Author Pei ChungAnderson HealthcareJuly 2nd, 2024 2:47pm

Note Date/Time July 2nd, 2024 2:47pm

Anderson Hospital 6800 State Route 162 Maryville, IL 62062 General Surgery Progress Note SignedPatient: Towell,Alexnder R MR#: M000499848 DOB: 08/04/1975 Acct:V00003676858Age: 48 ADM Date: 07/01/24 Loc: ANH3MEDSUR 303-01 Attending Dr: Pei Chang Chung M.D.cc: ~Progress Note: A&PAssessment and Plan(1) Adenocarcinoma of small bowel: Code(s):C17.9 - Malignant neoplasm of small intestine, unspecified Status: Acute Assessment and

Plan: doing well, await path, ADAT, cont encourage OOB/ISSubjectiveSubjectiveDate/Time Seen: 07/02/24 14:46Interval history: feels pretty good, up and ambulating s issue, no bowel fxn, tol clearsReview of SystemsReview of Systems: All systems reviewed & are unremarkable except as noted in HPI and below ExamConst: General: cooperative, comfortable and no acute distress GI: Inspection: normal to inspection, non-distended and incision GI Palp: Yes abdominal tenderness, Yes Soft to palpation, Yes Tenderness to palpation present (GI), No Guarding due to palpation present (GI) and No Rigid due to palpation Objective DataVital SignsVital Signs: Vital Signs - 24 hr 07/01/2415:49 07/01/2416:00 07/01/2416:15Temperature 36.5 C Pulse Rate 55 L 61 56 LRespiratory Rate 14 18 16Blood Pressure 117/62 113/58 L 126/66Pulse Oximetry 100 100 98Oxygen Delivery Simple FaceMask Simple FaceMask Room AirOxygen Flow Rate 8 8 07/01/2416:30 07/01/2416:45 07/01/2417:00Temperature Pulse Rate 66 70 77Respiratory Rate 18 16 18Blood Pressure 119/60 123/74 123/70Pulse Oximetry 96 100 100Oxygen Delivery Room Air Room Air Room AirOxygen Flow Rate 07/01/2417:20 07/01/2417:35 07/01/2418:05Temperature 36.0 C L 36.0 C L 36.0 C LPulse Rate 71 74 60Respiratory Rate 18 16 18Blood Pressure 139/56 L 150/58 H 141/58 HPulse Oximetry 97 99 98Oxygen Delivery Oxygen Flow Rate 07/01/2419:07 07/01/2420:00 07/01/2420:00Temperature 36.3 C L 36.3 C LPulse Rate 57 L 68Respiratory Rate 18 17Blood Pressure 132/55 L 122/64Pulse Oximetry 98 100 100Oxygen Delivery Room Air Oxygen Flow Rate 07/01/2423:57 07/02/2404:00 07/02/2408:00Temperature 36.9 C 36.6 C 36.0 C LPulse Rate 63 72 50 LRespiratory Rate 18 16 16Blood Pressure 113/62 123/63 125/65Pulse Oximetry 99 99 100Oxygen Delivery Oxygen Flow Rate 07/02/2408:00 07/02/2411:48Temperature 36.1 C LPulse Rate 58 LRespiratory Rate 16Blood Pressure 127/70Pulse Oximetry 99Oxygen Delivery Room Air Oxygen Flow Rate Intake/OutputIntake/Output: Intake & Output 06/29/24 06/30/24 07/01/24 07/02/24 23:59 23:59 23:59 23:59Intake Total 300 1050Output Total 550Balance 300 500Meds/ResultsMedications: Active MedicationsGeneric Name Dose Route Start Last Admin Trade Name Freq PRN Reason Stop Dose AdminHydrocodone Bitart/Acetaminophen 1 tab 07/01/24 15:35 07/02/24 06:21 Hydrocodone/Acetaminophen (*Crx) 5-325 Mg Tablet PO 1 tab Q4H PRN Administration Pain Rated 4-6 Enoxaparin Sodium 40 mg 07/02/24 09:00 07/02/24 08:05 Enoxaparin 40 Mg/0.4 Ml Syringe SUB-Q 40 mg DAILY SCH AdministrationFamotidine 20 mg 07/01/24 21:00 07/02/24 08:05 Famotidine 20 Mg/2 Ml Vial IV PUSH 20 mg Q12HR SCH AdministrationFentanyl Citrate 25 mcg 07/01/24 16:00 Fentanyl Citrate Inj (*Crx) 100 Mcg/2 Ml Vial IV PUSH Q2M PRN Pain Hydromorphone HCl 1 mg 07/01/24 17:16 Hydromorphone Hcl Inj (*Crx) 1 Mg/Ml Syr IV PUSH Q2H PRN Breakthrough Pain Rated 7-10 or NPO Hydromorphone HCl 0.5 mg 07/01/24 15:35 Hydromorphone Hcl Inj (*Crx) 1 Mg/Ml Syr IV PUSH Q2H PRN Breakthrough Pain Rated 4-6 or NPO Lactated Ringer’s 1,000 mls @ 100 mls/hr 07/01/24 15:35 07/02/24 10:18 Lr - Lactated Ringers Iv IV CONT 100 mls/hr .Q10H SCH AdministrationIbuprofen 800 mg in 200 mls @ 400 mls/hr 07/01/24 15:35 Caldolor 800 Mg/200 Ml IVPB Q6H PRN Breakthrough Pain Rated 1-3 or NPO Levothyroxine Sodium 100 mcg 07/02/24 06:30 07/02/24 05:17 Levothyroxine Sodium 100 Mcg Tablet PO 100 mcg DAILY@0630 SCH AdministrationNaloxone HCl 0.1 mg 07/01/24 15:35 Naloxone Hcl 0.4 Mg/Ml Vial IV PUSH Q2M PRN Opiate Reversal Ondansetron HCl 4 mg 07/01/24 15:35 Ondansetron Inj 4 Mg/2 Ml Vial IV PUSH Q4H PRN Nausea And Vomiting Radiology Results: ITS ImpressionsAbdomen X-Ray 07/01/24 15:32

IMPRESSION: No foreign body detected.LabsLabs: Laboratory Results - last 24 hr 07/02/24 06:04WBC 10.5 HRBC 4.37 LHgb 12.3 LHct 38.7 LMCV 88.6MCH 28.1MCHC 31.8 LRDW 17.1 HPlt Count 216MPV 11.0 HSodium 139Potassium 3.9Chloride 105Carbon Dioxide 23Anion Gap 11BUN 11 DCreatinine 1.00Estim Creat Clear Calc 90Estimated GFR > 60Glucose 113 HCalcium 9.2This report may have been done utilizing a voice recognition system. Attempts have been made to correct errors. However, there may be uncorrected grammatical,spelling, and recognition errors present.Report Initialized date/time: Chung, Pei Chang MD 07/02/24 / 1447Electronically signed by: Chung, Pei Chang MD 07/02/24 1447