Family Briefing — Susan

• Susan remains admitted at Cedar Memorial Hospital (San Diego) on a monitored unit (6 West Surg PCU, Room E412 / Bed 02).
• Why admitted (per notes): vomiting/reflux after recent esophageal stent placement with concern for aspiration‑related lung inflammation (“aspiration pneumonitis”) and dehydration; nutrition is being stabilized with tube feeds + clear liquids.
• What changed since the last update (Jan 4 ~4:00 PM): today’s hospitalist note documents stopping antibiotics for aspiration pneumonitis and shifting focus to constipation/bowel regimen so tube feeds can be advanced.
• Biggest barrier right now: tube feeds are still nowhere near goal and the note says they have not been able to advance because she has not had a bowel movement; a bowel regimen has been ordered.
• Expected next checks (next 24 hours): response to bowel regimen + whether tube feeds can be advanced toward goal; repeat electrolytes/CBC as feeds/fluids are adjusted; continued breathing checks while off antibiotics.
• Latest labs shown in today’s progress note (Jan 5 AM): sodium 130 (low) and magnesium 1.8 (low, improved vs 1.6); potassium 4.1; WBC 5.5 (normal); hemoglobin 9.4 (low).
• Culture updates shown in today’s progress note: blood culture shows no growth after 2 days; urine culture grew >100,000 CFU/mL Staphylococcus epidermidis (unclear from documentation whether treated vs considered contaminant).
• Discharge planning: the hospitalist note lists an expected discharge date of 1/6/2026 and disposition “home/self care,” but this is dependent on feeding/constipation progress and overall stability.
• Main immediate focus: get bowel function moving so tube feeds (and hydration) can be advanced safely.

This is NOT a diagnosis. It is an Averyn interpretation of a subset of information visible in the hospital portal/notes to help family understand urgency. Right now, Susan appears medically stable in several areas (vitals and breathing), but nutrition/feeding progress remains the main near‑term driver of risk and discharge readiness.

As of ~2:00 PM PT on Jan 5, things look overall stable with treatment underway — but tube‑feed advancement remains the main barrier, and today’s note links this to constipation/no bowel movement.

• Bowel movement / constipation response to the bowel regimen, and whether tube feeds can be advanced toward goal.
• Repeat labs (CBC + electrolytes/kidney panel, especially Na/Mg/Ca + hemoglobin) as feeds/fluids are adjusted.
• A clear feeding plan for the next 24–48 hours (target tube‑feed rate/schedule + what “good enough for home” looks like).
• Monitoring for any breathing change now that antibiotics are being discontinued (watching for fever or oxygen needs).
• Clarification of culture results and whether any antibiotic plan remains (urine culture grew Staph epidermidis; blood culture no growth after 2 days).

• Gastroenterology (GI) — overseeing stent tolerance + safe restart of liquids.
• Nutrition / dietitian — severe weight loss/malnutrition; helping plan calories + hydration safely.
• Speech‑swallow therapy — completed swallow study; guiding safe oral intake and strategies.
• Physical/occupational therapy — PT/OT addressing mobility and safe ADLs; OT anticipates discharge home with family care pending medical clearance (consider home health follow‑up).
• Palliative care (AIM) — often involved for symptom support (pain/nausea), not necessarily end‑of‑life.
• Case management — discharge planning for home health (Willow Home Health) + home infusion/tube‑feed supplies (Willow Home Infusion); SNF is listed as “willing to discuss” if home supports are insufficient.

• Chest X‑ray — showed right‑sided lung changes concerning for pneumonia/aspiration.
• CT chest/abdomen — no pulmonary embolism; showed aspiration‑type lung changes and fluid sitting above the esophageal stent (aspiration risk).
• Additional tests (Jan 3): feeding‑tube check X‑ray (tube position; moderate colonic stool burden noted), swallow study (MBS; no aspiration seen and clear liquids allowed), and echocardiogram (normal heart pumping).

The hospitalist note today lists an expected discharge date of 1/6/2026, but it’s still not possible to be certain from documentation alone. Discharge readiness appears most tied to whether tube feeds can be advanced to a sustainable plan (and constipation improves), while breathing remains stable off antibiotics and electrolytes stay in range.

• Earliest plausible: Tue 1/6, if she has bowel movement(s), tube feeds can be advanced to a workable home plan, electrolytes are stable with a clear replacement plan, and breathing remains stable off antibiotics.
• More likely: mid‑week (around 1/7–1/8) to allow more time for tube‑feed advancement/constipation management, electrolyte stability, and completion of discharge teaching + confirmed home services (Modern HH + Willow Home Infusion).
• Longer possible: several more days (or longer) if feeding can’t be stabilized, constipation persists, electrolytes keep fluctuating, breathing worsens, or the safest discharge setting becomes unclear (home vs SNF).

Susan, Linda, and Don have begun discussing discharge needs. Case management notes document resuming home health (Willow Home Health) and home infusion/tube‑feed supplies (Willow Home Infusion). Susan has also mentioned wanting her dental partials available to help when the diet advances beyond liquids.

The care team will generally look for: stable breathing/oxygen needs, a clear nutrition plan that works (tube feeds + any oral diet allowed), pain/nausea controlled enough for intake, safe mobility/ADLs (PT/OT goals), and a discharge setup that is realistic (home supports + home health/infusion arranged, or alternate setting if needed).

• Next check‑in: tomorrow (Tue) after early‑morning labs (often ~5–7 AM) and after the hospitalist note posts. We’ll focus on: bowel movement/constipation progress, tube‑feed rate changes, electrolyte stability, and whether 1/6 is still being discussed for discharge.
• We’ll send another briefing after that update, or sooner if a major change posts (diet/feeding plan change, new imaging, oxygen need, discharge plan shift).

• Feeding instructions (tube feeds and/or soft diet guidance)
• Medication changes
• Warning signs to watch for at home
• Follow-up appointments and next steps

Included for family members who prefer more detail. Values below reflect initial ED results (Jan 2), early inpatient labs (Jan 3–4), and the most recent labs/vitals shown in the Jan 5 progress note. This section is a snapshot (not a full chart).