90 year old female presents with bilateral swelling, redness and ulcers to lower extremities (ulcers are new).

CC/Chief Complaint: 90 year old female presents with bilateral swelling, redness and ulcers to lower extremities (ulcers are new).

HPI: Patient is a 90-year-old woman with a past medical history of hypertension, chronic obstructive pulmonary disease, morbid obesity, type 2 diabetes mellitus and gastroesophageal reflux disease. She also has chronic arthritis with multi-joint discomfort and difficulty walking. She is on chronic opioid therapy. She felt not to be a candidate for joint replacement due to multiple medical issues and advanced age. She was brought to the emergency department today for evaluation of increasing pain, redness, swelling and bruising of the lower extremities. She has chronic venous stasis dermatitis but now appears to have bilateral lower leg cellulitis. She is planning short-term rehabilitation. She will be admitted for IV antibiotic therapy and pain management.

Location: Joints and lower extremities.

Duration: 1 week

Character: N/A.

Aggravating factors: Moving. 

Relieving factors: N/A

Timing: Ongoing, past few weeks.

Severity: Pain is at a medium to high level (7 to 8 in FACES pain scale), pt reports inability to participate in usual activities.

Review of Systems:

Constitutional: No fever or weight loss.

Skin: Bilateral lower leg redness pain swelling and small blisters which have ruptured and oozing.

Eyes: No recent vision problems or eye pain.

ENT: No congestion, ear pain or sore throat.

Endocrine: No thyroid problems. Type II diabetes mellitus.

Cardiovascular: No chest pain. No palpitations.

Respiratory: No cough, congestion or wheezing.

Gastrointestinal: she complains of reflux and a hiatal hernia and periumbilical pain which is intermittent.

Genitourinary: No dysuria. No urinary frequency.

Musculoskeletal: Generalized chronic joint pain.

Neurologic: No headache. No focal weakness.

Past Medical History

Past Surgical History:

• Hospital observation service, per hour (05/19/2018)
• Introduction of Anesthetic agent into joints, percutaneous approach (04/16/2018)
• Introduction of Anti-inflammatory into joints, percutaneous approach (04/16/2018)
• Appendectomy
• Hernia repair
• Hysterectomy
• Knee replacement
• Shoulder surgery

Social history:

• Alcohol (Use alcohol screen below for admitted Pats) – No risk, 05/19/2018
• Blood management: Accepts blood
• Employment/School – No risk, 05/19/2018
• Home/Environment – No risk, 05/19/2018
• Substance abuse – No risk, 05/19/2018
• Tobacco – No risk, 05/19/2018; unknown if ever smoked, household tobacco concerns: No

Allergies: None

Past Medical History

Ongoing

• Arthritis
• Benign essential hypertension
• COPD (Chronic obstructive pulmonary disease)
• Degenerative joint disease
• Diabetes mellitus
• Diabetic neuropathy
• Emphysema
• Encounter for preventive health examination
• Esophagitis
• GERD (Gastroesophageal reflux disease)
• Hypertension
• Hypothyroidism
• Mixed hyperlipidemia
• Osteoarthritis of hip
• Type 1 diabetes mellitus

Family History: Cardiovascular disease and diabetes mellitus

Immunizations: Up to date

Lab results: