Age: 77.0
Sex: F
Vaccine: COVID19
Symptoms: Blood creatinine increased, Bradycardia, COVID-19, Cardiac pacemaker insertion, Colectomy
Clinical narrative: Date of Admission:  11/12/2023   Date of Discharge:  11/22/2023   Issues to be Addressed on followup with PCP:   Follow up pacemaker clinic s/p pacemaker insertion 11/21   Follow up Dr for staples removal, post op follow up   Reason for Hospitalization: Nausea and vomiting/abdominal pain   Significant Findings:  Incarcerated umbilicated hernia COVID positive  Sinus bradycardia with 2:1 Type II Mobitz Block Mild acute renal failure HTN   Diagnoses:   Active Hospital Problems   Diagnosis   ? (Principal) INCARCERATED UMBILICAL HERNIA   ? NONTRAUMATIC ACUTE KIDNEY INJURY   ? CANDIDA INTERTRIGO   ? BMI 35-35.9 ADULT   ? NON-ISCHEMIC MYOCARDIAL INJURY   ? SINUS BRADYCARDIA, PERSISTENT   ? AV BLOCK, MOBITZ TYPE 2   ? ATHEROSCLEROSIS OF AORTA   ? VENOUS STASIS EDEMA W INFLAMMATION OF BILAT LEGS   ? HTN (HYPERTENSION)     Resolved Hospital Problems No resolved problems to display.     Consults:  Surgery  Cardiology  Physical Therapy Anaesthesia      Primary Procedures:  Procedure(s):   11/12/2023 LAPAROTOMY EXPLORATORY LAPAROSCOPY DIAGNOSTIC VENTRAL HERNIA REPAIR, OPEN COLECTOMY TRANSVERSE, OPEN    11/21/2023:   DDD pacemaker placement   Complications:  none    Hospital Course:  80 year old male admitted to the general surgery service on 11/12/2023 for an incarcerated umbilical hernia complicated by sepsis s/p exploratory laparotomy with ventral hernia repair and transverse colectomy on 11/12/2023. Found incidentally to be COVID positive on 11/12 (patient declined RDV)   Postoperatively-the patient developed asymptomatic bradycardia with HR in the 30s ->EKG 111/3 with 2:1 Type II Mobitz Heart block (EKG on 11/12->had Type 1 Mobitz heart block on EKG 11/13)  Cardiology consulted-DDD pacemaker to be placed 11/21/2023.   Echo 11/13 -EF 50-55%   Had mild acute renal failure on admission (creat 1.44)-Now resolved.   Also has been hypertensive-started on amlodipine 2.5 mg and dose increased to max 10 mg, also restarted home lisinopril 5 mg daily and dose increased to 20 mg daily as well for better BP control.   From a surgical perspective, the patient is doing well-tolerating diet and with no significant abdominal pain.  Has 12/7 outpatient follow up with Dr.    Addendum: As for covid, the patient was asymptomatic during this hospital course and was never HYPOXIC.  Will complete 10 days of isolation on 11/22/2023.  (tested positive 11/12/2023)     Condition on Discharge:  stable    Code Status : Full Code    Discharge Disposition:  Home with Home Health    Pending Results:  None    Medications:  See discharge instructions for discharge medications     Discharge Instructions/Orders    ACTIVITIES/LIFESTYLE    Activities:    Activity permitted: No restrictions.    WOUND CARE  Not applicable.    DIET/NUTRITION  Diet: low salt    Seek medical attention for: Temperature of 100.4 degrees F or above  Pain unrelieved by medication  Persistent nausea/vomiting and/or inability to eat    Increase in fatigue, confusion or dizziness  Chest pain Shortness of breath Bleeding    FOLLOW UP APPOINTMENTS:     Future Appointments    Appointment Date & Time Visit Type Provider Department/Facility   Dec 07, 2023  3:00 PM Post Operative Care (M.D.) SURGERY CLINIC        Review your medications with your doctor to see if there are any changes.   The following referrals have been made:  home health and home physical therapy          Note Details  Author (M.D.) File Time 11/21/2023  1:24 PM Author Type Physician Status Addendum Last Editor (M.D.) Specialty Hospital Medicine Admit Date 11/12/2023  ED to Hosp-Admission (Discharged) on 11/12/2023  ED to Hosp-Admission (Discharged) on 11/12/2023   Revision History   Detailed Report  Note shared with patient Linked Episodes  UMBILICAL HERNIA REPAIR From 11/12/2023 to 11/13/2023 CARDIAC PACEMAKER INSERT From 11/15/2023 to 11/17/2023 CARDIAC PACEMAKER INSERT From 11/17/2023 to 11/22/2023  Hospital Problem List   HTN (HYPERTENSION)  ATHEROSCLEROSIS OF AORTA  INCARCERATED UMBILICAL HERNIA Resolved  AV BLOCK, MOBITZ TYPE 2 Resolved  SINUS BRADYCARDIA, PERSISTENT Resolved  HX OF COLECTOMY  VENOUS STASIS EDEMA W INFLAMMATION OF BILAT LEGS  NON-ISCHEMIC MYOCARDIAL INJURY Resolved  PRESENCE OF CARDIAC PACEMAKER  NONTRAUMATIC ACUTE KIDNEY INJURY Resolved  CANDIDA INTERTRIGO Resolved  BMI 35-35.9 ADULT Care Timeline  11/12   LAPAROTOMY EXPLORATORY    Admitted from ED 1943 11/21   CARDIAC PACEMAKER INSERTION PERMANENT INTRAVENOUS 11/22   Discharged 1217  Discharge   Home with Home Health   Discharge Instructions (Printed 11/22/2023)