CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 10 0000. ref SDS 7 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Meeting in Clinic Module 2 planned by Doctor Stewart during the
040902 - meeting on 151110 0130. ref SDS 10 IP42 Follows up, care by Lana last
040903 - Friday on 151211 0830. ref SDS 15 LX7H
040905 - ..
040906 - Visit Radiology get CD with files for xray and CT scan right wrist
040907 - performed on 151005. It was ordered on 151104 1315. ref SDS 9 PR4G
040909 - ..
040910 - Doctor Stewart did this meeting herself, without assistance of
040911 - resident. Could be that staff was allowed time off for Christmas.
040913 - ..
040914 - The doctor was caughing and sneezing, and did not look well. Doctor
040915 - Stewart said she cannot take time-off to recover, because there is
040916 - nobody else to care for her patients. She will take a week off-work
040917 - next week for the holidays, and hopes to rest and recover.
040919 - ..
040920 - Doctor Stewart asked how the wound is recovering?
040922 - ..
040923 - Reported improved progress, since switching to Hydrofera Blue
040924 - Bacterostatic dressing on 151130 0800. ref SDS 11 3Q8M
040925 -
040926 - [On 160418 0810 letter to Lana requesting re-supply of
040927 - Hydrofera Blue dressing for new debridement wound on big
040928 - toe left foot. ref SDS 17 NX45
040930 - ..
040931 - While we talked, a nurse came into the room. Doctor Stewart asked the
040932 - nurse if she can change the Hydrofera Blue wound dressing. The nurse
040933 - said she has never done it. The doctor asked the nurse to go find
040934 - Lana and advise she is needed to change the dressing.
040936 - ..
040937 - The nurse said that Lana is with another patient.
040939 - ..
040940 - Doctor Stewart said she can take 5 minutes to change this dressing.
040942 - ..
040943 - The nurse left the room to get Lana.
040945 - ..
040946 - While waiting for Lana, discussed issue of statin side effects causing
040947 - liver dysfunction shown by frequent urination, dehydration. Recently,
040948 - on 151215, Doctor Hewitson in Podiatry Biomechanics diagnosed rising
040949 - injuries to feet from dehydration. 151215 1000, ref SDS 16 MG6U
040950 - Bilirubin has been elevated the past 2 years while takig Atorvastatin
040951 - 10 mg.
040953 - ..
040954 - Doctor Stewart recommended discussing the matter with Doctor Simpson.
040956 - ..
040957 - He may be able to prescribe a statin with less severe side effects,
040958 - even though it does not lower LDL cholesterol to meet nominal
040959 - Cardiology goals. Since benefits of HDL 70, which enabled regression
040960 - of atherosclerotic plaques, shown by CCTA on 151019, ref SDS 8 JW8O,
040961 - and explained by Doctor Elicker on 151203, ref SDS 13 SZ5F, is
040962 - achieved through extended endurance exercise, here hiking 10,000 miles
040963 - the past 4 years, then elevated LDL lipid profile may be acceptable,
040964 - with follow up CCTA testing every 6 or 12 months that verifies
040965 - continuing evidence of no atherosclerotic plaques.
040967 - ..
040968 - About 3 minutes later, Lana came into the room. She brought with her
040969 - materials needed to change the dressing.
040971 - ..
040972 - Lana used scissors to cut existing bandaging from the lower left leg,
040973 - which she had placed last Friday on 151211 0830. ref SDS 15 LX7H
040974 - Since Lana was rushed to get back to her other patient, we did not
040975 - take pictures today showing progress of wound recovery.
040977 - ..
040978 - Doctor Stewart examined the open wound and commented healing is
040979 - occurring very well. She commended Lana for good work healing a
040980 - difficult wound, which was considered for surgical reconstruction
040981 - during the meeting on 151006 1315. ref SDS 7 LJ8N Today, the doctor
040982 - feels this will not be required, because the wound will fully recover
040983 - to match surrounding skin.
040985 - ..
040986 - Lana read wound dimensions for Doctor Stewart to report in Progress
040987 - Notes which she was typing with the computer in the examination room.
041000 - ..
041001 - Lana then cut a section of Hydrofera Blue Bacterostatic dressing to
041002 - fit the wound. She used a syringe to moisten with sterile liquid and
041003 - placed the moistened dressing to cover the hematoma wound on the lower
041004 - left leg. Doctor Stewart asked how to spell "Hydrofera Blue", so
041005 - helped her with spelling. Patient wrapped the dressing with 4" gauze
041006 - and then Kobin 4" elastic bandaging, which is protocol followed since
041007 - 150928. Lana then applied elastic netting to protect the bandaing
041008 - system.
041010 - ..
041011 - [On 160418 0810 letter to Lana requesting re-supply of
041012 - Hydrofera Blue dressing for new debridement wound on big
041013 - toe left foot. ref SDS 17 NX45
041015 - ..
041016 - After completing wound dressing, Lana scheduled next follow up in
041017 - Wound Care Clinic on Friday, 151218 0800.
041019 - ..
041020 - Lana again prescribed customer remove wrapping, apply moistening wound
041021 - dressing protocol, and wrap the Hydrofera Blue Bacterostatic wound
041022 - dressing again, on Thursday, 151217, as explained on 151207 0800.
041023 - ref SDS 14 1E3F This will be performed as done this past Sunday on
041024 - 151213, shown in case study on 140101 0600. ref SDS 1 MU6G
041026 - ..
041027 - Doctor Stewart thanked Lana for excellent work. Lana then rushed back
041028 - to her other patient. This work today demonstrated teamwork,
041029 - coordination, and collaboration among doctors implementing
041030 - doctor/patient partnership that optimizes outcomes.
041032 - ..
041033 - Doctor Stewart wants another follow up with surgery. She used the
041034 - computer in the examination room to enter in the VA schedule a
041035 - meeting on 160119.
041037 - ..
041038 - Thanked Doctor Stewart and commended Lana's work the past 3 months in
041039 - Wound Care Clinic.
041041 - ..
041042 - Wished Doctor Stewart Merry Christmas, and speedy recovery from her
041043 - cold/flue.
041045 - ..
041046 - On leaving the clinic saw Lana in the doorway of another examination
041047 - room. She was smiling. Apologized for interrupting her care for
041048 - another patient, per above. ref SDS 0 D95M She said everything worked
041049 - out okay.
041051 - ..
041052 - Stopped at the front desk. Megan scheduled next meeting with Lana in
041053 - Wound Care for 151218 0800.
041055 - ..
041056 - Megan also confirmed schedule for another meeting with Doctor Stewart
041057 - on 160119 1315, per the doctor's work plan, above. ref SDS 0 QO9I
041058 -
041059 -
041060 -
041061 -
041062 -
041063 -
0411 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
050401 - ..
050402 - Medical Chart Progress Notes for General Surgery Meeting 151215
050403 - Progress Notes General Surgery Meeting 151215 Doctor Stewart and Lana
050404 - Doctor Stewart and Lana Progress Notes General Surgery Meeting 151215
050405 -
050406 - Follow up ref SDS 7 DK5K.
050407 -
050408 - Progress Notes are one entry of several files stored on CD received
050409 - from VA on 151218, and includes General Surgery meeting on 151215
050410 - 0130; Doctor Stewart entered her Progress Notes at 1353...
050411 -
050412 - F:\05\00003\SM\CC\AGMJ\20151215-135346\w0144_welch_12 15 15.pdf
050414 - ..
050415 - LOCAL TITLE: SURGERY (GENERAL) CLINIC
050416 - STANDARD TITLE: SURGERY OUTPATIENT NOTE
050417 - DATE OF NOTE: DEC 15, 2015@13:53 ENTRY DATE: DEC 15, 2015@13:53:46
050418 - AUTHOR: STEWART,LYGIA EXP COSIGNER:
050419 - URGENCY: STATUS: COMPLETED
050421 - ..
050422 - Vital Signs:
050423 - Height: 64.5 in [163.8 cm] (09/23/2015 15:32)
050424 - Weight: 187.9 lb [85.4 kg] (12/11/2015 08:18)
050425 - BMI: 31.8 (Obesity Level I)
050426 - BP: 136/77 (12/11/2015 08:18)
050427 - Resp: 16 (10/05/2015 08:40)
050428 - Pulse: 77 (12/11/2015 08:18)
050429 - O2 Sat: 12/11/15 08:18:01 O98
050430 - Pain: 0 (12/11/2015 08:18)
050432 - ..
050434 - ...is a 70 year old man who is receiving treatment following I &
050435 - D of an infected hematoma, with LLE cellulitis (on 9/23/15).
050436 - The area is being treated with Hydrofera Blue with BId wound
050437 - changes.
050439 - ..
050440 - Exam: WDWN man in NAD. The wound looks very good, with healthy
050441 - granulation tissue, it is 2.2 X 0.8 cm in size.
050443 - ..
050444 - Impression: the wound is healing very well with current Tx. We will
050445 - continue.
050447 - ..
050448 - RTC 1/19/15
050450 - ..
050451 - Clinical Reminder Activity
050453 - ..
050454 - MED REC NON PRIMARY CARE:
050456 - ..
050457 - Current medications reviewed with patient/caregiver and reconciliation
050458 - of medications related to today's visit completed, including non-VA
050459 - medications and discrepancies, if identified, were addressed.
050460 - Medication changes and the importance of medication management were
050461 - reviewed with the patient/caregiver today based on individual needs.
050462 - Patient/caregiver acknowledged understanding of instructions as
050463 - stated. An updated list of reconciled medications has been provided
050464 - to the patient/caregiver.
050465 -
050466 - /es/ Lygia Stewart, M.D., 2860
050467 - Chief General Surgery, Assoc Chief Surgery
050468 - Signed: 12/15/2015 14:02
050469 -
050470 -
050471 -
050472 -
050473 -
050474 -
050475 -
0505 -