..'}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.02, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '40', 'valuenum': 40.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 109.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '181', 'valuenum': 181.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.82', 'valuenum': 3.82, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42.5', 'valuenum': 42.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'On Admission:\n\nVitals: 98.2 87 170/93 16 94% RA \nGen: NAD\nHeart: RRR\nLungs: CTABL\nAb: soft NT/ND\n\nRight lower extremity:\nSkin intact\nSoft, non-tender leg\nProximal thigh / hip tender to palpation\nAROM/PROM of hip and knee limited by pain\nFull AROM/PROM of the ankle \n___ fire\n+SILT SPN/DPN/TN/saphenous/sural distributions\n___ pulses, foot warm and well-perfused\n\nLeft lower extremity:\nSkin intact\nSoft, non-tender thigh and leg\nFull, painless AROM/PROM of hip, knee, and ankle\n___ fire\n+SILT SPN/DPN/TN/saphenous/sural distributions\n___ pulses, foot warm and well-perfused\n\nOn Discharge:\nT 97.8 HR 75 BP 145/50 RR 18 96% on RA\nGeneral - Awake and alert. In abduction pillow. NAD. Oriented x \n3. Quite friendly.\nRLE\n- Well healed anterior hip wound without sutures/staples in \nplace.\n- Wearing abduction pillow in bed.\n- SILT throughout\n- (+) ___ FHL TA GSC\n- (+) DP pulse', 'diagnoses': [{'icd_code': 'S066X0A', 'desc': 'Traumatic subarachnoid hemorrhage without loss of consciousness, initial encounter'}, {'icd_code': 'I130', 'desc': 'Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease'}, {'icd_code': 'E1122', 'desc': 'Type 2 diabetes mellitus with diabetic chronic kidney disease'}, {'icd_code': 'I5022', 'desc': 'Chronic systolic (congestive) heart failure'}, {'icd_code': 'D649', 'desc': 'Anemia, unspecified'}, {'icd_code': 'R55', 'desc': 'Syncope and collapse'}, {'icd_code': 'S0101XA', 'desc': 'Laceration without foreign body of scalp, initial encounter'}, {'icd_code': 'I161', 'desc': 'Hypertensive emergency'}, {'icd_code': 'N189', 'desc': 'Chronic kidney disease, unspecified'}, {'icd_code': 'I4510', 'desc': 'Unspecified right bundle-branch block'}, {'icd_code': 'F319', 'desc': 'Bipolar disorder, unspecified'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'R32', 'desc': 'Unspecified urinary incontinence'}, {'icd_code': 'Y92481', 'desc': 'Parking lot as the place of occurrence of the external cause'}, {'icd_code': 'W1830XA', 'desc': 'Fall on same level, unspecified, initial encounter'}], 'summary': "___ 07:14AM BLOOD WBC-12.0* RBC-2.87* Hgb-9.1* Hct-27.8* \nMCV-97 MCH-31.8 MCHC-32.9 RDW-13.7 Plt ___\n\n___ 07:28AM BLOOD Glucose-118* UreaN-19 Creat-0.9 Na-137 \nK-4.1 Cl-101 HCO3-27 AnGap-13\n\n___ 07:14AM BLOOD ___\n\nRight hip x-ray (___):\nRight hip dislocation.\n\nAP Pelvis (___):\nFollowing reduction, the femoral component of the total hip \narthroplasty \nappears to be well seated in the acetabulum. \n\nRight Ankle & Foot X-rays (___):\nNo evidence of acute bone or joint space abnormality. \nDegenerative changes are seen about the interphalangeal joints \nand there is a small inferior and posterior calcaneal spur. \nThere is extensive vascular calcification which could reflect \nunderlying \ndiabetes.\nThe patient presented to the emergency department and was \nevaluated by the orthopedic surgery team. The patient was found \nto have dislocation of her recent right total hip arthroplasty \nat ___ and was admitted to the \northopedic surgery service. INR was 4.7 on presentation, and the \npatient was given vitamin K & FFP. The patient was taken to the \noperating room on ___ for closed reduction under \nanesthesia, which the patient tolerated well (for full details \nplease see the separately dictated operative report). The \npatient was taken from the OR to the PACU in stable condition \nand after recovery from anesthesia was transferred to the floor. \n The patient was initially given IV fluids and IV pain \nmedications, and progressed to a regular diet and oral \nmedications by POD#1. Warfarin was restarted post-operatively, \nbut her INR became sub-therapeutic on POD#2 (1.4); she was given \nwarfarin 4 mg, but her INR was subsequently 1.3 on POD#3. She \nwas given warfarin 6 mg on POD#3. The patient's other home \nmedications were continued throughout this hospitalization. The \npatient worked with ___ who determined that discharge to rehab \nwas appropriate. On POD#1, patient complained of right foot \npain; x-rays were unremarkable for fracture. The foot pain \nsubsequently improved. The ___ hospital course was \notherwise unremarkable.\n\nAt the time of discharge the patient was afebrile with stable \nvital signs that were within normal limits, pain was well \ncontrolled with oral medications, and the patient was \nvoiding/moving bowels spontaneously. The patient is weight \nbearing as tolerated in the right lower extremity with abduction \nbrace on when out of bed and adhering to anterior precautions. \nShe may use an abduction pillow while in bed. She will be \ndischarged on warfarin for DVT prophylaxis; her rehab facility \nconfirmed that they would monitor and dose her warfarin \nappropriately to bring her INR into therapeutic range (2.0 - \n3.0). The patient will follow up with her primary surgeon at \n___. A thorough discussion was had with \nthe patient regarding the diagnosis and expected post-discharge \ncourse, and all questions were answered prior to discharge."}}	{'final_diagnoses': ['Prosthetic Hip Dislocation'], 'procedures': ['Right Hip Closed Reduction'], 'visit_summary': "The patient presented to the emergency department and was \nevaluated by the orthopedic surgery team. The patient was found \nto have dislocation of her recent right total hip arthroplasty \nat ___ and was admitted to the \northopedic surgery service. INR was 4.7 on presentation, and the \npatient was given vitamin K & FFP. The patient was taken to the \noperating room on ___ for closed reduction under \nanesthesia, which the patient tolerated well (for full details \nplease see the separately dictated operative report). The \npatient was taken from the OR to the PACU in stable condition \nand after recovery from anesthesia was transferred to the floor. \n The patient was initially given IV fluids and IV pain \nmedications, and progressed to a regular diet and oral \nmedications by POD#1. Warfarin was restarted post-operatively, \nbut her INR became sub-therapeutic on POD#2 (1.4); she was given \nwarfarin 4 mg, but her INR was subsequently 1.3 on POD#3. She \nwas given warfarin 6 mg on POD#3. The patient's other home \nmedications were continued throughout this hospitalization. The \npatient worked with ___ who determined that discharge to rehab \nwas appropriate. On POD#1, patient complained of right foot \npain; x-rays were unremarkable for fracture. The foot pain \nsubsequently improved. The ___ hospital course was \notherwise unremarkable.\n\nAt the time of discharge the patient was afebrile with stable \nvital signs that were within normal limits, pain was well \ncontrolled with oral medications, and the patient was \nvoiding/moving bowels spontaneously. The patient is weight \nbearing as tolerated in the right lower extremity with abduction \nbrace on when out of bed and adhering to anterior precautions. \nShe may use an abduction pillow while in bed. She will be \ndischarged on warfarin for DVT prophylaxis; her rehab facility \nconfirmed that they would monitor and dose her warfarin \nappropriately to bring her INR into therapeutic range (2.0 - \n3.0). The patient will follow up with her primary surgeon at \n___. A thorough discussion was had with \nthe patient regarding the diagnosis and expected post-discharge \ncourse, and all questions were answered prior to discharge.", 'medications_prescribed': ['Acetaminophen 650 mg PO Q8H:PRN PAIN \nNever exceed 4000 mg in 24 hours', 'Atenolol 50 mg PO DAILY', 'OxycoDONE (Immediate Release) 2.5-5 mg PO Q4H:PRN Pain \nRX oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours \nDisp #80 Tablet Refills:*0', 'Vitamin D 1000 UNIT PO DAILY', 'PredniSONE 2.5 mg PO DAILY \n___ MD to order daily dose PO DAILY16 Duration: 1 Dose']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 62, 'gender': 'M', 'symptoms': 'Lower abdominal pain & cramping at ___', 'medical_history': ['HTN', 'Impaired glucose tolderance', 'Migraine', 'Varicose veins', 'Nephrolithiasis'], 'family_history': 'DM, HTN, thyroid dz, ? hypercoaguability', 'present_illness': '___ G6P0 SAB4 TAB1 at ___ with severe abdominal pain & \ncramps starting ~6pm the night prior to admission. Also noted \nlight spotting. \n\nPregnancy otherwise notable for a 2 vessel cord, noted on survey \n(NIPT pending), and h/o recurrent pregnancy loss, on ASA. Also \nhas chronic HTN.', 'medications': [{'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Fenofibrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Neostigmine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'GlipiZIDE XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Nystatin Cream', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ketoconazole 2% ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'MetFORMIN (Glucophage)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Glycopyrrolate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'MetFORMIN (Glucophage)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin Glargine (CVICU Protocol)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '1', 'valuenum': 1.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.19', 'valuenum': 1.19, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.37', 'valuenum': 7.37, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '236', 'valuenum': 236.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'CONTROLLED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1', 'valuenum': 1.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '121', 'valuenum': 121.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '49', 'valuenum': 49.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.36', 'valuenum': 7.36, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '257', 'valuenum': 257.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.42', 'valuenum': 7.42, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '235', 'valuenum': 235.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '5.6', 'valuenum': 5.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '218', 'valuenum': 218.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.1', 'valuenum': 25.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.94', 'valuenum': 2.94, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.2', 'valuenum': 27.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '79.5', 'valuenum': 79.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '230', 'valuenum': 230.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.16', 'valuenum': 3.16, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.1', 'valuenum': 20.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.08', 'valuenum': 0.08, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.17', 'valuenum': 0.17, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.70', 'valuenum': 0.7, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.97', 'valuenum': 15.97, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.8', 'valuenum': 37.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-1', 'valuenum': -1.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.15', 'valuenum': 1.15, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '178', 'valuenum': 178.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '43', 'valuenum': 43.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.36', 'valuenum': 7.36, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '289', 'valuenum': 289.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'CONTROLLED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.3,. Estimated GFR = 56 if non African-American (mL/min/1.73 m2). Estimated GFR = 68 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '224', 'valuenum': 224.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.99', 'valuenum': 3.99, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38.1', 'valuenum': 38.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.8', 'valuenum': 25.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.16', 'valuenum': 1.16, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '157', 'valuenum': 157.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.32', 'valuenum': 7.32, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.37', 'valuenum': 7.37, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '128', 'valuenum': 128.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.10', 'valuenum': 1.1, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '130', 'valuenum': 130.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.43', 'valuenum': 7.43, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 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'priority': None, 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.38', 'valuenum': 7.38, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 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'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '353', 'valuenum': 353.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.81', 'valuenum': 3.81, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '39.7', 'valuenum': 39.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.9', 'valuenum': 27.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '55.9', 'valuenum': 55.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'On admission pt was uncomfortable. BP 181/109\nCV: WNL\nChest clear\nFundus tender to palpation\nExt: No CT\nBBOW to introitus', 'diagnoses': [{'icd_code': 'Q231', 'desc': 'Congenital insufficiency of aortic valve'}, {'icd_code': 'G629', 'desc': 'Polyneuropathy, unspecified'}, {'icd_code': 'I129', 'desc': 'Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease'}, {'icd_code': 'E119', 'desc': 'Type 2 diabetes mellitus without complications'}, {'icd_code': 'I4891', 'desc': 'Unspecified atrial fibrillation'}, {'icd_code': 'N189', 'desc': 'Chronic kidney disease, unspecified'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'Z8546', 'desc': 'Personal history of malignant neoplasm of prostate'}, {'icd_code': 'Z7902', 'desc': 'Long term (current) use of antithrombotics/antiplatelets'}, {'icd_code': 'Z7982', 'desc': 'Long term (current) use of aspirin'}, {'icd_code': 'E669', 'desc': 'Obesity, unspecified'}, {'icd_code': 'Z6836', 'desc': 'Body mass index [BMI] 36.0-36.9, adult'}, {'icd_code': 'Z85828', 'desc': 'Personal history of other malignant neoplasm of skin'}], 'summary': '___ 04:25AM GLUCOSE-124* UREA N-5* CREAT-0.4 SODIUM-134 \nPOTASSIUM-3.6 CHLORIDE-101 TOTAL CO2-17* ANION GAP-20\n___ 04:25AM ALT(SGPT)-15 AST(SGOT)-20\n___ 04:25AM URIC ACID-4.5\n___ 04:25AM URINE HOURS-RANDOM CREAT-90 TOT PROT-23 \nPROT/CREA-0.3\n___ 04:25AM URINE bnzodzpn-NEG barbitrt-NEG opiates-POS \ncocaine-NEG amphetmn-NEG oxycodn-NEG mthdone-NEG marijuana-NEG\n___ 04:25AM WBC-14.3 RBC-4.79 HGB-12.7 HCT-37.3 MCV-78* \nMCH-26.5* MCHC-34.1 RDW-14.5\n___ 04:25AM NEUTS-83.2* LYMPHS-11.4* MONOS-4.2 EOS-0.9 \nBASOS-0.2\n___ 04:25AM ___ PTT-24.6* ___\n___ 04:25AM PLT COUNT-___P responded to a single dose of IV labetalol.\nDelivered a liveborn F soon after admission. Infant survived \n~10 minutes.\nNo lacerations. Placenta delivered spontaneously and appeared \nintact.\nBleeding described as minimal.\n\nPostpartum course notable for appropriate grieving. Pt was seen \nby priest & SW.\nShe wanted chromosomes sent & a visual inspection of the baby, \nbut no autopsy.\nPlacenta sent for path.\n\nPt noted markedly decreased pain and minimal bleeding. No \npre-eclampsia sx.\nAfter delivery she was started on labetalol 200mg po bid (down \nfrom 400mg bid as outpatient) & BPs were mostly 130s/90s. Dose \nincreased to 200mg tid for d/c.\n\nD/C exam notable for non-tender abdomen & minimal bleeding.\n\nPt reports good supports.'}}	{'final_diagnoses': ['Previable preterm delivery', 'Hypertension'], 'procedures': ['SVD of previable baby'], 'visit_summary': 'Delivered a liveborn F soon after admission. Infant survived \n~10 minutes.\nNo lacerations. Placenta delivered spontaneously and appeared \nintact.\nBleeding described as minimal.\n\nPostpartum course notable for appropriate grieving. Pt was seen \nby priest & SW.\nShe wanted chromosomes sent & a visual inspection of the baby, \nbut no autopsy.\nPlacenta sent for path.\n\nPt noted markedly decreased pain and minimal bleeding. No \npre-eclampsia sx.\nAfter delivery she was started on labetalol 200mg po bid (down \nfrom 400mg bid as outpatient) & BPs were mostly 130s/90s. Dose \nincreased to 200mg tid for d/c.\n\nD/C exam notable for non-tender abdomen & minimal bleeding.\n\nPt reports good supports.', 'medications_prescribed': ['Labetalol 200 mg PO TID', 'Acetaminophen ___ mg PO Q4H:PRN Pain', 'Ibuprofen 600 mg PO Q6H:PRN Pain \nRX ibuprofen 600 mg 1 tablet(s) by mouth every six (6) hours \nDisp #30 Tablet Refills:*0']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 68, 'gender': 'F', 'symptoms': 'Fever', 'medical_history': ['ONCOLOGY HISTORY:\n___ Severe headache started\n___ MRI showed hemorrhagic right temporal lesion\n___ Subtotal resection of right temporal mass by Dr. ___: ANAPLASTIC EPENDYMOMA, CLEAR CELL TYPE, WHO GRADE III\n>80% OLIG2, EMA pos, MIB-1 ___, EGFR, 1p19q \n.\nCSF on ___- NEGATIVE FOR MALIGNANT CELLS.', 'OTHER PAST MEDICAL HISTORY:\n1. Hypertension\n2. Coronary artery disease\n3. Triple CABG ___\n4. Dyslipidemia\n5. Prostatism\n6. Gastritis, GERD\n7. Appendectomy\n8. Angiogram and stenting ___- no longer on plavix. Is \ncurrently taking daily aspirin.'], 'family_history': 'Non Contributory', 'present_illness': 'Patient is a ___ year old right handed man with right temporal \nanaplastic ependymoma, discovered after sudden onset bitemporal \nthrobbing headache. \n.\nThe patient underwent surgical removal of said tumor on ___ \n(Dr. ___ a subtotal resection of right temporal mass) \nwith pathology consistent with anaplastic ependymoma, clear \ncell type, WHO grade III. Generally, he has been doing well \nsince the surgery but his family noted that he occasionally was \nsomewhat unsteady on his feet for which he now uses a cane. He \nalso had difficulty with left-sided peripheral vision. His \nheadache improved but did not resolve completely. \n.\nHe was started on CVP therapy on ___, when he received \ncarboplatin and etoposide. He tolerated this first dose well \nand left clinical afebrile and in good clinical condition. He \nreturned today for his second dose with complaints of fatigue \nand vague abdominal symptoms, including bloating with some \nnausea the day before. \n.\nTemperature was taken prior to initiation of chemotherapy and \nwas found to be elevated to 102.8. Repeat was 103.5. Again, \nthe patient was asymptomatic at this time and was actually \nsurprised he had a temperature. His family also reported some \nconfusion but was referring to "little things" at home that have \nbeen doing on since ___. There was no acute mental status \nchange in the last few days. He denied fevers, chills, \nvomiting, diarrhea, constipation, rash, dizziness, \nlightheadedness or syncope. He also denied dysuria, urge, or \nfrequency. He did report non-productive cough. He also reports \nchest pain and shortness of breath on excessive exertion but \ndenies both at rest. He denies recent travel, new medications \n(except for chemotherapy), or sick contacts. The patient did \nnot receive a flu shot this year. There is no weakness, no \nnumbness, tingling, no dizziness, no double vision, no \ndifficulty swallowing, or speaking, no ear-ringing, no memory \nproblems.\n.\nGiven elevated fever, blood and urine cultures were drawn and \nthe patient was admitted to ___ for further evaluation.', 'medications': [{'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Chloraseptic Throat Spray', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Gastroview (Diatrizoate Meglumine & Sodium)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '43.8', 'valuenum': 43.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '193', 'valuenum': 193.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.46', 'valuenum': 4.46, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44.0', 'valuenum': 44.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '187', 'valuenum': 187.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38.4', 'valuenum': 38.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '219', 'valuenum': 219.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.03', 'valuenum': 4.03, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42.1', 'valuenum': 42.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 111.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'VS: T- 101.7, BP- 126/84 P- 90 R- 20 O2- 91% on RA. \nGENERAL: NAD, pleasant. AAO x 3. Cognitive functions are\nsatisfactory in all aspects. \nHEENT: No LAD, EOMI. MMM. No dysarthria. \nCV: Regular rate and rhythm\nLungs: Bibasilar crackles (R>L) with good respiratory effort.\nAbdomen: Positive bowel sounds, soft, non-tender, \nnon-distended. \nExt: No edema, clubbing, cyanosis.', 'diagnoses': [{'icd_code': 'K56609', 'desc': 'Unspecified intestinal obstruction, unspecified as to partial versus complete obstruction'}, {'icd_code': 'Z853', 'desc': 'Personal history of malignant neoplasm of breast'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}], 'summary': "ADMISSION LABS:\n\n___ 12:50PM UREA N-10 CREAT-1.0 SODIUM-143 POTASSIUM-2.8* \nCHLORIDE-104 TOTAL CO2-26 ANION GAP-16\n___ 12:50PM WBC-4.2 RBC-3.57* HGB-11.0* HCT-32.4* MCV-91 \nMCH-30.9 MCHC-34.1 RDW-14.6\n___ 11:14AM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 11:14AM URINE BLOOD-SM NITRITE-NEG PROTEIN-30 \nGLUCOSE-70 KETONE-40 BILIRUBIN-NEG UROBILNGN-NEG PH-5.5 LEUK-SM \n___ 10:15AM UREA N-11 CREAT-0.9 SODIUM-142 POTASSIUM-3.5 \nCHLORIDE-107 TOTAL CO2-24 ANION GAP-15\n___ 10:15AM CALCIUM-9.1\n\nCXR ___:\nIMPRESSION: No active pulmonary disease. Status post CABG. \nProminent \ncardiac silhouette. \n\nRUQ US ___:\nIMPRESSION: \n \n1. No sonographic findings of cholecystitis as questioned. \n2. Mildly increased hepatic echogenicity, findings likely due to \nfatty \ndeposition. Please note that additional forms of liver disease \nsuch as \nfibrosis and cirrhosis cannot be excluded based on this exam. \n\nLEUS ___:\nIMPRESSION: No evidence of DVT.\n\nCSF cytology ___:\nCerebrospinal fluid (lumbar puncture): \n \n ATYPICAL. \n \n Single multipolar mitotic figure. \n\nLFT's:\n___ 08:30AM BLOOD ALT-34 AST-74* AlkPhos-40 TotBili-2.0* \nDirBili-0.8* IndBili-1.2\n___ 06:40AM BLOOD ALT-57* AST-113* LD(LDH)-346* AlkPhos-74 \nTotBili-2.2\n___ 05:55AM BLOOD ALT-102 AST-172* AlkPhos-183* \nTotBili-3.7* DirBili-2.5* IndBili-1.2\n___ 06:05AM BLOOD ALT-124* AST-172* LD(___)-386* \nAlkPhos-257* TotBili-5.4*\n___ male with right-handed man with right temporal anaplastic \nependymoma, found to be febrile during chemotherapy \nadministration and admitted for workup. \n\n# Fever- Unclear etiology with broad differential. \n- Pt with no localizing signs or symptoms on admission other \nthan dry cough and occasional muscle aches \n- One possibility considered was a reaction to chemo\n- Patient received his first dose of chemotherapy ___ with \nfever presenting within 24 hours of administration. \n- Other possibilites include bacterial or viral process.\n- The patient's original UA showed small leuks, 6 wbc and small \nbacteria, all concerning for UTI but certainly not conclusive. \n - Urine culture, however, showed only Gneg staph epi, ___ \nculture negative for growth\n- Originally treated for presumed UTI with IV cipro, but once \ncultures came back negative this treatment plan was discontinued \nas it was unclear if he in fact had a UTI\n- He was complaining of non-productive cough, but CXR did not \nshow any consolidation.\n- LEUS did not reveal any DVT\n- RUQ US did not show any cholecystitis\n- Blood cx negative\n- LP was performed, culture with no polys or micros, viral \nculture negative as well\n- A source for his fever was therefore never isolated\n- After this extensive workup was completed and the patient \nremained asymptomatic he was deemed stable for discharge with \nclose follow up with Dr. ___\n\n# Transaminitis\n- Pt's initial LFT notable for a rise in AST, TBili of 2\n- Pt's LFT continued to rise throughout his admission, see \nattached results section for details\n- RUQ US was negative for cholecystitis, did comment on fatty \nliver\n- Fatty liver alone would not account for this acute rise in \nLFTs however\n- Obtained a liver consult, they felt that his LFT abnormalities \nwere likely ___ his chemo agents, although the cholestatic \npicture is not usual for his regimen\n- Held tylenol and statin, avoided hepatotoxic meds\n- He will have a LFT check this week with Dr. ___\n\n# Anaplastic ependymoma- Patient followed by Dr. ___. He \nwas started on cycle 1 of CVP on ___ with second dose held \ngiven fever today in clinic\n- f/u with Dr. ___ next dose of chemotherapy\n- continued levetiracetam"}}	{'final_diagnoses': ['Primary:\nFever of Unknown Origin\nNeutropenia', 'Secondary:\nTemporal Ependymoma'], 'procedures': ['Lumbar Puncture'], 'visit_summary': "___ male with right-handed man with right temporal anaplastic \nependymoma, found to be febrile during chemotherapy \nadministration and admitted for workup. \n\n# Fever- Unclear etiology with broad differential. \n- Pt with no localizing signs or symptoms on admission other \nthan dry cough and occasional muscle aches \n- One possibility considered was a reaction to chemo\n- Patient received his first dose of chemotherapy ___ with \nfever presenting within 24 hours of administration. \n- Other possibilites include bacterial or viral process.\n- The patient's original UA showed small leuks, 6 wbc and small \nbacteria, all concerning for UTI but certainly not conclusive. \n - Urine culture, however, showed only Gneg staph epi, ___ \nculture negative for growth\n- Originally treated for presumed UTI with IV cipro, but once \ncultures came back negative this treatment plan was discontinued \nas it was unclear if he in fact had a UTI\n- He was complaining of non-productive cough, but CXR did not \nshow any consolidation.\n- LEUS did not reveal any DVT\n- RUQ US did not show any cholecystitis\n- Blood cx negative\n- LP was performed, culture with no polys or micros, viral \nculture negative as well\n- A source for his fever was therefore never isolated\n- After this extensive workup was completed and the patient \nremained asymptomatic he was deemed stable for discharge with \nclose follow up with Dr. ___\n\n# Transaminitis\n- Pt's initial LFT notable for a rise in AST, TBili of 2\n- Pt's LFT continued to rise throughout his admission, see \nattached results section for details\n- RUQ US was negative for cholecystitis, did comment on fatty \nliver\n- Fatty liver alone would not account for this acute rise in \nLFTs however\n- Obtained a liver consult, they felt that his LFT abnormalities \nwere likely ___ his chemo agents, although the cholestatic \npicture is not usual for his regimen\n- Held tylenol and statin, avoided hepatotoxic meds\n- He will have a LFT check this week with Dr. ___\n\n# Anaplastic ependymoma- Patient followed by Dr. ___. He \nwas started on cycle 1 of CVP on ___ with second dose held \ngiven fever today in clinic\n- f/u with Dr. ___ next dose of chemotherapy\n- continued levetiracetam", 'medications_prescribed': ['1. isosorbide mononitrate 30 mg Tablet Extended Release 24 hr \nSig: One (1) Tablet Extended Release 24 hr PO QPM (once a day \n(in the evening)). ', '2. levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2 \ntimes a day). ', '3. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '4. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID \n(2 times a day). ', '5. nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) Tablet, \nSublingual Sublingual PRN (as needed) as needed for chest pain. ', '6. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). ', '7. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily). ', '8. omega-3 fatty acids Capsule Sig: One (1) Capsule PO BID \n(2 times a day). ', '9. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday) as needed for constipation. ', '10. terazosin 1 mg Capsule Sig: One (1) Capsule PO HS (at \nbedtime). ', '11. glipizide 5 mg Tablet Sig: One (1) Tablet PO once a day. ', '12. Percocet ___ mg Tablet Sig: One (1) Tablet PO every four \n(4) hours as needed for pain. ', '13. Cerovite Senior Tablet Sig: One (1) Tablet PO once a \nday. ', '14. Outpatient Lab Work\nPlease obtain LFTs at Dr ___ visit']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 47, 'gender': 'F', 'symptoms': 'hematuria with urinary retention', 'medical_history': ['Recent diagnosis of sarcomatoid carcinoma', 'Recent gross hematuria', 'Urethral stricture s/p dilation x2', 'HTN', 'HLD', 'Right hand trauma s/p surgery x2', 'Abscess surgery buttocks'], 'family_history': 'No history of GU malignancy.', 'present_illness': '___ with HTN, HLD, urethral stricture s/p dilation x2 recent \nadmission at ___ for hematuria and urinary retention where he \nwas found to have sarcomatoid carcinoma of bladder who presents \nwith hematuria and urinary retention.\n\nHe was in his usual state of health until 1.5 months ago. At \nthat time he developed hematuria and urinary retention. He has \nhad a 25 pound weight loss. He was seen and evaluated by urology \nat ___ and ultimately diagnosed with bladder cancer (sarcomatoid \ncarcinoma). He underwent significant work up and was seen by \nurology and oncology at ___ with recommendation of radical \ncystectomy +/- adjuvant or palliative chemotherapy. The patient \nwanted a second opinion and had an outpatient follow up with Dr. \n___ at ___.\n\n2 days prior to admission he again developed hematuria, with \nclots and acute urinary retention. He had a foley catheter \nplaced and was discharged from the ED. Then the foley catheter \nwas obstructed. He presented to OSH and had three-way foley \ncatheter placed. The family requested transfer to ___ for \nurology and oncology evaluation.\n\nCurrently, he feels okay. He denies fevers, chills, nausea, \nvomiting, diarrhea, constipation, abdominal pain, back pain, or \nother symptoms.\n\nROS: Per above. Otherwise negative.', 'medications': [{'medication': 'Fluticasone Propionate NASAL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NU', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Maalox/Diphenhydramine/Lidocaine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Repaglinide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sucralfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'MetFORMIN (Glucophage)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Fluoxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Fluticasone-Salmeterol Diskus (250/50) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Nitroglycerin SL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SL', 'frequency': 'PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '___', 'valuenum': 96.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': 'NotDone. CK-MB NOT PERFORMED, TOTAL CK < 100.'}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.4', 'valuenum': 23.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '76', 'valuenum': 76.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '250', 'valuenum': 250.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.48', 'valuenum': 4.48, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Admission Exam:\nGeneral: no distress, in bed\nVitals: 97.8 120/60 66 18 98% RA\nPain: ___\nHEENT: poor dentition\nCardiac: rr, nl rate, soft murmur, systolic\nLungs: CTAB\nAbd: soft, nontender, nondistended\nGU: three way foley catheter\nExt: wwp, no edema\nPsych: pleasant\nNeuro: grossly, no deficits\n\nDischarge Exam:\nGeneral: no distress, in bed\nVitals: AVSS\nPain: ___\nHEENT: poor dentition\nAbd: soft, nontender, nondistended\nGU: three way foley catheter', 'diagnoses': [{'icd_code': '78659', 'desc': 'Other chest pain'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}], 'summary': 'Admission Labs:\n___ 03:00AM BLOOD WBC-18.1* RBC-3.57* Hgb-10.5# Hct-32.3 \nMCV-91 MCH-29.3 MCHC-32.4 RDW-13.3 Plt ___\n___ 03:00AM BLOOD Neuts-78.0* Lymphs-11.0* Monos-6.6 \nEos-4.0 Baso-0.4\n___ 07:40AM BLOOD ___ PTT-29.7 ___\n___ 03:00AM BLOOD Glucose-108* UreaN-12 Creat-1.1 Na-136 \nK-4.2 Cl-104 HCO3-21* AnGap-15\n___ 07:40AM BLOOD Calcium-10.6* Phos-3.6 Mg-1.9\n\nDischarge Labs:\n___ 05:53AM BLOOD WBC-19.6* RBC-3.81* Hgb-11.2* Hct-34.7* \nMCV-91 MCH-29.4 MCHC-32.2 RDW-13.6 Plt ___\n___ 07:40AM BLOOD Glucose-97 UreaN-13 Creat-1.0 Na-136 \nK-4.2 Cl-102 HCO3-22 AnGap-16\n\nUrine:\n___ 01:55AM URINE Color-Straw Appear-Hazy Sp ___\n___ 01:55AM URINE Blood-MOD Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-LG\n___ 01:55AM URINE RBC-12* WBC-128* Bacteri-MOD Yeast-NONE \nEpi-<1 \n\nENTEROCOCCUS SP.\nAMPICILLIN------------ <=2 S\nNITROFURANTOIN-------- <=16 S\nTETRACYCLINE---------- =>16 R\nVANCOMYCIN------------ 1 S\n___ with recent diagnosis of bladder cancer presents with gross \nhematuria with acute urinary obstruction.\n\n# Gross hematuria\n# Acute urinary obstruction\n# Bladder cancer\n# Urinary tract infection\nHe has undergone work up at ___ with recommendation of radical \ncystectomy followed by adjuvant or palliative chemotherapy. At \n___, he was seen by urology and oncology. They recommended \nradical cystectomy. He will follow up with Dr. ___ to discuss.\n\nWe attempted voiding trial however this failed due to urinary \nretention. He had a 3- way catheter placed. He continued to have \nsome hematuria but with stable hematocrit. This is expected to \ncontinue until surgical management of his bladder cancer. He is \nat high risk of clogging his catheter given the amount of \nsediment and blood clots in his urine.\n\nIn addition, he was found to have an enterococcus UTI (no clear \nsymptoms, but with leukocytosis, hematuria and bladder cancer \nfelt to be UTI) which was treated ampicillin (sensitive based on \nculture). This will continue until at least his follow up \nappointment with Dr. ___.'}}	{'final_diagnoses': ['Gross hematuria', 'Blood loss anemia', 'Acute urinary retention', 'Bladder malignancy'], 'procedures': ['OSH: three way foley placement', 'Replacement of three way foley after failed voiding trial'], 'visit_summary': '___ with recent diagnosis of bladder cancer presents with gross \nhematuria with acute urinary obstruction.\n\n# Gross hematuria\n# Acute urinary obstruction\n# Bladder cancer\n# Urinary tract infection\nHe has undergone work up at ___ with recommendation of radical \ncystectomy followed by adjuvant or palliative chemotherapy. At \n___, he was seen by urology and oncology. They recommended \nradical cystectomy. He will follow up with Dr. ___ to discuss.\n\nWe attempted voiding trial however this failed due to urinary \nretention. He had a 3- way catheter placed. He continued to have \nsome hematuria but with stable hematocrit. This is expected to \ncontinue until surgical management of his bladder cancer. He is \nat high risk of clogging his catheter given the amount of \nsediment and blood clots in his urine.\n\nIn addition, he was found to have an enterococcus UTI (no clear \nsymptoms, but with leukocytosis, hematuria and bladder cancer \nfelt to be UTI) which was treated ampicillin (sensitive based on \nculture). This will continue until at least his follow up \nappointment with Dr. ___.', 'medications_prescribed': ['Tamsulosin 0.4 mg PO HS', 'Acetaminophen 650 mg PO Q6H:PRN pain', 'Atorvastatin 10 mg PO DAILY', 'Senna 8.6 mg PO BID:PRN constipation', 'Polyethylene Glycol 17 g PO DAILY:PRN constipation', 'Ampicillin 500 mg PO Q6H', 'RX ampicillin 500 mg 1 capsule(s) by mouth every 6 hours Disp #36 Capsule Refills:*0']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 69, 'gender': 'F', 'symptoms': 'NSTEMI, Chest Pain', 'medical_history': ['AVR in ___ @ ___', 'CAD s/p multiple caths', 'A.Fib on coumadin', 'Stroke - ___ years ago when off coumadin for cardiac cath', 'Hypertension', 'Diabetes', 'BPH', '+ tobacco use', 'Cardiac Risk Factors:(+)Diabetes,(+)Dyslipidemia,(+)Hypertension'], 'family_history': 'There is no family history of premature coronary artery disease \nor sudden death.', 'present_illness': ' Patient is a ___ y/o male with a PMH significant for hyptension, \ndiabetes, hyperlipidemia, A.fib on coumadin, who presents from \n___ for cardiac catheterization after and \nepisode of chest pain that ruled in for an MI. The morning of \n___ he experienced an episode of left sided non-radiating, \naching chest pain, at home he took 4 SL nitros with no relief, \ncalled ___, was given 4 baby aspirin and 1 spray of nitro with \nimprovement in his pain. He says that his chest pain lasted 1.5 \nhours, and resolved while in the ambulance, was not associated \nwith any diaphoresis, nausea or shortness of breath, but did \nworsen with exertion. At ___ he ruled in for an \nNSTEMI with peak troponin of 1.48, CK-MB of 4.7, CK of 71 and an \nindex of 6.6, was started on a heparin gtt, continued on \naspirin, statin, beta blocker and transferred to ___ for \nfuther management and cardiac catheterization. He is s/p a \nrecent cardiac catheterization at ___ for chest \npain, the procedure at the time was complicated by a \npseudoaneurysm, which was then repaired by Dr. ___ \nvascular surgery. During that catheterization they reportedly \nfound an 80% stenosis in the left circumflex, no intervention \nwas done due to pseudoaneurysm formation. \n.\nUpon arrival to ___ he says that he feels well, is currently \nCP free and wondering when he will go for his procedure tomorrow \nmorning. Initial vitals were: 98.5, 133/73, 70, 18, 98% on 4L \nwith a fingerstick of 131. He is currently denying any CP, SOB, \nn/v/d, fever/chills, cough, palpitations or diaphoresis. He \ndoes have leg swelling, he says that since his pseudoaneurysm \nrepair he has had R>L leg swelling, for which he has been taking \nlasix. \n. \nOn review of systems, he denies any prior history of deep venous \nthrombosis, pulmonary embolism, bleeding at the time of surgery, \nmyalgias, joint pains, cough, hemoptysis, black stools or red \nstools. He denies recent fevers, chills or rigors. He denies \nexertional buttock or calf pain. All of the other review of \nsystems were negative. \nCardiac review of systems is notable for absence of dyspnea on \nexertion, paroxysmal nocturnal dyspnea, orthopnea, palpitations, \nsyncope or presyncope.', 'medications': [{'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Cefpodoxime Proxetil', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Ipratropium Bromide MDI', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 1%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IH', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ipratropium Bromide MDI', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Midazolam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Chlorthalidone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem Extended-Release', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Olanzapine (Disintegrating Tablet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q1H', 'doses_per_24_hrs': 24.0}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Ipratropium Bromide MDI', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Tobramycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Dexmedetomidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium Bromide MDI', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Midazolam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium Bromide MDI', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Alprazolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ipratropium Bromide MDI', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Sodium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Tiotropium Bromide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '38.1', 'valuenum': 38.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '315', 'valuenum': 315.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.16', 'valuenum': 4.16, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '419', 'valuenum': 419.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '404', 'valuenum': 404.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 125.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '720', 'valuenum': 720.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 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'priority': 'STAT', 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 86.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO 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'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '40', 'valuenum': 40.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 76.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'value': '___', 'valuenum': 7.24, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-1', 'valuenum': -1.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.40', 'valuenum': 1.4, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '152', 'valuenum': 152.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 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'priority': None, 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 148.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '113', 'valuenum': 113.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 210.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '402', 'valuenum': 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'comments': 'NEG.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.39', 'valuenum': 1.39, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '197', 'valuenum': 197.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 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None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '/16.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'ug/mL', 'ref_range_lower': 6.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': 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'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '45.0', 'valuenum': 45.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '298', 'valuenum': 298.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.96', 'valuenum': 4.96, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20.8', 'valuenum': 20.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 40.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.5,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 86.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '43.1', 'valuenum': 43.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '273', 'valuenum': 273.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.74', 'valuenum': 4.74, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21.4', 'valuenum': 21.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '42.4', 'valuenum': 42.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.8', 'valuenum': 28.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '248', 'valuenum': 248.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.68', 'valuenum': 4.68, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.6', 'valuenum': 17.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 43.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 77.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 41.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 79.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '41.4', 'valuenum': 41.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '277', 'valuenum': 277.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.63', 'valuenum': 4.63, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20.3', 'valuenum': 20.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 44.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': '___', 'valuenum': 62.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': '7.45', 'valuenum': 7.45, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '154', 'valuenum': 154.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 42.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 86.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 49.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '___', 'valuenum': 83.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '7.36', 'valuenum': 7.36, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 44.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'value': '60', 'valuenum': 60.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.46', 'valuenum': 7.46, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}], 'exams': 'VS - 98.5, 133/73, 70, 18, 98% on 4L \nGen: WDWN elderly male in NAD. Oriented x3. Mood, affect \nappropriate. \nHEENT: Sclera anicteric. Conjunctiva were pink, no pallor or \ncyanosis of the oral mucosa. No xanthalesma. \nNeck: Supple with JVP 5cm above clavicle. \nCV: Irregular, mechanical heart sounds, loudest at LUSB No S3 or \nS4. \nChest: No chest wall deformities, scoliosis or kyphosis. Resp \nwere unlabored, no accessory muscle use. crackles ___ up on the \nright and at the left base . \nAbd: Soft, NTND. No HSM or tenderness. \nExt: ___ RLE edema, 1+ edema LLE \nRight Groin: scar with 3cm mass of tissue under, no bruit\nLeft Groin: no bruit, 2+ pulse', 'diagnoses': [{'icd_code': '49121', 'desc': 'Obstructive chronic bronchitis with (acute) exacerbation'}, {'icd_code': '4870', 'desc': 'Influenza with pneumonia'}, {'icd_code': '51881', 'desc': 'Acute respiratory failure'}, {'icd_code': '4275', 'desc': 'Cardiac arrest'}, {'icd_code': '42732', 'desc': 'Atrial flutter'}, {'icd_code': '2764', 'desc': 'Mixed acid-base balance disorder'}, {'icd_code': '4430', 'desc': "Raynaud's syndrome"}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '4589', 'desc': 'Hypotension, unspecified'}], 'summary': '___ 10:30PM BLOOD WBC-6.1 RBC-3.33* Hgb-10.1* Hct-30.5* \nMCV-91 MCH-30.4 MCHC-33.2 RDW-16.3* Plt ___\n___ 10:24PM BLOOD Hct-28.8\n___ 06:34AM BLOOD WBC-9.0 RBC-2.80 Hgb-8.4* Hct-26.1* \nMCV-93 MCH-30.1 MCHC-32.2 RDW-16.6* Plt ___\n___ 06:00AM BLOOD WBC-9.2 RBC-3.11* Hgb-9.5* Hct-28.9* \nMCV-93 MCH-30.6 MCHC-33.0 RDW-16.6* Plt ___\n___ 10:30PM BLOOD Glucose-168* UreaN-28* Creat-1.6* Na-141 \nK-3.7 Cl-104 HCO3-27 AnGap-14\n___ 06:55AM BLOOD Glucose-100 UreaN-24* Creat-1.5* Na-144 \nK-3.7 Cl-103 HCO3-30 AnGap-15\n___ 03:35AM BLOOD Glucose-179* UreaN-20 Creat-1.2 Na-141 \nK-3.7 Cl-103 HCO3-30 AnGap-12\n___ 04:00AM BLOOD Glucose-123* UreaN-20 Creat-1.3* Na-143 \nK-4.3 Cl-105 HCO3-28 AnGap-14\n___ 06:00AM BLOOD Glucose-103* UreaN-35* Creat-1.7* Na-137 \nK-4.5 Cl-99 HCO3-25 AnGap-18\n___ 06:20AM BLOOD CK(CPK)-36\n___ 09:50PM BLOOD CK(CPK)-83\n___ 03:35AM BLOOD CK(CPK)-95\n___ 06:20AM BLOOD CK-MB-NotDone cTropnT-0.11\n___ 06:20AM BLOOD Triglyc-48 HDL-51 CHOL/HD-2.5 LDLcalc-66\n. \nOn discharge:\n___ 06:35AM BLOOD WBC-6.7 RBC-3.17* Hgb-9.2* Hct-29.4* \nMCV-93 MCH-29.1 MCHC-31.3 RDW-16.5* Plt ___\n___ 06:35AM BLOOD Plt ___\n___ 06:35AM BLOOD Glucose-99 UreaN-36* Creat-1.6* Na-140 \nK-4.5 Cl-103 HCO3-29 AnGap-13\n___ 03:35AM BLOOD CK(CPK)-95\n___ 03:35AM BLOOD CK-MB-NotDone\n___ 06:35AM BLOOD Calcium-9.1 Phos-3.7 Mg-1.9\n.Cardiac Cath (Prelim): FINAL DIAGNOSIS: \n1. Three vessel coronary artery disease. \n2. Moderately successful PTCA of the LPDA and unsuccessful PTCA \nof the \nOM. \n.Persantine Stress: MPRESSION: No anginal type symptoms or \ninterpretable ST segments in setting of LBBB. Nuclear report \nsent separately \nIMPRESSION: Moderate enlargement of left ventricle with no \ndefinite perfusion abnormality. Gated images were not performed \ndue to patient rhythm abnormality.\nPatient is a ___ y/o male with a PMH significant for CAD, \nhyptension, diabetes, hyperlipidemia, A.fib on coumadin, who \npresents from ___ for cardiac \ncatheterization after and episode of chest pain who ruled in for \nan NSTEMI. He was admitted to ___ on ___ \nand underwent cardiac catheterization on ___. His \npost-catheterization course was complicated by a R groin \ncellulitis and L groin hematoma. On ___ he was \ndischarged to a rehab facility in good condition, ambulatory, \nwith stable vital signs, with appropriate outpatient follow-up \narranged. His hospital course was notable for: \n. \n#. CAD/NSTEMI: Patient with known CAD ruled in for an NSTEMI at \n___ was transferred for cardiac catheterization. \nPatient is s/p cath on ___ where they were able to POBA a \nlesion in his circ but unable to place a stent. He reported \nthat he continued to have daily chest pain, that was identical \nto his CP at home, that improves with ___ SL nitros. Recently \nRanexa was added for increased anti-anginal effect. He was \ncontinued on atorvastatin, aspirin, and discharged with \noutpatient follow-up scheduled for ___ with his cardiologist \nDr. ___. \n.\n#.Left Groin Hematoma: Pt was noted to have a L groin hematoma \nafter catheterization. He underwent an u/s examination to rule \nout AV fistula, which was negative for AV fistula and \npseudoanuerysm.\n. \n#. Pump: no echo in our system, BNP mildly elevated at 518 at \n___, but with initial volume overload on exam that \nappeared consistent with acute diastolic heart failure, now \nvolume status is improved, right heart cath with PCWP of 15, now \nappears consistent with chronic diastolic HF \n.\n#. Rhythm: patient with known A.fib on coumadin as an \noutpatient, currently rate controlled on outpatient regimen of \nmetoprolol 50mg TID, on heparin gtt while not on coumadin \n--patient needs to be bridged in the setting of having a prior \nstroke while off coumadin, has taken lovenox in the past will \nlook into outpatient lovenox bridge to coumadin \n--monitor on telemetry \n--continue coumadin \n. \n#. Right Groin Erythema: exam consistent with cellulitis, \nultrasound shows 8.4cm hematoma which has decreased in size from \nprior. Started on vancomycin, has been afebrile with normal \nwhite count. Pt received a PICC line on ___. He is being \ndischarged with prescriptions for Vancomycin and Ciprofloxacin \nand scheduled to complete a two week course. The last dose of \neach medicine will be administered on 750 mg q24h. \n.\n#. History of AVR: \nPt was discharged on home outpatient Coumadin regimen\n.\n#. Diabetes: patient currently being managed on metformin as an \noutpatient, will hold metformin and continue prior insulin \nsliding scale\n.\n#. Hypertension: continue outpatient metoprolol and Imdur. \nValsartan was d/c during this hospitalization.\n.\n#. Chronic Renal Insufficiency: creatinine increased to 1.7 \nduring this hospitalization. At the time of discharge, \ncreatinine had decreased to 1.6. His creatinine should be \nfollowed and trended as an outpatient.\n.\nOn ___, the Pt was discharged to a rehab facility \nin good condition, ambulatory, with stable vital signs.'}}	{'final_diagnoses': ['Non- ST elevation myocardial infarction', 'R groin cellulitis', 'L groin hematoma', 'Coronary artery disease', 'aortic valve replacement', 'atrial fibrillation', 'hypertension', 'diabetes'], 'procedures': ['Cardiac Catheterization'], 'visit_summary': 'Patient is a ___ y/o male with a PMH significant for CAD, \nhyptension, diabetes, hyperlipidemia, A.fib on coumadin, who \npresents from ___ for cardiac \ncatheterization after and episode of chest pain who ruled in for \nan NSTEMI. He was admitted to ___ on ___ \nand underwent cardiac catheterization on ___. His \npost-catheterization course was complicated by a R groin \ncellulitis and L groin hematoma. On ___ he was \ndischarged to a rehab facility in good condition, ambulatory, \nwith stable vital signs, with appropriate outpatient follow-up \narranged. His hospital course was notable for: \n. \n#. CAD/NSTEMI: Patient with known CAD ruled in for an NSTEMI at \n___ was transferred for cardiac catheterization. \nPatient is s/p cath on ___ where they were able to POBA a \nlesion in his circ but unable to place a stent. He reported \nthat he continued to have daily chest pain, that was identical \nto his CP at home, that improves with ___ SL nitros. Recently \nRanexa was added for increased anti-anginal effect. He was \ncontinued on atorvastatin, aspirin, and discharged with \noutpatient follow-up scheduled for ___ with his cardiologist \nDr. ___. \n.\n#.Left Groin Hematoma: Pt was noted to have a L groin hematoma \nafter catheterization. He underwent an u/s examination to rule \nout AV fistula, which was negative for AV fistula and \npseudoanuerysm.\n. \n#. Pump: no echo in our system, BNP mildly elevated at 518 at \n___, but with initial volume overload on exam that \nappeared consistent with acute diastolic heart failure, now \nvolume status is improved, right heart cath with PCWP of 15, now \nappears consistent with chronic diastolic HF \n.\n#. Rhythm: patient with known A.fib on coumadin as an \noutpatient, currently rate controlled on outpatient regimen of \nmetoprolol 50mg TID, on heparin gtt while not on coumadin \n--patient needs to be bridged in the setting of having a prior \nstroke while off coumadin, has taken lovenox in the past will \nlook into outpatient lovenox bridge to coumadin \n--monitor on telemetry \n--continue coumadin \n. \n#. Right Groin Erythema: exam consistent with cellulitis, \nultrasound shows 8.4cm hematoma which has decreased in size from \nprior. Started on vancomycin, has been afebrile with normal \nwhite count. Pt received a PICC line on ___. He is being \ndischarged with prescriptions for Vancomycin and Ciprofloxacin \nand scheduled to complete a two week course. The last dose of \neach medicine will be administered on 750 mg q24h. \n.\n#. History of AVR: \nPt was discharged on home outpatient Coumadin regimen\n.\n#. Diabetes: patient currently being managed on metformin as an \noutpatient, will hold metformin and continue prior insulin \nsliding scale\n.\n#. Hypertension: continue outpatient metoprolol and Imdur. \nValsartan was d/c during this hospitalization.\n.\n#. Chronic Renal Insufficiency: creatinine increased to 1.7 \nduring this hospitalization. At the time of discharge, \ncreatinine had decreased to 1.6. His creatinine should be \nfollowed and trended as an outpatient.\n.\nOn ___, the Pt was discharged to a rehab facility \nin good condition, ambulatory, with stable vital signs.', 'medications_prescribed': ['Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily).', 'Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day.\nDisp:30 Tablet(s) Refills:2', 'Isosorbide Mononitrate 60 mg Tablet Sustained Release 24 hr \nSig: Two (2) Tablet Sustained Release 24 hr PO DAILY (Daily).', 'Vancomycin 500 mg Recon Soln Sig: One (1) Recon Soln \nIntravenous Q 24H (Every 24 Hours): Please give daily to \ncomplete 2 week course. Last day of treatment will be ___. \nDisp:30 Recon Soln(s) Refills:2', 'Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID \n(3 times a day).', 'Ranolazine 500 mg Tablet Sustained Release 12 hr Sig: One (1) \nTablet Sustained Release 12 hr PO BID (2 times a day).\nDisp:60 Tablet Sustained Release 12 hr(s) Refills:2', 'Docusate Sodium 100 mg Capsule Sig: Two (2) Capsule PO BID (2 \ntimes a day).', 'Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:30 Tablet(s) Refills:2', 'Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) \nCapsule, Sust. Release 24 hr PO HS (at bedtime).', 'Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet, \nSublingual Sublingual PRN (as needed) as needed for chest pain.', 'Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H \n(every 12 hours): Please take to complete two week course. Last \nday of treatment will be ___. .\nDisp:20 Tablet(s) Refills:0', 'Insulin Lispro 100 unit/mL Solution Sig: One (1) \nSubcutaneous ASDIR (AS DIRECTED): Please see printed sliding \nscale.\nDisp:qs 1 months supply Refills:2', 'Glucagon (Human Recombinant) 1 mg Recon Soln Sig: One (1) \nRecon Soln Injection Q15MIN () as needed for hypoglycemia \nprotocol.', 'Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal \nDAILY (Daily) as needed for constipation.', 'Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday) as needed for constipation.', 'Warfarin 2 mg Tablet Sig: Two (2) Tablet PO Once Daily at 4 \n___.', 'Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) \nTablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for \nconstipation.', 'Polyethylene Glycol 3350 17 gram/dose Powder Sig: One (1) \nPO DAILY (Daily) as needed for constipation .']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 65, 'gender': 'F', 'symptoms': 'episodes of shaking and falling down, post-lumbar puncture \nheadache, unstable walking', 'medical_history': ['Optic neuritis, on prednisone taper, followed by Dr.\n___', 'PTSD from childhood trauma', 'Depression', 'Stage 1 BrCa s/p mastectomy (dx ___, no chemo)'], 'family_history': 'Mother and sister with breast cancer- family is BRCA negative. \nFather had brain aneurysm, brothers with ___ disease, \nDaughter with ___ disease, son with asthma, mother with \nbreast cancer, sister with colon cancer', 'present_illness': 'Ms. ___ is a ___ yo RHW with history of possible seizures,\nepisodic neurologic deficits undergoing outpatient workup for MS\nwho presented to the ED with headaches twice in 24 hours, and \nnow\nhas had 3 events concerning for seizures in 24 hours. \nPlease see Dr. ___ from last night for further details\nof that presentation. She was discharged from the ED to pain\nclinic this morning for a blood patch for presumed post LP\nheadache. The blood patch had no effect, and within 2 hours she\ndrove back to ED for headache. The headache is no longer clearly\npositional, as it persists despite lying flat. It is bifrontal\nand stabbing sharp pain with mild photophobia and nausea. She \nc/o\nR fingertip and toe tingling. \nThen at 3:30pm, she had an episode witnessed by her husband that\nbegan with rolling toward him (on the left side) and then \nshaking\nin all extremities, with her tongue hanging out and eyes rolled\nback. She was unresponsive. She had stopped convulsing when ED\nresident arrived but remained unresponsive, and she avoided\nallowing her arm to hit her face when lifted. She had been\nincontinent of urine. She said she was "confused" but returned\nback to baseline over the next ___ minutes. She still had some\nsmall right hand shaking numbness during this time but was\nconscious. The patient herself remembers a strange feeling with\ntunnel vision and tinnitis before the event, then next remembers\na doctor shining light in her eyes. \nI examined the patient around 4pm. She reported having seizures\nin the ___ similar to this one. She never remembered anything\nabout her seizures, but would find herself on the floor with\nurinary incontinence. She did not have financial resources or\ninsurance, but was seen once at ___ where EEG was\nperformed. She said she had "Jacksonian" seizures but was never\nrecommended to take any medicines for this. The episodes abated\nbut would occur rarely over the past ___ years. \nShe is undergoing a workup for MS because she has been \nclinically\ndiagnosed with optic neuritis. She had an episode of L sided\nweakness in the early ___ and was wheelchair bound for 1 month. \n\nShe currently has multiple other complaints such as right hand\nand foot tingling that comes and goes at baseline, and\nintermittent vomiting and diarrhea for months.', 'medications': [{'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Cepacol (Menthol)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Montelukast Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Benzonatate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Chlorpheniramine-Hydrocodone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetylcysteine 20%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'NEB', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Fluticasone Propionate NASAL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NU', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 0.5%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TT', 'frequency': '1X', 'doses_per_24_hrs': 0.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Guaifenesin-CODEINE Phosphate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fexofenadine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Cyclobenzaprine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Guaifenesin-CODEINE Phosphate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Cyproheptadine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Fluticasone-Salmeterol Diskus (250/50) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sulfameth/Trimethoprim DS', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '32.2', 'valuenum': 32.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.8', 'valuenum': 26.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '652', 'valuenum': 652.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.05', 'valuenum': 4.05, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.6', 'valuenum': 17.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'ng/dL', 'ref_range_lower': 0.93, 'ref_range_upper': 1.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'IU/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': 'LESS THAN 20. NOTE NEW METHOD AND NEW REFERENCE RANGE AS OF ___.'}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.6,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 12.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 55.0, 'flag': None, 'priority': 'STAT', 'comments': 'MEASURED BY ___. TG NOT RELIABLE IN PRESENCE OF ANTI-TG. SEE ONLINE LAB MANUAL.'}, {'value': None, 'valuenum': None, 'valueuom': 'IU/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': 'LESS THAN 10. NOTE NEW METHOD AND NEW REFERENCE RANGE AS OF ___.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.1', 'valuenum': 27.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.7', 'valuenum': 26.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '705', 'valuenum': 705.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.13', 'valuenum': 4.13, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.5', 'valuenum': 16.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.7', 'valuenum': 26.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '619', 'valuenum': 619.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.94', 'valuenum': 3.94, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Admission:\nVitals: 97.4 95 132/81 20 99% \nGeneral: pleasant, appears comfortable, not anxious about \nseizure\nevent \nHEENT: NC/AT\nNeck: Supple, no nuchal rigidity\nPulmonary: CTABL\nCardiac: RRR, no murmurs\nAbdomen: soft, nontender, nondistended\nExtremities: no edema, pulses palpated\nSkin: no rashes or lesions noted.\n \nNeurologic:\n-Mental Status: Alert, oriented to ___ and Womens" then\ncorrects to BI, thinks date is ___. Able to\nrelate history without difficulty. Unable to name ___\nbackward, skips 2 and gets 2 backwards. Language is fluent with\nintact repetition and comprehension. Normal prosody. There \nwere\nno paraphasic errors. Pt. was able to name both high and low\nfrequency objects. Speech was not dysarthric. Able to follow \nboth\nmidline and appendicular\ncommands. Pt. was able to register 3 objects and recalled ___ at\n5 minutes despite multiple choice. There was no evidence of\napraxia or neglect.\n\n-Cranial Nerves:\nI: Olfaction not tested.\nII: PERRL 3 to 2mm and brisk. VFF to confrontation. \nIII, IV, VI: EOMI without nystagmus. Normal saccades.\nV: Facial sensation intact to light touch.\nVII: No facial droop, facial musculature symmetric.\nVIII: Hearing intact to finger-rub bilaterally.\nIX, X: Palate elevates symmetrically.\nXI: ___ strength in trapezii and SCM bilaterally.\nXII: Tongue full strength bilaterally.\n\n-Motor: Normal bulk, tone throughout. On pronator drift the \nright\nside drifts downward without prontation. \nR upper and lower extremity giveway weakness, but can elicit <1\nsecond of full strength throughout. L side full. \n\n-Sensory: No deficits to light touch, temperature, vibration or\njoint position throughout. Decreased pinprick on right face,\nbilateral arms circumferentially, and lower lateral calf and\ndorsal foot on the right. No sensory level. \n\n-DTRs: 2+ and symmetric throughout. Toes downgoing bilaterally. \n\n-Coordination: exhibits pastpointing in different directions on\nbilateral FNF, HKS and toe to finger touch is intact bilaterally\n\n-Gait: good initation, normal base and stride, steady. \n\nDischarge:\nVitals T 99, BP 118/83, HR 76, RR 20, O2 98% on RA.\nMS: Awake, alert, speech fluent and comprehension intact, OX3.\nCN: PERRL, EOMI, face symmetric, tongue midline\nMotor: Tone normal, diffusely reduced strength on formal testing \nthroughout right upper extremity, left extremity full. Right arm \ndrifts downward without pronation.\nDTR: 2+ throughout, toes are down, no clonus\nCoordination: Intentional-appearing dysmetria on FNF testing on \nright side, left side normal.', 'diagnoses': [{'icd_code': '5180', 'desc': 'Pulmonary collapse'}, {'icd_code': '486', 'desc': 'Pneumonia, organism unspecified'}, {'icd_code': '4232', 'desc': 'Constrictive pericarditis'}, {'icd_code': '51919', 'desc': 'Other diseases of trachea and bronchus'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '135', 'desc': 'Sarcoidosis'}, {'icd_code': '5178', 'desc': 'Lung involvement in other diseases classified elsewhere'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '5533', 'desc': 'Diaphragmatic hernia without mention of obstruction or gangrene'}, {'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': '49300', 'desc': 'Extrinsic asthma, unspecified'}, {'icd_code': '2713', 'desc': 'Intestinal disaccharidase deficiencies and disaccharide malabsorption'}, {'icd_code': '33829', 'desc': 'Other chronic pain'}, {'icd_code': '27800', 'desc': 'Obesity, unspecified'}, {'icd_code': 'V5865', 'desc': 'Long-term (current) use of steroids'}], 'summary': "___ 04:00AM BLOOD Glucose-94 UreaN-15 Creat-0.7 Na-140 \nK-3.7 Cl-104 HCO3-25 AnGap-15\n___ 05:17AM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG\n\nECG: Sinus rhythm. Normal ECG. Compared to the previous tracing \nof ___ there are no additional interval diagnostic changes.\n\nCT head ___: FINDINGS: There is no evidence of intracranial \nhemorrhage, edema, shift of\nnormally midline structures, hydrocephalus, or acute large \nvascular territorial infarction. The orbits are unremarkable. \nThe visualized portions of the paranasal sinuses and mastoid air \ncells are well aerated. No suspicious lytic or blastic bone \nlesion is identified. Scattered hyperdense round scalp lesions \nwere seen on prior MRI from ___, some of which \ndemonstrate punctate internal calcifications, possibly \ngranulomas.\nIMPRESSION: No acute intracranial abnormality.\n NOTE ADDED IN ATTENDING REVIEW: There are a few well-defined, \nround lesions in the vertex scalp superficial soft tissues. \nThese correspond to lesions on MR, demonstrate punctate central \ncalcifications, and contact the skin, and very likely represent \nsebaceous cysts; correlate with physical exam.\n\nCT head ___ (after a fall):\nThere is no evidence of hemorrhage, edema, mass, mass effect or \nacute vascular territorial infarction. The ventricles and sulci \nare normal in appearance. There is preservation of the \ngray-white matter differentiation and the basal cisterns appear \npatent. There is no evidence of fracture. Multiple round \ncalcified skin lesions are identified in the frontal scalp and \nvertex and are consistent with sebaceous cysts. The visualized \nparanasal sinuses, mastoid air cells and middle ear cavities are \ngrossly clear. The orbits are unremarkable. \nIMPRESSION:\nNo acute intracranial abnormality.\n\nEEG ___: IMPRESSION: This is an abnormal video-EEG \nmonitoring session because of multiple nonepileptic events. \nClinically, these are characterized by right arm floppy shaking, \nside-to-side head shaking, and unresponsiveness. Some of the \nepisodes are quite prolonged. There is no ictal EEG correlate to \nany of these episodes; her baseline alpha rhythm and background \nactivity are seen throughout most of the events, and immediately \non cessation of abnormal movements after all events. Her \ninterictal EEG is normal. These findings are consistent with a \ndiagnosis of nonepileptic psychogenic events. \n\nEEG ___: IMPRESSION: This is a normal video-EEG monitoring \nsession. None of the patient's typical events were recorded \nduring this abbreviated study. The patient discontinued the \nstudy on her own by ripping off all of her EEG electrodes at \n8:45 AM. Before this, the interictal EEG was normal.\nMrs. ___ is a ___ woman with a past medical history of \ndepression and posttraumatic stress disorder, who was being \nworked up for visual problems concerning for optic neuritis, who \npresented with headache after a spinal tap, as well as spells \nconsisting of arm shaking and/or falling to the ground.\n\n#Neuro\nHer head CT did not show a mass lesion, bleed or hypodensity. \nHer CSF (from the tap performed a few days before admission) did \nnot have oligoclonal bands. 12 hours of EEG recording captured \nseveral events with right arm shaking and unresponsiveness, that \nwere not seizures. Her baseline EEG was normal as well. We were \nunable to record for more than 12 hours, since the patient kept \npulling off her leads. \nShe also had several falls during her stay off EEG that included \nextremity shaking, and always occurred in a stressful situation \nand in the presence of somebody in her room.\nShe complained about a headache after her spinal tap as an \noutpatient, and threatened several times to leave AMA should we \nnot treat her with oxycodone or stronger opioids. Her headache \nresolved completely after two days of iv fluids, fioricet and \ntramadol.\nDuring her stay we found varying neurological symptoms, such as \nintermittent dragging of the right foot, gait instability, and \ngiveaway weakness on her right upper extremity. She was \nevaluated by ___ who felt that she was not safe to go home given \nher gait instability, and recommended rehab. Mrs. ___ refused \nrehab, and left against medical advice.\n\nAlthough we did not capture an event including a fall on EEG, we \nfeel since her baseline EEG is completely normal, the shaking \nevents we managed to capture were nonepileptic, and since the \nneurologic findings with giveaway weakness changed from day to \nday, seizures are extremely unlikely as a cause of her falls. \nThe falls are most likely nonepileptic events.\nAlso, her CSF results did not show signs typical for a \ndemyelinating disorder, and her MRI was negative.\n\n#Psych\nPsychiatry was consulted and felt that except for her depression \nand posttraumatic stress disorder she did not meet the criteria \nfor another psychiatric diagnose, and that she was capable of \nmaking her own decisions. They recommended tapering down the \nolanzapine a few days after discharge which we had changed from \nPRN to standing while an inpatient."}}	{'final_diagnoses': ['non-epileptic psychogenic events, 780.39', 'headache, post-lumbar puncture', 'gait instability'], 'procedures': ['None'], 'visit_summary': 'Mrs. ___ is a ___ woman with a past medical history of \ndepression and posttraumatic stress disorder, who was being \nworked up for visual problems concerning for optic neuritis, who \npresented with headache after a spinal tap, as well as spells \nconsisting of arm shaking and/or falling to the ground.\n\n#Neuro\nHer head CT did not show a mass lesion, bleed or hypodensity. \nHer CSF (from the tap performed a few days before admission) did \nnot have oligoclonal bands. 12 hours of EEG recording captured \nseveral events with right arm shaking and unresponsiveness, that \nwere not seizures. Her baseline EEG was normal as well. We were \nunable to record for more than 12 hours, since the patient kept \npulling off her leads. \nShe also had several falls during her stay off EEG that included \nextremity shaking, and always occurred in a stressful situation \nand in the presence of somebody in her room.\nShe complained about a headache after her spinal tap as an \noutpatient, and threatened several times to leave AMA should we \nnot treat her with oxycodone or stronger opioids. Her headache \nresolved completely after two days of iv fluids, fioricet and \ntramadol.\nDuring her stay we found varying neurological symptoms, such as \nintermittent dragging of the right foot, gait instability, and \ngiveaway weakness on her right upper extremity. She was \nevaluated by ___ who felt that she was not safe to go home given \nher gait instability, and recommended rehab. Mrs. ___ refused \nrehab, and left against medical advice.\n\nAlthough we did not capture an event including a fall on EEG, we \nfeel since her baseline EEG is completely normal, the shaking \nevents we managed to capture were nonepileptic, and since the \nneurologic findings with giveaway weakness changed from day to \nday, seizures are extremely unlikely as a cause of her falls. \nThe falls are most likely nonepileptic events.\nAlso, her CSF results did not show signs typical for a \ndemyelinating disorder, and her MRI was negative.\n\n#Psych\nPsychiatry was consulted and felt that except for her depression \nand posttraumatic stress disorder she did not meet the criteria \nfor another psychiatric diagnose, and that she was capable of \nmaking her own decisions. They recommended tapering down the \nolanzapine a few days after discharge which we had changed from \nPRN to standing while an inpatient.', 'medications_prescribed': ['Escitalopram Oxalate 10 mg PO DAILY', 'OLANZapine 5 mg PO HS, may be discontinued if pt stable', 'Omeprazole 20 mg PO DAILY']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 55, 'gender': 'M', 'symptoms': 'acute on chronic abdominal pain', 'medical_history': ['Aortic insufficiency', 'History of endocarditis', 'SVT s/p ablation', 'DVT and PE in setting of PICC line', 'Slowed motility s/p G/J tube', 'Malnutrition on TPN', 'Hypothyroidism', 'Acquired hyperinsulinemia', 'Migraine headaches', 'Depression'], 'family_history': 'Brother with ___. Sister with SLE. Father with ETOH abuse. Denies family history of clots.', 'present_illness': '___ with extensive and complex history of chronic abdominal pain, endocarditis, DVT/PE in setting of PICC line, depression, multiple abdominal surgeries presenting with acute on chronic abdominal pain. Pt is known to this writer from a hospitalization in ___ she has been hospitalized at ___ 46 times since entry into ___ system in ___, and has been hospitalized on multiple occasions at ___, as well other hospitals, in that time frame. Pt reports that she was recently admitted to ___ for sepsis, from ___. Pt reports that BCx from ___ and ___ were positive for Clostridium septicum, afer incubation for ___ days. She reports multiple CT scans at ___, one of which came back with "enteritis." WBC increased from 4.5k to 13.9k, then 20.6. At ___, she states that she was treated with ___ days of ceftriaxone or cefepime, then transitioned to linezolid. She notes that she initially presented there on ___ with rigors, headache, and abdominal pain.\n\nPt describes constipation since discharge from ___, which is a longstanding issue, although able to pass BM on the day prior to presentation to this hospital. She endorses crampy abdominal pain associated with PO intake, approx. 1 hour after eating, intermittent, lasts ___ hours, then resolves. She reports that she stopped pain medications 1 month ago, received 1 week prescription on ___ for dilaudid, then detoxed herself. At ___, she had been off medications for 8 days; she was apparently told at ___ that sxs were related to opioid withdrawal, an assessment with which she disagrees. She is able to keep down clear liquids. Endorses emesis ___ episodes of emesis q1h, which comes in paroxysms. Emesis is more like saliva. She also describes rash on face and neck which apparently developed at ___, nonpruritic, she is unclear what caused it. Denies dysuria.\n\nAbdominal pain is ___, intermittent. She notes a pain across the top of abdomen, cramping; she associates this pain with eating, similar to chronic abdominal pain. There is another, throbbing pain, RLQ, worse with movement, at its worst it reaches a ___ she associates this pain with infection, and is the more concerned about this second pain.\n\nSome records from ___ are faxed to ___ overnight. Review of these records reveals a hospitalization ___ for reported hematochezia, although it is unclear if there was any documented BRBPR during that hospitalization. The discharge summary from her ___ hospitalization has not yet been completed. Labs from that hospitalization ___ are notable for WBC as high as 20.6, as described by pt, although ___ from ___ was between 6.7 and 10.7. BCx from ___ were positive for clostridium septicum. BCx from ___ were negative. CT abd/pelvis performed during an ED visit to ___ on ___ revealed chronic changes, as well as "extensive retained stool throughout the colon, mild wall thickening versus under distention of the rectum and distal sigmoid colon, interval development of intra and extrahepatic biliary ductal dilatation, in the setting of normal LFTs the finding is of uncertain significant and may be transient, correlate with symptoms." CT report also notes that this is the pt\'s ___ CT examination performed at ___ since ___, and the fifth CT examination performed in less than one month time frame. Review of OMR reveals at least 36 CT abd/pelvis or chest since entry into ___ system, for total of 68 CT scans. Given summary of ___ records by Dr. ___ ___, pt has been imaged many times at that institution as well.\n\nIn the ___ ED:\nVS 99.2, ___, 100% RA\nLabs unrevealing\nCT abd/pelvis with contrast without acute findings to explain symptoms\n\nPt received 1L NS, Zofran 4 mg IV x2 (no witnessed emesis recorded in ED, dilaudid 0.5 mg IV x2, then 1 mg IV x1.\n\nIt appears that no attempts were made to corroborate her reported history of recent sepsis with Clostridium septicuum; unclear indication for IV opioids administered in ED, in this patient with multiple safety alerts regarding narcotic use.\n\nOn arrival to the floor:\nPt endorses ___ abdominal pain as described above.\n\nROS: all else negative', 'medications': [{'medication': 'Ursodiol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Cyclobenzaprine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Mirtazapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Dapsone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Mycophenolate Mofetil', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Tacrolimus', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'BENZODIAZEPINE IMMUNOASSAY SCREEN DOES NOT RELIABLY DETECT SOME DRUGS,;INCLUDING LORAZEPAM, CLONAZEPAM, AND FLUNITRAZEPAM.'}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2.5, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': 'LOW RISK <1.0, AVERAGE RISK 1.0-3.0, HIGH RISK >3.0 (BUT <10).'}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.1,. Estimated GFR = 69 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. 80 (THESE UNITS) = 0.08 (% BY WEIGHT).'}, {'value': '___', 'valuenum': 86.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'POSITIVE TRICYCLIC RESULTS REPRESENT POTENTIALLY TOXIC LEVELS;THERAPEUTIC TRICYCLIC LEVELS WILL TYPICALLY HAVE NEGATIVE RESULTS.'}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': 'VERIFIED.'}, {'value': '24', 'valuenum': 24.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '62', 'valuenum': 62.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'LOW.'}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.96', 'valuenum': 3.96, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 9.8, 'valueuom': 'ng/mL', 'ref_range_lower': 5.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': 'TARGET 12-HR TROUGH (EARLY POST-TX): 5-20 [24-HR TROUGH 33-50% LOWER]. MEASURED BY ___ AS OF ___.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.050', 'valuenum': 1.05, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'HOLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.9, 'valueuom': 'ng/mL', 'ref_range_lower': 5.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'TARGET 12-HR TROUGH (EARLY POST-TX): 5-20 [24-HR TROUGH 33-50% LOWER]. MEASURED BY ___ AS OF ___.'}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.3', 'valuenum': 23.3, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.4', 'valuenum': 16.4, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '56.7', 'valuenum': 56.7, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.70', 'valuenum': 3.7, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 106.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'Vitals: 97.2, 149/92, 64, 100% RA\nGEN: Alert, oriented, moves easily in bed, animated, NAD \nHEENT: NCAT, Pupils equal and reactive, sclerae anicteric, OP clear, MMM, erythematous papular rash over face without secondary changes\nNeck: Supple, no cervical, supraclavicular LAD. \nCV: S1S2, reg rate and rhythm, no murmurs, rubs or gallops\nRESP: Good air movement bilaterally, no rhonchi or wheezing\nABD: Soft, mildly distended, nontender to palpation with stethoscope while discussing AA meetings; with manual palpation, +voluntary guarding, grimacing with RLQ palpation, nontender to palpation at epigastrium, hypoactive bowel sounds. Multiple surgical scars noted. No rebound tenderness.\nGU: no foley\nEXTR: WWP, no c/c/e\nNeuro: grossly intact\nPSYCH: Appropriate and calm, interactive, animated', 'diagnoses': [{'icd_code': '7242', 'desc': 'Lumbago'}, {'icd_code': '33819', 'desc': 'Other acute pain'}, {'icd_code': '33829', 'desc': 'Other chronic pain'}, {'icd_code': '78900', 'desc': 'Abdominal pain, unspecified site'}, {'icd_code': 'V427'}, {'icd_code': '72252', 'desc': 'Degeneration of lumbar or lumbosacral intervertebral disc'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '07054', 'desc': 'Chronic hepatitis C without mention of hepatic coma'}, {'icd_code': '4011', 'desc': 'Benign essential hypertension'}, {'icd_code': '2875', 'desc': 'Thrombocytopenia, unspecified'}], 'summary': "___ 07:22PM URINE HOURS-RANDOM\n___ 07:22PM URINE HOURS-RANDOM\n___ 07:22PM URINE HOURS-RANDOM\n___ 07:22PM URINE UCG-NEGATIVE\n___ 07:22PM URINE UHOLD-HOLD\n___ 07:22PM URINE GR HOLD-HOLD\n___ 05:29PM LACTATE-1.6 K+-5.3\n___ 05:09PM LACTATE-1.5\n___ 05:03PM GLUCOSE-83 UREA N-9 CREAT-0.7 SODIUM-139 POTASSIUM-7.1 CHLORIDE-109* TOTAL CO2-23 ANION GAP-14\n___ 05:03PM estGFR-Using this\n___ 05:03PM ALT(SGPT)-36 AST(SGOT)-56* ALK PHOS-102 TOT BILI-0.3\n___ 05:03PM LIPASE-45\n___ 05:03PM ALBUMIN-4.3\n___ 05:03PM WBC-7.3 RBC-4.68# HGB-13.5# HCT-42.6# MCV-91 MCH-28.8 MCHC-31.7* RDW-16.4* RDWSD-54.4\n___ 05:03PM NEUTS-41.9 ___ MONOS-8.3 EOS-4.0 BASOS-1.6 IM ___ AbsNeut-3.06 AbsLymp-3.21 AbsMono-0.61 AbsEos-0.29 AbsBaso-0.12*\n___ 05:03PM PLT SMR-NORMAL PLT COUNT-228\n\nCT abd/pelvis ___:\nFinal Report \nEXAMINATION: CT ABD AND PELVIS WITH CONTRAST \n \nINDICATION: ___ with abdominal pain, history of clostridium sepsis. Evaluate \nfor intra-abdominal abscess. \n \nNote that contrast allergy listed is to gadolinium and patient has had \nmultiple CT studies with IV contrast in our system. \n \nTECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired \nthrough the abdomen and pelvis following intravenous contrast administration \nwith split bolus technique. \nOral contrast was administered. \nCoronal and sagittal reformations were performed and reviewed on PACS. \n \nDOSE: Total DLP (Body) = 751 mGy-cm. \n \nCOMPARISON: CT abdomen and pelvis of ___ and ___. \n \nFINDINGS: \n \nLOWER CHEST: Visualized lung fields are within normal limits. There is no \nevidence of pleural or pericardial effusion. \n \nABDOMEN: \n \nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There is no evidence of focal lesions. There is mild unchanged intrahepatic biliary dilatation in the setting of prior cholecystectomy. \n \nPANCREAS: The patient is post distal pancreatectomy. The residual pancreas is unremarkable. No peripancreatic stranding or ductal dilatation. \n\n \nSPLEEN: The spleen is surgically absent. \n \nADRENALS: The right and left adrenal glands are normal in size and shape. \n \nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. Subcentimeter bilateral renal hypodensities are too small to characterize by CT, but statistically likely cysts. There is no perinephric abnormality. \n \nGASTROINTESTINAL: As before, the patient is post Roux-en-Y gastric bypass with several additional multiple small bowel resections. Small bowel loops demonstrate normal caliber, wall thickness, and enhancement throughout. The colon and rectum are within normal limits. No evidence of anastomotic leak or extraluminal p.o. contrast. \n \nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no free fluid in the pelvis. \n \nREPRODUCTIVE ORGANS: As before, the uterus is not visualized. \n \nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. \n \nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease is noted. \n \nBONES: No acute abnormalities. \n \nSOFT TISSUES: The patient is status post bilateral breast implantation. The previously described soft tissue nodule measuring up to 1.4 cm in the left lower chest wall (2:3) is unchanged. \n \nIMPRESSION: \n \nNo acute intra-abdominal or intrapelvic process to explain the patient's symptoms.\n___ with PMx of endocarditis, chronic abdominal pain, h/o multiple prior DVT and PE (on Xarelto), SVT s/p ablation, 1+ aortic regurg, s/p CCY, s/p APY, s/p RNY (___) and reversal of RNY (___), ?insulinoma (sp resection per pt), s/p splenectomy, h/o etoh and cocaine abuse, recurrent bacteremia (previously w central vein access), s/p multiple abdominal surgeries, hypothyroidism, probable somatization per prior psychiatric evaluations, extensive use of healthcare system (sp 9 admissions to ___ within past year), who initially presented with acute on chronic abdominal pain.\n\n#Acute on chronic abd pain\n#Constipation\n#Dysmotility\n#History of C. septicum bacteremia. \nPatient presented with her chronic abdominal pain and a recent, documented diagnosis of clostridium septicum bacteremia. The patient herself associated her RLQ abdominal pain with her recurrent infections. As C. septicum is highly associated with colonic malignancy, gastroenterology was consulted, who recommended a colonoscopy. Prep was difficult and took five days, slowly infusing through an NGT. However, on ___, the patient had her colonoscopy which only showed a polyp, which was removed. As no other organic cause of her pain or bacteremia was noted, she was discharged on her home regimen on ___.\n\n#Acute hypercarbic respiratory failure due to opiate overdose. \nAs below, the patient had taken large doses of opiates at home. On ___ a CODE BLUE was called after the patient was found unresponsive with a pulse in the room by her nurse. The patient had received 1mg IM hydromorphone around 2pm on ___ and then 1.5mg SQ hydromorphone around 5pm. She was without IV access so IO was placed in the left leg. Narcan 0.04 x2 was given and patient became responsive. Anesthesia was bag ventilating and was near intubation at the time the patient woke up. The patient was in excruciating pain upon awakening due to IO placement. Multiple attempts were made at placement of an IV but were unsuccessful. She was transferred to the ICU for further monitoring. On arrival to the MICU, patient was in pain from IO insertion but otherwise breathing well. She had a right IJ central line placed by anesthesia upon arrival with removal of left IO. She was monitored in the ICU overnight and transferred to the floor on ___. After this, all opiate and benzodiazepine medications were discontinued, and she had no further respiratory issues.\n\n#Hx of opioid dependence\n#Chronic pain.\nLongstanding issue, with very extensive evaluation for her chronic abdominal pain in the past, and has recently detoxed herself off of opioids. Review of PMP confirms that she has not been prescribed opioids or benzos since ___. As above, after patient coded, she was not given any additional opiates or benzodiazepine medications. She did intermittently have headaches and abdominal pain, which was treated with IV Tylenol and ketorolac. She will take oral Tylenol for pain control at home\n\n#Need for IV access. Patient has a history of DVT ___ PICC line, and required an I/O when she transferred to the ICU. An IJ was placed. After transfer to the floor, I discussed the risk and benefits of continuing this line, especially given her history of recurrent infections. Ultimately, the patient opted to keep the line for access, and it was discontinued prior to discharge. The line was removed while saline and IV Tylenol were being infused but at a rate of 5ml/hr despite this no Tylenol was being drained from bottle and it was mostly saline and there was no evidence of extravasation clinically."}}	{'final_diagnoses': ['chronic abdominal pain', 'colon polyp', 'respiratory distress'], 'procedures': ['colonoscopy'], 'visit_summary': '___ with PMx of endocarditis, chronic abdominal pain, h/o multiple prior DVT and PE (on Xarelto), SVT s/p ablation, 1+ aortic regurg, s/p CCY, s/p APY, s/p RNY (___) and reversal of RNY (___), ?insulinoma (sp resection per pt), s/p splenectomy, h/o etoh and cocaine abuse, recurrent bacteremia (previously w central vein access), s/p multiple abdominal surgeries, hypothyroidism, probable somatization per prior psychiatric evaluations, extensive use of healthcare system (sp 9 admissions to ___ within past year), who initially presented with acute on chronic abdominal pain.\n\n#Acute on chronic abd pain\n#Constipation\n#Dysmotility\n#History of C. septicum bacteremia. \nPatient presented with her chronic abdominal pain and a recent, documented diagnosis of clostridium septicum bacteremia. The patient herself associated her RLQ abdominal pain with her recurrent infections. As C. septicum is highly associated with colonic malignancy, gastroenterology was consulted, who recommended a colonoscopy. Prep was difficult and took five days, slowly infusing through an NGT. However, on ___, the patient had her colonoscopy which only showed a polyp, which was removed. As no other organic cause of her pain or bacteremia was noted, she was discharged on her home regimen on ___.\n\n#Acute hypercarbic respiratory failure due to opiate overdose. \nAs below, the patient had taken large doses of opiates at home. On ___ a CODE BLUE was called after the patient was found unresponsive with a pulse in the room by her nurse. The patient had received 1mg IM hydromorphone around 2pm on ___ and then 1.5mg SQ hydromorphone around 5pm. She was without IV access so IO was placed in the left leg. Narcan 0.04 x2 was given and patient became responsive. Anesthesia was bag ventilating and was near intubation at the time the patient woke up. The patient was in excruciating pain upon awakening due to IO placement. Multiple attempts were made at placement of an IV but were unsuccessful. She was transferred to the ICU for further monitoring. On arrival to the MICU, patient was in pain from IO insertion but otherwise breathing well. She had a right IJ central line placed by anesthesia upon arrival with removal of left IO. She was monitored in the ICU overnight and transferred to the floor on ___. After this, all opiate and benzodiazepine medications were discontinued, and she had no further respiratory issues.\n\n#Hx of opioid dependence\n#Chronic pain.\nLongstanding issue, with very extensive evaluation for her chronic abdominal pain in the past, and has recently detoxed herself off of opioids. Review of PMP confirms that she has not been prescribed opioids or benzos since ___. As above, after patient coded, she was not given any additional opiates or benzodiazepine medications. She did intermittently have headaches and abdominal pain, which was treated with IV Tylenol and ketorolac. She will take oral Tylenol for pain control at home\n\n#Need for IV access. Patient has a history of DVT ___ PICC line, and required an I/O when she transferred to the ICU. An IJ was placed. After transfer to the floor, I discussed the risk and benefits of continuing this line, especially given her history of recurrent infections. Ultimately, the patient opted to keep the line for access, and it was discontinued prior to discharge. The line was removed while saline and IV Tylenol were being infused but at a rate of 5ml/hr despite this no Tylenol was being drained from bottle and it was mostly saline and there was no evidence of extravasation clinically.', 'medications_prescribed': ['Bisacodyl 10 mg PR QHS:PRN constipation', 'Docusate Sodium 200 mg PO BID', 'Gabapentin 1200 mg PO BID', 'Levothyroxine Sodium 25 mcg PO DAILY', 'Senna 17.2 mg PO BID', 'Pantoprazole 40 mg PO Q24H', 'Ondansetron 8 mg PO Q8H:PRN nausea', 'Rivaroxaban 20 mg PO DAILY', 'Promethazine 25 mg PO Q4H:PRN nausea', 'Nystatin Ointment 1 Appl TP BID', 'nystatin 100,000 unit/gram topical BID']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 49, 'gender': 'F', 'symptoms': 'epigastric pain', 'medical_history': ['GERD', 'Chronic abdominal pain', 'Mastodynia', 'low back pain', 'Myofacial pain syndrome', 'chronic pelvic pain', 'adhesive capsuleitis', 'cervical radiculopathy'], 'family_history': 'sister with occasional migraine like headaches \nSon and daughter with DMII\nFather died of unspecified/unknown cancer', 'present_illness': '___ ___ female with PMH of GCA in remission, \nHTN, migraine, chronic LBP, and MGUS presenting for evaluation \nof abdominal pain. She is interviewed with assistance of her \ndaughter, ___. She reports 3 days of intermittent epigastric \nabdominal pain with associated nausea and 2 episodes of\nnon-bilious, non-bloody emesis. She denies associated \nconstipation, diarrhea, or dysuria. The pain worsened today, \nprompting her to come to the ED. \n\nShe describes the pain as burning and nonradiating. Eating \nintermittently makes it worse but she has been able to tolerate \nPO intake. Has a history of GERD for which she takes PPI but \nreports this feels different and has not been relieved by PPI. \nEndorses mild throat irritation but denies other URI symptoms or\nfatigue. Denies history of viral hepatitis. No new exposures. \nDenies headache, fever/chills, CP/pressure, palpitations. No \nrecent travel. Denies new edication including herbal/OTC meds. \nIs prescribed Excedrine Migraine which she reports taking on \noccasion with her last dose 2 tabs last week. She denies taking\nit or any other products containing acetaminophen on a regular \nbasis. Liver was consulted in the ED and felt this presentation \nless likely ___ stones based on imaging so low likelihood that \nshe will need ERCP. She was admitted West for workup of her \nacute liver injury.', 'medications': [{'medication': 'Magnesium Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.6,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 40-49 is 99 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 84.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 20.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.4', 'valuenum': 23.4, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.6', 'valuenum': 24.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '63', 'valuenum': 63.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '65.3', 'valuenum': 65.3, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '336', 'valuenum': 336.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19.4', 'valuenum': 19.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.29', 'valuenum': 3.29, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '246', 'valuenum': 246.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '281', 'valuenum': 281.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mIU/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 100000.0, 'flag': None, 'priority': 'STAT', 'comments': '<5. VALUES <5 ARE NEGATIVE;VALUES 5-25 ARE EQUIVOCAL;VALUES >25 ARE POSITIVE.'}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23.8', 'valuenum': 23.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.8', 'valuenum': 6.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.7', 'valuenum': 18.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '66', 'valuenum': 66.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '307', 'valuenum': 307.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23.6', 'valuenum': 23.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.61', 'valuenum': 3.61, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23.0', 'valuenum': 23.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19.1', 'valuenum': 19.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '67', 'valuenum': 67.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '301', 'valuenum': 301.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23.6', 'valuenum': 23.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.42', 'valuenum': 3.42, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.2', 'valuenum': 26.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19.5', 'valuenum': 19.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '68', 'valuenum': 68.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '296', 'valuenum': 296.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23.9', 'valuenum': 23.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.86', 'valuenum': 3.86, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.9', 'valuenum': 6.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.2, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': None, 'priority': 'ROUTINE', 'comments': 'ADA RECOMMENDATIONS:; <7% GOAL OF THERAPY; >8% WARRANTS THERAPEUTIC ACTION.'}, {'value': '___', 'valuenum': 103.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '292', 'valuenum': 292.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.2', 'valuenum': 26.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.3', 'valuenum': 20.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '70', 'valuenum': 70.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '260', 'valuenum': 260.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.5', 'valuenum': 24.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.75', 'valuenum': 3.75, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.12', 'valuenum': 1.12, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.43', 'valuenum': 7.43, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 165.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 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'priority': 'STAT', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '73', 'valuenum': 73.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '278', 'valuenum': 278.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.3', 'valuenum': 24.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.58', 'valuenum': 4.58, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 87.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.0', 'valuenum': 22.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '224', 'valuenum': 224.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.9', 'valuenum': 25.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.00', 'valuenum': 4.0, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 71.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.6', 'valuenum': 22.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '209', 'valuenum': 209.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.7', 'valuenum': 26.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.86', 'valuenum': 3.86, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22.6', 'valuenum': 22.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '201', 'valuenum': 201.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.2', 'valuenum': 26.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.87', 'valuenum': 3.87, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.6', 'valuenum': 5.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Admission Physical Exam\nVS: 97.8 150 / 84 78 18 95 Ra \nGENERAL: NAD \nHEENT: Left pupil 4mm and less reactive, right briskly reactive\n(chronic per pt); dry MMM, no OP erythema or exudate\nNECK: supple, no LAD, no JVD \nHEART: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNGS: CTAB, no wheezes, rales, rhonchi, breathing comfortably\nwithout use of accessory muscles \nABDOMEN: nondistended, soft, tender to moderate palpation in\nepigastrium, no TTP in 4 quadrants; no rebound/guarding, no\nhepatosplenomegaly; normoactive BS \nBACK/SPINE: able to bend forward in bed; mild spinal and\nparaspinal TTP mid-thorax, full cervical ROM, no lumbar TTP or\nCVA tenderness\nEXTREMITIES: no cyanosis, clubbing, or edema \nPULSES: 2+ DP pulses bilaterally \nNEURO: A&Ox3, moving all 4 extremities with purpose \nSKIN: warm and well perfused, no jaundice, no excoriations,\nlesions, no rashes \n\nDischarge Physical Exam\n___ ___ Temp: 97.7 PO BP: 132/75 HR: 63 RR: 20 O2 sat: 98%\nO2 delivery: Ra \nHEENT: Left pupil 4mm and less reactive, right briskly reactive\n(chronic per pt); moist MMM, no OP erythema or exudate\nNECK: supple, no LAD, no JVD \nHEART: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNGS: CTAB, no wheezes, rales, rhonchi, breathing comfortably\nwithout use of accessory muscles \nABDOMEN: nondistended, soft, tender to moderate palpation in\nepigastrium; no rebound/guarding, no\nhepatosplenomegaly; normoactive BS \nBACK/SPINE: able to bend forward in bed; mild spinal and\nparaspinal TTP mid-thorax, full cervical ROM, no lumbar TTP or\nCVA tenderness\nEXTREMITIES: no cyanosis, clubbing, or edema \nPULSES: 2+ DP pulses bilaterally \nNEURO: A&Ox3, moving all 4 extremities with purpose, negative \nfor\nasterexis\nSKIN: warm and well perfused, no jaundice, no excoriations,\nlesions, no rashes', 'diagnoses': [{'icd_code': '2189', 'desc': 'Leiomyoma of uterus, unspecified'}, {'icd_code': '2851', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2409', 'desc': 'Goiter, unspecified'}, {'icd_code': '27800', 'desc': 'Obesity, unspecified'}, {'icd_code': 'V8536', 'desc': 'Body Mass Index 36.0-36.9, adult'}, {'icd_code': 'V0481', 'desc': 'Need for prophylactic vaccination and inoculation against influenza'}], 'summary': "Admission Labs\n___ 08:15PM BLOOD WBC-5.3 RBC-4.44 Hgb-13.6 Hct-40.0 MCV-90 \nMCH-30.6 MCHC-34.0 RDW-13.0 RDWSD-42.7 Plt ___\n___ 08:15PM BLOOD Neuts-35.6 ___ Monos-8.5 Eos-2.4 \nBaso-0.8 Im ___ AbsNeut-1.90 AbsLymp-2.78 AbsMono-0.45 \nAbsEos-0.13 AbsBaso-0.04\n___ 08:15PM BLOOD ___ PTT-28.7 ___\n___ 08:15PM BLOOD Glucose-115* UreaN-9 Creat-0.8 Na-142 \nK-3.8 Cl-102 HCO3-28 AnGap-12\n___ 08:15PM BLOOD ALT-1123* AST-1300* LD(LDH)-1224* \nAlkPhos-326* TotBili-2.5* DirBili-1.4* IndBili-1.1\n___ 08:15PM BLOOD Lipase-56 GGT-1031\n___ 08:15PM BLOOD CK-MB-1 cTropnT-<0.01\n___ 08:15PM BLOOD Albumin-3.9\n___ 04:18AM BLOOD Albumin-3.5 Calcium-8.7 Phos-4.0 Mg-2.0 \nCholest-201\n___ 08:15PM BLOOD CRP-5.2\n___ 08:15PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nTricycl-NEG\n\nPertinent Labs/Findings\n___ 04:18AM BLOOD ALT-916 AST-841* LD(___)-769* \nAlkPhos-301* TotBili-2.3\n___ 07:00AM BLOOD ALT-608 AST-321* LD(LDH)-264* \nAlkPhos-273* TotBili-1.5\n___ 04:18AM BLOOD Triglyc-70 HDL-46 CHOL/HD-4.4 \nLDLcalc-141\n___ 04:18AM BLOOD HBsAg-NEG HBsAb-NEG HBcAb-NEG IgM HAV-NEG\n___ 04:18AM BLOOD AMA-NEGATIVE Smooth-NEGATIVE\n___ 04:18AM BLOOD ___\n___ 07:00AM BLOOD IgM-21\n___ 04:18AM BLOOD IgG-684\n___ 04:18AM BLOOD HCV Ab-NEG\n___ 04:18AM BLOOD CMV VL-NOT DETECT\n___ 04:18AM BLOOD HCV VL-NOT DETECT\nSED RATE BY MODIFIED 19 \n\n___ RUQUS\n1. Cholelithiasis without gallbladder wall thickening or other \nsonographic \nsigns of acute cholecystitis. \n2. No evidence of biliary dilatation. \n\n___ CXR\nNo acute intrathoracic process. \n\nDischarge Labs\n___ 07:00AM BLOOD WBC-5.4 RBC-4.35 Hgb-13.3 Hct-40.2 MCV-92 \nMCH-30.6 MCHC-33.1 RDW-13.2 RDWSD-45.1 Plt ___\n___ 07:00AM BLOOD Glucose-96 UreaN-11 Creat-0.7 Na-144 \nK-3.9 Cl-104 HCO3-25 AnGap-15\n___ 07:00AM BLOOD ALT-608 AST-321* LD(LDH)-264* \nAlkPhos-273* TotBili-1.5\nPATIENT SUMMARY\n=================\n___ ___ female with PMH of GCA in remission, \nHTN, migraine, chronic LBP, and MGUS presenting for evaluation \nof abdominal pain and found to have abnormal LFTs suggestive of \nacute hepatitis. Her LFTs improved without medical intervention. \nA number of labs were negative and non-diagnostic for the reason \nof her hepatic injury.\n\nACUTE ISSUES: \n============== \n#Epigastric pain:\n#Hepatitis\n#Mixed predominant hepatocellular and less-so cholestatic liver \ninjury: Pt presented with hepatocellular pattern with less \nstriking elevation of alkaline phosphatase and bilirubin. \nPreserved synthetic function with normal INR and albumin \nsuggested acute process. Liver team consulted and aided in \nwork-up. Etiology remained unclear but leading differential \ndrug-induced hepatitis vs. rebound hepatic injury from recent \ncholelithiasis. Work-up for viral hepatitis (A/B/C antibody not \nreactive with negative C viral load, negative CMV VL) were \nnegative and autoimmune hepatitis labs were negative ___, \nAnti-smooth, IgM, IgG; AMA). Overall medication reconciliation \nwith patient and interpreter and also daughter w/ aid of \ninterpreter resulted with different histories. This author's \nhistory taking found that the patient was taking ibuprofen 2x \nper day for her pain however, patient told GI team she was \ntaking Percocet. It was unclear if patient had drug-induced \nhepatitis from Tylenol toxicity. GGT was elevated, hep A/B/C \nserologies negative, trop/ckmb neg, CMV neg, Hep A/B/C antibody \nnegative, HCV VL not detected, ___ negative, AMSA neg, IgG 684 \n(low), IgM 21 (low). Patient was continued on home PPI. Her pain \nimproved during her hospitalization without intervention.\n\nCHRONIC ISSUES: \n===============\n#Hx GCA. large vessel vasculitis that is followed by rheum and \nwas deemed in clinical remission and off prednisone since ___ \nand off methotrexate since ___. Patient did not present with \nheadache or new vision changes.\n\n#R CRAO: Patient has history of sudden R vision loss with R \nischemic optic neuritis s/p treatment with steroids and Plavix \nin ___. No further episodes since. Pt reports chronic, stable \nvision loss on right, with preserved vision on L. No headache or \njaw sxs. Right pupil dilated and less responsive then left at \nbaseline. \n\n#HTN: SBP in 150s on admission. Renal function at baseline. \nContinued on home HCTZ 12.5mg.\n\n#Migraine: had tried CCB and triptan in past. Now takes \nExcedrine migraine prn. Reports use ___ weekly at most with last \ndose ___ days ago on admission. Patient and family counseled \nthat she should not take acetaminophen-containing medications \nuntil instructed by healthcare provider.\n\n#Chronic low back pain: severe and debilitating limiting pt \nability to do ADLs/IADLs. Treated with lidocaine patch QAM while \ninpatient. Patient discharge on home medications with avoidance \nof acetaminophen per above.\n\n#MGUS: IgG kappa, low-intermediate risk. Treatment naive. ___ \n___ protein found ___ on ___ admission with +SPEP and \n+UPEP. Skeletal survey at that time demonstrated equivocal lytic \nlesion in the calvarium and in the right femoral neck. F/U \nsurvey ___ neg for lesions. Pt last seen at ___ heme/onc in \n___ with instructions to f/u in 3 months but was lost to f/u. \nBack pain stable, normal CBC and renal function. No e/o disease \nprogression. Onc follow-up as outpatient.\n\n#CODE: Full (presumed) \n#CONTACT: No HCP\nEmerg contact: daughter, ___, ___\n\nTRANSITIONAL ISSUES:\n================\n[] Hepatitis: Recheck LFTs 1 week after d/c (per liver)\n[] Hepatitis: Patient to follow up with liver clinic, liver will \nset up this appointment. But if pt. has not heard from liver \nclinic regarding this appointment, please call ___ \nto schedule.\n[] Cholelithiasis: Patient found to have stones in gallbladder \nin RUQUS, would consider biliary colic if patient represents \nwith abdominal pain. Given presentation, could consider \ncholecystectomy if ongoing symptoms a recurrent episode\n[] Anemia: Patient needs outpatient heme/onc follow-up for her \nMGUS (last appointment was due in ___\n#CODE: Full (presumed) \n#CONTACT: No HCP\nEmerg contact: daughter, ___, ___\nSon, ___, ___"}}	{'final_diagnoses': ['Hepatitis', 'Migraine headaches', 'Giant-cell arteritis', 'Chronic lower back pain'], 'procedures': ['None'], 'visit_summary': "PATIENT SUMMARY\n=================\n___ ___ female with PMH of GCA in remission, \nHTN, migraine, chronic LBP, and MGUS presenting for evaluation \nof abdominal pain and found to have abnormal LFTs suggestive of \nacute hepatitis. Her LFTs improved without medical intervention. \nA number of labs were negative and non-diagnostic for the reason \nof her hepatic injury.\n\nACUTE ISSUES: \n============== \n#Epigastric pain:\n#Hepatitis\n#Mixed predominant hepatocellular and less-so cholestatic liver \ninjury: Pt presented with hepatocellular pattern with less \nstriking elevation of alkaline phosphatase and bilirubin. \nPreserved synthetic function with normal INR and albumin \nsuggested acute process. Liver team consulted and aided in \nwork-up. Etiology remained unclear but leading differential \ndrug-induced hepatitis vs. rebound hepatic injury from recent \ncholelithiasis. Work-up for viral hepatitis (A/B/C antibody not \nreactive with negative C viral load, negative CMV VL) were \nnegative and autoimmune hepatitis labs were negative ___, \nAnti-smooth, IgM, IgG; AMA). Overall medication reconciliation \nwith patient and interpreter and also daughter w/ aid of \ninterpreter resulted with different histories. This author's \nhistory taking found that the patient was taking ibuprofen 2x \nper day for her pain however, patient told GI team she was \ntaking Percocet. It was unclear if patient had drug-induced \nhepatitis from Tylenol toxicity. GGT was elevated, hep A/B/C \nserologies negative, trop/ckmb neg, CMV neg, Hep A/B/C antibody \nnegative, HCV VL not detected, ___ negative, AMSA neg, IgG 684 \n(low), IgM 21 (low). Patient was continued on home PPI. Her pain \nimproved during her hospitalization without intervention.\n\nCHRONIC ISSUES: \n===============\n#Hx GCA. large vessel vasculitis that is followed by rheum and \nwas deemed in clinical remission and off prednisone since ___ \nand off methotrexate since ___. Patient did not present with \nheadache or new vision changes.\n\n#R CRAO: Patient has history of sudden R vision loss with R \nischemic optic neuritis s/p treatment with steroids and Plavix \nin ___. No further episodes since. Pt reports chronic, stable \nvision loss on right, with preserved vision on L. No headache or \njaw sxs. Right pupil dilated and less responsive then left at \nbaseline. \n\n#HTN: SBP in 150s on admission. Renal function at baseline. \nContinued on home HCTZ 12.5mg.\n\n#Migraine: had tried CCB and triptan in past. Now takes \nExcedrine migraine prn. Reports use ___ weekly at most with last \ndose ___ days ago on admission. Patient and family counseled \nthat she should not take acetaminophen-containing medications \nuntil instructed by healthcare provider.\n\n#Chronic low back pain: severe and debilitating limiting pt \nability to do ADLs/IADLs. Treated with lidocaine patch QAM while \ninpatient. Patient discharge on home medications with avoidance \nof acetaminophen per above.\n\n#MGUS: IgG kappa, low-intermediate risk. Treatment naive. ___ \n___ protein found ___ on ___ admission with +SPEP and \n+UPEP. Skeletal survey at that time demonstrated equivocal lytic \nlesion in the calvarium and in the right femoral neck. F/U \nsurvey ___ neg for lesions. Pt last seen at ___ heme/onc in \n___ with instructions to f/u in 3 months but was lost to f/u. \nBack pain stable, normal CBC and renal function. No e/o disease \nprogression. Onc follow-up as outpatient.\n\n#CODE: Full (presumed) \n#CONTACT: No HCP\nEmerg contact: daughter, ___, ___\n\nTRANSITIONAL ISSUES:\n================\n[] Hepatitis: Recheck LFTs 1 week after d/c (per liver)\n[] Hepatitis: Patient to follow up with liver clinic, liver will \nset up this appointment. But if pt. has not heard from liver \nclinic regarding this appointment, please call ___ \nto schedule.\n[] Cholelithiasis: Patient found to have stones in gallbladder \nin RUQUS, would consider biliary colic if patient represents \nwith abdominal pain. Given presentation, could consider \ncholecystectomy if ongoing symptoms a recurrent episode\n[] Anemia: Patient needs outpatient heme/onc follow-up for her \nMGUS (last appointment was due in ___\n#CODE: Full (presumed) \n#CONTACT: No HCP\nEmerg contact: daughter, ___, ___\nSon, ___, ___", 'medications_prescribed': ['Hydrochlorothiazide 12.5 mg PO DAILY', 'Omeprazole 20 mg PO QHS']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 22, 'gender': 'M', 'symptoms': 'weakness, headache, ear pain, syncope', 'medical_history': ['ONCOLOGIC HISTORY:\n# stage IIIB classical Hodgkin lymphoma, nodular sclerosis \nsubtype: \n- initially presented to his PCP ___ ___ with 1.5 months of \nfevers, night sweats, and fatigue and associated cervical and \nsupraclavicular lymphadenopathy. He underwent ultrasound-guided \nFNA and core biopsy of a right cervical lymph node on ___ \ncytology and flow cytometry were nondiagnostic, and pathology \nfrom the core needle biopsy showed an atypical lymphoid \ninfiltrate. He underwent excisional cervical lymph node biopsy \non\n___ pathology from this was diagnostic of classical Hodgkin\nlymphoma, nodular sclerosis subtype.\n- His symptoms continued and on ___ he was sent to the ED by \nhis PCP after complaining of intractable B type symptoms \nincluding daily fevers to 101-102, night sweats, as well as \nextreme fatigue and was admitted to the hematologic malignancy \nservice. On ___ he had a CT torso showing extensive \nsupraclavicular, axillary, retroperitoneal, and pelvic \nlymphadenopathy, some of which showed interval enlargement \ncompared to CT on ___, and normal size spleen. He also had \nbone marrow biopsy on ___ showing hypercellular bone marrow \nfor age with maturing trilineage hematopoiesis without \ninvolvement by Hodgkin lymphoma. Cytogenetic analysis did not \nreveal any abnormality. \n- He was treated with prednisone ___ and ___ and then received \nC1D1 of ABVD on ___. His night sweats persisted and his \nfevers\ncontinued intermittently. Infectious workup was negative. He\nunderwent port placement on ___ and was discharged home the\nsame day. He was re-admitted ___ with non-neutropenic \nfever\nwith a negative workup. \n- ___ C1D1 ABVD, ___ C1D15 ABVD\n- ___ C1D1 ChlVPP (switched due to concern for anemia and\nworsening DLCO)\n- ___ C2D1 ChlVPP\n- ___ C3D1 ChlVPP - vinblastine (both day 1 and 8) held \nbecause of neuropathy\n- ___ C4D1 ChlVPP - vinblastine given without dose \nadjustment\n- PET/CT on ___ and ___ following two and four cycles \nof\nchemotherapy showed no evidence of FDG-avid disease.', 'OTHER MEDICAL HISTORY:\n1) Jehovah\'s witness - his wife has a form that states that he\ndoes not want transfusions of whole blood, red cells, white\ncells, plasma, or platelets. The form also states that he\nrefuses all "minor fractions of blood" except "recombinant\nproducts that are not taken from blood and that may be \nprescribed\nin place of some blood fractions. In talking to him and his \nwife,\nthey do not want any products derived from blood, even in the\ncase of life-threatening illnesses. \n2) Diabetes type II, c/b peripheral neuropathy - ___ A1C\n8.9%\n3) Hypertension\n4) GERD\n5) Spinal stenosis\n6) Osteoarthritis\n7) Asthma\n8) h/o TIA - per review of records - he and his wife are unsure\nof the exact details\n9) Colonic polyps\n10) cataract surgery - 2 and ___ years ago\n11) left ankle/tendon surgery - 4 or ___ years ago'], 'family_history': 'No family history of cancer. Father died of a stroke.', 'present_illness': "___ with hx of hodgkin's lymphoma, last ___ (in \nremission), DM2 on insulin, HTN, GERD, asthma, ?TIA, recent \nL.facial/ear zoster s/p tx with acyclovir with residual \npost-herpetic neuralgia who p/w ___ days of generalized \nweakness, HA-frontal ___ with neck stiffness and photophobia, \ncontinued, but unchanged ear pain and tinnitus. Reports chronic \nphotophobia since lymphoma diagnosis. Pt reports constant \nheadache, has progressively worsened, no association to \nposition, no new neurologic symptoms, confusion, focal weakness, \nspeech difficulty or bowel or bladder incontinence. This am, pt \nwith his wife helping him to bathroom when felt dizzy, \nnauseated, slid to floor, but denied head trauma or neck pain. \nPt states LOC and wife reports he did not speak for 1 min. Pt's \nwife reports he reported nausea, sweating, dizziness, and \ncontinued headache around this episode, but denied other \nneurologic ROS as above and denied cardiac ROS including CP, \nSOB, palpitations. ___ wife reports LOC ___. Pt also reports \ndry cough intermittently productive of white phlegm over last 2 \ndays. He did report rhinorrhea and ST initially, now improved. \n___ reported fever to 101 at home with chills, but denied travel \nor sick contacts. In addition, pt reports chronic neuropathy in \nb/l feet up to his knees. He wore tight shoes recently, \ndeveloped a L.big toe ulcer, then popped it and then rewore the \nsame shoes. Pt reports some yellow, blood tinged drainage at \ntimes, but denied any pain. +decreased appetite.\n.", 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'MetroNIDAZOLE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '1.81', 'valuenum': 1.81, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37.7', 'valuenum': 37.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '72.9', 'valuenum': 72.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '480', 'valuenum': 480.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.11', 'valuenum': 4.11, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.09', 'valuenum': 0.09, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.13', 'valuenum': 0.13, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.78', 'valuenum': 1.78, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.43', 'valuenum': 10.43, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '42.6', 'valuenum': 42.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 123.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.6', 'valuenum': 38.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '446', 'valuenum': 446.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.23', 'valuenum': 4.23, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.6', 'valuenum': 41.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'On admission:\nGEN:sitting upright in bed, cooperative, NAD\nvitals: T 97.5, BP 160/70, HR 95, RR 20, sat 97% on RA\nHEENT: ncat perrla, EOMI, anicteric, R.TM clear, L.TM with faint \nerythema but no ear tenderness to palp. No obvious OP lesions. \nL.face with a few healed lesions and on L.ear-healed. (pt \nreports old zoster).\nneck: R.sided submandibular/cervical fullness. L.sided \nsupraclavicular fullness. Supple, full range of motion, no JVP\nchest:b/l ae no w/c/r. Scar where portocath used to be\nheart:s1s2 rr no m/r/g\nabd:+bs, soft, NT, ND, no guarding or rebound\next: no c/c/e 2+pulses, except for L.DP 1+\nskin: L.big toe-distal surface with ulcer-eschar with \ngranulation tissue, no bleeding or pus\nlymph nodes-no apparent axillary or inguinal LAD. +R.sided \ncervical and L.supraclavicular fullness.\nneuro: AAOx3, Cn2-12 intact, motor ___ x4, sensation equal. \n+decreased sensation b/l to knees. No tremor\npsych:calm, cooperative\n--------------\nOn discharge:\nVS: 99.2 150/61 97 17 94%RA FSG ___\nGEN: pleasant, nad, oriented x 3\nEENT: PERRL, EOMI, sclerae anicteric, neck supple, MMM, no\nulcers/lesions/thrush\nCV: Distant heart sounds, RRR, normal S1, S2, no M/G/R\nPULM: CTA bilat w/o wheezes/rhonchi/rales\nBACK: no focal tenderness, no CVAT\nGI: obese, normoactive BS, soft, non-tender, non-distended, no\nhepatosplenomegaly\nMSK: no joint swelling or erythema\nEXT: warm and well perfused, no edema, 2+ DP pulses palpable\nbilaterally. LLE with gauze over L hallux.\nLYMPH: no cervical, axillary, or inguinal lymphadenopathy\nSKIN: no rashes, no jaundice\nNEURO: AAOx3. CN II-XII intact. Normal finger-to-nose testing, \nno\npronator drift. Able to follow multi-step commands.\nPSYCH: non-anxious, normal affect', 'diagnoses': [{'icd_code': 'T814XXA', 'desc': 'Infection following a procedure, initial encounter'}, {'icd_code': 'K651', 'desc': 'Peritoneal abscess'}, {'icd_code': 'Y838', 'desc': 'Other surgical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure'}, {'icd_code': 'Y92009', 'desc': 'Unspecified place in unspecified non-institutional (private) residence as the place of occurrence of the external cause'}], 'summary': "___ 09:16AM LACTATE-1.3\n___ 08:55AM GLUCOSE-167* UREA N-25* CREAT-1.3* SODIUM-137 \nPOTASSIUM-4.1 CHLORIDE-103 TOTAL CO2-24 ANION GAP-14\n___ 08:55AM estGFR-Using this\n___ 08:55AM cTropnT-<0.01\n___ 08:55AM CALCIUM-8.9 PHOSPHATE-3.0 MAGNESIUM-1.9\n___ 08:55AM WBC-5.3 RBC-3.52* HGB-11.1* HCT-31.1* MCV-88 \nMCH-31.7 MCHC-35.9* RDW-14.3\n___ 08:55AM NEUTS-74.4* LYMPHS-17.1* MONOS-7.5 EOS-0.6 \nBASOS-0.4\n___ 08:55AM PLT COUNT-___: \nNo acute intracranial process. \n\n___: BCx: negative\n.\nCSF;SPINAL FLUID TUBE 3.\nGRAM STAIN (Final ___:\nNO POLYMORPHONUCLEAR LEUKOCYTES SEEN.\nNO MICROORGANISMS SEEN.\nCULTURE: no growth\n.\n___ 6:28 pm SWAB Source: L.big toe.\nGRAM STAIN (Final ___:\n1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES.\nNO MICROORGANISMS SEEN.\nWOUND CULTURE mixed flora\n.\nEBV serologies IgG+, IgM neg\nGAS culture neg\n.\nResp viral screen-- +paraflu type 3\nIMAGING DATA:\nCXR ___:\nPA AND LATERAL CHEST RADIOGRAPH: Cardiac, mediastinal and hilar\ncontours are within normal limits. Both lungs ___ lung\nvolumes with crowding of bronchovascular markings. Opacification\nin the retrocardiac region may represent atelectasis; however,\nunderlying infectious process cannot be completely excluded in\nthe correct clinical setting. Right base atelectasis is seen.\n.\n___ CT neck w contrast: 1. Solitary right level 2 \nlymphadenopathy, this likely represents reactive adenopathy, \nhowever, recurrent lymphoma is less likely, but is not excluded \non this study.\n2. Fluid within both maxillary and left mastoid sinuses, could \nbe secondary to active inflammation. Recommended clinical \ncorrelation.\n.\n___ Xray foot:\n1. Findings above concerning for distal phalanx great toe \nosteomyelitis.\n2. Unchanged mid foot degenerative changes.\n.\n___ ABI: On the right, a relatively normal study of lower \nextremity at rest except for noncompressible vessels. On the \nleft, there is significant SFA and likely tibial artery \nocclusive disease. \n.\n___ xray Foot a/p lateral: These demonstrate resection of the \ndistal phalanx of the hallux. Tiny osseous fragments in the \nsurgical bed may be post-surgical. There is overlying soft \ntissue swelling.\nAgain appreciated is joint space narrowing and osteophyte \nformation at the\ntalonavicular joint, vascular calcifications and dorsal and \nplantar calcaneal osteophytes. There is no acute fracture.\n.\nMICROBIOLOGY DATA:\n___ 11:00 am TISSUE Site: TOE\nCLEAN PROXIMAL MARGIN LEFT ___ TOE.\nGRAM STAIN (Final ___:\nNO POLYMORPHONUCLEAR LEUKOCYTES SEEN.\nNO MICROORGANISMS SEEN.\nTissue: no growth (final)\nAnaerobic cx pending\n.\n___ 11:00 am TISSUE DISTAL BONE LEFT ___ TOE.\nGRAM STAIN (Final ___:\nNO POLYMORPHONUCLEAR LEUKOCYTES SEEN.\nNO MICROORGANISMS SEEN.\nTISSUE (Final ___: \n SENSI PER ___ ___ ___. \n STAPHYLOCOCCUS, COAGULASE NEGATIVE. RARE GROWTH. \n \n STAPHYLOCOCCUS, COAGULASE NEGATIVE. RARE GROWTH. ___\nMORPHOLOGY. \n \n\n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n STAPHYLOCOCCUS, COAGULASE NEGATIVE\n \| STAPHYLOCOCCUS, \nCOAGULASE NEGATIVE\n \| \| \nCLINDAMYCIN-----------<=0.25 S <=0.25 S\nERYTHROMYCIN---------- =>8 R =>8 R\nGENTAMICIN------------ <=0.5 S <=0.5 S\nLEVOFLOXACIN----------<=0.12 S 1 S\nOXACILLIN------------- =>4 R <=0.25 S\nRIFAMPIN-------------- <=0.5 S\nTETRACYCLINE---------- 2 S <=1 S\nVANCOMYCIN------------ 2 S 1 S\n\n ANAEROBIC CULTURE (Final ___: NO ANAEROBES ISOLATED. \n\n.\n___ Pathology L proximal hallux: pending\nPt is a ___ speaking ___ y.o male with h.o Hodgkin's lymphoma \ns/p ___ (last ___ ___ thought to be in remission, not \nneutropenic), DM2, GERD, OA, asthma, ?TIA with recent zoster \ninfection s/p tx with acyclovir with resultant post-herpetic \nneuralgia who presented to the ED with reports of fever, \nheadache, neck stiffness, continued ear pain/tinnitus from \nrecent zoster, foot ulcer, and URI symptoms. \n. \n#fever/headache-PARAINFLUENZA-Pt was not neutropenic and was not \ncurrently getting ___. Pt with recent zoster infection and \nreportedly is s/p tx with acyclovir. However, p/w with headache, \nneck stiffness, fever. Pt reported chronic photophobia and \nunchanged post-herpetic symptoms of the ear and left face. \nSymptoms were concerning for meningitis, especially viral causes \nsuch as VSV. HSV is another possibility. CSF is not particularly \nconvincing for bacterial cause. Other possibilies include \ninfluenza or other respiratory or viral infection. \nBacteremia-source L.toe is another possibility. Pt did have \nneck/cervical fullness on exam and there is a possibility of \nrecurrent lymphoma. However, infectious etiologies appeared more \nlikely at this time. Pt does not have any indwelling lines. CXR \nwithout overt PNA. IGg level is ok. Meningitis w/u negative. \nRespiratory screen positive for paraflu. CT neck with reactive \nlymphadenopathy. CSF culture negative, HSV and VZV pcrs \nnegative. Blood cultures NGTD, ua negative. Pt was initially \nplaced on vanco, ceftriaxone, ampicillin and acyclovir at \nmeningitis dosing. This was DC'd when cultures returned \nnegative. ID was consulted and heme/onc was aware of admission. \n\n. \n#syncope-likely vasovagal vs. orthostatic. Pt reported \nnausea/diaphoresis surrounding the event, but denied cardiac or \nneurologic symptoms other than continued headache and overall \nweakness as above. Reports chronic dizziness. Pt with poor PO \nintake recently. 2 sets of cardiac enzymes negative. Pt was \nfound to be orthostatic. s/p IVF. No events on tele. Resolved. \n. \n#cough/URI symptoms-Pt with fever as above. CXR without overt \nPNA. Respiratory screen positive for parainfluenza. Improving. \nPt was given nebs and cough suppressant prn. \n. \n#diabetic toe ulcer/?osteomyelitis/PVD-Pt with diabetes and \nrecent chemotherapy. Eschar with surrounding mild erythema. Pt \nwith palpable, but significantly decreased pulses and known \nneuropathy on admission. Xray suggesting osteo. ABI's showing \nsignificant SFA and tibial arterial disease. Podiatry and \nvascular were consulted and pt underwent L hallux debridement at \nthe bedside ___ and superficial wound swab grew GPCs. He had \nsubsequent SFA stent on ___ by vascular and was started on \nPlavix 75mg daily. On ___ he went to the OR for L hallux \ndebridement. Distal and proximal tissue was sent to ___ for \nculture and proximal tissue was sent to pathology for margins. \nThe pt remained afebrile and without signs of systemic infection \nand gram stains showed no PMNs and no micro. Therefore the pt \nwas discharged home and will follow-up with ID on ___. \nAt that time it will be determined if antibiotics should be \ninitiated based on the final culture and path data.\n. \n#Acute renal failure-baseline cr 0.9-1.2. Likely prerenal from \npoor PO intake, fever and use of diuretics. Improved with IVF. \n. \n#post-herpetic neuralgia/neuropathy. Pt reports persistent, \nunchanged symptoms. Lesions appear to be healed. Increased \nlyrica to 150mg TID. Pt is s/p acyclovir 1 month ago. \n. \n#normocytic anemia-no signs of active bleeding. Likely anemia of \nchronic illness. stable. No transfusions as ___\n. \n#HTN, benign- continued home meds\n. \n#type 2 diabetes-HISS/long acting. ___ QID, DM diet \n. \n#GERD-PPI increased to 40mg daily, maalox prn \n. \n#asthma-continue outpt flovent, nebs prn. \n. \n#h.o TIA?-continue baby asa \n. \n#FEN-DM diet \n. \n#PPX-hep SC TID \n. \n#code- Full, discussed with patient. \n. \n#contact-HCP is pt's son ___ ___\n.\n# ___: Home with ___ for daily wound care.\n-------------"}}	{'final_diagnoses': ['parainfluenza viral infection', 'post herpetic neuralgia', 'type 2 diabetes uncontrolled with complication', 'diabetic foot ulcer', '?osteomyelitis', 'PVD'], 'procedures': ['lumbar puncture', 'debridement', 'angioplasty'], 'visit_summary': "Pt is a ___ speaking ___ y.o male with h.o Hodgkin's lymphoma \ns/p ___ (last ___ ___ thought to be in remission, not \nneutropenic), DM2, GERD, OA, asthma, ?TIA with recent zoster \ninfection s/p tx with acyclovir with resultant post-herpetic \nneuralgia who presented to the ED with reports of fever, \nheadache, neck stiffness, continued ear pain/tinnitus from \nrecent zoster, foot ulcer, and URI symptoms. \n. \n#fever/headache-PARAINFLUENZA-Pt was not neutropenic and was not \ncurrently getting ___. Pt with recent zoster infection and \nreportedly is s/p tx with acyclovir. However, p/w with headache, \nneck stiffness, fever. Pt reported chronic photophobia and \nunchanged post-herpetic symptoms of the ear and left face. \nSymptoms were concerning for meningitis, especially viral causes \nsuch as VSV. HSV is another possibility. CSF is not particularly \nconvincing for bacterial cause. Other possibilies include \ninfluenza or other respiratory or viral infection. \nBacteremia-source L.toe is another possibility. Pt did have \nneck/cervical fullness on exam and there is a possibility of \nrecurrent lymphoma. However, infectious etiologies appeared more \nlikely at this time. Pt does not have any indwelling lines. CXR \nwithout overt PNA. IGg level is ok. Meningitis w/u negative. \nRespiratory screen positive for paraflu. CT neck with reactive \nlymphadenopathy. CSF culture negative, HSV and VZV pcrs \nnegative. Blood cultures NGTD, ua negative. Pt was initially \nplaced on vanco, ceftriaxone, ampicillin and acyclovir at \nmeningitis dosing. This was DC'd when cultures returned \nnegative. ID was consulted and heme/onc was aware of admission. \n\n. \n#syncope-likely vasovagal vs. orthostatic. Pt reported \nnausea/diaphoresis surrounding the event, but denied cardiac or \nneurologic symptoms other than continued headache and overall \nweakness as above. Reports chronic dizziness. Pt with poor PO \nintake recently. 2 sets of cardiac enzymes negative. Pt was \nfound to be orthostatic. s/p IVF. No events on tele. Resolved. \n. \n#cough/URI symptoms-Pt with fever as above. CXR without overt \nPNA. Respiratory screen positive for parainfluenza. Improving. \nPt was given nebs and cough suppressant prn. \n. \n#diabetic toe ulcer/?osteomyelitis/PVD-Pt with diabetes and \nrecent chemotherapy. Eschar with surrounding mild erythema. Pt \nwith palpable, but significantly decreased pulses and known \nneuropathy on admission. Xray suggesting osteo. ABI's showing \nsignificant SFA and tibial arterial disease. Podiatry and \nvascular were consulted and pt underwent L hallux debridement at \nthe bedside ___ and superficial wound swab grew GPCs. He had \nsubsequent SFA stent on ___ by vascular and was started on \nPlavix 75mg daily. On ___ he went to the OR for L hallux \ndebridement. Distal and proximal tissue was sent to ___ for \nculture and proximal tissue was sent to pathology for margins. \nThe pt remained afebrile and without signs of systemic infection \nand gram stains showed no PMNs and no micro. Therefore the pt \nwas discharged home and will follow-up with ID on ___. \nAt that time it will be determined if antibiotics should be \ninitiated based on the final culture and path data.\n. \n#Acute renal failure-baseline cr 0.9-1.2. Likely prerenal from \npoor PO intake, fever and use of diuretics. Improved with IVF. \n. \n#post-herpetic neuralgia/neuropathy. Pt reports persistent, \nunchanged symptoms. Lesions appear to be healed. Increased \nlyrica to 150mg TID. Pt is s/p acyclovir 1 month ago. \n. \n#normocytic anemia-no signs of active bleeding. Likely anemia of \nchronic illness. stable. No transfusions as ___\n. \n#HTN, benign- continued home meds\n. \n#type 2 diabetes-HISS/long acting. ___ QID, DM diet \n. \n#GERD-PPI increased to 40mg daily, maalox prn \n. \n#asthma-continue outpt flovent, nebs prn. \n. \n#h.o TIA?-continue baby asa \n. \n#FEN-DM diet \n. \n#PPX-hep SC TID \n. \n#code- Full, discussed with patient. \n. \n#contact-HCP is pt's son ___ ___\n.\n# ___: Home with ___ for daily wound care.\n-------------", 'medications_prescribed': ['1. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily).', '2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day).', '3. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday) as needed for constipation.', '4. fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff \nInhalation BID (2 times a day).', '5. valsartan 160 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).', '6. chlorthalidone 25 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '7. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:30 Tablet(s) Refills:2', '8. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2) \nCapsule, Delayed Release(E.C.) PO DAILY (Daily).\nDisp:60 Capsule, Delayed Release(E.C.)(s) Refills:2', '9. pregabalin 100 mg Capsule Sig: One (1) Capsule PO three times \na day.', '10. alum-mag hydroxide-simeth 200-200-20 mg/5 mL Suspension Sig: \n___ MLs PO QID (4 times a day) as needed for reflux.\nDisp:1 month supply Refills:0', '11. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig: \n___ puffs Inhalation every four (4) hours as needed for \nshortness of breath or wheezing.\nDisp:1 inhaler Refills:0', '12. ergocalciferol (vitamin D2) Oral', '13. magnesium oxide 400 mg Tablet Sig: One (1) Tablet PO once a \nday.', '14. dextromethorphan-guaifenesin ___ mg/5 mL Liquid Sig: ___ \nMLs PO every ___ hours as needed for cough.\nDisp:1 month supply Refills:0', '15. Humulin N 100 unit/mL Suspension Sig: as directed \nSubcutaneous as directed: 75 ___, y 45 \n___\n(75u in morning, 45u at night).', '16. Novolog PenFill 100 unit/mL Cartridge Sig: as directed \nSubcutaneous qachs: sliding scale with meal snad at bedtime.']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 31, 'gender': 'M', 'symptoms': 'R sided weakness and sensory changes', 'medical_history': ['HTN', 'pipeline embolization of a L ICA aneurysm (2- to 3-mm left\nsuperior hypophyseal artery aneurysm) with Dr. ___ on ___', 'cervical spondylosis', 'vertigo, follows with Dr. ___'], 'family_history': 'Father died at a young age of bleeding in the brain.', 'present_illness': 'The patient is a ___ year old ___ man with\na history of HTN and brain aneurysm s/p L ICA pipeline,\npresenting with intermittent R arm weakness and sensory changes.\nHistory was obtained using the daughters to translate and then\nwith the help of Dr. ___ who speaks ___. \n\nThe patient got a pipeline embolization of a L ICA aneurysm (2-\nto 3-mm left superior hypophyseal artery aneurysm) with Dr.\n___ on ___. He was initially on ASA 811 and Brilinta. The\ndaughters stated that he was told he was a "Plavix \nnon-responder"\nwhich is why he was on Brilinta, but do not know how that\ninformation was determined. Brilinta was DCed for only 2 days on\n___ after the patient called complaining of hematuria. After\nhis urine cleared his daughters told him to restart the Brilinta\nand finish up the planned 3 month course, which finished in the\nend of ___. He then had a diagnostic angiogram ___ which\nshowed obliteration of the aneurysm but a "minor amount of\nstenosis/ thrombus in the left supra clinoid carotid artery." A\nletter from Neurosurgery at this time directed him to increase\nASA to 325 mg and start plavix, however, per the daughters he \nhad\nonly been on ASA and never started Plavix because they \nunderstood\nhe did not respond to this.\n\nHistory is obtained with translation from the daughters, who are\nat bedside, and with the help of Dr. ___ who speaks\n___. When asked about numbness, the patient states he has\nhad intermittent R hand numbness on and off for the past 2 \nmonths\nat least 10 times. The numbness starts in his fingers and \ntravels\nup his arm over ___ minutes with a slow ___, and then \nsubsides.\nOn at least one occasion this has progressed to shaking of\nthe R arm, without LOC or progression to the leg. This shaking\nlasted 1 minute and then spontaneously resolved.\n\nOne week before the ___ angio the patient reported a 5 minute\nepisode of R hand numbness with weakness as well this time. He\nnotes he had difficulty holding his chopsticks. Then, ever since\nthe ___ angio he has intermittently noted mild R hand weakness,\n"difficulty controlling his R hand," with difficulty holding his\nchopsticks. Two days ago he felt nauseous and noted \nintermittent,\nmild R hand weakness. He was still able to use his hand but had\ndifficulty doing daily tasks. Yesterday he states he felt \n"weird"\nall day starting in the morning, when his R hand was weak while\nbrushing his teeth, but he was able to complete this task. At\ndinner, he had trouble using his chopsticks again. His daughters\nwere home with him but did not watch him eat and did not notice\nanything out of the ordinary. Then at 2 AM last night the \npatient\nwoke up to use the bathroom and noted he could not move his R\nhand at all. He was able to walk to the bathroom and urinate\nusing his L hand. He woke up his wife and spoke with her about\nhis hand weakness, and everything was normal with his speech and\nwalking. He tried a ___ herbal remedy patch which he applied\nto his R hand, which did not help. In the morning his R hand\nremained very weak so he told his daughters, who brought him to\nthe ED.\n\nIn the ED he was initially examined by the ED resident and\nNeurosurgery resident, who noted R arm>leg weakness with a\nflaccid R hand (no movement in the R hand at all noted by both\nresidents). Neurosurgery recommended CTA head to evaluate the\npipeline. After he got back from ___, he had return of his R \nhand\nfunction and states he was much improved from prior. \nNeurosurgery\nrecommended continuing ASA 325 and starting Plavix 75. Neurology\nwas consulted for further investigation. \n\nOn ROS, the patient notes pain behind his eyes bilaterally for\nthe past few months after aneurysm coiling, which comes and \ngoes.\nThis is throbbing and associated with photophobia. He also has a\nheadache on the top/back of his head after the coiling which si\n___ and lasts ___ minutes at a time, occurring several times\nper day. He also notes difficulty with tripping while walking,\nwhich his daughter says had been going on for years. He most\nrecently tripped n his R foot 2 days ago and feels this has\ngotten worse recently, and he has been falling to the R side. He\nendorses changes with vision with blurry vision on the L since\n___. He also has chronic vertigo for which he follows with Dr.\n___ in Neurology.\n\nOn neurologic review of systems, the patient endorses HA, denies\nlightheadedness, or confusion.\nDenies difficulty with producing or comprehending speech.\nEndorses blurred vision, denies diplopia, endorses vertigo,\ndenies dysarthria, or dysphagia.\nEndorses R hand weakness as above.\nDenies loss of sensation.\nDenies bowel or bladder incontinence or retention.\nEndorses difficulty with gait.\n\nOn general review of systems, the patient denies fevers, rigors,\nnight sweats, or noticeable weight loss.\nDenies chest pain, palpitations, dyspnea, or cough.\nDenies nausea, vomiting, diarrhea.', 'medications': [{'medication': 'Oxycodone-Acetaminophen (5mg-325mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [], 'exams': 'ADMISSION EXAMINATION:\n\nPhysical Examination:\nVS 98.2 71 134/66 18\nGeneral: NAD, lying in bed comfortably. \nHead: NC/AT, no conjunctival icterus, no oropharyngeal lesions \nNeck: Supple, no nuchal rigidity, no meningismus\n\nNeurologic Examination:\n\n- Mental Status - \nAwake, alert, oriented x 3. Attention to examiner easily \nattained\nand maintained. Concentration maintained when recalling days\nbackwards. Recalls a coherent history which is obtained with\ninterpretation from his 2 daughters at the bedside. Structure of\nspeech demonstrates fluency with full sentences, intact\nrepetition, and intact verbal comprehension. Content of speech\ndemonstrates intact naming (culturally appropriate, not able to\nname hammock) and no paraphasias. Normal prosody. No dysarthria\nper daughters. No evidence of hemineglect. No left-right \nagnosia.\n\n- Cranial Nerves -\nI. not tested\nII. Equal and reactive pupils (3mm to 2mm). The patient states\nhis vision is blurry in the R hemifield with stroke cards, but\nwhen asked to look at examiners face says everything is clear.\nVisual fields were full to finger counting. \nIII, IV, VI. smooth and full extraocular movements without\ndiplopia or nystagmus. \nV. facial sensation was intact, muscles of mastication with full\nstrength\nVII. face was symmetric with full strength of facial muscles\nVIII. hearing was intact to finger rub bilaterally. \nIX, X. symmetric palate elevation and symmetric tongue \nprotrusion\nwith full movement.\nXI. SCM and trapezius were of normal strength and volume.\n\n- Motor -\nMuscule bulk and tone were normal. R arm pronation. No tremor or\nasterixis.\n Delt Bic Tri ECR Fext IO Fflx IP Quad Ham TA Gas\nL 5 5 ___ 5 5 5 5 5 5 5\nR 5 5 ___ 5 5 5 5 5 5 5\n\n- Sensation -\nIntact to light touch, no extinction to DSS. \n\n- DTRs -\n Bic Tri ___ Quad Gastroc\nL 3 2 2 3 2\nR 3 2 2 3 2\nPlantar response extensor bilaterally.\n\n- Cerebellar -\nNo dysmetria with finger to nose or HTS testing bilaterally.\n\n- Gait -\ndeferred\n\n============================\n\nDISCHARGE EXAMINATION:\n\nPhysical Examination:\nGeneral: NAD, lying in bed comfortably. \nHead: NC/AT, no conjunctival icterus, no oropharyngeal lesions \nNeck: Supple\n\nNeurologic Examination:\n\n- Mental Status - \nAwake, alert, oriented x 3. Attention to examiner easily \nattained\nand maintained. Concentration maintained when recalling days\nbackwards. Recalls a coherent history which is obtained with\ninterpretation from his 2 daughters at the bedside. Structure of\nspeech demonstrates fluency with full sentences, intact\nrepetition, and intact verbal comprehension. Content of speech\ndemonstrates intact naming (culturally appropriate, not able to\nname hammock) and no paraphasias. Normal prosody. No dysarthria\nper daughters. No evidence of hemineglect. No left-right \nagnosia.\n\n- Cranial Nerves -\nI. not tested\nII. Equal and reactive pupils (3mm to 2mm). Visual fields were \nfull to finger counting. \nIII, IV, VI. smooth and full extraocular movements without \ndiplopia or nystagmus. \nV. facial sensation was intact, muscles of mastication with full \nstrength\nVII. face was symmetric with full strength of facial muscles\nVIII. hearing was intact to finger rub bilaterally. \nIX, X. symmetric palate elevation and symmetric tongue \nprotrusion with full movement.\nXI. SCM and trapezius were of normal strength and volume.\n\n- Motor -\nMuscule bulk and tone were normal. R arm pronation. No tremor or\nasterixis.\n Delt Bic Tri ECR Fext IO Fflx IP Quad Ham TA Gas\nL 5 5 ___ 5 5 5 5 5 5 5\nR 4+ 4+ 5 4+ 4+ 5 4+ 5 5 5 5 5\n\n- Sensation -\nIntact to light touch, no extinction to DSS. \n\n- DTRs -\n Bic Tri ___ Quad Gastroc\nL 3 2 2 3 2\nR 3 2 2 3 2\nPlantar response extensor bilaterally.\n\n- Cerebellar -\nNo dysmetria with finger to nose or HTS testing bilaterally.\n\n- Gait -\nGood initiation, narrow base, steady gait, good stride length', 'diagnoses': [{'icd_code': '5409', 'desc': 'Acute appendicitis without mention of peritonitis'}, {'icd_code': '5531', 'desc': 'Umbilical hernia without mention of obstruction or gangrene'}], 'summary': '___ 10:15AM BLOOD WBC-6.5 RBC-4.83 Hgb-14.2 Hct-41.8 MCV-87 \nMCH-29.4 MCHC-34.0 RDW-11.7 RDWSD-36.8 Plt ___\n___ 10:15AM BLOOD Neuts-54.0 ___ Monos-7.9 Eos-6.5 \nBaso-0.5 Im ___ AbsNeut-3.49 AbsLymp-1.99 AbsMono-0.51 \nAbsEos-0.42 AbsBaso-0.03\n___ 10:49AM BLOOD ___ PTT-31.1 ___\n___ 10:15AM BLOOD Glucose-109* UreaN-14 Creat-0.8 Na-141 \nK-4.4 Cl-104 HCO3-26 AnGap-15\n___ 10:49AM BLOOD Calcium-8.9 Phos-2.7 Mg-2.2 Cholest-192\n___ 10:15AM BLOOD ALT-37 AST-28 AlkPhos-59 TotBili-0.3\n___ 10:15AM BLOOD Lipase-26\n___ 10:49AM BLOOD %HbA1c-5.8 eAG-120\n___ 10:49AM BLOOD Triglyc-300* HDL-42 CHOL/HD-4.6 \nLDLcalc-90\n___ 10:49AM BLOOD TSH-0.60\n___ 10:15AM BLOOD ASA-NEG Acetmnp-NEG Bnzodzp-NEG \nBarbitr-NEG Tricycl-NEG\n___ 10:15AM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG\n___ 10:15AM URINE bnzodzp-NEG barbitr-NEG opiates-NEG \ncocaine-NEG amphetm-NEG mthdone-NEG\n\nIMAGING:\n\nCTA head/neck ___:\nIMPRESSION: \n1. The stented left internal carotid artery aneurysm \ndemonstrates no \npersistent lumen. \n2. No acute intracranial abnormalities. \n\nMRI brain ___:\nIMPRESSION: \n1. Scattered acute to subacute infarction in the left frontal \nand parietal \nlobes in the left middle cerebral artery distribution. The \npattern is most suggestive of an embolic etiology \n2. No evidence of hemorrhage. \n3. Age-related volume loss with findings of small vessel \nischemic disease. \n\nTTE ___:\nIMPRESSION: No ASD, PFO or cardiac source of embolism seen. \nNormal global and regional biventricular systolic function. \nPatient admitted for intermittent right arm and hand weakness \nand sensory changes over past 2 months after discontinuing \nticagrelor (for post-pipeline antiplatelet therapy) in the \nsetting of single episode of hematuria and hematochezia. Stroke \nworkup included: MRI brain with multiple punctate infarcts in \nleft MCA distribution of different ages, HbA1 5.8. Etiology \nthought most likely related to thrombo-embolic phenomenon \nrelated to the left ICA pipeline (possible small thrombus seen \non last angiogram). Patient was restarted on ticagrelor 80mg BID \nfor secondary prevention, and aspirin was reduced from 325mg to \n81mg. It is possible that the episodes of right hand tingling \nwith radiation up the left arm (and an episode of possible right \narm shaking) are due to simple partial seizures instead of \nmanifestations of the left MCA punctate infarcts. These \nparesthesias may also be symptoms of right sided cervical \nradiculopathy (he has moderate to severe cervical spinal \nstenosis and significant neural foraminal narrowing bilaterally \nat C4/5 and C5/6. I discussed the risks and benefits of starting \na low dose anti seizure medication such as Keppra with the \npatient and his daughter. We decided to defer starting Keppra \nfor now due to concern about possible side effects. '}}	{'final_diagnoses': ['Multiple left MCA embolic infarcts', 'Hypertension', 'Left'], 'procedures': ['N/A'], 'visit_summary': 'Patient admitted for intermittent right arm and hand weakness \nand sensory changes over past 2 months after discontinuing \nticagrelor (for post-pipeline antiplatelet therapy) in the \nsetting of single episode of hematuria and hematochezia. Stroke \nworkup included: MRI brain with multiple punctate infarcts in \nleft MCA distribution of different ages, HbA1 5.8. Etiology \nthought most likely related to thrombo-embolic phenomenon \nrelated to the left ICA pipeline (possible small thrombus seen \non last angiogram). Patient was restarted on ticagrelor 80mg BID \nfor secondary prevention, and aspirin was reduced from 325mg to \n81mg. It is possible that the episodes of right hand tingling \nwith radiation up the left arm (and an episode of possible right \narm shaking) are due to simple partial seizures instead of \nmanifestations of the left MCA punctate infarcts. These \nparesthesias may also be symptoms of right sided cervical \nradiculopathy (he has moderate to severe cervical spinal \nstenosis and significant neural foraminal narrowing bilaterally \nat C4/5 and C5/6. I discussed the risks and benefits of starting \na low dose anti seizure medication such as Keppra with the \npatient and his daughter. We decided to defer starting Keppra \nfor now due to concern about possible side effects. ', 'medications_prescribed': ['Aspirin 81 mg PO DAILY \nRX aspirin 81 mg 1 tablet(s) by mouth daily Disp #30 Tablet \nRefills:3', 'Docusate Sodium 100 mg PO BID:PRN constipation', 'TiCAGRELOR 90 mg PO BID \nRX ticagrelor [BRILINTA] 90 mg 1 tablet(s) by mouth twice daily \nDisp #60 Tablet Refills:3', 'Amlodipine 5 mg PO DAILY', 'Lisinopril 40 mg PO DAILY']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 55, 'gender': 'F', 'symptoms': 'Blood in the urine.', 'medical_history': ['- ESRD on ___ hemodialysis for the past ___ years.', '- Diastolic heart failure with preserved EF', '- Bilateral renal masses, per family have been followed serially \nwith imaging and are slow-growing ', '- Hypertension', '- BPH', '- Gout', '- Hyperlipidemia', '- S/P Carotid Endarterectomy ', '- S/P cataract surgery', '- S/P knee replacement'], 'family_history': 'No family history of kidney disease, one daughther died of \nbreast cancer at age ___. ', 'present_illness': '___ year-old male with ESRD on HD (MWF), known history of \nbilateral renal masses (but with decision not to pursue further \ninvasive workup), and hypertension who presented to ___ \n___ this morning with 3 days of gross hematuria.\n\nPatient reports that three days prior, he noticed bright red, \nbloody urine. He went to see his urologist who scheduled him \nfor a CT scan in late ___. He continued to have bloody urine \nthe next two days. Due to the development of thick blood (not \nclots), he presented to ___ where CT abd/pelvis which \nshowed bilateral partial exophytic renal masses, incidental \npancreatic lesion and a partial distended bladder with clots. \nThe OSH ED was unable to pass a Foley so he was transferred to \n___ for evaluation. Patient reports some dysuria which \nstarted after multiple attempts to place a foley catheter. He \ndenies fevers, chills, SOB, chest pain, orthopea, PND, abdominal \npain, back pain, hematochezia, melena. \n. \nIn the ED, initial VS: T 98.2 HR 59 BP 177/44 O2 100%RA. In the \nED she was given 8mg morphine and 2mg dilaudid during placement \nof foley catheter. Urology was consulted who put patient on \ncontinuous bladder irrigation which initially irrigated blood \nclots but few hours after irrigation color became more pink and \nclear.', 'medications': [{'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen-Caff-Butalbital', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Duloxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Cyanocobalamin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '70', 'valuenum': 70.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': 'NotDone. CK-MB NOT PERFORMED, TOTAL CK < 100.'}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.8,. Estimated GFR = 74 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.09, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42.2', 'valuenum': 42.2, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.8', 'valuenum': 35.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47.4', 'valuenum': 47.4, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '348', 'valuenum': 348.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.96', 'valuenum': 3.96, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': 'NotDone. CK-MB NOT PERFORMED, TOTAL CK < 100.'}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}], 'exams': 'VS: T 96.5 BP 150/64 HR 67 O2 96%RA\nGENERAL: Well-appearing man in NAD, comfortable, appropriate. \nHEENT: NC/AT, PERRLA, EOMI, sclerae anicteric, mucous memberanes \ndry, OP clear. \nNECK: Supple, no cervical or supraclavicular lympphadenopathy \nLUNGS: CTA bilat, no r/rh/wh, good air movement, resp unlabored. \n\nHEART: RRR, nl s1/s2, ___ systolic murmur radiating to carotids, \n___ murmurs at mitral area. \nABDOMEN: Soft/NT/ND \nEXTREMITIES: WWP, 2+ edema. \nSKIN: No rashes or lesions. \nNEURO: Awake, A&Ox3', 'diagnoses': [{'icd_code': '7245', 'desc': 'Backache, unspecified'}, {'icd_code': '78659', 'desc': 'Other chest pain'}, {'icd_code': '78820', 'desc': 'Retention of urine, unspecified'}, {'icd_code': '7876', 'desc': 'Incontinence of feces'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '2811', 'desc': 'Other vitamin B12 deficiency anemia'}], 'summary': "___ 11:00AM BLOOD WBC-8.9 RBC-3.47* Hgb-11.6* Hct-33.1* \nMCV-95 MCH-33.5* MCHC-35.1* RDW-13.2 Plt ___\n___ 07:18AM BLOOD WBC-8.3 RBC-3.10* Hgb-10.5* Hct-29.4* \nMCV-95 MCH-33.8* MCHC-35.7* RDW-13.4 Plt ___\n___ 06:04AM BLOOD WBC-7.8 RBC-3.15* Hgb-10.7* Hct-29.5* \nMCV-94 MCH-33.8* MCHC-36.1* RDW-13.5 Plt ___\n___ 11:00AM BLOOD Neuts-71.9* ___ Monos-5.1 Eos-3.7 \nBaso-0.4\n___ 11:00AM BLOOD Glucose-120* UreaN-53* Creat-4.9* Na-137 \nK-4.2 Cl-94* HCO3-32 AnGap-15\n___ 07:18AM BLOOD Glucose-101* UreaN-58* Creat-4.4* Na-136 \nK-3.8 Cl-98 HCO3-28 AnGap-14\n___ 06:04AM BLOOD Glucose-98 UreaN-36* Creat-3.8* Na-138 \nK-3.9 Cl-96 HCO3-33* AnGap-13\n___ 07:18AM BLOOD Lipase-28\n___ 07:18AM BLOOD Calcium-7.9* Phos-5.2* Mg-1.6\n___ 06:04AM BLOOD Calcium-8.4 Phos-4.2 Mg-1.9\n___ 11:00AM URINE Color-Red Appear-Cloudy Sp ___\n___ 04:40PM URINE Color-Yellow Appear-Clear Sp ___\n___ 11:00AM URINE Blood-LG Nitrite-NEG Protein-300 \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-8.0 Leuks-LG\n___ 04:40PM URINE Blood-MOD Nitrite-NEG Protein-30 \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-MOD\n___ 11:00AM URINE RBC->182* WBC->182* Bacteri-NONE \nYeast-NONE Epi-0\n___ 04:40PM URINE RBC-30* WBC-10* Bacteri-FEW Yeast-NONE \nEpi-0\n\nUrine Culture: ___: Final: No growth.\n\nCT Abdomen/Pelvis: OSH: \nBilateral partially exophytic renal lesions noted. The largest \nand most irregular in appearance projects from the R kidney and \nmeasures up to approximately 5.4cm. This mass is heterogeneous \nand is generally of increased density, likely corresponding to \nthe patient's known renal neoplasm. Bladder partially distended \nand contains dependent clotted blood products. Diverticulosis. \nIncidental 18 mm hypodense lesions related to the proximal \npancreas, incompletely characterized.\n___ year-old male with ESRD on HD (___), diastolic heart failure, \nHTN, known history of bilateral renal masses, BPH who presents \nwith three days of gross hematuria.\n\n# Hematuria: Patient has known history of renal masses since \n___ and reports being followed by nephrologist and urologist at \n___. He has declined any invasive \nprocedures to determine the identity of these masses in the \npast. Initially presented to OSH, where CT abdomen/pelvis \ndemonstrated known masses with unclear interval change. Patient \naware of the possibility of malignancy (renal, bladder, \nprostate) as the etiology for his hematuria but declined \ninvasive testing during this hospitalization. OSH CT also \ndemonstrated distended bladder with clots and urology was \nconsulted, who placed three way foley for continuous bladder \nirrigation. Urine analysis equivocal but culture without \ngrowth. Patient's hematocrit remained stable and patient was \nhemodynamically stable as well. Aspirin was held during episode \nof hematuria, but restarted after improvement of hematuria. Per \nurology recommendation patient was discharged with a foley in \nplace, which he should keep in for 5 days until he sees his \nurologist. There was no gross hematuria on CBI clamping trial. \nUrology did not recommend any further procedure and recommended \nthat patient follow up with his outpatient urologist, Dr. ___, \n___ further evaluation of gross hematuria. \n\n# ESRD: Patient has had ESRD on hemodialysis (MWF) since ___ \nmost likely secondary to chronic HTN and renal masses. He is \nfollowed at ___ at ___ by \nnephrologist, Dr. ___. On admission patient had lower \nextremity edema but was not volume overloaded. Evaluated by \nrenal team and underwent hemodialysis treatment on ___. He \nwill follow his regular schedule on discharge.\n\n#Anemia: Hematocrit stable after review of outpatient ___ \nrecords from ___. \n\n# Pancreatic lesion: The CT scan from ___ also \nreported presence of incidental pancreatic lesion. Patient will \nsee PCP for further evaluation and management.\n\nINACTIVE ISSUES:\n# HTN: Hemodynamically stable. Continued home Labetalol.\n\n# Lower extremity swelling: Continued home Lasix \n\n# Gout: Stable. Alluporinol renally dosed to 150mg every other \nday down from 100mg everyday.\n\n# Hyperlipidemia: Stable. Continued simvastatin.\n\n# BPH: Stable, but prostate may be contributing to hematuria. \nContinued Terazosin."}}	{'final_diagnoses': ['1. Gross Hematuria', '2. Bilateral Renal Masses', '3. Benign Prostatic hypertrophy'], 'procedures': ['Hemodialysis.'], 'visit_summary': "___ year-old male with ESRD on HD (___), diastolic heart failure, \nHTN, known history of bilateral renal masses, BPH who presents \nwith three days of gross hematuria.\n\n# Hematuria: Patient has known history of renal masses since \n___ and reports being followed by nephrologist and urologist at \n___. He has declined any invasive \nprocedures to determine the identity of these masses in the \npast. Initially presented to OSH, where CT abdomen/pelvis \ndemonstrated known masses with unclear interval change. Patient \naware of the possibility of malignancy (renal, bladder, \nprostate) as the etiology for his hematuria but declined \ninvasive testing during this hospitalization. OSH CT also \ndemonstrated distended bladder with clots and urology was \nconsulted, who placed three way foley for continuous bladder \nirrigation. Urine analysis equivocal but culture without \ngrowth. Patient's hematocrit remained stable and patient was \nhemodynamically stable as well. Aspirin was held during episode \nof hematuria, but restarted after improvement of hematuria. Per \nurology recommendation patient was discharged with a foley in \nplace, which he should keep in for 5 days until he sees his \nurologist. There was no gross hematuria on CBI clamping trial. \nUrology did not recommend any further procedure and recommended \nthat patient follow up with his outpatient urologist, Dr. ___, \n___ further evaluation of gross hematuria. \n\n# ESRD: Patient has had ESRD on hemodialysis (MWF) since ___ \nmost likely secondary to chronic HTN and renal masses. He is \nfollowed at ___ at ___ by \nnephrologist, Dr. ___. On admission patient had lower \nextremity edema but was not volume overloaded. Evaluated by \nrenal team and underwent hemodialysis treatment on ___. He \nwill follow his regular schedule on discharge.\n\n#Anemia: Hematocrit stable after review of outpatient ___ \nrecords from ___. \n\n# Pancreatic lesion: The CT scan from ___ also \nreported presence of incidental pancreatic lesion. Patient will \nsee PCP for further evaluation and management.\n\nINACTIVE ISSUES:\n# HTN: Hemodynamically stable. Continued home Labetalol.\n\n# Lower extremity swelling: Continued home Lasix \n\n# Gout: Stable. Alluporinol renally dosed to 150mg every other \nday down from 100mg everyday.\n\n# Hyperlipidemia: Stable. Continued simvastatin.\n\n# BPH: Stable, but prostate may be contributing to hematuria. \nContinued Terazosin.", 'medications_prescribed': ['1. allopurinol ___ mg Tablet Sig: 1.5 Tablets ___ EVERY OTHER DAY \n(Every Other Day). ', '2. labetalol 100 mg Tablet Sig: Three (3) Tablet ___ BID (2 times \na day). ', '3. furosemide 40 mg Tablet Sig: Two (2) Tablet ___. ', '4. terazosin 5 mg Capsule Sig: Two (2) Capsule ___ once a day. ', '5. simvastatin 40 mg Tablet Sig: One (1) Tablet ___ \n(___). ', '6. lansoprazole 30 mg Tablet,Rapid Dissolve, ___ Sig: One (1) \nTablet,Rapid Dissolve, ___ ___. Disp:30 Tablet,Rapid Dissolve, ___ Refills:2*', '7. metolazone 2.5 mg Tablet Sig: Two (2) Tablet ___ \n(___). ', '8. Dialyvite Oral', '9. sodium bicarbonate 650 mg Tablet Sig: One (1) Tablet ___ three \ntimes a day. ', '10. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \n___.']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 29, 'gender': 'M', 'symptoms': 'abdominal pain', 'medical_history': ['1. Idiopathic calcific pancreatitis: \n -Onset ___. Lap chole. GB neg IgG4 staining. \n -ERCP/sphincterotomy/stent for ? SOD ___. \n -Failed pred trial ___. \n -Distal pancreatectomy/splenectomy ___ Dr ___. \n -EUS/celiac plexus blocks ___. \n -TPN in ___. \n -PEG-J ___. Enteroscopy/PEG-J exchange ___. \n -Not a candidate for completion pancreatectomy due to medical\ncomorbidities. ', '2. central DI d/t Rathkeâ\x80\x99s cleft cyst drainage ___ in \nnasal\nDDAVP ', '3. JRA medrol 8 and Rituximab ', '4. Hereditary cataracts OD enucleation ', '5. DM lantus/aspart ', '6. CVA and DVT/PE felt ___ inflammtory hypercoaguable state\n(APLAS labs negative) ', '7. Chronic pain c/b tolerance and possible hyperalgesia f/b Dr.\n___ poor follow up '], 'family_history': 'No known GI illnesses in family. Great-grandmother with RA. \nGrandmother with IDDM type I', 'present_illness': 'Patient is a ___ y/o woman with PMHx of IDDM type I, Rheumatoid \nArthritis on \nPlaquenil and Methylprednisolone, recurrent pancreatitis with \nhistory of pancreatic abscess s/p partial pancreatectomy (___) \nand splenectomy, s/p cholecystectomy (___) who presents with \nabdominal pain and nausea/vomiting for 2 weeks.\n\nShe was recently admitted to ___ for similar sxs from \n___ for abdominal pain. KUB showed significant stool \nburden and thus started on Moviprep with BMs and subseuqnet \nimprovement in pain. She was discharged on home meds including a \nshort script of PO dilaudid to last until her next appointment. \nOf note, patient has had extensive GI workup at ___ (followed by \nDr ___ including EGD, motility studies that have been \nnormal. See ___ below for further details. \n\nShe reports she has had ongoing abdominal pain since discharge, \nepigastric radiating to the back that she feels is similar to \nher prior pancreatitis episodes. She also reports nausea with 2 \nepisodes non bloody bilious emesis. She reports BMs once every 3 \ndays since discharge, and has been taking her Colace/senna \ndaily. She is frustrated with her course and wants to known the \ncause of her pancreatitis. States that only IV pain medications \nwill work to alleviate her pain currently. She says has tried \ntricyclics and gabapentin in the past without relief. Denies \nfever, chills, weight loss, hematochezia, hematemesis, chest \npain, shortness of breath.\n\nIn ED, VS: 99.7 105 102/62 18 100% RA \nOn exam noted to have epigastric tenderness\nLabs showed baseline anemia (H/H 8.9/28.6). INR 1.4, lactate 2.1\nKUB showed nonobstructed bowel-gas pattern. No evidence of \npneumoperitoneum or\nobstruction.\nShe was given\n___ 04:15 IV HYDROmorphone (Dilaudid) .5 mg \n___ 04:15 IV Ondansetron 4 mg \n___ 04:49 IV HYDROmorphone (Dilaudid) .5 mg \n___ 06:12 IV Ondansetron 4 mg \n___ 06:32 IV Lorazepam 1 mg \n___ 07:47 IV HYDROmorphone (Dilaudid) .5 mg \n___ 09:34 IV HYDROmorphone (Dilaudid) .5 mg \n___ 13:14 IV HYDROmorphone (Dilaudid) .5 mg \nDespite above treatments, she was unable to tolerate PO and thus \nadmitted.\nTransfer VS: 97.6 54 120/78 16 100% RA \n\nOn arrival to floor, she is reporting ___ pain and is tearful. \nReports epigastric pain that is similar to prior pancreatitis \nepisodes.', 'medications': [{'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Psyllium Wafer', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 195.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.8', 'valuenum': 36.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '210', 'valuenum': 210.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.47', 'valuenum': 4.47, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Admission exam:\nGen: young woman, tearful intermittently, NAD\nHEENT: NCAT, EOMI\nNeck: No JVD\nCV: RRR, nl S1 S2, no m/r/g\nLungs: CTA b/l, no wheezing or rales\nAbd: soft, non distended, normoactive bowel sounds, tenderness \nto palpation in epigastrium but distractable, no rebound or \nguarding\nExt: No edema\nSkin: No rashes\nNeuro: CN II-XII intact\nMSK: No joint swelling\nPsych: Anxious, perseverating on pain and IV pain medications\n\nDischarge exam:\nVitals: 98.8 119 / ___\nGeneral: patient walking around room and to bathroom without \nissues, but starts crying when provider walks into room\nCV: r/r/r, no m/r/g\nLungs: CTA bilatearlly\nAbd: soft, normoactive bowel sounds, tenderness to palpation in \nall quadrants but distractable with conversation\nExt: thin, no edema', 'diagnoses': [{'icd_code': '566', 'desc': 'Abscess of anal and rectal regions'}, {'icd_code': '56400', 'desc': 'Constipation, unspecified'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}], 'summary': 'Admission Labs:\n___ 08:35AM URINE UCG-NEG\n___ 04:14AM LACTATE-2.1\n___ 03:34AM ___ PTT-43.7 ___\n___ 02:10AM GLUCOSE-235* UREA N-6 CREAT-0.7 SODIUM-142 \nPOTASSIUM-3.5 CHLORIDE-105 TOTAL CO2-23 ANION GAP-18\n___ 02:10AM ALT(SGPT)-9 AST(SGOT)-13 ALK PHOS-91 TOT \nBILI-<0.2\n___ 02:10AM WBC-6.8 RBC-3.40* HGB-8.9* HCT-28.6* MCV-84 \nMCH-26.2 MCHC-31.1* RDW-17.6* RDWSD-54.0\n\nDischarge labs:\n___ 06:44AM BLOOD WBC-6.4 RBC-3.61 Hgb-9.4* Hct-30.2* \nMCV-84 MCH-26.0 MCHC-31.1* RDW-17.5* RDWSD-53.2* Plt ___\n___ 06:44AM BLOOD ___ PTT-47.7* ___\n___ 06:44AM BLOOD Glucose-109* UreaN-3* Creat-0.6 Na-140 \nK-3.9 Cl-101 HCO3-26 AnGap-17\n___ 06:44AM BLOOD ALT-10 AST-16 LD(LDH)-180 AlkPhos-91 \nTotBili-0.2\n\nImaging:\nKUB\nIMPRESSION: Nonobstructed bowel-gas pattern. No evidence of \npneumoperitoneum or\nobstruction.\nMs. ___ is a ___ y/o woman with PMHx of IDDM type I, \nRheumatoid Arthritis on Plaquenil and Methylprednisolone, \nrecurrent pancreatitis with history of pancreatic abscess s/p \npartial pancreatectomy (___) and splenectomy, s/p \ncholecystectomy (___) who presents with abdominal pain and \nnausea/vomiting for 2 weeks.\n\n# Abdominal pain: Patient has had multiple admissions in the \npast at ___ for this symptomatology. She has had extensive \nworkup at ___ including EGD, swallowing study, multiple MRIs and \nCT scans, which have not shown any pathology. She was recently \ndischarged from ___ on ___ and presented to ___ on ___ and \ndischarged on ___ prior to presenting to ___ on ___ for \nthis admission. Discussion with PCP and pain specialist revealed \nthat ___ has been limiting IV narcotics to the patient and PCP \nis concerned regarding opiate addition (see below). As lab \nstudies and KUB were within normal limits and exam demonstrated \ndistractible tenderness, patient\'s IV dilaudid was discontinued \nand patient felt she could go home. She tolerated a regular diet \nprior to discharge. \n\n# Possible opiate abuse / addiction: Please see OMR note \nentitled "Pain management plan" for further details. Per ___ \nproviders, there has been drug seeking behavior witnessed during \nprior episodes and treatment has been offered. She was \npreviously on methadone but that was discontinued. She has been \noffered suboxone, but she has refused it. She was encouraged to \nfollow-up with these outpatient providers and did not receive a \nprescription for narcotics on discharge.\n\n# IDDM Type I: A1C 6.6% in ___. On Lantus and Humalog at \nhome. Continue lantus 4 units qhs and novolog 2 units with \nmeals.\n\n# APLS\n# Hx of stroke (___): Hx of CVA, PE, DVT per ___ records. \nRecord of possible APLS though APLS labs were negative. Given \nsubtherapeutic INR and prior CVA history, patient bridged with \nLovenox 50mg q12. \n\n# Rheumatoid Arthritis: Home Plaquenil 200 mg QHS and \nmethylprednisolone 8 mg daily were continued. \n\n>30 minutes were spent on discharge day of planning and care \ncoordination.\n\nCHRONIC ISSUES\n# Hypertension: Continued home lisinopril and metoprolol \n# Pancreatic insufficiency: Continued Creon 12 TID with meals\n# Diabetes Insipidus: C/w Desmopressin spray QHS\n# Insomnia: trazodone was held.'}}	{'final_diagnoses': ['Chronic abdominal pain'], 'procedures': ['None'], 'visit_summary': 'Ms. ___ is a ___ y/o woman with PMHx of IDDM type I, \nRheumatoid Arthritis on Plaquenil and Methylprednisolone, \nrecurrent pancreatitis with history of pancreatic abscess s/p \npartial pancreatectomy (___) and splenectomy, s/p \ncholecystectomy (___) who presents with abdominal pain and \nnausea/vomiting for 2 weeks.\n\n# Abdominal pain: Patient has had multiple admissions in the \npast at ___ for this symptomatology. She has had extensive \nworkup at ___ including EGD, swallowing study, multiple MRIs and \nCT scans, which have not shown any pathology. She was recently \ndischarged from ___ on ___ and presented to ___ on ___ and \ndischarged on ___ prior to presenting to ___ on ___ for \nthis admission. Discussion with PCP and pain specialist revealed \nthat ___ has been limiting IV narcotics to the patient and PCP \nis concerned regarding opiate addition (see below). As lab \nstudies and KUB were within normal limits and exam demonstrated \ndistractible tenderness, patient\'s IV dilaudid was discontinued \nand patient felt she could go home. She tolerated a regular diet \nprior to discharge. \n\n# Possible opiate abuse / addiction: Please see OMR note \nentitled "Pain management plan" for further details. Per ___ \nproviders, there has been drug seeking behavior witnessed during \nprior episodes and treatment has been offered. She was \npreviously on methadone but that was discontinued. She has been \noffered suboxone, but she has refused it. She was encouraged to \nfollow-up with these outpatient providers and did not receive a \nprescription for narcotics on discharge.\n\n# IDDM Type I: A1C 6.6% in ___. On Lantus and Humalog at \nhome. Continue lantus 4 units qhs and novolog 2 units with \nmeals.\n\n# APLS\n# Hx of stroke (___): Hx of CVA, PE, DVT per ___ records. \nRecord of possible APLS though APLS labs were negative. Given \nsubtherapeutic INR and prior CVA history, patient bridged with \nLovenox 50mg q12. \n\n# Rheumatoid Arthritis: Home Plaquenil 200 mg QHS and \nmethylprednisolone 8 mg daily were continued. \n\n>30 minutes were spent on discharge day of planning and care \ncoordination.\n\nCHRONIC ISSUES\n# Hypertension: Continued home lisinopril and metoprolol \n# Pancreatic insufficiency: Continued Creon 12 TID with meals\n# Diabetes Insipidus: C/w Desmopressin spray QHS\n# Insomnia: trazodone was held.', 'medications_prescribed': ['1. HYDROmorphone (Dilaudid) 4 mg PO Q4H:PRN Pain - Mild ', '2. Bisacodyl 10 mg PR QHS:PRN constipation ', '3. Creon 12 2 CAP PO TID W/MEALS ', '4. Desmopressin Nasal 10 mcg NAS QHS ', '5. Docusate Sodium 100 mg PO BID ', '6. DULoxetine 30 mg PO DAILY ', '7. Enoxaparin Sodium 50 mg SC Q12H \nStart: Today - ___, First Dose: Next Routine Administration \nTime ', '8. FoLIC Acid 1 mg PO DAILY ', '9. Hydroxychloroquine Sulfate 200 mg PO QHS ', '10. Lantus (insulin glargine) 100 unit/mL subcutaneous QHS ', '11. Lisinopril 5 mg PO DAILY ', '12. Methylprednisolone 8 mg PO DAILY \nTapered dose - DOWN ', '13. Metoclopramide 10 mg PO Q6H:PRN nausea ', '14. Multivitamins 1 TAB PO DAILY ', '15. NovoLOG (insulin aspart) 100 unit/mL subcutaneous TID \nW/MEALS ', '16. Omeprazole 40 mg PO DAILY ', '17. Ondansetron 4 mg PO Q8H:PRN nausea ', '18. Polyethylene Glycol 17 g PO DAILY ', '19. Senna 8.6 mg PO BID ', '20. TraZODone 50 mg PO QHS ', '21. Vitamin D ___ UNIT PO DAILY ', '22. Warfarin 5 mg PO DAILY16 ']}
Generate a treatment plan with clinical reasoning for this case:	{'patient_profile': {'age': 87, 'gender': 'F', 'symptoms': 'Worsening shortness of breath', 'medical_history': ['- Severe mitral stenosis (area < 1.0cm2)', '- Presumed diastolic dysfunction', '- PEA arrest in ___. Husband resuscitated her. Found to be \nin complete heart block s/p pace maker placement. Anoxic brain \ndamage with short term memory loss. ', '- Left breast cancer status post mastectomy with radiation\ntherapy in ___ and ___.', '- AML - in CCR, s/p Cy/TBI conditioning and allogeneic T-cell \ndepleted allogeneic bone marrow transplant from sister in \n___.', '- BMT complicated by lymphoproliferative disorder status post \ntonsillectomy and Rituxan in ___, ITP s/p Rituxan in ___ \nwithout recurrence, and hypogammaglobulinemia requiring monthly \nIVIG.', '- Basal cell carcinoma with excision in ___.', '- Iron overload diagnosed by liver biopsy in ___ and \nundergoing periodic phlebotomy'], 'family_history': 'Breast cancer in mother and sister ', 'present_illness': 'Mrs. ___ is a ___ year old woman with a history of breast \ncancer status post resection and radiation to the chest; acute \nmyelogenous leukemia status post chemotherapy and allo stem cell \ntransplant, complicated by post-transplant lymphoproliferative \ndisorder status post Rituxan (now on monthly IVIG for \nhypogammaglobulinemia and history of ITP), hepatic iron overload\nand granulomatous liver disease. \n\nShe was admitted to ___ in ___ with melena and acute on \nchronic dypnea on exertion. Work-up at that time included a \ntransesophageal echocardiogram that demonstrated severe mitral \nstenosis and mild mitral regurgitation.\n\nUpper endoscopy during the same admission was significant for \nnew grade 1 varices and portal gastropathy, consistent with \nportal hypertension. She was asked to obtain clearance for \nsurgery from Hepatology, Pulmonology and Oncology. She has \nsince obtained clearance from her other providers. \n\nShe stated that she has noted continued progressive dyspnea. \nShe noted dyspnea with walking ___ feet. She cannot climb one \nflight of stairs without stopping to catch her breath. She \nsometimes becomes so short of breath that she feels lightheaded. \n She has stable 2 pillow orthopnea. She denied syncope, \npresyncope, shortness of breath at rest, chest pain,\npalpitations, paroxysmal nocturnal dyspnea, or lower extremity \nedema. cardiac catheterization was done. ___ was \nconsulted by cardiac surgery for Mitral Valve replacement \n(tissue) +/- CABG.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Triamterene-Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin Flush CVL (100 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4-6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush CVL (100 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Triamterene-Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Tiotropium Bromide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Levetiracetam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Phenaseptic Throat Spray', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'MRX1:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 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'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 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'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '-3', 'valuenum': -3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 100.0, 'ref_range_upper': 112.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 0.94, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '185', 'valuenum': 185.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '49', 'valuenum': 49.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.29', 'valuenum': 7.29, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '223', 'valuenum': 223.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': None, 'priority': None, 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 148.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '-2', 'valuenum': -2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 100.0, 'ref_range_upper': 112.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.14', 'valuenum': 1.14, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '180', 'valuenum': 180.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 4.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.33', 'valuenum': 7.33, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 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'STAT', 'comments': None}, {'value': '27.4', 'valuenum': 27.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '70', 'valuenum': 70.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.90', 'valuenum': 2.9, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '174', 'valuenum': 174.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.9', 'valuenum': 26.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.81', 'valuenum': 2.81, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 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'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.4', 'valuenum': 23.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.4', 'valuenum': 16.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.48', 'valuenum': 2.48, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.2', 'valuenum': 24.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.1', 'valuenum': 17.1, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '52.1', 'valuenum': 52.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.0', 'valuenum': 24.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.55', 'valuenum': 2.55, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.6', 'valuenum': 5.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'Pulse: 82 BP: 115/68 Resp: 16 O2 sat: RA 100%\nHeight: 4ft 10" Weight: 127lbs\n\nGeneral:\nSkin: Dry, intact\nHEENT: PERRLA, EOMI \nNeck: Supple, full ROM\nChest: Lungs clear bilaterally\nHeart: RRR, II/VI \nAbdomen: +BS, softn, non-tender, non-distended\nExtremities: Warm, well-perfused, trace to 1+ edema b/l\nVaricosities: None \nNeuro: Grossly intact\nPulses:\nFemoral Right:+1 Left:+1\nDP Right:+2 Left:+2\n___ Right: +2 Left:+2\nRadial Right: +2 Left:+2\n\nCarotid Bruit Right: None Left:None', 'diagnoses': [{'icd_code': '85201', 'desc': 'Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness'}, {'icd_code': '82380', 'desc': 'Closed fracture of unspecified part of tibia alone'}, {'icd_code': '82332', 'desc': 'Open fracture of shaft of fibula with tibia'}, {'icd_code': '88111', 'desc': 'Open wound of elbow, complicated'}, {'icd_code': '8082', 'desc': 'Closed fracture of pubis'}, {'icd_code': '8056', 'desc': 'Closed fracture of sacrum and coccyx without mention of spinal cord injury'}, {'icd_code': '8080', 'desc': 'Closed fracture of acetabulum'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '496', 'desc': 'Chronic airway obstruction, not elsewhere classified'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '5715', 'desc': 'Cirrhosis of liver without mention of alcohol'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2874', 'desc': 'Secondary thrombocytopenia'}, {'icd_code': 'E8147', 'desc': 'Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian'}], 'summary': "___ Cardiac Catheterization\nAssessment & Recommendations\n1. No angiographic CAD\n2. Moderate to severe mitral stenosis based on mitral valve \narea.\n\n___ ECHO\nPre-Bypass:\n1. The left atrium is normal in size. No spontaneous echo \ncontrast or thrombus is seen in the body of the left atrium or \nleft atrial appendage. No atrial septal defect is seen by 2D or \ncolor Doppler. \n2. Left ventricular wall thicknesses are normal. The left \nventricular cavity size is normal. Overall left ventricular \nsystolic function is normal (LVEF>55%). Left ventricular \ndysnchrony is present. \n3. Right ventricular chamber size and free wall motion are \nnormal. \n4. There are simple atheroma in the descending thoracic aorta. \n5. There are three aortic valve leaflets. The aortic valve \nleaflets are moderately thickened. There are filamentous strands \non the aortic leaflets possibly Lambl's excresences. There is \nmild aortic valve stenosis (valve area 1.5 cm2). Trace aortic \nregurgitation is seen. \n6. The mitral valve leaflets are moderately thickened. The \nanterior mitral leaflet is heavily calcified with severly \nrestricted movement. There is moderate valvular mitral stenosis \n(area 1.0-1.5cm2). Mild (1+) mitral regurgitation is seen. \n7. The tricuspid valve leaflets are mildly thickened. \n8. There is a very small pericardial effusion. \n9. Dr. ___ was notified in person of the results on \n___ at 0800. \n\nPost-Bypass:\n1. The patient is A-V paced on a phenylephrine and epinephrine \ninfusion. \n2. Left ventricular function is preserved with an estimated \nEF-55%. Right ventricular function is moderately depressed.\n3. There is a well seated bioprosthetic valve in the mitral \nposition. There are no paravalvular leaks. The peak and mean \ngradients are ___ mmHg.\n4. There is no evidence of aortic dissection s/p decannulation.\n5. The remainder of the exam is unchanged. \n.\nEMG ___\nFINDINGS: \n \nLimited study. There is no electrophysiologic evidence for a \ngeneralized \nmyopathy. A very mild predominantly sensory polyneuropathy \ncannot be excluded \ngiven the limited testing performed. Finally, the reduced \nactivation on needle \nelectromyography suggests that poor effort or a central process \nis \ncontributing to the patient's weakness. \n.\n___ Liver/GB U/S\nIMPRESSION: \nGrossly unchanged appearance compared to the prior ultrasound on \n___ \nwith occlusive thrombus in the main and left portal veins. \n \nThe study and the report were reviewed by the staff radiologist. \n\n.\n___ Head CT w/o contrast\nIMPRESSION: \n \n1. No acute intracranial process. \n \n2. Atrophy, slightly increased since the prior study. \n \n.\n\n___ 08:29AM BLOOD WBC-7.1 RBC-3.52* Hgb-10.4* Hct-30.9* \nMCV-88 MCH-29.6 MCHC-33.7 RDW-17.3* Plt ___\n___ 03:12AM BLOOD WBC-9.9 RBC-3.47* Hgb-10.4* Hct-30.1* \nMCV-87 MCH-29.9 MCHC-34.4 RDW-17.0* Plt ___\n___ 03:13AM BLOOD ___ PTT-22.9* ___\n___ 01:30AM BLOOD ___ PTT-21.7* ___\n___ 08:29AM BLOOD Glucose-140* UreaN-29* Creat-1.2* Na-138 \nK-3.1* Cl-100 HCO3-26 AnGap-15\n___ 03:12AM BLOOD Glucose-154* UreaN-46* Creat-1.3* Na-138 \nK-3.4 Cl-96 HCO3-26 AnGap-19\n___ 02:00PM BLOOD Creat-1.3* Na-144 K-4.8 Cl-99\nMrs. ___ was admitted to the ___ on ___ for surgical \nmanagement of her mitral valve disease. She underwent a cardiac \ncatheterization in preparation which showed no significant \ncoronary artery disease. She was worked-up in the usual \npreoperative manner. On ___ she was taken to the operating \nroom where she underwent a Mitral valve replacement with a size \n25 mm ___ Mosaic tissue valve and removal of aortic valve \nmass. Please see operative note for details. Postoperatively \nshe was taken to the intensive care unit for monitoring. EP was \nconsulted for PPM interrogation postoperatively. Per EP: \nPresenting rhythm: AS-Vpaced in the ___ Rhythm: \nCHB,Programmed Mode: DDD, lower rate 50 bpm. Tolerated \ninterrogation well.\n\nShe initially woke in a delirious manner, was extubated ___, on \nprecedex. Her mental status improved with time, but pain \ncontrol was a problem and she was continued on PRN Fentanyl and \nUltram given her multiple drug allergies. She had no focal \ndeficits during this time. Her chest tubes were removed on ___ \nwithout difficulty. Incentive spirometry and diuresis were used \nfor bibasilar pleural effusion/atelectasis (R>L).\n\nShe remained in the CVICU for inotropic and vasopressor support \nand continued delerium. Repeat echocardiogram on ___ revealed a \nwell-seated bioprosthetic mitral valve with normal disc motion \nand high normal gradient. No mitral regurgitation. Normal \nbiventricular cavity sizes with preserved global biventricular \nsystolic function. Mild aortic regurgitation. She was \nthrombocytopenic postop likely due to her liver dysfunction. HIT \nwas sent. Results were negative. \n\nPOD#6 she had hemodynamic instability thought to be due to \ncardiogenic shock with interval development of respiratory \ndistress and evidence of septic shock with ARDS\nfrom VAP due to H. influenza. She went into respiratory distress \nand required reintubation. She had a right thoracentesis for a \nlarge pleural effusion. Initially drained 1 Liter. ID was \nconsulted for management of septic shock, and concern for \nNeisseria growing in blood cultures, as well as H.Flu in her \nsputum.She was placed on appropriate antibiotics per ID. \n\nSeveral days postoperatively her HCT dropped and a GI bleed was \nsuspected with her recent history. Hepatology was consulted \nregarding possible source of bleed. ___ per Hepatology, with \nregards to her liver disease, prior to her surgery she was \nnotably a child ___ class A cirrhotic and while currently she \nis not showing overt signs of decompensation (i.e. jaundice) she \ndoes appears to have some ascites on exam. Additionally, her \ndelirium prior to respiratory failure may have been evidence of \nhepatic encephalopathy. \n\nShe demonstrated some hemodynamic and respiratory improvement. \nShe weaned again to extubation on ___ and had continued \ndelerium. Tube feeds were started for nutrition. She weaned from \npressors. On postoperative day 13, she developed melena and \ncopious hemoptysis. She was reintubated for airway protection. \nGI was consulted urgently. She underwent an EGD which showed \nclot and fundal varices. Octreotide and Protonix drip were \ninitiated. Statin and aspirin were discontinued due to her liver \ndysfunction, thrombocytopenia and GI bleed. She was rescoped the \nfollowing next 2 days and kept intubated. On ___, three \nesophageal varices were banded and she weaned to extubate. Liver \ndoppler flow study done for possible future TIPs with GI. The \nSpeech and swallow service was consulted. She passed her swallow \nstudy and her diet was advanced per speech and swallow \nrecommendations. \n\nShe underwent a left sided thoracentesis on ___, which \nevacuated 800 cc. She remained extubated.\n\nDuring her postoperative course she became hypernatremic and had \nto be treated with Dextrose/water infusion to bring down her \nsodium. She remained extracellularly volume overloaded however, \nand gentle diuresis was continued.\n\nHer white count remained stable and she remained afebrile. She \nhad been treated with a full course of antibiotics for \nHaemophilus Influenza in her sputum culture and Neisseria in her \nblood cultures. Her mental status remained somnolent and \nintermittently confused. Hepatic encephalopathy versus ICU \ndelerium was considered. She was initially started on Ritalin \nto stimulate appetite and regulate sleep-wake cycles, but this \nwas discontinued. A head CT on ___ showed no acute intracranial \nprocess. The neurology service was consulted. A continuous EEG \nwas obtained which was indicative of diffuse cerebral \ndysfunction and was etiologically non-specific. There were \noccasional intermixed triphasic waves which can be seen in \nmetabolic encephalopathies. Her exam findings in conjuction with \nEEG findings were thought to be related to hepatic \nencephalopathy. Baclofen was weaned as it can induce \nencephalopathic features.\n\nShe developed transaminitis along with elevated amylase and \nlipase. Right upper quadrant ultrasound was obtained. The study \nrevealed grossly unchanged appearance compared to the prior \nultrasound on ___ with occlusive thrombus in the main \nand left portal veins. \n\nShe continued to be followed by the physical therapy and speech \ntherapy services. She was discharged to ___ on \npostoperative day 28. She will follow up with Dr. ___ as an \noutpatient."}}	{'final_diagnoses': ['- Diastolic congestive heart failure ', '- Mitral valve stenosis ', '- Upper gastrointestinal bleeding ', '- Esophageal Varices s/p banding ', '- Portal Hypertension ', '- Hepatic Encephalopathy ', '- Pneumonia ', '- ARDS ', '- Pleural Effusions ', '- Cirrhosis - Child ___ Class A ', '- PEA arrest ___ ', '- Complete heart block s/p permanent pacemaker ', '- Anoxic brain injury with short term memory loss ', '- Left breast cancer s/p mastectomy with radiation therapy in \n___ and ___.', '- AML - in CCR, s/p Cy/TBI conditioning and allogeneic T-cell \ndepleted allogeneic bone marrow transplant from sister in \n___.', '- BMT complicated by lymphoproliferative disorder status post \ntonsillectomy and Rituxan in ___, ITP s/p Rituxan in ___ \nwithout recurrence, and hypogammaglobulinemia requiring monthly \nIVIG. ', '- Basal cell carcinoma with excision in ___. ', '- Iron overload diagnosed by liver biopsy in ___ and \nundergoing periodic phlebotomy '], 'procedures': ['___ - MV Replacement(25mm ___ Mosaic Porcine)/Removal \nof Aortic Mass.', '___ - Cardiac Catheterization', '___ - EGD s/p endoscopic band ligation x3 of esophageal \nvarices'], 'visit_summary': 'Mrs. ___ was admitted to the ___ on ___ for surgical \nmanagement of her mitral valve disease. She underwent a cardiac \ncatheterization in preparation which showed no significant \ncoronary artery disease. She was worked-up in the usual \npreoperative manner. On ___ she was taken to the operating \nroom where she underwent a Mitral valve replacement with a size \n25 mm ___ Mosaic tissue valve and removal of aortic valve \nmass. Please see operative note for details. Postoperatively \nshe was taken to the intensive care unit for monitoring. EP was \nconsulted for PPM interrogation postoperatively. Per EP: \nPresenting rhythm: AS-Vpaced in the ___ Rhythm: \nCHB,Programmed Mode: DDD, lower rate 50 bpm. Tolerated \ninterrogation well.\n\nShe initially woke in a delirious manner, was extubated ___, on \nprecedex. Her mental status improved with time, but pain \ncontrol was a problem and she was continued on PRN Fentanyl and \nUltram given her multiple drug allergies. She had no focal \ndeficits during this time. Her chest tubes were removed on ___ \nwithout difficulty. Incentive spirometry and diuresis were used \nfor bibasilar pleural effusion/atelectasis (R>L).\n\nShe remained in the CVICU for inotropic and vasopressor support \nand continued delerium. Repeat echocardiogram on ___ revealed a \nwell-seated bioprosthetic mitral valve with normal disc motion \nand high normal gradient. No mitral regurgitation. Normal \nbiventricular cavity sizes with preserved global biventricular \nsystolic function. Mild aortic regurgitation. She was \nthrombocytopenic postop likely due to her liver dysfunction. HIT \nwas sent. Results were negative. \n\nPOD#6 she had hemodynamic instability thought to be due to \ncardiogenic shock with interval development of respiratory \ndistress and evidence of septic shock with ARDS\nfrom VAP due to H. influenza. She went into respiratory distress \nand required reintubation. She had a right thoracentesis for a \nlarge pleural effusion. Initially drained 1 Liter. ID was \nconsulted for management of septic shock, and concern for \nNeisseria growing in blood cultures, as well as H.Flu in her \nsputum.She was placed on appropriate antibiotics per ID. \n\nSeveral days postoperatively her HCT dropped and a GI bleed was \nsuspected with her recent history. Hepatology was consulted \nregarding possible source of bleed. ___ per Hepatology, with \nregards to her liver disease, prior to her surgery she was \nnotably a child ___ class A cirrhotic and while currently she \nis not showing overt signs of decompensation (i.e. jaundice) she \ndoes appears to have some ascites on exam. Additionally, her \ndelirium prior to respiratory failure may have been evidence of \nhepatic encephalopathy. \n\nShe demonstrated some hemodynamic and respiratory improvement. \nShe weaned again to extubation on ___ and had continued \ndelerium. Tube feeds were started for nutrition. She weaned from \npressors. On postoperative day 13, she developed melena and \ncopious hemoptysis. She was reintubated for airway protection. \nGI was consulted urgently. She underwent an EGD which showed \nclot and fundal varices. Octreotide and Protonix drip were \ninitiated. Statin and aspirin were discontinued due to her liver \ndysfunction, thrombocytopenia and GI bleed. She was rescoped the \nfollowing next 2 days and kept intubated. On ___, three \nesophageal varices were banded and she weaned to extubate. Liver \ndoppler flow study done for possible future TIPs with GI. The \nSpeech and swallow service was consulted. She passed her swallow \nstudy and her diet was advanced per speech and swallow \nrecommendations. \n\nShe underwent a left sided thoracentesis on ___, which \nevacuated 800 cc. She remained extubated.\n\nDuring her postoperative course she became hypernatremic and had \nto be treated with Dextrose/water infusion to bring down her \nsodium. She remained extracellularly volume overloaded however, \nand gentle diuresis was continued.\n\nHer white count remained stable and she remained afebrile. She \nhad been treated with a full course of antibiotics for \nHaemophilus Influenza in her sputum culture and Neisseria in her \nblood cultures. Her mental status remained somnolent and \nintermittently confused. Hepatic encephalopathy versus ICU \ndelerium was considered. She was initially started on Ritalin \nto stimulate appetite and regulate sleep-wake cycles, but this \nwas discontinued. A head CT on ___ showed no acute intracranial \nprocess. The neurology service was consulted. A continuous EEG \nwas obtained which was indicative of diffuse cerebral \ndysfunction and was etiologically non-specific. There were \noccasional intermixed triphasic waves which can be seen in \nmetabolic encephalopathies. Her exam findings in conjuction with \nEEG findings were thought to be related to hepatic \nencephalopathy. Baclofen was weaned as it can induce \nencephalopathic features.\n\nShe developed transaminitis along with elevated amylase and \nlipase. Right upper quadrant ultrasound was obtained. The study \nrevealed grossly unchanged appearance compared to the prior \nultrasound on ___ with occlusive thrombus in the main \nand left portal veins. \n\nShe continued to be followed by the physical therapy and speech \ntherapy services. She was discharged to ___ on \npostoperative day 28. She will follow up with Dr. ___ as an \noutpatient.', 'medications_prescribed': ['1. Acyclovir 400 mg PO Q12H ', '2. Albuterol Inhaler 2 PUFF IH BID:PRN sob ', '3. Baclofen 2.5 mg PO BID \n2.5mg BID x 4 days, then 2.5mg daily x 1 week, then discontinue ', '4. FoLIC Acid 1 mg PO DAILY ', '5. Multivitamins 1 TAB PO DAILY ', '6. Docusate Sodium 100 mg PO BID ', '7. Midodrine 5 mg PO TID ', '8. Nadolol 20 mg PO DAILY ', '9. Pantoprazole 40 mg PO Q12H ', '10. Rifaximin 550 mg PO BID ', '11. Sucralfate 1 gm PO QID ', '12. Gammagard Liquid NF (immune globulin (human) (IgG)) 10 % \nInjection monthly ', '13. Furosemide 20 mg PO DAILY Duration: 7 Days ', '14. Potassium Chloride 20 mEq PO DAILY Duration: 7 Days ', '15. Fleet Enema ___AILY:PRN constipation ', '16. Lactulose 30 mL PO TID \ngoal ___ BM per day until f/u with GI ']}