James Petrovsky was at his usual state until 3/12/2017 evening, he refused to walk or stand. When staff assisted him to stand, he dropped to the floor. The nursing assessment was completed, he was afebrile and no distress was noted. On the morning of 3/13/2017, still he refused to walk or stand and nurse was notified. Up on nursing assessment, he had shortness of breath with wheezing and his SPO2 was around 84% on room air.
He was sent to Vista East ER on 3/13/2017 by 911 due to respiratory distress and low oxygen saturations [84% spo2].
James Petrovsky was hospitalized from 3/13/17 to 3/18/2017 at vista East hospital for pneumonia and acute respiratory failure with hypercapnia. He received I. V antibiotics, I. V fluids, steroids, BIPAP and Nebulizer [Duo Neb] treatments. His WBC count was elevated with bandemia suggestive of infection and he was pan cultured. His EKG showed normal sinus rhythm with nonspecific changes, cardiac markers were negative and the lactic acid level was within the normal limits. The labs were negative for streptococcus pneumonia antigen & legionella antigen. The chest x ray and CT scan of chest was significant for interstitial, ground glass infiltrates, peribronchial thickening, and mediastinal lymphadenopathy. The blood & urine cultures were negative for infection. He had bronchoscopy on 3/15/2017, significant for tracheobronchial malacia and mucous plugging only and mucous plugs were removed during the bronchoscopy. During the hospitalization, guardian made the decision for DNR & DNI. He was continued on puree diet & honey thickened liquids, the chew & swallow evaluation recommended the same on 3/14/17. His liver enzymes were elevated during the hospitalization and the ultrasound of the liver was significant for fatty liver. His acute respiratory failure responded to the treatment, the BIPAP was gradually weaned to 2L oxygen by nasal cannula all the time. During the hospitalization, he received Cortisporin ear drops to left ear for ear infection. He was discharged to Kiley with the diagnosis of pneumonia and acute respiratory failure on 3/18/2017. His medical status remained same with respiratory failure in spite of the hospitalization & treatments up on the discharge on 3/18/17. He was discharged with oral antibiotics [Levaquin] for seven days for pneumonia; 3L oxygen by nasal cannula all the time, steroid inhaler twice a day, Duo Neb [ Albuterol & Ipratropium Nebulizer] treatments four times per day for chronic respiratory failure. …show more content…
His supervision was changed to medical one to one to keep the oxygen saturations above 90% with 3L oxygen. The DNR status from hospital was transferred to Kiley on 3/18/17 and remained on DNR at Kiley too.
At Kiley Center, he was continued Duo Nebulizer treatments four times per day, oxygen 3L by nasal cannula all the time for chronic respiratory failure and maintained on medical one to one supervision. He was unable to walk or stand due to respiratory distress and was getting short of breath even with positional change due to chronic respiratory failure.
The 2-D echocardiogram [portable] ordered to rule out any cardiac etiology for respiratory distress. The echo on 3/22/17 showed mild diastolic dysfunction with EF of 58%, small left ventricle chamber and had limited images only. He had repeat labs on 3/30/17, showed normal electrolytes, normal liver enzymes with mildly low albumin [3.1], normal CBC with normal white cell count [9.4] and normal thyroid functions [TSH1.41]. He
He was sent to Vista East ER on 3/13/2017 by 911 due to respiratory distress and low oxygen saturations [84% spo2].
James Petrovsky was hospitalized from 3/13/17 to 3/18/2017 at vista East hospital for pneumonia and acute respiratory failure with hypercapnia. He received I. V antibiotics, I. V fluids, steroids, BIPAP and Nebulizer [Duo Neb] treatments. His WBC count was elevated with bandemia suggestive of infection and he was pan cultured. His EKG showed normal sinus rhythm with nonspecific changes, cardiac markers were negative and the lactic acid level was within the normal limits. The labs were negative for streptococcus pneumonia antigen & legionella antigen. The chest x ray and CT scan of chest was significant for interstitial, ground glass infiltrates, peribronchial thickening, and mediastinal lymphadenopathy. The blood & urine cultures were negative for infection. He had bronchoscopy on 3/15/2017, significant for tracheobronchial malacia and mucous plugging only and mucous plugs were removed during the bronchoscopy. During the hospitalization, guardian made the decision for DNR & DNI. He was continued on puree diet & honey thickened liquids, the chew & swallow evaluation recommended the same on 3/14/17. His liver enzymes were elevated during the hospitalization and the ultrasound of the liver was significant for fatty liver. His acute respiratory failure responded to the treatment, the BIPAP was gradually weaned to 2L oxygen by nasal cannula all the time. During the hospitalization, he received Cortisporin ear drops to left ear for ear infection. He was discharged to Kiley with the diagnosis of pneumonia and acute respiratory failure on 3/18/2017. His medical status remained same with respiratory failure in spite of the hospitalization & treatments up on the discharge on 3/18/17. He was discharged with oral antibiotics [Levaquin] for seven days for pneumonia; 3L oxygen by nasal cannula all the time, steroid inhaler twice a day, Duo Neb [ Albuterol & Ipratropium Nebulizer] treatments four times per day for chronic respiratory failure. …show more content…
His supervision was changed to medical one to one to keep the oxygen saturations above 90% with 3L oxygen. The DNR status from hospital was transferred to Kiley on 3/18/17 and remained on DNR at Kiley too.
At Kiley Center, he was continued Duo Nebulizer treatments four times per day, oxygen 3L by nasal cannula all the time for chronic respiratory failure and maintained on medical one to one supervision. He was unable to walk or stand due to respiratory distress and was getting short of breath even with positional change due to chronic respiratory failure.
The 2-D echocardiogram [portable] ordered to rule out any cardiac etiology for respiratory distress. The echo on 3/22/17 showed mild diastolic dysfunction with EF of 58%, small left ventricle chamber and had limited images only. He had repeat labs on 3/30/17, showed normal electrolytes, normal liver enzymes with mildly low albumin [3.1], normal CBC with normal white cell count [9.4] and normal thyroid functions [TSH1.41]. He