Age: 88.0
Sex: F
Vaccine: COVID19
Symptoms: Urine ketone body present, Urine leukocyte esterase positive, White blood cell count decreased, White blood cells urine positive, X-ray abnormal
Clinical narrative: This is an 89-year-old female with extensive past medical history that includes coronary artery disease status post CABG, combined systolic-diastolic congestive heart failure, chronic kidney disease stage 3, history of COPD though not wearing any oxygen currently, history of pulmonary embolism no longer on any anticoagulation, hyperlipidemia, history of ischemic cardiomyopathy, hypertension, and dementia that presents to the emergency room after her daughter decided to bring her.  Her daughter states that over the past 2 days patient has not been eating.  She has been drinking.  She enjoys drinking tea, lemonade and water.  She states that she has had a chronic cough.  She reports that her mother has had generalized weakness and has been complaining of increased fatigue stating ?I just want to lay down?.  She states that her mother is not complaining of any chest pain or shortness of breath.  She was complaining of some back pain.  No fever or chills no leg swelling.  She has not had any recent falls.  She denies that her mom has any constipation or diarrhea.  She did complete the COVID vaccine.   Evaluation in the emergency room revealed patient's blood pressure 153/73 a pulse of 91, respirations of 20, a temperature 98°, patient is oxygenating on room air 98%.  CBC revealed a white blood cell count of 3.46, hemoglobin hematocrit of 11.2 and 33.9, platelet count of 102. BNP of 608, troponin of 0.040.  Urinalysis was abnormal with 3+ white blood cell esterase, 2+ trace protein, trace ketones, white blood cell count of 20 1-50, red blood cell count of 6-11; she is pending a urine culture.  Potassium of 3.3.  BUN and creatinine of 21 and 1.7, albumin of 3.3.  She had a chest x-ray performed.  Cardiomegaly was present, fullness of the right hilum is which is considered stable.  No focal consolidation or pleural effusion or edema was noted.   Interventions in the emergency room include Rocephin 1 g IV x1 dose.  Hospitalist service was called for admission on 7/25/2021. COVID 19 was positive on 7/25; pt did have Moderna vaccine. Initially CXR did not show evidence of pneumonia.  UA was suggestive of UTI.  Blood cultures positive for Staphylococcus Coagulase Negative (Methicillin Resistant) x 2.  ID consulted.  Repeat blood cultures ordered for 7/29; No growth. Patient was treated with Vancomycin. Pt started on oxygen via NC at 2 L.  CXR is concerning for developing COVID pneumonia.  There were some findings that were questionable for free air under the diaphragm b/l vs consolidation with subpleural sparing. Xray abdominal series with chest done and showed b/l COVID pneumonia.  Patient lethargy gradually improved.  Pt also with drop in Hgb to 8.6; Hgb was 9.6 on 8/2 and 10.8 on 7/29.  Stool occult blood +. No obvious bleeding. Hemoglobin has been stable.   patient will f/u with PCP and may need outpatient scope. Patient c/o abd pain and general surgery was consulted who did not think there is anything surgical.  CT abdomen-multifocal atypical pneumonia.  Trace pleural effusions left greater than right.Generalized anasarca. Moderately prominent retained fecal material within the colon. Colonic diverticulosis most notable in the sigmoid colon.  Patient condition overall improved. Patient will be discharged home with home health.