Age: 92.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Cough, Decreased appetite, Dyspnoea, Electrocardiogram normal, Fall
Clinical narrative: Now multiple admissions to hospital related to COVID (admitted 11.17.21-11.22.21 then sent to rehab).... now  readmitted today 11.24.21.  COVID-19 positive (11.17.21);  fully vaccinated.  Admission Date: November 17, 2021 Discharge Date: November 22, 2021 Pneumonia due to COVID-19 virus HISTORY OF PRESENT ILLNESS: PT is a 92 y.o. male PMHx of PVD, HTN, BPH, GERD who presents today with weakness and cough. He states 5 days PTA he developed weakness. He lives at home with a friend and is independent with ADLs but states he's been needing to use a cane to ambulate due to weakness. Two days PTA he developed productive cough, SOB as well as decreased appetite. He drank 2 12 oz glasses of water this morning and doesn't think he drinks enough water. He denies any myalgia but endorsed an episode of flank pain. Due to his progressive symptoms he came to the ED. In the ED he was afebrile, normal HR and RR but hypertensive and SpO2 down to 90 percent on room air. He was placed on 2L NC.  Labs significant for Hb 11.0, normal WBC, Na 123, BUN 24, creatinine 1.01, troponin 37 and 38 on repeat. UA with proteniuria but otherwise bland. EKG with NSR. CXR with bilateral infiltrates. He was given dexamethasone, calcium gluconate, tylenol and zofran and admitted for further evaluation. Assessment and Plan COVID-19 PNA Acute hypoxic respiratory insufficiency secondary to above - pt with SOB, cough, chest x-ray with bilateral infiltrates - pt vaccinated in 3/2021, due for booster - continue dexamethasone 6 mg daily x 10 days - continuous pulse ox - the patient is on 2L NC - Lovenox for VTE prophylaxis - supportive care REHAB admission:  Admission Date: 11/22/2021 Discharge Date: 11/24/21 11/24: unfortunately, the patient had increasing O2 requirements the AM of 11/24 ultimately requiring 12L on Venturi mask to maintain saturations in 90s. Hospitalist consult placed. Venous doppler bilateral lower extremities unremarkable for DVT, but given concern for clinical deterioration, decision was made to discharge patient from rehab and admit to acute care hospital. COVID-19 pneumonia Acute hypoxic respiratory failure 2/2 COVID 11/23: continue supplemental O2 PRN to maintain in 90s. CXR with bilateral infiltrates, Pt was vaccinated 3/2021. Had not received booster. Was not given remdesivir or monoclonal antibodies, is on steroids - dexamethasone 6 mg daily for 10d, started 11/18. + test 11/17. HISTORY OF PRESENT ILLNESS: Patient is a 92 y.o. male with a past medical history of GERD, BPH, PVD and hypertension who presented to Hospital on 11/17 with weakness and cough that started five days prior.  He found to be COVID-19 positive.  He had both vaccines (Pfizer - last dose 3/3021) but had not had the booster shot. He was found to be hyponatremic and hypoxic - requiring 2 L O2 NC.  He was started on Decadron 6 mg.  Nephrology was consulted to manage his hyponatremia.  Nephrology felt the symptoms were consistent with SIADH and the patient was started on a fluid restriction.  Ultimately he was also started on sodium tablets with improvement of his hyponatremia.  The patient was able to be weaned to room air at times and other times did require 1-2 L O2,  He was felt stable for discharge to rehab on 11/23.  After discharge the patient's oxygen requirements have been increasing.  The patient has a persistent non-productive cough.  He denies any further increase in dyspnea or work of breathing.  He does note some calf discomfort, more on the right side.  No LE edema.  Denies chest pain.  Was having some "ribs" pain with coughing - now his coughing hurts in his hip.  On review the patient has been mildly hypertensive since admission.  No fevers.  He does report feeling more overall weak and fatigued. Given the patient's respiratory status, he is no longer appropriate for rehab, he will be transferred to inpatient.