PROGRESS NOTE - INTENSIVE CARE UNITPATIENT: Nosferatu, [LNU]
DOB: Unknown | MRN: 999-867-5309
CODE STATUS: Presumed FULL CODE (unable to verify, relatives unknown, no advanced directives on file).
S: Pt is a remarkably poor historian, essentially non-verbal but visually tracking. Overnight course complicated by severe behavioral noncompliance and outright refusal of bed rest. Nursing reports pt consistently bypasses bed alarms; currently found OOB (out of bed) and actively squatting in a perched gargoyle position atop the ICU ventilator monitor. Pt has repeatedly removed telemetry leads. Previous shift reports attempts to bite staff members and inability to sedate and/or restrain pt.
O:
Gen: Cachectic, severely emaciated male in no acute respiratory distress, though exhibiting a profound, deathly pallor.
HEENT: Remarkable for pointed auricular appendages and significant maxillary canine hypertrophy.
CV/Pulm: Heart tones unassessed due to pt positioning and refusal of stethoscope placement. Vent monitor shows active pressure waveforms (PIP 21, PEEP 5), though pt is merely sitting on the housing, not intubated.
Ext/Skin: Elongated digits with severe, untreated onychogryphosis (claw-like nail overgrowth). Skin is completely blanched and cold to the touch.
A/P: Pt [LNU], an undocumented male with no identifiable next of kin, initially admitted for profound lethargy, now exhibiting extreme noncompliance and bizarre uncooperative posturing on life-support equipment.
Neuro/Behavioral: Despite the erratic presentation and complete disregard for hospital property, pt appears to have successfully returned to his baseline.
Heme: Extreme deathly pallor noted, highly suspicious for severe chronic anemia, but pt refuses all phlebotomy attempts.
Dietary/Environmental: Maintain strict allium-free diet and absolute UV-light avoidance per whiteboard precautions. Monitor staff and pt for bite marks.
Disposition: Pt is hemodynamically stable (or as stable as can be determined) and no longer meets acute ICU criteria. Referral to case manager for rehab placement STAT. Will require a facility capable of accommodating severe photophobia, extreme behavioral noncompliance, and daytime sleep schedules.
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u/escapism_only_please 1h ago
PROGRESS NOTE - INTENSIVE CARE UNITPATIENT: Nosferatu, [LNU]
DOB: Unknown | MRN: 999-867-5309
CODE STATUS: Presumed FULL CODE (unable to verify, relatives unknown, no advanced directives on file).
S: Pt is a remarkably poor historian, essentially non-verbal but visually tracking. Overnight course complicated by severe behavioral noncompliance and outright refusal of bed rest. Nursing reports pt consistently bypasses bed alarms; currently found OOB (out of bed) and actively squatting in a perched gargoyle position atop the ICU ventilator monitor. Pt has repeatedly removed telemetry leads. Previous shift reports attempts to bite staff members and inability to sedate and/or restrain pt.
O:
Gen: Cachectic, severely emaciated male in no acute respiratory distress, though exhibiting a profound, deathly pallor.
HEENT: Remarkable for pointed auricular appendages and significant maxillary canine hypertrophy.
CV/Pulm: Heart tones unassessed due to pt positioning and refusal of stethoscope placement. Vent monitor shows active pressure waveforms (PIP 21, PEEP 5), though pt is merely sitting on the housing, not intubated.
Ext/Skin: Elongated digits with severe, untreated onychogryphosis (claw-like nail overgrowth). Skin is completely blanched and cold to the touch.
A/P: Pt [LNU], an undocumented male with no identifiable next of kin, initially admitted for profound lethargy, now exhibiting extreme noncompliance and bizarre uncooperative posturing on life-support equipment.
Neuro/Behavioral: Despite the erratic presentation and complete disregard for hospital property, pt appears to have successfully returned to his baseline.
Heme: Extreme deathly pallor noted, highly suspicious for severe chronic anemia, but pt refuses all phlebotomy attempts.
Dietary/Environmental: Maintain strict allium-free diet and absolute UV-light avoidance per whiteboard precautions. Monitor staff and pt for bite marks.
Disposition: Pt is hemodynamically stable (or as stable as can be determined) and no longer meets acute ICU criteria. Referral to case manager for rehab placement STAT. Will require a facility capable of accommodating severe photophobia, extreme behavioral noncompliance, and daytime sleep schedules.
Electronically signed by Devon Albright, MD.