Document Evaluation

## Discharge Note Patient Name: [Patient Name Redacted for Privacy] Patient ID: 17199296813608 Date of Discharge: 2024-02-09 1. ADMISSION SUMMARY The patient is a 61-year-old male with a history of pancreatic adenocarcinoma, admitted on February 6, 2024, for management of persistent epigastric pain and consideration for a celiac plexus nerve block. He previously underwent diagnostic laparotomy, exploration laparotomy, and stereotactic body radiation therapy (SBRT). He is currently receiving gemcitabine chemotherapy. 2. PERTINENT PAST MEDICAL HISTORY * Pancreatic Adenocarcinoma (unresectable) * Diabetes Mellitus * History of Exploratory Laparotomy and Laparoscopy * Prior Chemotherapy (mFOLFIRINOX) and Radiation Therapy (SBRT) 3. HOSPITAL COURSE The patient was admitted with ongoing abdominal pain despite gemcitabine chemotherapy. A celiac plexus nerve block was performed on February 7, 2024, under sedation with image guidance. Post-procedure, the patient reported some pain relief. Pain management was optimized with a multimodal approach. The patient tolerated the procedure well and remained stable throughout the hospitalization. Psychosocial support was provided, addressing pain-related distress and emotional concerns. Medication reconciliation was completed. 4. PROCEDURES AND IMAGING * Bilateral Neurolytic Celiac Plexus Block: February 7, 2024, performed at L1 level with contrast injection confirming adequate spread. 5ml of 0.25% marcaine followed by 20ml of 100% absolute alcohol was injected bilaterally. * CAP Scan (December 7, 2023): Demonstrated a larger exophytic pancreatic head tumor (3.5cm) and new nodular peritoneal/omental thickening suspicious for carcinomatosis. No pulmonary or hepatic metastasis were identified. 5. DISCHARGE MEDICATIONS * Bisacodyl 5mg tablet: 1 tablet PO daily. * Paracetamol 500mg tablet: 2 tablets PO twice daily PRN for pain. * Ondansetron 8mg tablet: 1 tablet PO every 8 hours PRN for nausea. * Lorazepam 1mg tablet: 2 tablets PO at bedtime. * Lansoprazole 15mg capsule: 1 capsule PO daily at 7 AM, one hour before breakfast. * Lactulose 67mg/mL syrup: 30mL PO three times daily. * Gabapentin 400mg capsule: 1 capsule PO three times daily. * Morphine Sulfate 10mg tablet: As previously prescribed (details in pain assessment notes - multiple dosages and schedules). *Please continue as directed by your pain specialist.* 6. FOLLOW‑UP APPOINTMENTS * Follow-up with Dr. Smaeer Al-Smadi in 2 weeks (March 3, 2024). * Continue regular oncology follow-up as scheduled. 7. DIETARY INSTRUCTIONS * Low bacterial diet: Focus on well-cooked foods. * Maintain adequate hydration: Drink 2-3 liters of fluids daily. 8. ACTIVITY INSTRUCTIONS * Rest as needed. * Avoid strenuous activity for the first week post-discharge. * Gradually increase activity levels as tolerated. 9. WARNING SIGNS Seek immediate medical attention if you experience any of the following: * Shortness of breath * Altered level of consciousness * Uncontrolled pain * Fever > 38.0°C (100.4°F) * Uncontrolled nausea, vomiting, or diarrhea * Signs of infection at the nerve block site (redness, swelling, drainage) * New or worsening weakness or numbness in your legs * Difficulty with bladder or bowel control 10. HOME CARE INSTRUCTIONS * Maintain prone positioning for approximately 30 minutes after meals to help contain the alcohol used during the nerve block. * Monitor blood pressure for potential drops and maintain adequate hydration. * Be aware of potential side effects from the nerve block, including abdominal discomfort, numbness, and temporary pain exacerbation. * Continue to take all medications as prescribed. * Contact your primary care physician or oncologist with any concerns. * The patient's wife has been provided with emotional support and information regarding available resources. ____________________________ [Physician Signature] [Physician Printed Name]