Whitlow discharge packet Jan 2025
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1740 Hensley Fork Drive NW
Cleveland, TN 37311
Whitlow Memorial Hospital (423) 555-0138
whitlowmemorial.example
Discharge Packet
Pruitt, Lorraine M. · MRN WM-0733916 · discharged 01/18/2025 · page 1 of 10
Face sheet
Patient: Lorraine M. Pruitt Date of birth: 02/11/1945 Sex: F MRN: WM-0733916
Address: 2217 Larkmoor Lane NW, Cleveland, TN 37312 Home phone: (423) 555-0162
Admitted: 01/14/2025, 7:52 AM, through the Emergency Department Room: 2 West, 226
Discharged: 01/18/2025, 11:40 AM, to home, with family
Attending: Priya Nambiar, MD, Hospital Medicine Cardiology: Nadia Rahimi, MD
Primary care: Samuel Tolbert, MD
Insurance Plan Member number
Primary Medicare Part A and Part B 4KT7-WL2-MS63
Secondary Evermont Health Assurance, Medicare Supplement Plan G EVG80447162
Allergies: penicillins (hives); sulfonamide antibiotics (rash, lip swelling).
Intolerances: codeine (vomiting); lisinopril (cough). Adhesive tape tears her skin; use paper
tape.
Code status this admission: full code. Advance care plan on file, dated 03/14/2023.
Health care agent: Walter E. Pruitt Jr., son, (423) 555-0148. Alternate: Russell D. Pruitt,
son, (423) 555-0124.
Preferred pharmacy: Sorrelwood Pharmacy, 3410 Keelwood Street NW, Cleveland, (423)
555-0130
In this packet
Face sheet, page 1. Discharge summary, 2. Your medication list, 3. About the medicines that
changed, 4. Living with heart failure: your daily plan, 5. Eating less salt and limiting fluids, 6.
Daily weight log, 7. Follow-up appointments and results still pending, 8. Your rights, your
records and your bill, 9. Acknowledgment, 10.
Pruitt, Lorraine M. · MRN WM-0733916 · discharged 01/18/2025 · page 2 of 10
Discharge summary
Diagnoses
1. Acute on chronic heart failure with preserved ejection fraction
2. Atrial fibrillation, rate controlled, on apixaban
3. Type 2 diabetes on basal insulin
4. Chronic kidney disease stage 3b
5. Hypertension
6. Hypothyroidism, osteoporosis, glaucoma
Hospital course
79-year-old woman admitted with three days of shortness of breath, inability to lie flat and leg
swelling. Weight on admission 159 lb. BNP 1,240. Chest x-ray showed pulmonary congestion.
Echocardiogram on 01/15: ejection fraction 55 to 60%, grade 2 diastolic dysfunction, no
significant valve disease. Treated with intravenous furosemide with a net loss of 11 lb over four
days. Amlodipine was stopped because it was adding to the leg swelling; blood pressure stayed
controlled without it. Blood sugars ran 140 to 210 on her home insulin dose. No chest pain;
troponin negative twice. On the day of discharge she walked 150 feet with her walker without
shortness of breath. Oxygen saturation 96% on room air.
Condition at discharge
Stable. Lungs clear. Trace ankle swelling. Alert, and at her usual level of thinking according to
her son.
Measured on 01/18/2025 Result
Weight 148 lb
Blood pressure 124/68
Heart rate 72, irregular
Creatinine 1.6 mg/dL
Potassium 3.9 mmol/L
Sodium 137 mmol/L
BNP 410 pg/mL
Hemoglobin A1c (01/15/2025) 8.6 %
P. Nambiar, MD, Hospital Medicine. Dictated 01/18/2025.
Pruitt, Lorraine M. · MRN WM-0733916 · discharged 01/18/2025 · page 3 of 10
Your medication list
This list replaces every older list.
Medication Dose When What to do
Furosemide (Lasix) 40 mg every morning CHANGED from 20
mg
Potassium chloride ER 10 mEq once a day for 7 days NEW, then stop
Amlodipine 5 mg STOP
Apixaban (Eliquis) 5 mg twice a day continue
Metoprolol succinate 50 mg every morning continue
ER
Losartan 50 mg every morning continue
Insulin glargine 14 units at bedtime continue
(Lantus)
Metformin 500 mg twice a day with meals continue
Levothyroxine 88 mcg every morning, empty continue
stomach
Atorvastatin 40 mg at bedtime continue
Sertraline 50 mg every morning continue
Famotidine 20 mg at bedtime continue
Gabapentin 300 mg at bedtime continue
Latanoprost eye drops 1 drop each at bedtime continue
eye
Denosumab (Prolia) 60 mg every 6 months next due March 2025
Vitamin D3 2000 IU once a day continue
Acetaminophen 500 mg if needed, 3 a day at most continue
Do not take ibuprofen, naproxen or aspirin for pain. Morning doses were given in the hospital
on 01/18/2025. Reviewed with Walter Pruitt Jr., son and health care agent, by T. Okafor, RN,
and J. Whitson, PharmD.
Pruitt, Lorraine M. · MRN WM-0733916 · discharged 01/18/2025 · page 4 of 10
About the medicines that changed
Furosemide (Lasix), a water pill
Furosemide makes the kidneys pass more salt and water. It is the medicine that keeps fluid out
of the lungs and legs. Give it in the morning so that trips to the bathroom are over before
bedtime. Stand up slowly; it can cause dizziness, especially in the first week at a new dose. Call
the cardiology office for dizziness that does not pass, for muscle cramps, or if she is passing
very little urine.
Furosemide can lower potassium and can strain the kidneys if she becomes too dry. That is
why blood is checked on 01/24/2025 and again at the cardiology visit.
Potassium chloride, for 7 days only
Take with food and a full glass of water. Do not crush. Stop after the seventh day unless the
office tells you otherwise after the blood test.
Amlodipine, stopped
Amlodipine is a blood pressure medicine that often causes ankle swelling. It has been stopped.
Remove it from the pill organizer and from the cabinet. Her blood pressure is being controlled
by losartan and metoprolol. Check her blood pressure at home three times a week and bring
the numbers to her visits.
Apixaban (Eliquis), not changed
Apixaban lowers the risk of stroke from atrial fibrillation. Do not skip a dose and do not double
a dose. Call for bleeding that does not stop in 10 minutes, black stools, or a fall with a blow to
the head.
Insulin glargine (Lantus), not changed
Her bedtime dose stays the same. Appetite is often poor for a few days after a hospital stay. If
she eats less than half of her meals for a day, check her blood sugar before the bedtime dose
and call the endocrinology office for any reading under 100 at bedtime or under 80 at any time.
Pruitt, Lorraine M. · MRN WM-0733916 · discharged 01/18/2025 · page 5 of 10
Living with heart failure: your daily plan
Heart failure does not mean the heart has stopped. In Mrs. Pruitt's case the heart squeezes
normally but is stiff and does not fill well, so fluid backs up into the lungs and the legs. The
water pill removes that fluid. Weight is the earliest sign that fluid is coming back, usually days
before the breathing gets worse.
Every morning
1. Weigh after using the bathroom and before breakfast, in the same clothes, on the same
scale, on a hard floor.
2. Write the weight on the log on page 7.
3. Look at both ankles and press a thumb over the shin bone for five seconds. A dent that stays
is swelling.
4. Ask whether she is more short of breath than yesterday, and whether she needed more
pillows to sleep.
Her dry weight at discharge is 148 lb. This is the weight to compare against. The cardiology
office may reset it from time to time.
Green zone: no action needed
Weight within 2 lb of dry weight. No new swelling. Breathing as usual. Keep giving her
medicines as listed on page 3.
Yellow zone: act today
Weight up 3 lb or more from the day before, or 5 lb or more in one week
New or increased swelling of the ankles, legs or belly
More short of breath with usual activity, a new cough at night, or needing an extra pillow
In the yellow zone give one extra furosemide 20 mg tablet that day (a supply of 20 mg tablets is
included with her discharge prescriptions for this purpose) and call Sourwood Heart &
Vascular the same day, (423) 555-0176. Do not give the extra tablet more than two days in a
row without speaking to the office.
Red zone: call 911
Struggling to breathe at rest, or unable to speak a full sentence
Chest pain or pressure that lasts more than a few minutes
Fainting, or new confusion with a fast heartbeat
Coughing up pink, frothy mucus
Pruitt, Lorraine M. · MRN WM-0733916 · discharged 01/18/2025 · page 6 of 10
Eating less salt and limiting fluids
Sodium: no more than 2,000 mg a day. Fluids: no more than 1.5 liters a day, which is about
6 cups of 8 ounces.
Salt makes the body hold water. Most of the salt people eat is already in the food when they buy
it, not added from the shaker. Read the Nutrition Facts label: look at the milligrams of sodium
per serving, and then at how small the serving is.
Usually high in sodium A better choice
Canned soup, bouillon, broth Homemade soup with no-salt-added tomatoes or
stock
Canned vegetables Frozen vegetables, or cans marked "no salt added"
Saltines, chips, pretzels Unsalted-top crackers, unsalted nuts
Ham, bacon, sausage, hot dogs, lunch meat Fresh chicken, fish, pork or beef cooked at home
Pickles, olives, sauerkraut Fresh cucumber, vinegar slaw
Tomato and vegetable juice Low-sodium juice, or fruit
Frozen dinners, boxed rice and noodle Plain rice or noodles, seasoned at home
mixes
Soy sauce, ketchup, bottled dressings Lemon, vinegar, herbs, salt-free seasoning blends
Do not use a salt substitute made with potassium unless her doctor says so.
Counting fluids
Everything that is liquid at room temperature counts: water, coffee, tea, milk, juice, soup, ice
cream, gelatin and ice. Six cups a day is the limit. Many families set out the day's cups or mark
a pitcher in the morning. If her mouth is dry, try hard candy, frozen grapes or rinsing without
swallowing.
Do not cut fluids below the limit to make the weight look better. Too little fluid is hard on the
kidneys.
A dietitian visit can be arranged by her primary care office and is covered by Medicare for
patients with diabetes or kidney disease.
Pruitt, Lorraine M. · MRN WM-0733916 · discharged 01/18/2025 · page 7 of 10
Daily weight log
Weigh every morning. Bring this page to every visit. Ask the office for more copies.
Date Weight, Swelling (none, some, a Breathing (same, Extra tablet
lb lot) worse) given?
1/19 148 none same no
1/20 148 none same no
1/21 149 none same no
1/22 148
Weight on the hospital scale at discharge, 01/18/2025: 148 lb. Home scales differ. Weigh at
home on the first morning and use that number as her starting weight if it is different from
ours.
If you call about a weight gain, have ready: today's weight, yesterday's weight, the weight one
week ago, and whether the extra tablet has been given.
Pruitt, Lorraine M. · MRN WM-0733916 · discharged 01/18/2025 · page 8 of 10
Follow-up appointments and results still pending
With When Where For
Samuel 01/24/2025, 2:15 Tolbert & Greer Internal Hospital follow-up, with a basic
Tolbert, PM Medicine, 1180 Paulmont metabolic panel the same day
MD Parkway NW
Nadia 02/04/2025, Sourwood Heart & Vascular, Heart failure visit, with a
Rahimi, 10:20 AM 1740 Hensley Fork Drive NW repeat echocardiogram
MD
Mei-Ling March 2025, Longbranch Nephrology Kidney function
Tsai, MD already scheduled
If she cannot keep an appointment, call the office to move it. Do not skip the blood test on
01/24.
Results still pending
Thyroid stimulating hormone, drawn 01/17/2025. The result will go to Dr. Tolbert.
Activity
Walk every day, a little farther each day, with the walker. Rest when short of breath. No lifting
over 10 pounds for two weeks. She may shower with help. She should not drive until Dr.
Tolbert has seen her.
Help at home
Home health nursing was offered and declined. The family has a private home care aide three
mornings a week and a medical alert pendant. A referral can be made later through primary
care if her needs change.
When to come back to the Emergency Department
Shortness of breath at rest, chest pain, fainting, a fall with injury, black or bloody stools, or a
blood sugar under 60 that does not come up with juice.
Pruitt, Lorraine M. · MRN WM-0733916 · discharged 01/18/2025 · page 9 of 10
Your rights, your records and your bill
Your records
The discharge summary and test results from this stay are sent to your primary care doctor and
to the specialists named on the face sheet. You, or a person you have authorized, can see them
in the MyWhitlow patient portal about three days after discharge. A proxy who holds a health
care power of attorney on file with the hospital may sign in with his or her own account. Paper
copies are available from Health Information Management, (423) 555-0138, option 4. There is
no charge for a copy sent to another doctor.
An important message from Medicare
As a hospital inpatient covered by Medicare, you have the right to receive the services you
need, to be involved in decisions about your stay, and to appeal if you think you are being
discharged too soon. This notice was given on 01/14/2025 and again on 01/17/2025. No appeal
was filed.
Your bill
The hospital bills Medicare first and then any supplemental plan on file. You will receive a
statement only after both have processed the claim, usually six to ten weeks after discharge.
Doctors who saw you in the hospital may bill separately. Questions about a bill go to Patient
Financial Services, (423) 555-0170, weekdays 8 to 4:30.
Advance directives
The hospital has on file an Appointment of Health Care Agent and Advance Care Plan dated
03/14/2023. If you change it, bring the new form to any registration desk.
Concerns
If you have a concern about your care, ask for the nurse manager of 2 West or call the Patient
Advocate, (423) 555-0138, option 7. You may also contact the Tennessee Department of
Health.
Pruitt, Lorraine M. · MRN WM-0733916 · discharged 01/18/2025 · page 10 of 10
Acknowledgment
I have received this discharge packet of 10 pages. The nurse went over the medication list on
page 3 and the heart failure plan on page 5 with me, and I had the chance to ask questions.
The patient was weighed on the unit scale this morning and the use of the weight log was
shown.
Prescriptions were sent electronically to Sorrelwood Pharmacy: furosemide 40 mg, 30
tablets; furosemide 20 mg, 10 tablets; potassium chloride ER 10 mEq, 7 tablets.
Belongings returned: glasses, upper denture and cup, hearing aids (2) with charger, robe,
walker, cell phone.
Intravenous line removed, site clean and dry. Identification band removed.
Signature of patient or representative
Walter E Pruitt Jr
Relationship son, health care agent
Date and time 01/18/2025, 11:25 AM
Nurse
T. Okafor RN
Left the unit by wheelchair at 11:40 AM with her son, by private vehicle.
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Values from records
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The record values this file is made from: the ones its text names with {{record.field}}, and the fields its template reads. A value here is in the file's source; whether it is readable depends on the look.
| Value | Now |
|---|---|
| lorraine.date_of_birth | 1945-02-11 |
| card-lorraine-medicare.identification_number | 4KT7-WL2-MS63 |
| card-lorraine-medigap.identification_number | EVG80447162 |
| hr-lorraine-2025-echo.date | 2025-02-04 |
The values at render time were not recorded: the file was rendered before files/rendered.json existed. Rendering it again records them.