Ruth Delgado

Inpatient

77 · female · MRN-RDELG77E

Community-acquired pneumonia

Location: Med Surg 2 Room 130
Admitted: Mar 5, 2025
Length of stay: 4 days
Status: in-progress

Vitals

Temperature

36.9 C

Heart rate

78 /min

Respiratory rate

17 /min

SpO2

96 % on room air

Encounter reason

Community-acquired pneumonia

Hypertensionactive
Atrial fibrillationactive
Chronic kidney disease stage 3active

Problem list

Hypertension
Atrial fibrillation
Chronic kidney disease stage 3

Medications

amoxicillin/clavulanate 875 mg oral BID
apixaban 5 mg BID
amlodipine 5 mg daily

Labs (most recent)

WBC: 9.0 x10^3/uL
Creatinine: 1.3 mg/dL

Clinical note

Subjective: 77F with community-acquired pneumonia, now afebrile with improved cough. Objective: SpO2 96% on room air; tolerating diet. Assessment/Plan: Transitioned to oral antibiotics; off oxygen. Ready for discharge home.