I'll share patient history and progress notes, alot of them, give me a progress summary because attendant want to shift patient to hometown hospital

Patient Chart 111100538 : Ms MALIK BIBI BIBI Female : 74 Y 414 - 414 - Ward 4 Admission Note Date: 27-Apr-2026 Name: Malik Bibi Age: 70 years Gender: Female Residence: Mardan Mode of Admission: Via ER Date of Admission: 27/11/26 Chief Complaints * Bleeding per rectum for 5 days * Fall from stretcher 5 days ago History of Present Illness (HOPI) According to the attendant, the patient was in her usual state of health 5 days ago when she developed bleeding per rectum. The onset was sudden, and since then she has had only one episode. The blood was red in color, approximately one jug in amount, and contained some clots. There was no history of melena. Following the bleeding episode, the patient developed dizziness, sweating, and felt cold. She was taken to KTH, where she received blood transfusion. While being shifted back home from the hospital, she sustained a fall from a stretcher. After the fall, she complained of severe pain in the left leg. Investigations confirmed a fracture of the left leg and dislocation of the left elbow. Past History * Newly diagnosed Diabetes Mellitus (HbA1c: 8.8%) * Hypertension for 15 years (non-compliant with medications) * ? Obesity hypoventilation syndrome Surgical History * PCNL and cholecystectomy performed 10 years ago at Shifa International Hospital * Postoperatively became bed-bound Family History * Positive for hypertension Personal History * Housewife * Functional class IV * Widow (husband deceased) * Has 5 sons and 1 daughter Patient Chart 111100538 : Ms MALIK BIBI BIBI Female : 74 Y 414 - 414 - Ward 4 Admission Note Date: 27-Apr-2026 Name: Malik Bibi Age: 70 years Gender: Female Residence: Mardan Mode of Admission: Via ER Date of Admission: 27/11/26 Chief Complaints * Bleeding per rectum for 5 days * Fall from stretcher 5 days ago History of Present Illness (HOPI) According to the attendant, the patient was in her usual state of health 5 days ago when she developed bleeding per rectum. The onset was sudden, and since then she has had only one episode. The blood was red in color, approximately one jug in amount, and contained some clots. There was no history of melena. Following the bleeding episode, the patient developed dizziness, sweating, and felt cold. She was taken to KTH, where she received blood transfusion. While being shifted back home from the hospital, she sustained a fall from a stretcher. After the fall, she complained of severe pain in the left leg. Investigations confirmed a fracture of the left leg and dislocation of the left elbow. Past History * Newly diagnosed Diabetes Mellitus (HbA1c: 8.8%) * Hypertension for 15 years (non-compliant with medications) * ? Obesity hypoventilation syndrome Surgical History * PCNL and cholecystectomy performed 10 years ago at Shifa International Hospital * Postoperatively became bed-bound Family History * Positive for hypertension Personal History * Housewife * Functional class IV * Widow (husband deceased) * Has 5 sons and 1 daughter * No history of illicit drug use * Appetite decreased * Sleep: disturbed * Bowel habits: mostly constipated Drug History * Tab. Sofvasc 10 mg OD * Syp. Duphalac Allergy History * No known allergies Vaccination History * Up to date * COVID vaccine received Systemic Review CNS: * No headache, seizures, or focal deficits * Post-bleeding dizziness present CVS: * No syncope, palpitations, or chest pain Respiratory: * Cough with white sputum GIT: * Constipation present * No abdominal pain, diarrhea, or vomiting Genitourinary: * No frequency, urgency, nocturia, dysuria, or incontinence Musculoskeletal: * No generalized body aches, fever, lymphadenopathy, or joint pain Patient Chart 111100538 : Ms MALIK BIBI BIBI Female : 74 Y 414 - 414 - Ward 4 Admission Note Date: 27-Apr-2026 Name: Malik Bibi Age: 70 years Gender: Female Residence: Mardan Mode of Admission: Via ER Date of Admission: 27/11/26 Chief Complaints * Bleeding per rectum for 5 days * Fall from stretcher 5 days ago History of Present Illness (HOPI) According to the attendant, the patient was in her usual state of health 5 days ago when she developed bleeding per rectum. The onset was sudden, and since then she has had only one episode. The blood was red in color, approximately one jug in amount, and contained some clots. There was no history of melena. Following the bleeding episode, the patient developed dizziness, sweating, and felt cold. She was taken to KTH, where she received blood transfusion. While being shifted back home from the hospital, she sustained a fall from a stretcher. After the fall, she complained of severe pain in the left leg. Investigations confirmed a fracture of the left leg and dislocation of the left elbow. Past History * Newly diagnosed Diabetes Mellitus (HbA1c: 8.8%) * Hypertension for 15 years (non-compliant with medications) * ? Obesity hypoventilation syndrome Surgical History * PCNL and cholecystectomy performed 10 years ago at Shifa International Hospital * Postoperatively became bed-bound Family History * Positive for hypertension Personal History * Housewife * Functional class IV * Widow (husband deceased) * Has 5 sons and 1 daughter * No history of illicit drug use * Appetite decreased * Sleep: disturbed * Bowel habits: mostly constipated Drug History * Tab. Sofvasc 10 mg OD * Syp. Duphalac Allergy History * No known allergies Vaccination History * Up to date * COVID vaccine received Systemic Review CNS: * No headache, seizures, or focal deficits * Post-bleeding dizziness present CVS: * No syncope, palpitations, or chest pain Respiratory: * Cough with white sputum GIT: * Constipation present * No abdominal pain, diarrhea, or vomiting Genitourinary: * No frequency, urgency, nocturia, dysuria, or incontinence Musculoskeletal: * No generalized body aches, fever, lymphadenopathy, or joint pain Diagnosis Date: 27-Apr-2026 Z048 - Encounter for examination and observation for oth reasons Date: 02-Jul-2025 R05 - Cough Date: 02-Jul-2025 I10 - Hypertension Date: 02-Jul-2025 K8010 - Post cholecystectomy Date: 02-Jul-2025 N390 - Urinary tract infection/Urosepsis Date: 02-Jul-2025 E662 - ? Obesity hypoventilation syndrome Date: 28-Jun-2025 Z048 - Encounter for examination and observation for oth reasons Date: 28-Jun-2025 Z048 - Encounter for examination and observation for oth reasons Date: 25-Jul-2024 - Urinary Incontinence Date: 25-Jul-2024 - Urinary Incontinence Date: 24-Apr-2019 - . Date: 24-Apr-2019 - CHRONIC OBSTRUCTIVE AIRWAY DISEASE Date: 24-Apr-2019 - UTI Date: 24-Apr-2019 - LRTI Discharge Date: 27-Apr-2026 Admission Reason: Date: 02-Jul-2025 Admission Reason: OBSERVATION Date: 28-Jun-2025 Admission Reason: obERVATION Date: 24-Apr-2019 Admission Reason: - ER Notes Date: 28-Apr-2026 Clinical Findings: HX OF FALL 3 DAYS BACK ALTERED SENSORIUM shortness of breath Presenting Complaint: HX OF FALL 3 DAYS BACK ALTERED SENSORIUM shortness of breath Date: 29-Jun-2025 Past History: -HTN -COPD/ASTHMA -CHOLECYSTECTOMY -KIDNEY STONES -BED RIDDEN Clinical Findings: -FEVER -COUGH -IRRELEVANT TALK -INCREASE THIRST Presenting Complaint: -FEVER -COUGH -IRRELEVANT TALK -INCREASE THIRST OPD Notes Date: 25-Jul-2024 Chief Complaints : Urinary incontinence Constipation. Unable to void in washroom. History of Presenting Illness Complaints : Past Medical / Surgical History : Hypertension. Date: 25-Jul-2024 Chief Complaints : Urinary incontinence Unable to void when goes to washroom. Constipation. Generalized body aches History of Presenting Illness Complaints : Past Medical / Surgical History : Hypertensive Treatment Plan : Advised to see Neurologist Dr Haroon. Progress Note Date: 06-May-2026 Thank u for call Patient by Dr.Hamid fazeel -Bed sore 3rd degree on sacral region -Plan advised -Apply duoderm CGF dressing for 1 week -Use air mattress keep on high pressure -Avoid crease on bed sheet and cloths -Change position every hour (1hourly) - keep patient on high protein diet -Use ring cushing -send serum albumin -change dressing after 1 week and reapply duoderm CGF dressing after washing the wound with soap of water Date: 06-May-2026 Morning DPR Malik bibi, 74-year-old female from Mardan Patient is DNR Known case of: HTN,Obesity Hypoventilation Syndrome,Post PCNL in Shifa (10 years back) ,DM (HBA1C 8.8%),Post Cholecystectomy ,Bed bound since the past 10 years . Presented with: Bleeding per rectum 5 days back (1 episode of massive PR bleed). History of fall from Stretcher resulting in pain right elbow and left lower limb. xrays were done and shows left distal femur fracture. Active Issues: Grade 3 bedsore------------duoderm dressing applied on 4th May Left femur fracture----------Above knee scotch cast applied to the left lower limb Uncontrolled diabetes-------resolved Sats dropping ASSESSMENT BP:130 / 80 - Sat: 96 on 3 litres - Pulse: 109 - Temp: 99 - Resp: 20 PLAN Kleen enema in stat Glycerine suppositories Nilstat oral drops Plastic surgery review of Dr Hamid Fazeel Chest X ray Daily 2 hourly suctioning Wean off oxygen Nebs 4 hourly Chest physio Date: 05-May-2026 Morning round PSb Dr Hanif Plan advised Regular chest physio Suctioning Every two hourly posture change Bed sore care IV fluids at the rate of 50ml/hr Date: 04-May-2026 Morning round Psb Dr Hanif Plan advised Shift down to room Change rocephin to meronem Pass Cvp line Attendants counselled regarding patient condition ( condition gonna worsen further) poor prognosis. GCS continuesly down most likely due to sepsis Advised strict vitals monitoring. Date: 03-May-2026 malik bibi a 74 years old lady from mardan. 7th day of admission. K/C : DM, HTN , Obesity hypoventilation syndrome ? P/C : Bleeding per rectum ( 1 episode ) Left distal femur fracture A/C : Grade 1 bedsore oozing from right arm left distal femur fracture uptrending CRP Disoriented VITALS : HR : 110 bpm, Spo2: 94 % on 5 L O2, RR : 24/min, BP : 90/50 mmhg, RBS : 139 mg/dl . PLAN: patient discussed with Dr AFAQ -repeat D-dimers, ABGS, trop i and ECG. -repeat Renal profile, CBC and CRP tomorrow. Date: 02-May-2026 Morning DPR Name: Malik Bibi Age: 70 years Gender: Female Residence: Mardan Mode of Admission: Via ER Date of Admission: 27/11/26 Chief Complaints * Bleeding per rectum for 5 days * Fall from stretcher 5 days ago Patient Seen by Dr Hanif Plan: CXR bed side CST Date: 01-May-2026 Orthopedic review. Patient's next of kin, 2 sons, 1 daughter 1 granddaughter and 1 grandson met with Prof. Dr. Raja Irfan Qadir at clinic. Extensive discussion had about the patient's plan of care. Pros and cons of surgical and non surgical management discussed. Keeping in view the high risk in surgery and DNR status decision made by the next of kin to proceed with conservative management with above knee scotch cast and planned follow-up to monitor fracture healing. Above knee scotch cast applied to the left lower limb by Orthopedic team. PLAN Keep the left lower limb elevated. Monitor the toes for any swelling or discoloration. Ensure the edges of the cast are well padded and monitor for any redness or ulceration. Can be discharged from Orthopedic perspective, Follow-up in OPD with Prof. Dr. Raja Irfan Qadir after 2 weeks. Date: 01-May-2026 MDT notes. Prof. Dr. Raja Irfan Qadir met with Dr. Muhammad Hayat Anesthesia consultant and ICU in charge. The patient's present health and risks for surgery were discussed. The patient was determined high risk for surgery including the possibility of on table death. PLAN Prof. Dr. Raja Irfan Qadir will meet with the patient's next of kin to make a joint decision about proceeding with surgical or non surgical management and further plan of care. Date: 01-May-2026 Orthopedic round. Patient seen and examined by Prof. Dr. Raja Irfan Qadir. Patient's attendants (daughter and grandson) counseled in detail regarding pros and cons of operative and non operative management. As the next of kin was not present at the time, they were asked to visit Prof. Dr. Raja Irfan Qadir at their clinic. PLAN Keep patient NBM and prepared for surgery. Ask the next of kin to visit Prof. Dr. Raja Irfan Qadir in clinic to further discuss and make a joint decision in the best interest of the patient regarding further plan of care. Date: 01-May-2026 The attendant is not willing to give surgical consent. Date: 30-Apr-2026 Orthopedic Review: Pt seen by ortho team.They advised 1 pint RCC transfusion today and 2 pints reserve for tomorrow surgey.They Refused to take patient under their care so pt will remain in HDU till

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Orthopedic Review: Pt seen by ortho team.They advised 1 pint RCC transfusion today and 2 pints reserve for tomorrow surgey.They Refused to take patient under their care so pt will remain in HDU till ortho round tomorrow Orthopedic round. Patient seen and examined by Prof. Dr. Raja Irfan Qadir. Patient's attendants (daughter and grandson) counseled in detail regarding pros and cons of operative and non operative management. As the next of kin was not present at the time, they were asked to visit Prof. Dr. Raja Irfan Qadir at their clinic. PLAN Keep patient NBM and prepared for surgery. Ask the next of kin to visit Prof. Dr. Raja Irfan Qadir in clinic to further discuss and make a joint decision in the best interest of the patient regarding further plan of care. MDT notes. Prof. Dr. Raja Irfan Qadir met with Dr. Muhammad Hayat Anesthesia consultant and ICU in charge. The patient's present health and risks for surgery were discussed. The patient was determined high risk for surgery including the possibility of on table death. PLAN Prof. Dr. Raja Irfan Qadir will meet with the patient's next of kin to make a joint decision about proceeding with surgical or non surgical management and further plan of care. Orthopedic review. Patient's next of kin, 2 sons, 1 daughter 1 granddaughter and 1 grandson met with Prof. Dr. Raja Irfan Qadir at clinic. Extensive discussion had about the patient's plan of care. Pros and cons of surgical and non surgical management discussed. Keeping in view the high risk in surgery and DNR status decision made by the next of kin to proceed with conservative management with above knee scotch cast and planned follow-up to monitor fracture healing. Above knee scotch cast applied to the left lower limb by Orthopedic team. PLAN Keep the left lower limb elevated. Monitor the toes for any swelling or discoloration. Ensure the edges of the cast are well padded and monitor for any redness or ulceration. Can be discharged from Orthopedic perspective, Follow-up in OPD with Prof. Dr. Raja Irfan Qadir after 2 weeks. malik bibi a 74 years old lady from mardan. 7th day of admission. K/C : DM, HTN , Obesity hypoventilation syndrome ? P/C : Bleeding per rectum ( 1 episode ) Left distal femur fracture A/C : Grade 1 bedsore oozing from right arm left distal femur fracture uptrending CRP Disoriented VITALS : HR : 110 bpm, Spo2: 94 % on 5 L O2, RR : 24/min, BP : 90/50 mmhg, RBS : 139 mg/dl . PLAN: patient discussed with Dr AFAQ -repeat D-dimers, ABGS, trop i and ECG. -repeat Renal profile, CBC and CRP tomorrow. Morning round Psb Dr Hanif Plan advised Shift down to room Change rocephin to meronem Pass Cvp line Attendants counselled regarding patient condition ( condition gonna worsen further) poor prognosis. GCS continuesly down most likely due to sepsis Advised strict vitals monitoring. Morning round PSb Dr Hanif Plan advised Regular chest physio Suctioning Every two hourly posture change Bed sore care IV fluids at the rate of 50ml/hr Malik bibi, 74-year-old female from Mardan Patient is DNR Known case of: HTN,Obesity Hypoventilation Syndrome,Post PCNL in Shifa (10 years back) ,DM (HBA1C 8.8%),Post Cholecystectomy ,Bed bound since the past 10 years . Presented with: Bleeding per rectum 5 days back (1 episode of massive PR bleed). History of fall from Stretcher resulting in pain right elbow and left lower limb. xrays were done and shows left distal femur fracture. Active Issues: Grade 3 bedsore------------duoderm dressing applied on 4th May Left femur fracture----------Above knee scotch cast applied to the left lower limb Uncontrolled diabetes-------resolved Sats dropping ASSESSMENT BP:130 / 80 - Sat: 96 on 3 litres - Pulse: 109 - Temp: 99 - Resp: 20 PLAN Kleen enema in stat Glycerine suppositories Nilstat oral drops Plastic surgery review of Dr Hamid Fazeel Chest X ray Daily 2 hourly suctioning Wean off oxygen Nebs 4 hourly Chest physio

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