View Patient Profiles

Schmidt, Rebecca

MRN: 191007

Room: 366

DOB: 7/14/1945

Age: 80

Gender: Female

Allergies: Penicillins (GI upset), Levofloxacin (tendon rupture)

Admit Notes

Clinical Notes

Vitals

Labs, Cultures, Imaging

Clinical Calculators

MAR

Current Orders

Home Med List

Med Reconciliation

Discharge Planning

Setting	Adult Medicine Unit
Scenario	Today, RS is diagnosed with a urinary tract infection based on her clinical presentation, urinalysis, and urine culture. The medical team asks you, as the family medicine pharmacist, for recommendations in regards to antibiotics and any other suggestions regarding RS’s care.
Admission note taken on 10/18/25
CC	“I feel feverish and my lower back pain has been worsening over the last couple of days.”
HPI	RS presents to the emergency department from home with her daughter at 0730 on 9/5/2019. The patient complains of generalized bilateral flank pain. The pain has been coming and going for the last day and a half. RS states that she has a decrease in appetite as well as an increase in nausea. In the emergency department, the provider is concerned for a urinary tract infection, obtains urine and blood cultures, and initiates ceftriaxone. In addition, the provider ordered a complete blood count, comprehensive metabolic panel, and urinalysis. RS is transferred to the medical floor for further management.
PMH	Pyelonephritis, recurrent Atrial fibrillation Hypertension Type 2 diabetes Rheumatoid arthritis GERD CKD stage 3B DVT (6 years ago)
Social History	Alcohol: Denies Tobacco: 25 pack year history, smokes 1/2 pack per day, 1st cigarette 4 hours after waking Illicit drugs: Denies Employment: Retired from IBM 14 years ago Marital status: Married for 58 years; spouse deceased Housing: Single family home; lives alone Transportation: Does not drive; relies on daughter who works	Family History	Mother died of natural causes at age 90 Father died of myocardial infarction at age 88 Sister, age 75, living with type 2 diabetes mellitus
Vaccine History	Received all recommended childhood and adolescent immunizations through age 18. Td (2 years ago), Tdap (12 years ago) Influenza (2 years ago) VAR: history of varicella infection as a child, RZV (2 doses, 1 year ago) PCV13 (14 years ago), PPSV23 (13 years ago)	Surgical History	Right hip replacement (10 years ago) Tendon repaired (5 years ago)
Physical Exam	ROS: Positive for bilateral flank pain (pain score of 5), dysuria, urinary frequency, fever; denies dyspnea on exertion, dry cough, fatigue, headache, chest pain, diarrhea General: Overweight female in mild distress HEENT: Conjunctiva clear, mucosal membranes appear wet and moist; no palpable lymphadenopathy Pulmonary: No rhonchi/crackles Cardiovascular: Negative JVD; tachycardic without murmurs/rubs/gallops Abdomen: normal bowel sounds Genitourinary: WNL Extremities: No pitting edema Neuro: AO X 3

Clinical Laboratory Report

Test Name	10/20/25	10/19/25	10/18/25	09/14/25	Range
Sodium (Na⁺)	140	140	141	139	136-145 mEq/L
Potassium (K⁺)	4	3.9	4.2	3.8	3.5-5 mEq/L
Chloride (Cl^-)	99	99	101	102	98-106 mEq/L
Bicarbonate (HCO₃^-)	23	22	25	24	23-28 mEq/L
Urea nitrogen (BUN)	16	16	20	17	8-20 mg/dL
Creatinine	1.6	1.6	1.7	1.5	0.5-1.3 mg/dL
Glucose	114	115	123	117	70-115 mg/dL
Hemoglobin A1c				6.6	5.3-7.5 %
Calcium,Total	8.6	8.9	8.7	8.7	8.6-10.2 mg/dL
Phosphate	3.1	3	3.3	3.2	3-4.5 mg/dL
Magnesium	1.9	2	2	2	1.6-2.6 mEq/L
Protein, total	5.5	5.6	5.6	5.7	5.5-9 g/dL
Albumin	3	3	2.9	3.4	3.5-5.5 g/dL
Aminotransferase,aspartate (AST)	18	17	20	19	10-40 units/L
Aminotransferase,alanine (ALT)	31	30	32	32	10-40 units/L
Lactic dehydrogenase (LDH)	94	95	95	94	80-225 units/L
Alkaline phosphatase	50	50	52	53	30-120 units/L
Bilirubin, Total	1.2	1.2	1.2	1.2	0.3-1 mg/dL
Leukocytes (WBC)	15	15.5	18	7.4	4.5-11 x10³/mcL
Red blood cells (RBC), Female	4.5	4.5	4.6	4.6	4.3-5.7 x10⁸/mcL
Hemoglobin, Female	12.1	11.7	12.2	12.4	12-16 g/dL
Hematocrit, Female	31	31	33	32	37-47 %
Mean corpuscular hemoglobin (MCH)	32	31	30	31	27-33 picogram
Mean corpuscular volume (MCV)	88	87	90	89	76-100 mcm³
Platelets	220	226	210	232	150-450 x10³/mcL
International normalized ratio (INR)	1.0	1	1.1	1.0	0.8-1.2
Prothrombin time (PT)	11.8	12.2	10.5	10.3	9.5-11.3 sec
Partial thromboplastin time,activated (aPTT)	30	29	30	28	25-35 sec

Additional Labs:

Fasting Lipid Panel (1 month ago)	Result
Total cholesterol (mg/dL)	150
LDL (mg/dL)	86
HDL (mg/dL)	60
Triglycerides (mg/dL)	133

Other Labs	Date	Result
MRSA nares screening	Yesterday	Negative

Urinalysis (1 day ago)	Result
Specific Gravity	1.015
Color	Dark yellow
Clarity	Cloudy
Leukocyte Esterase	Positive
Nitrite	Positive
Protein	30 mg/dL
Glucose	Negative
Ketone	Negative
Hemoglobin	Moderate
pH	5.0
Squamous epithelial	3/HPF
RBC	45/HPF
WBC	960/HPF
Bacteria per high-power field	4+
Mucous	Occasional

Cultures:

Microbiology	Date	Stain & Culture
Urine culture	Collected: 3 days ago Finalized: today	>100,000 CFU/mL Klebsiella pneumoniae Ampicillin/sulbactam – Resistant Ampicillin – Resistant Cefazolin – Resistant Cefepime – Resistant Ceftriaxone - Resistant Ceftazidime/avibactam – Susceptible Ciprofloxacin - Susceptible Ertapenem – Resistant Gentamicin – Intermediate Meropenem – Resistant Nitrofurantoin – Susceptible Piperacillin/tazobactam – Resistant Tobramycin – Intermediate Trimethoprim/sulfamethoxazole - Resistant
Blood culture, aerobic	Collected: 3 days ago	No growth at 72 hours
Blood culture, anaerobic	Collected: 3 days ago	No growth at 72 hours

Imaging Studies:

Test	Date	Result
EKG	3 days ago	Atrial fibrillation; QTc = 380 ms
CT abdomen/pelvis without contrast	3 days ago	No change from previous CT 2 months ago. No hydronephrosis, renal calculi or obstructing stone.

Vital Sign	10/20/25 07:24	23:45	17:14	10/19/25 07:13	23:58	17:47	10/18/25 08:25	09/14/25 08:11
Height (cm)	155			155			155	155
Weight (kg)	65.9			65			66	66
Body Temperature (°C)	38.1	39.2	38.8	38.4	37.7	37.7	38.5	37.1
Blood Pressure (mmHg)	135 / 85	130/81	132/80	132/80	135/86	135/86	134/86	129/81
Heart Rate (bpm)	105	100	100	99	92	93	92	75
Respiratory Rate (bpm)	16	16	16	17	18	17	18	17
Oxygen Saturation (%)	97	97	96	98	98	97	97	98

Current Orders

DRUG	DOSE	FREQ & TIME	PRN?

CONC	VOL	SOLN	RATE

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?

USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?
			PRN yes, SOB
USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?
			PRN yes, pain (1-3) or fever > 38⁰C
USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?
			PRN yes, pain (4-6)
USE	START DATE	STOP DATE	NOTES

DRUG	DOSE	FREQ & TIME	PRN?
			PRN yes, pain (7-10)
USE	START DATE	STOP DATE	NOTES

Medication
History

RS reports she rarely misses any doses of her medications.
According to the patient’s daughter and confirmed with the prescription monitoring program, the patient takes oxycodone 1-2 times per week.
The patient’s prednisone and oxycodone dose have been stable and her rheumatoid arthritis is well controlled.
The patient reports that her GERD symptoms are well controlled with famotidine.
The patient has received five courses of intravenous antibiotics in the past year with the most recent treatment being 3 months ago.

Home Medication List: verified by pharmacy on admit (10/18/25)

Patient Name: Schmidt, Rebecca Date of Birth: 7/14/1945 Room#: 366	Allergies:	Immunization History:
Community Rx Info: Rx Insurance:	Social History:
Additional Notes:

DRUG STRENGTH DF	STRENGTH ROUTE FREQ	PRN?	MED REC ACTION
Albuterol Sulfate 108 mcg/puff HFA inhaler	1 puff PO Q4-6H	yes, SOB
Amlodipine 2.5 mg tablet	1 PO QD	no
Glipizide 2.5 mg tablet	1 PO QD	no
Metoprolol tartrate 25 mg tablet	1 PO BID	no
Oxycodone 5 mg tablet	1 PO BID	yes, severe pain
Prednisone 2.5 mg tablet	1 PO QD	no
Docusate/senna 50 mg/8.6 mg tablet	2 PO QD	no
Famotidine 20 mg tablet	1 PO BID	no
			Action Key: C = Continue, D = Discontinue^, H = Hold^, M = Modify^* ^*must provide reason

Medication	10/20/25	10/19/25	10/18/25
Ceftriaxone 1 g IV Q24H Rate: 100 mL/hr		08:30	08:31
Amlodipine 2.5 mg PO QD		09:57	09:35
Glipizide 2.5 mg PO QD		09:46	09:52
Prednisone 2.5 mg PO QD		09:16	09:39
Docusate/senna 100 mg/17.2 mg PO QD		09:42	09:22
Pantoprazole 40 mg PO QD		06:53	06:11
Enoxaparin 30 mg SC Q24H		09:45	09:39
Albuterol sulfate 108 mcg PO Q4H PRN PRN yes, SOB
Acetaminophen 500 mg PO Q6H PRN PRN yes, pain (1-3) or fever > 38⁰C
Hydrocodone/acetaminophen 5 mg/325 mg PO BID PRN PRN yes, pain (4-6)
Oxycodone 5 mg PO BID PRN PRN yes, pain (7-10)

Clinical Notes

Medication Discharge Orders

Hospital Medications
Medication	Instructions	Comments	Continue	Modify	Discontinue	New Rx sent

Previous Home Medications
Medication	Instructions	Comments	Continue	Modify	Discontinue	New Rx sent

Discharge Planning - Medication List and Instructions

Patient Name:
Admission Date:	Discharge Date:	Service:
Principle Diagnosis on Admission:
Secondary Diagnosis:
Allergies:

Medications ADDED this visit: (begin taking these)	Medications CHANGED this visit: (modify what you were taking)	Medications STOPPED this visit: (stop taking these)

Final Discharge Medication List
Medication/Route/Dosage/Frequency/Duration	Comments	Morning	Afternoon	Evening	Bedtime










As Needed Medications

Medication Reconciliation - Finalized Medication List

Patient Name: Schmidt, Rebecca

Date of Birth: 7/14/1945

Room: 366

Medication (name/strength)	Dose	Route	Frequency	Notes

Height	155 cm
Actual Body Weight (ABW)	65.9 kg
Ideal Body Weight (IBW)	47.8 kg
ABW % of IBW	138 %
Adjusted Body Weight (AjBW)	55 kg
Body Surface Area (BSA)	1.68 m²
Body Mass Index (BMI)	27.4 kg/m²