Scott Lake Health And Rehabilitation Center

alert and able to swallow, give 15 grams glucose gel or carbohydrates to include but not limited to:

jeopardy to resident health or snack, notify PCP.3. [blank]4.

For severe hypoglycemic symptoms-Glucagon Emergency Injection Kit safety 1 mg- inject 1 mg IM [intramuscular] as needed for BG below 70 with lethargy and unable to swallow, may repeat x 1, notify PCP.This checklist does not have places to check off each item or a place to

managers, included the following items to be checked:-chart review-Hospital DC [discharge] summary if NO, notify medical records to fax request and keep confirmed fax on/in chart.-Hard scripts for narcotics, order summary.

Get if needed ASAP [as soon as possible]-Parameters for blood pressure meds-BS [blood sugar] checks for diabetics (need to have a labeled machine)-Hypoglycemia PRN [as needed] protocolNew antibiotics-diagnosis-stop date-IV or PO (by mouth)-Surveillance infection criteria-Isolation yes or no An interview was conducted on 9/30/25 at 5:00 p.m. with Staff G, LPN/UM.

Staff G confirmed he was the UM for Resident #1. A copy of her admission packet checklist was requested.

Staff G's office was observed to have large stacks of paper on a bookcase.

Staff G stated those were admission packet checklists for residents, but he did not have an admission packet checklist completed by the nurse for Resident #1.

Staff G explained that the admitted nurse filled out the admission check sheets then night shift nurses did a chart check and then management did a chart check the next morning. An interview was conducted on 10/1/25 at 1:22 p.m. with the facility's Medical Director of the facility.

The Medical Director said he was informed of the admission errors with medication orders for Resident #1 but was not fully aware of the specifics. He said his expectation on admission was a picture of the resident's hospital orders were sent to the physician; the physician reviewed and verified the orders and sent clarification and/or new orders.

The Medical Director said the provider is expected to review orders between visits to ensure accuracy. He said he expected the nurses to have completed audits to ensure accura[TRUNCATED]

106120 10/01/2025

Scott Lake Health and Rehabilitation Center 800 E County Rd 540a Lakeland, FL 33813

Review of Resident #1's hospital records dated 8/30/25 showed:Presenting Problem: hyperglycemia, given 15 units of insulin at facility.History of Present Illness: [AGE] year-old female with a past medical history of diabetes, hyperlipidemia,hypertension, and prior breast cancer (status post left mastectomy and lymph node removal, in remission), [NAME] [inferior mesenteric artery] occlusion and SMA [superior mesenteric artery] stenosis presents with a 3-day history of abdominal pain and hyperglycemia.

Glucose greater than 600 at facility given insulin prior to transport.

Patient notes her pain is diffuse 8 out of 10 intensity nonradiating with no alleviating factors.

Lab results in the emergency department showed:8/30/2025 5:58 p.m.WBC (white blood cell count) 16.42 x10^3/ microliter (uL) HIGHPlatelet 600 x10^3/uL HIGHNeutrophil Auto 72.5 % HIGHLymphocyte Auto 13.3 % LOWMonocyte Auto 12.4 % HIGHEosinophil Auto 0.3 % LOWAbsolute Neutrophil 11.91 x10^3/uL HIGHAbsolute Monocyte 2.03 x10^3/uL HIGHBUN 44 mg/dL HIGHCreatinine 1.47 mg/dL HIGHEstimated glomerular filtration rate (eGFR) Chronic kidney disease-equation for prediction and interpretation (CKD-EPI) 36 mL/min/1.73m^2 LOWCalcium Level 11.3 mg/dL HIGHAlkaline Phosphatase 182 U/L HIGHLipase Level 127 U/L HIGHPro b-type natriuretic peptide (PBNP) 1,010 pg/mL HIGHHS Troponin-T 60 ng/L CRITICALLY HIGHCarbamaz Level <2.0 ug/mL LOWT4 Free 1.86 ng/dL HIGHUrinalysis (UA) Appear ClearUA Color Pale yellowUA Glucose 4+UA Ketones 1+UA Protein 3+UA Bacteria Auto FewUA Epithelial Cells Auto None SeenUA Hyaline Cast Auto Few8/30/25 6:22 p.m.POC [point of care] Potassium 3.4 mmol/L LOWPOC Sodium 129 mmol/L LOWPOC [NAME] [lactate] 3.30 mmol/L HIGH Vital signs8/30/25 6:00 p.m.Blood pressure 158/93Heart rate 101Respiratory rate 18 breathes/minute Discussion of Management with Hospitalist revealed: [AGE] year-old female presents to the emergency department with diffuse abdominal pain in the setting of known severe atherosclerosis of the aorta [NAME] SMA. CT [computed tomography] angiogram above no evidence of ischemic colitis unclear etiology of the patient's pain white count is 17 she was given vancomycin and Zosyn.

Glucose greater than 600 now in the 400s after insulin.

Given further fluids and insulin in the emergency department.

She will be admitted for further management of her hyperglycemia possible underlying sepsis blood cultures were sent.

Lactate was 3.3. [normal is <2] Of note patient also with new ischemic appearing EKG [electrocardiogram] with lateral ST depressions elevated troponins of 60 and 54.

She is not complaining of chest pain however concern for potential NSTEMI [Non-ST-Segment Elevation Myocardial Infarction] given elevated troponins and ischemic EKG.

She will be admitted to the cardiac floor for further management of numerous above conditions.Diagnoses listed were hyperglycemia due to type 2 diabetes mellitus, abnormal EKG, elevated troponin, lactic acidemia, hypertension, and abdominal pain. A Cleveland Clinic article titled Troponin Test, reviewed on 3/17/22, explained: A troponin test looks for the protein troponin (there are two forms related to your heart, troponin I and troponin T) in your blood.

Normally, troponin stays inside your heart muscle's cells, but damage to those cells - like the kind of damage from a heart attack - causes troponin to leak into your blood.

Higher levels of troponin in[TRUNCATE