Ms. Smith was a seventy-one-year-old white female being admitted to the medical CCU/ICU from the ER with chief complaints of a ground-level fall, hypotension, and a wound on the abdomen.

Ms. Smith was a seventy-one-year-old white female being admitted to the medical CCU/ICU

from the ER with chief complaints of a ground-level fall, hypotension, and a wound on the

abdomen. A family member at the bedside at the time of admission stated that she was going to

pick the patient up for wound care this morning when she found her on the bathroom floor in

about two inches of water. The patient self-reports she fell trying to get up from the toilet just a

few moments before the family member’s arrival and cracked the tank of the toilet open when

she made an impact against it. Ms. Smith reports that she lives alone, that she is unable to get up

without assistance, and she did not have her cell phone with her which she usually keeps on her

in case of emergencies. The patient also reports that she has had a wound on her abdomen for

about two months now and has been seeing the wound care team in the outpatient clinic. The

wound was being treated with daily dressing changes completed by the patient or family, but she

was to be seen in the wound care clinic every Tuesday. Also, the patient was recently prescribed

Bactrim for the treatment of the wound by the wound care clinic provider, the antibiotic

treatment had been going well until the last few days she was experiencing a lot of nausea and

diarrhea, but she reports that she thought it may have been a virus or something she had eaten.

Ms. Smith had an extensive medical history including Falls, Chronic Obstructive Pulmonary

Disorder (COPD), Congestive Heart Failure (CHF), Atrial Fibrillation, Watchman Device

Implantation, Diabetes Mellitus Type 2 (DM2), Hypertension (HTN), Hyperlipidemia (HLD),

Transient Ischemic Attack (TIA), and Seizures all of which were provided per the patient, family

member, and previous medical records. Home and hospital fall prevention measures were

discussed with the patient and she said she would remove the rugs from her bathroom upon

returning. The home medications list was then reviewed with the patient and family with a list

the patient had supplied. While reconciling the medications, I noticed the patient was taking

Entresto, Lisinopril, Amlodipine, Hydrochlorothiazide, and Furosemide along with several other

medications. I confirmed with the patient that she was taking both the Hydrochlorothiazide and

the Furosemide, she stated that she had only been taking both for about a week since her last visit

with her cardiologist.

Her blood pressure had improved and remained stable following a two-liter bolus and continuous

maintenance fluids. She reported no chest pain, no headache, or dizziness, just generalized

fatigue and soreness following the fall. She had little bruising from the fall, and no obvious signs

of a head injury such as knots, bruising, or bleeding since she was unsure if she hit her head or

not. Head, neck, chest, abdomen, and pelvis CT were also negative for any acute findings. The

wound on her abdomen appeared healthy and was completely closed, she reported that before the

antibiotics the wound was red and had been draining a lot. Upon completion of the assessment,

all findings were reported to the primary provider, an immediate hold was placed on all blood

pressure medications, and the cardiology team was consulted for clarification of medication

management.

The cardiology team saw the patient later that evening and reviewed the medical record, the

patient was informed that she was not to be taking the hydrochlorothiazide and Furosemide