| Louis, Ashanti |
| MRN: 423143 | Room: 776 | DOB: 6/24/1957 | Age: 68 | Gender: Female | Allergies: Augmentin (diarrhea), Dapagliflozin (rash) |
| Setting | Intermediate Care Unit (IMCU) | ||
| Scenario | Please see clinical note. As a member of the care team, please address pharmacotherapy recommendations with regard to targeted treatment of her meningitis as well as her other disease states, in order to optimize this patient’s care both in the hospital and at discharge. The pharmacist was specifically consulted to dose vancomycin for this patient. | ||
| Admission note taken on 10/19/25 | |||
| CC | “My wife is confused and out of it.” | ||
| HPI | Ashanti Louis is a 68 yo female patient brought to the ED by her husband and daughter for decreased level of consciousness, fever, and confusion. According to her husband she had been complaining of lack of energy and being tired for about a month but overall was in her usual state of health and independent with all activities. In fact, yesterday Mrs. Louis had volunteered at her local women's shelter and spent some time watching her 3 grandchildren. The morning of admission she claimed she was not feeling well and thought she might be picking up a cold. Her husband noted she only had a little tea for breakfast. She developed a fever and a headache and went to lay down and rest for a bit. When her husband went in to check on her about an hour later, he found her hard to arouse, confused and talking nonsense. He called his daughter, and they brought Mrs. Louis to the ER. | ||
| PMH |
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| Social History |
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Family History |
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| Vaccine History |
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Surgical History |
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| Physical Exam |
Review of Systems (source: husband)
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| Test Name | 10/19/25 | 12/23/24 | Range |
| Sodium (Na+) | 137 | 142 | 136-145 mEq/L |
| Potassium (K+) | 3.1 | 3.8 | 3.5-5 mEq/L |
| Chloride (Cl-) | 104 | 105 | 98-106 mEq/L |
| Bicarbonate (HCO3-) | 20 | 25 | 23-28 mEq/L |
| Urea nitrogen (BUN) | 59 | 15 | 8-20 mg/dL |
| Creatinine | 2.2 | 1.6 | 0.5-1.3 mg/dL |
| Glucose | 148 | 125 | 70-115 mg/dL |
| Hemoglobin A1c | 7.5 | 7.6 | 5.3-7.5 % |
| Calcium,Total | 8.2 | 8.7 | 8.6-10.2 mg/dL |
| Phosphate | 3.4 | 4.2 | 3-4.5 mg/dL |
| Magnesium | 2.0 | 2.6 | 1.6-2.6 mEq/L |
| Protein, total | 5.5-9 g/dL | ||
| Albumin | 3.3 | 3.4 | 3.5-5.5 g/dL |
| Aminotransferase,aspartate (AST) | 17 | 26 | 10-40 units/L |
| Aminotransferase,alanine (ALT) | 26 | 34 | 10-40 units/L |
| Lactic dehydrogenase (LDH) | 80-225 units/L | ||
| Alkaline phosphatase | 99 | 79 | 30-120 units/L |
| Bilirubin, Total | 0.7 | 0.6 | 0.3-1 mg/dL |
| Leukocytes (WBC) | 22.9 | 7.93 | 4.5-11 x103/mcL |
| Red blood cells (RBC), Female | 3.8 | 4.45 | 4.3-5.7 x108/mcL |
| Hemoglobin, Female | 8.7 | 12 | 12-16 g/dL |
| Hematocrit, Female | 30 | 39 | 37-47 % |
| Mean corpuscular hemoglobin (MCH) | 19.5 | 28.8 | 27-33 picogram |
| Mean corpuscular volume (MCV) | 67.8 | 87.6 | 76-100 mcm3 |
| Platelets | 313 | 263 | 150-450 x103/mcL |
| International normalized ratio (INR) | 1.0 | 0.8-1.2 | |
| Prothrombin time (PT) | 9.5-11.3 sec | ||
| Partial thromboplastin time,activated (aPTT) | 25-35 sec |
| Additional Labs: |
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| Cultures: |
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| Imaging Studies: |
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| Medication History |
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| Patient Name: Louis, Ashanti Date of Birth: 6/24/1957 Room#: 776 |
Allergies: |
Immunization History: |
| Community Rx Info: Rx Insurance: |
Social History: |
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| Additional Notes: | ||
STRENGTH DF |
ROUTE FREQ |
DOSE (date/time) |
EFFECTS |
ACTION |
REASON |
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| Action Key: C = Continue, D = Discontinue*, H = Hold*, M = Modify* *must provide reason |
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| Medication | 10/19/25 |
| NaCl 0.9% 75 mL/hr IV continuous | 8:57 |
| Ceftriaxone 2,000 mg IV Q24H Rate: 100 mL/hr | 9:47 |
| Vancomycin 1,000 mg IV once Rate: 250 mL/hr | 10:20 |
| Acyclovir 990 mg IV Q12H Rate: 150 mL/hr | 10:19 |
| Enoxaparin 40 mg SC QD | |
| Pantoprazole 40 mg IV QD Rate: 400 mL/hr | |
| Acetaminophen 1,000 mg PO Q6H PRN PRN mild pain (1-3) | |
| Ondansetron 4 mg IV Q8H PRN PRN nausea/vomiting Rate: 1 mL/min | |
| Fentanyl 25 mcg IV Q4H PRN PRN severe pain (7-10) Rate: 0.25 mL/min | |
| Lactated Ringers 3,000 mL IV once | 7:28 |
| Dexamethasone 10 mg IV once | 8:53 |
| Hospital Medications | ||||||
| Medication | Instructions | Comments | Continue | Modify | Discontinue | New Rx sent |
| Previous Home Medications | ||||||
| Medication | Instructions | Comments | Continue | Modify | Discontinue | New Rx sent |
| 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 | |||||
| Patient Name: Louis, Ashanti | Date of Birth: 6/24/1957 | Room: 776 |
| Medication (name/strength) | Dose | Route | Frequency | Notes |