Age: 88.0
Sex: M
Vaccine: COVID19
Symptoms: Blood culture positive, Blood lactic acid increased, Blood magnesium, Blood potassium normal, Blood sodium decreased
Clinical narrative: ED to Hosp-Admission  Discharged 10/5/2021 - 10/8/2021 (3 days) Hospital   Hospital Problems             * (Principal) COVID-19 Yes   Chief Complaint  Patient presents with  ? Fever  Hypoxia due to COVID-19 pneumonia Check CRP, ferritin Decadron and remdesivir Proning Nasal cannula keep saturation above 90%   Elevated dimer 0.61 Normal for age-adjusted   Elevated lactic acid Most likely due to dehydration 2 L NS bolus was given Follow lactic acid   AKI, on CKD due to dehydration, Patient reports that he has not been drinking, due to general weakness 2 L NS bolus given All kidney function in a.m.   History of CAD status post bypass Continue clopidogrel, Lipitor   History of high blood pressure Continue atenolol, amlodipine Nursing communication, contact patient pharmacy in a.m. to verify his medication     o Nutrition: Heart heart healthy o VTE prophylaxis: Heparin subcutaneous prophylactic o DNR (Do Not Resuscitate) discussed with patient     Extended Emergency Contact Information Primary Emergency Contact: (redacted) Address: (redacted) Home Phone: (redacted) Mobile Phone: (redacted)  Relation: (redacted) Preferred language: (redacted) Interpreter needed? (redacted) Secondary Emergency Contact: (redacted) Address: (redacted) Mobile Phone: (redacted) Relation: (redacted) Preferred language: (redacted) Interpreter needed? (redacted)   History of Present Illness       With past medical history of CABG, hypertension, CVA, came to emergency room complaining of general weakness for 1 week. Patient has poor appetite, was spending most of the time in the bed for 1 week, reports cough. In the emergency room patient found her saturation 89% on room air, having fever 100.5, x-ray of the chest showed bilateral infiltrates, lab work showed AKI on CKD. Covid test came back positive, patient also admission for hypoxia due to COVID-19 pneumonia.   Patient seen examined bedside, not in acute distress, comfortably resting in the bed Hospital Course:   Please refer to the admission H&P for details of presentation. In summary, Patient with known history of hypertension, dyslipidemia & peripheral vascular disease with admitted to the hospital service for evaluation of cough and fever.  Patient was found to be having hypoxia secondary to bilateral COVID-19 pneumonia and subsequently was treated with remdesivir and Decadron.  Patient completed the course of remdesivir during hospitalization.  Patient had acute kidney injury that improved with IV hydration.  Patient had mild bradycardia during hospitalization while on remdesivir.  Patient also had elevated lactic acid which improved during hospitalization.  Patient had positive blood cultures upon admission which was coagulase-negative staphylococcus, thought to be contaminant.  His blood culture is well controlled during hospitalization hydrochlorothiazide was stopped and the dose of lisinopril was reduced to 20 mg once daily at discharge.  Patient currently feels well and is wanting to go home today.  Patient is advised to follow-up with primary care physician within a span of one to 2 weeks.  Currently patient is being discharged in a medically stable condition after being evaluated by our team.  All the questions and concerns of the patient and family were addressed in detail at the time of discharge.