Age: 96.0
Sex: F
Vaccine: COVID19
Symptoms: Nausea, Nitrite urine, Oropharyngeal pain, Protein urine, Pyrexia
Clinical narrative: Date of Admission:  10/5/2023    Date of Discharge:  10/7/2023    Primary Care Physician:  MD   Pending Study Results at Discharge: None   Issues to be Addressed in Follow-up:   1) continued resolution of fevers chills shortness of breath and other infectious COVID symptoms   2) optimization of other medical issues as outpatient   Reason for Hospital Admission (Admitting Diagnosis):  COVID 19    HPI on admission:    Patient is a 98 Y  female with history of hyperlipidemia, hypertension, CKD D stage IIIb, osteoporosis and secondary hyperparathyroidism who presents secondary to increased weakness.   History obtained from daughter at the bedside who explains that the family just recently went on a cruise and returned on Monday, 10/02/23.  Daughter did not feel well and so took a COVID-19 test which returned positive.  Patient was complaining of sore throat that started yesterday and she was noted to be more confused this morning when using the restroom.  She usually wakes up around 9 or 10 in the morning but was still asleep and unable to keep eyes open.  This afternoon she ate very little and threw up Tylenol that she was given.  Noted to have dry cough but no reports of any diarrhea or urinary symptoms.  Daughter endorses nausea, 1 episode of emesis, fever with Tmax of 105 °F, diaphoresis, decreased appetite and increased weakness.     Hospital Course:   Patient initially presented to the emergency room with fevers chills cough shortness of breath found to have severe sepsis with acute hypoxemic respiratory failure due to acute COVID-19 infection.  Patient was started on dexamethasone and remdesivir and experienced rapid improvement.  Patient was successfully weaned off of oxygen and sepsis resolved.  Dexamethasone was discontinued due to resolution of acute hypoxemic respiratory failure.  Patient had dramatic symptomatic improvement as well, reporting resolution of shortness of breath fevers and chills and improvement of cough.  Given resolution of severe sepsis and dramatic symptomatic improvement, the patient was discharged home.  Patient will follow-up with primary care to ensure continued resolution of COVID and infectious symptoms for optimization of other medical issues.   Significant Findings:    Please see above   Hospital Course By Problem: Patient Active Hospital Problem List:  SEVERE SEPSIS W ACUTE ORGAN DYSFUNCTION (10/7/2023)  COVID-19 DISEASE (10/5/2023)  ACUTE HYPOXEMIC RESPIRATORY FAILURE (10/7/2023)   Assessment:  -Fevers chills shortness of breath resolved cough improved - BP 137/62  | Pulse 65  | Temp 97.7 °F (36.5 °C)  | Resp 18  | Wt 61.9 kg (136 lb 8 oz)  | SpO2 97%  | Breastfeeding No  | BMI 26.66 kg/m²   Lab Results Component Value Date   WBC COUNT 7.9 10/07/2023    Lab Results Component Value Date   Hgb 13.7 10/07/2023    Lab Results Component Value Date   ALT 18 10/07/2023   AST 24 10/07/2023   ALKALINE PHOSPHATASE 58 10/07/2023   Bilirubin, total 0.3 10/07/2023   Amylase      198 (H) 10/03/2010   Lipase 44 10/05/2023    Lab Results Component Value Date   Lactate, ser/plas      2.0 (AA) 10/03/2010     Lab Results Component Value Date/Time   CORONAVIRUS COVID DETECTED (A) 10/05/2023 06:13 PM   No results for input(s): "UPH", "USG", "UAGLU", "UKET", "UABILI", "UPROTEIN", "ULEUKESTER", "UNITRITE", "URBC", "UWBC", "UBACT" in the last 72 hours. - CXR: No acute disease    Plan:  - Continue Remdesivir - s/p Dexamethasone - Off supplemental O2 - Continue Lovenox for DVT prophylaxis - Home today w/ HH PT  -  tessalon perls as outpatient (is allergic to Guaifenesin)    HYPERLIPIDEMIA (12/16/1994)  HTN (HYPERTENSION) (12/16/1994)  HTN (HYPERTENSION) (6/21/2006)   Assessment:   Vitals:   10/06/23 0839 10/06/23 1543 10/06/23 2323 10/07/23 0731 BP: 103/44 126/55 120/51 137/62 Pulse: 65 60 57 65 Resp: 20 18 18 18 Temp: 97.9 °F (36.6 °C) 98 °F (36.7 °C) 97.9 °F (36.6 °C) 97.7 °F (36.5 °C) SpO2: 93% 94% 93% 97% Weight:              Plan:  - Continue Amlodipine 5 mg QD, atenolol 50 mg daily with holding parameters   CKD STAGE 3B (GFR 30-44) (9/22/2021)  SECONDARY HYPERPARATHYROIDISM, RENAL ORIGIN (5/2/2022)  CKD   Assessment:  - estimated creatinine clearance is 23.7 mL/min (based on SCr of 1.09 mg/dL). -   Lab Results Component Value Date   Creatinine 1.09 10/07/2023   Creatinine 1.13 (H) 10/06/2023   Creatinine 1.18 (H) 10/05/2023   - Cr at baseline    Plan:  - Avoid nephrotoxins - Risk factor reduction - Continued optimization as outpatient   LEFT IRITIS (5/15/2009)  BILAT ANATOMICAL NARROW ANGLE, ANTERIOR CHAMBER (11/14/2013)   Assessment: noted   Plan: Continue prednisolone OU QD   MAJOR NEUROCOGNITIVE DISORDER DUE TO UNSPECIFIED DISEASE (UNSPECIFIED DEMENTIA) (10/12/2019)   Assessment: Noted   Plan: Not currently on medications as outpatient       Complications:  None   Diagnoses:  Active Hospital Problems   Diagnosis   ? (Principal) SEVERE SEPSIS W ACUTE ORGAN DYSFUNCTION   ? ACUTE HYPOXEMIC RESPIRATORY FAILURE   ? COVID-19 DISEASE   ? HTN (HYPERTENSION)   ? HYPERLIPIDEMIA   ? SECONDARY HYPERPARATHYROIDISM, RENAL ORIGIN   ? CKD STAGE 3B (GFR 30-44)   ? BILAT ANATOMICAL NARROW ANGLE, ANTERIOR CHAMBER   ? LEFT IRITIS   ? MAJOR NEUROCOGNITIVE DISORDER DUE TO UNSPECIFIED DISEASE (UNSPECIFIED DEMENTIA)     Resolved Hospital Problems No resolved problems to display.     Primary Procedures:  None      Secondary Procedures: None   Consults:  None   Condition on Discharge:  Stable    Code Status at Time of Discharge: DNR     Discharge Disposition:  Home with Home Health   Discharge Medications: Medications, instructions, follow up information: See patient instructions (or SNF Admission orders if applicable).           DO   10/7/2023 11:15 AM             Note Details  Author (D.O.) File Time 10/7/2023 11:17 AM Author Type PHYSICIAN (D.O.) Status Signed Last Editor (D.O.) Specialty Hospital Medicine Hospital Acct # Admit Date 10/5/2023  ED to Hosp-Admission (Discharged) on 10/5/2023  ED to Hosp-Admission (Discharged) on 10/5/2023   Detailed Report  Note shared with patient Hospital Problem List   HYPERLIPIDEMIA  HTN (HYPERTENSION)  MAJOR NEUROCOGNITIVE DISORDER DUE TO UNSPECIFIED DISEASE (UNSPECIFIED DEMENTIA)  CKD STAGE 3B (GFR 30-44)  SECONDARY HYPERPARATHYROIDISM, RENAL ORIGIN  SEVERE SEPSIS W ACUTE ORGAN DYSFUNCTION  LEFT IRITIS  BILAT ANATOMICAL NARROW ANGLE, ANTERIOR CHAMBER  COVID-19 DISEASE  ACUTE HYPOXEMIC RESPIRATORY FAILURE Care Timeline  10/06   Admitted from ED (Observation) 0110 10/07   Discharged 1348  Discharge   Home or Self Care.   Discharge Instructions (AVS) (Printed 10/7/2023)